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Nevada Hospitals Fear COVID-19 Strain Will Decrease Care

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(AP Photo/John Locher)

An ambulance is parked at the University Medical Center in Las Vegas on Oct. 12, 2020. Spikes of the coronavirus are hitting spots around the United States, forcing public health officials to scramble to ensure there are enough hospital beds to accommodate the sick.

Nevada’s hitting a record number of coronavirus cases almost daily now.

On Thursday, state health officials reported a record-high 2,416 new cases and six additional deaths.  

Dr. Fermin Leguen is the acting chief health officer for the Southern Nevada Health District. He said there has been an increase in testing from about 4,000 to 5,000 a day about four weeks ago to 11,000 to 12,000 per day now.

The test positivity rate is also going up, which is the percentage of tests performed that come back positive. Dr. Leguen said a few weeks ago the state's positivity rate was 11 to 12 percent but now it's at 15 percent, which means while more people are getting tested a greater percentage of those tests are coming back positive.

There is one bright spot in the ongoing pandemic and that is the lower mortality rate. Dr. Leguen said there are a number of reasons why the mortality rate is down.

For one thing, doctors and nurses know much more about which treatments work against the illness, and in the early stages of the pandemic, older people were getting the disease. Now, younger people are getting the illness, and since they are less likely to have chronic illnesses, they are less likely to have serious complications from COVID-19.

With that said, Dr. Leguen said it does not mean a younger person can't get very sick and die.

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"The younger ones usually either develop no sign or symptoms or develop a mild presentation and this is in general and I want to emphasize 'in general' because we still have a large number of young people who die because of COVID," he said.

Besides concerns about people dying from COVID-19, there is a concern in the healthcare industry about hospitals becoming overwhelmed with patients. 

Dr. Joe Corcoran is the chief medical officer for HCA Healthcare, which owns Sunrise Hospital, Sunrise Children's Hospital, MountainView and Southern Hills Hospitals.

He said right now Sunrise Hospital is at about 87 percent capacity and has more patients than it did in August. He said all three hospitals are seeing more patients than they did in March but not as many, overall, as they did during the surge in the summer.

Dr. Corcoran agreed with Dr. Leguen that one important thing to come out of the pandemic has been better treatments and better outcomes.

"As an organization, we've treated over 75,000 in-patients with coronavirus," he said, "So, there has been a lot of learning about how to deliver better care... and that is resulting in a shorter length of stay, improved survivability, in a shorter length of time on a ventilator when that's needed." 

He also agreed that they're seeing younger people with the illness. That doesn't mean they are less sick, but instead, younger people just have more "gas in the tank" to fight off the infection.

Those younger patients can still become very sick and require a lot of care, one of Dr. Corcoran's biggest concerns is staffing. He said that even without a pandemic staffing is a concern.

Now, with cases surging throughout the country, finding back-up staff will be extremely difficult.

"This infection is at alarming rates in almost all 50 states," he said, "So there is not a lot of cavalry that we can reach out to, to bring forward to our front lines," he said. 

Mason Van Houweling is facing that same problem. He is the CEO of University Medical Center, Clark County's public hospital.

He said now hospitals around the country are competing for the same pool of staff. 

"Traveler nurses have typically been easy to come by, but it's even more so difficult now because we're all competing for the same nurse out there in the country," he said.

To make matters worse, Van Houweling said UMC has seen an increase in the number of doctors and nurses retiring because of the strain of the pandemic.

"We've always been really on the razor's edge as far as healthcare staffing here in Nevada... but when you have this type of challenge regarding staffing, it definitely does put an impact and strain on the healthcare system."

Tamara Erickson has first-hand knowledge about the strain the pandemic is having on hospital staffing. She is a registered nurse and the head representative for National Nurses United at St. Mary's Regional Medical Center in Reno.

She said nurses are being asked to care for more patients, and they are worried about the safety of patients. 

