November 30, 2020

Hospital leaders warn of growing hospitalizations: ‘We are really totally full’

Leaders from three hospitals in Albuquerque continued to ask New Mexicans to abide by COVID-19-safe practices and warned that hospitals are full—and that they expect to see another big jump in confirmed cases in the coming weeks after the Thanksgiving holiday.

Dr. Jason Mitchell, the Presbyterian chief medical officer, said that all main hospitals are already over ICU capacity and at 110 percent or 120 percent of normal capacity.

“At Presbyterian, we’re at surge level at Pres hospital, which means that we’ve done everything we can to expand, short of crisis standards of care,” he said. “And we are out of ICU beds currently. And so we are really totally full.”

This impacts rural hospitals as well, which may have to delay patients who need a higher standard of care while the “hub” hospitals across the state try to find an available bed.

“When the big hospitals are full, they don’t have the ability to transfer here, oftentimes, and they’ll look outside of the state as well, as you begin to look across the southwest to try to find beds,” he said.

Lovelace Chief Medical Officer Dr. Vesta Sandoval agreed and said “our hospitals are very full.”

And if things did not improve in the state, “we will overwhelm our facilities, our physicians, our nurses won’t be able to take care of patients that are coming through the door, even with ordinary problems: patients having babies or patients having heart attacks.”

She also noted that hospitals are “collaborating very closely” in moving patients and making sure one hospital is not overwhelmed as much as possible.

The worst-case scenario is they have to begin rationing care, if the hospital does not have the capacity or resources to treat all patients to their full extent. 

“It’s something we don’t want to get to,” he warned. “And it’s something with the current numbers we may possibly get to over the next couple of weeks.”

And they expect cases to continue to increase soon after the holiday.

Hospitals are already doing as much as they can to keep patients from needing hospital stays. Mitchell said that their facility is doing what they can outpatient, and having a clinic to infuse remdesivir, an antiviral medicine, at its Kaseman facility.

“Additionally, home monitoring, so making sure we monitor people at home. The better the home monitoring is, the better the home health is, the less likely you are to have to admit somebody,” he said. “And then finally doing outreach in advance so that we can find those individuals who are really at risk and have COVID and begin to communicate with them early on in the infection, and so that you can treat symptoms and monitor them and prevent them from ending up in the [emergency department].”

The other hospital systems are also doing what they can to provide outpatient treatment, like going home with oxygen and a monitor if they do not need to be hospitalized, to leave the hospitalizations to the most severe cases.

University of New Mexico Hospital Chief Quality and Safety Officer Dr. Rohini McKee said, “I don’t expect that we’ve reached a peak or a plateau” in the state when it comes to COVID-19.

She predicted that travel over Thanksgiving “will manifest itself probably by about two weeks from now is when we probably see case numbers go up.”

Mitchell said that the modeling by the state, Presbyterian Health Services and Los Alamos National Labs all project the number of hospitalizations will continue to increase.

“Even if the caseload has theoretically leveled off, we’re still seeing the infection when people that contract it at two and three weeks ago in the hospital now,” Mitchell said. 

He also noted that the holiday weekend could cause a delay in testing with closed locations and reduced staffing at labs, so it “may or may not represent a true decrease in the community spread.”

The easing of restrictions, set to begin on Wednesday on a county-by-county basis, could also have a big impact on cases.

“I would be very concerned if we returned to everything that we were like two weeks ago,” Mitchell said. “Only instead of starting with 100 cases per day, and going from there, we’re starting from 2,000 cases a day and going from there, you could get into a really dangerous spot very, very quickly.”

Sandoval agreed.

“Looking at the last few days, it’s difficult to really understand the impact of Thanksgiving, and travel, and all those factors are going to have and of course, we’re going to see those seven days from now,” she said.

McKee noted that the big problem is not as much with spread of COVID-19 at businesses, but with gatherings with families and friends, which spreads the disease.

“The behavioral changes have to come from within,” she said. “We can begin to shut down businesses temporarily, to help reduce the spread, but it is changing those behaviors, I think that’s going to make a big difference and keep our cases down over the next few weeks.”