Dubuque County’s medical leaders today said that without an immediate turnaround in community spread of COVID-19, an already critical situation inside local hospitals could turn “catastrophic.”
The number of confirmed cases in Dubuque County has skyrocketed as of late, with more than 7,000 total now reported and an average of 126 new confirmed cases per day over the previous two weeks. Case counts also have surged in surrounding counties, many of which also are served by Dubuque’s hospitals.
“We’re seeing scores of patients coming in every day with COVID-19,” said Dr. Khawar Warraich, hospitalist and medical director for Grand River Medical Group, during a press conference. “I have never seen so many patients getting admitted to the (intensive care unit). I have never seen multiple patients, very sick patients, having to stay in the ER for extended periods of time because we don’t have beds available or staff available.
“This is unlike anything I have seen in my career.”
On Tuesday, the Iowa Department of Public Health reported that, as of Monday, there were 43 Dubuque County residents with COVID-19 who were hospitalized, along with 27 from Jackson County, 15 each from Clayton and Jones Counties, and nine from Delaware County.
Statewide, as of 5 p.m. Tuesday, there were 1,190 COVID-19 patients in hospitals — an increase of 230 people, or 24%, over 24 hours earlier. There were 210 COVID-19 patients in ICUs statewide.
“The overall patient volume is stressing our health care system and putting capacity at risk,” said Gov. Kim Reynolds during a Tuesday morning press conference. “Staffing them is becoming increasingly challenging. The situation has the potential to impact any Iowan who needs care for any reason.”
While Reynolds said that at that time people hospitalized due to COVID-19 accounted for 15% of the total census statewide, local doctors said the percentage was much higher at the Dubuque County facilities.
“As we speak, we have patients waiting in the ER with COVID-19,” said Chad Wolbers, president and CEO of UnityPoint Health-Finley Hospital in Dubuque.
Kay Takes, president of MercyOne in eastern Iowa, said the spike in hospitalizations at MercyOne Dubuque Medical Center is “escalating at a rapid pace,” having doubled in the past two weeks.
“Our bed capacity and staff are taxed,” she said. “We need the public’s help right now to change the trajectory from what could be catastrophic, to one we can continue to manage.”
Capacity vs. capability
The group explained that the problem is not as much a matter of capacity — which was a major concern at the pandemic’s beginning — but of capability.
“Capacity is the actual number of physical beds in place,” said Dr. Hendrik Schultz, chief medical officer for Medical Associates Clinics. “That depends on staffing, resources like protective gear, machines like respirators, therapists to work them, as well as beds.”
Local medical facilities are straining to handle the patient volume they have now, due to staffing and other factors, regardless of how many beds still are available.
That is not to say actual capacity has not also become an issue in the region.
In a statement today, Charlie Button, CEO of Regional Medical Center in Manchester, Iowa, said it faces a similar strain.
“All health care facilities in our region, including RMC, are running at near capacity or are at full capacity,” he wrote. “It is affecting our hospital. Our providers and staff continue to work extremely hard but are wearing down.”
Clayton County (Iowa) Board of Health Chairwoman Dr. Michele Dikkers said the rise in cases stems has strained most northeast Iowa hospitals to the point where they are at or near patient capacity, especially in rural areas, she said.
During a Jo Daviess County (Ill.) Board of Health meeting this week, Tracy Bauer, the president and CEO of Midwest Medical Center in Galena, warned that her hospital was full and nearby facilities were not accepting any more patient transfers.
“There are no more beds available,” she said. “Last week, we had a patient that needed an ICU, and it took us three hours to find one.”
Wolbers said Finley’s “staffing crisis” was like nothing he had ever seen.
“We have so many team members out, so many more staff sick,” he said. “And our staff is not sick from getting infected here at work. It’s very much a function of community spread.”
Wolbers added that Finley has two or three times the staff out sick now as at any other point in the pandemic.
Normally, hospitals would be able to reach out to external staffing services to fill in if they were short-staffed.
“But the whole Midwest is affected,” Schultz said. “The pools you can usually tap from elsewhere are limited as well.”
This has left hospitals with few options.
“At a point, we get to, ‘How do we free up staff?'” Takes said. “That’s where questions of canceling non-emergency services come. That’s not something we want to do because all patients need care.”
Warraich said staffing issues compound other aspects inherent to a novel virus.
“We have health care workers getting sick and falling out of the working pool,” he said. “Then, we have logistic issues. We have equipment issues. Everything is stretched thin.”
Another problem is that very sick COVID-19 patients are hospitalized for a month or more, rather than just a week, like for typical pneumonia.
The Dubuque hospitals are working through their surge plans, shifting services and staff around as best they can now.
“We have all of our patients with COVID-19 in the medical wing,” Takes said. “We relocated our pediatric services so we could make more room in the medical area.”
And she said the hospitals and Dubuque County COVID-19 Incident Management Team are always adapting their surge plans.
But local officials said they need the community to begin more closely following mitigation measures such as wearing masks, social distancing, limiting trips outside their homes and not gathering in groups.
“We can’t control the demand,” Takes said. “We need help from the community.”
Mary Rose Corrigan, City of Dubuque public health specialist and a member of the county’s incident management team, said that includes the holidays.
“Family and social planning and discussion should happen now,” she said. “You need to be assured that everyone you come in contact with are following those measures to avoid exposure and keep others from risk.”
Warraich said, “Unless we change the way we’re dealing with this pandemic as a community, things are going to get way, way worse.”