"The stress factor is phenomenal when you're dealing with so many sick people," she said, "I think as much as anything our fear is that of staffing."

She said management at St. Mary's has chosen to change the ratio of nurses to patients, which she worries is not safe.

Erickson believes one way to address the problem of staffing is to limit or stop entirely elective surgeries. At the beginning of the pandemic, elective surgeries were stopped. She questions why those surgeries are allowed now.

"This puts an incredible strain on staffing," she said, "You talk about 80 percent max capacity in the hospital but are you talking about what staffing can actually handle safely?"

Erickson said the nurses she works with are working hard in a dangerous situation, but they're getting push back from management when they ask for more appropriate protective equipment and are being asked to care for more patients than is safe.

She said now is not the time for management to argue with staff, but instead, it is time to listen to staff recommendations.

St. Mary's Regional Medical Center send KNPR News the following statement: 

“Saint Mary’s is committed to protecting the safety of patients, providers and the community and remains in close contact with the Washoe County Health District (WCHD) and the Centers of Disease Control and Prevention (CDC) to ensure proper precautions are followed. Saint Mary’s PPE practices exceed recommendations provided by CDC guidelines in this current pandemic.

Saint Mary’s continues to follow terms within the CNA contract. Like hospitals across the nation, Saint Mary’s is facing staffing constraints due to this pandemic. We are continuing to staff appropriately to patient acuity using the crisis standards of care as guidelines. We are also exploring alternative, temporary positions to assist frontline staff during the expected continuing COVID-19 patient surge.

Patient care remains our number one priority and our goal is to continue working together as a united team to ensure Saint Mary’s Regional Medical Center remains the best place for quality and compassionate care.”

Van Houweling pointed out that not all surgeries are non-essential. He said at UMC they are doing surgeries like tumor removals, heart surgeries and more that have been put off because of the pandemic but still need to be done.

However, he cannot speak to what St. Mary's is doing specifically but he said hospitals are very concerned about staffing needs and are looking closely at the impact surgeries are having on staff.

While hospitals and medical staff grow increasingly concerned about being overwhelmed with patients, there is also concern from business owners and employees that Gov. Steve Sisolak will order another shutdown.

Brian Labus is an epidemiologist, and he is on the governor's task force. He does not think the state will need another shutdown - if people take precautions seriously.

"If people are willing to stay home without things being closed down, if they're only going out for essentials and were being very careful about getting together in groups, then we can stop transmission without completely shutting down the community."

But Labus said people were asked not to gather for Halloween and many did anyway.

"We're seeing the same thing here with Thanksgiving, and I expect that with Christmas and New Year's as well," he said, "People are still going to want to get together and that's going to lead to potential transmission and really extending this current surge into the new year quite a bit."

While that seems like more grim news in a year that has been full of it, there is a glimmer of hope. Early testing of vaccines has shown promise. 

Labus said the state has a whole plan for when a vaccine is available, but even when it is available, it will be months before there is a big change.

"A lot of these vaccines require two doses and those are a month apart," he said, "It takes five weeks after the first dose to do something. We're on kind of a longer timeline. I would say probably into next summer is when we'll start to see a really big reduction in the disease from the vaccine, because by then, we'll have a lot of people vaccinated."

(Editor's Note: In the interview, host Joe Schoenmann quoted Clark County School District Superintendent Jesus Jara that 11 students had taken their lives this school year, but only one student had killed themselves last year. According to a story in the Nevada Current, those statistics are incorrect. The school district said 10 students had committed suicide in the 2019-2020 school year)

Guests

Dr. Fermin Leguen, acting chief health officer, Southern Nevada Health District; Mason Van Houweling, CEO, University Medical Center; Dr. Joe Corcoran, Chief Medical Officer, Sunrise Hospitals; Tamara Erickson, representative, National Nurses United at St. Mary’s Regional Medical Center; Brian Labus, Epidemiologist and Assistant Professor, UNLV’s School of Public Health

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