December 8, 2020

Hospital leaders warn rationing of care nears if hospitalizations rise

Local hospital leaders pleaded with New Mexicans to do their part to help slow the spread of COVID-19 to avoid a last-case scenario: rationing care.

In a press conference on Monday, leaders from the University of New Mexico Hospital, Lovelace and Presbyterian said they remain stretched beyond normal capacity for both general and ICU beds.

“We need your help,” University of New Mexico Chief Medical Officer Dr. Irene Agostini said.

“We need you to keep wearing a mask, washing your hands and not gathering in groups,” she said. “We also know that preparing for the holidays and getting ready for the holidays makes this much more difficult.”

The others agreed.

“The numbers have come down just slightly, but not enough. And our hospitals are full. So we need to continue, we need to be consistent,” Lovelace Chief Medical Officer Dr. Vesta Sandoval said. “And we need to just stay on our same path. In order to avoid overwhelming hospitals, and moving into crisis, we want you to protect yourself, we want you to protect your family, we want you to protect your community, we do not want to have to take this last step.”

The leaders said this would be unprecedented. 

Presbyterian Chief Patient Safety Officer and Medical Director of Infection Control Dr. Jeff Salvon-Harman compared it to humanitarian crises, disasters or military operational settings. Those, he noted, were “much more time limited” than the current crisis.

“We’ve never really had to manage over this potential duration of time,” he said. “And under the circumstance, where it’s not a momentary event that only has maybe weeks or a couple of months of lasting impact.”

Agostini said that it is “very unprecedented” in her 30 years in the field, and said the 1918 Spanish Flu pandemic is likely the last comparable pandemic.

To address this, some hospitals are already in the first tier of crisis standards of care, though it depends on the current situation in each hospital, so it can change on a daily or even hourly basis. 

The state has allowed COVID-19 credentialed doctors to help treat COVID-19 patients even if it is outside their scope of practice, under the direction of physicians who have treated COVID-19 patients.

“We’ve asked [healthcare workers], let’s say from radiology or dermatology, to work under an internal medicine physician to take care of COVID patients,” Agostini said.

Similarly, she said, medical residents have been shifted from their regular rotations to instead treat COVID-19 patients. The university is also bringing back medical students because personal protective equipment is more widely available after shortages earlier in the year.

This all has been a massive push by the health care system in the state, she said.

“We have pushed the health care system in New Mexico to the brink. We have all created space in our hospitals, brought traveling nurses in, working in all sorts of spaces to continue to provide health care for New Mexico.”

At Lovelace Hospital, Sandoval said, clinic workers have been helping treat COVID-19 patients as well to aid the hospital staff. 

“It really takes a village,” she said. “It takes all of us to pitch in, in order to manage this huge number of patients that we’re seeing.”

The hospitals have also contracted with hundreds of traveling nurses to bolster their workforce, though they could still use more since hospitals throughout the nation have seen increases in hospitalizations.

The state has also allowed more drastic measures to address the shortage of health care workers.

Health care workers who have a high risk of exposure from someone other than a family member can now continue to treat patients if they are asymptomatic. For further tiers, it would allow doctors who have tested positive but are asymptomatic to treat patients.

“We accept that there is manageable risk for the high risk exposed, but really want to take all appropriate actions to prevent having to bring COVID-19 infected healthcare workers, even if asymptomatic, into the workplace to provide care to patients,” Salvon-Harman said.

While it may appear that there are ICU beds available, the leaders said that the issue is having enough available staff to treat patients in those beds.

One bright spot on the horizon was the expected decision by the U.S. Food and Drug Administration to issue an emergency use authorization for a vaccine developed by Pfizer, the first such authorization for a COVID-19 vaccine. It could happen as early as this week.

The state has prepared for this, and they all said they had ultra cold storage—the vaccine must be kept at minus 112 degrees fahrenheit until use—and expanded that capacity.

Healthcare workers would be those who received the first 17,500 doses of the Pfizer vaccine under the current state plan.

“We do have the abilities to centrally manage receiving of shipments from the manufacturer, and to manage redistribution for our healthcare workforce vaccinations on the near horizon,” Salvon-Harmon said. “So we really want everybody to have confidence that across the state, all of us are well positioned to be able to support vaccination of our healthcare workforce during phase 1A of the state’s strategy for rollout of the vaccine.”

Still, there are many challenges facing the state when it comes to further distribution and rollout of the vaccine.

Until a vaccine is widely available and administered to enough of the population, New Mexicans will need to continue to wear masks, socially distance and otherwise do their best not to spread the disease. This includes avoiding gatherings, which have been a major source of spread of COVID-19 in recent weeks, as the state and nation have seen their highest numbers of new cases.

The leaders acknowledged the difficulty of not seeing family in person, especially during the holiday season, but said it would be better than the alternative.

“It’s heartbreaking to not spend a holiday with your loved ones,” Salvon-Harman said. “It’s better to speak to them on the phone, or better to speak to them via FaceTime or any online video chat platform than to attend their funeral.”