If you live in southwest Missouri, hospital executives say acquiring a severe case of COVID-19 could now mean a stay in St. Louis or Kansas City, as the global pandemic that has killed 3.9 million people continues to stretch Missouri hospital staffing toward what one statewide association recently called a “breaking point” in its 2021 workforce report.
A handful of Springfield-area patients are already being treated hundreds of miles away in the state’s two biggest cities, the leader of CoxHealth confirmed Tuesday morning.
Springfield-area COVID cases up 44 percent in two weeks
The news comes as Delta variant COVID-19 infections are surging in southwest Missouri, even as large swaths of residents have opted not to take advantage of vaccines shown to prevent or lessen the impact of the disease by providing immunity.
Data collected by the New York Times showed Tuesday that infections in metro Springfield have increased 44 percent over the past two weeks, a period in which the U.S. as a whole saw a 15-percent decline.
The infection rate per 100,000 people for the Springfield area, 38 new cases per day, is almost 10 times greater than the national rate, the Times reported.
Mercy Springfield reported it had hospitalized 104 COVID-19 patients on Tuesday, said Mercy Springfield president Craig McCoy; Cox reported roughly 100 for the day, said system president Steve Edwards.
The numbers are just part of a tapestry of facts that show how the pandemic has evolved since its winter peak, when COVID-19 patient census numbers sometimes reached 170. On Jan. 20, Edwards noted on Twitter that Cox accepted a patient transfer from Louisiana. About a month later, he said Cox was able to vacate its emergency COVID-19 intensive care unit.
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For hospitals, what does ‘on COVID diversion’ mean?
But now, things have changed.
“For the first time, we’ve been on COVID diversion,” Edwards said Tuesday.
“On diversion,” he explained, is a status that can switch rapidly from on to off and back again. It means that at a given moment, a hospital “feels that their capacity to handle a particular type of patients is limited to the extent that they’re telling the referring hospitals and the ambulances to not send them patients of that type.”
In recent times four Cox patients have been transferred to BJC HealthCare, St. Louis-area health system with 14 hospitals including Barnes-Jewish, a big teaching hospital tied to Washington University’s medical school. A BJC spokesperson confirmed the number of patients Tuesday.
Another four Cox patients have been transferred to St. Luke’s Health System in Kansas City, Edwards said. (After two attempts, the News-Leader was not able to reach St. Luke’s officials for comment by deadline on Tuesday.)
Edwards cited internal Cox data showing 47 COVID patients transferred into Cox facilities from June 1 to 21, many of them from hospitals in smaller communities such as Lebanon and Mountain View, while 23 transferred out.
Patient transfers from the Springfield area to other big-city hospital systems appeared to be limited early this week. A spokesperson for SSM Health in St. Louis, which runs Saint Louis University Hospital and seven other facilities, said late Monday it had recently accepted three Ozark County patients for non-COVID care, but no other southwest Missouri patients.
Cox had recently warned that resource challenges might force patients to be diverted outside the Springfield area, Edwards added.
“It’s really just this moment-by-moment surge capacity that both Cox and Mercy are dealing with,” Edwards said.
Ethical dilemmas: To transfer COVID patients, or not?
Hospitals face an ethical dilemma, Edwards said: Increased patient counts are good for the hospital’s bottom line, but New York City’s early experience with COVID-19 in 2020 showed that as COVID-19 patient counts climb, quality of care declines.
“Do you board a patient in the E.R. for 24 hours, which is how long it might take to get into a bed in the tower?” Edwards asked by way of showing the choices hospitals have to make right now. “Or do you transfer that patient who is requiring hospitalization, who will grow more acutely ill, but is in a better position to transfer now, to another hospital that might have a COVID census of 10 (patients)?”
Meanwhile, Edwards said hospital workers recognize the burden long-distance treatment options pose for the families of sick people.
Mercy Springfield’s president, Craig McCoy, said it had not sent patients to bigger cities at this time, even though the system is headquartered in suburban St. Louis. It has moved patients around within its four-state system and tried to keep them as close to home as possible, he said.
“We’re going to do everything within our power to make sure we don’t have to transfer anybody else out of the community because we believe that the best care is where you have your local support,” McCoy said.
Hospital staffing issues
Local hospitals are well-equipped in some ways, and less so in others, executives said.
“We have literally years worth of supplies,” Edwards said. “We’ve built up a great reserve, we’ve got sufficient equipment, we’ve added more than 150 beds.”
The issue now is staffing coupled with high rates of infection taking place in southwest Missouri, Edwards added. Staffing for positions like nurses and respiratory therapists is a key challenge.
Many traveling nurses seem to be taking the summer off after working hard and getting paid at high rates during earlier COVID-19 surges, he said.
Dave Dillon, a spokesperson for the Missouri Hospital Association, said at this time, “hospitals aren’t as well-staffed as during the surge” of COVID-19 infections from last winter.
“Many have reduced the expensive agency staff that helped then get through the high hospitalization months,” Dillon told the News-Leader by email on Tuesday. Many pandemic contracts between hospitals and temporary workers such as traveling nurses have expired, including a big state contract between Missouri and Texas-based healthcare staffing firm Vizient Inc.
“Those staff have probably departed for their next placements,” Dillon said.
Another problem cited by health care leaders is the return of patients who need hospital care for non-COVID treatments.
“It is fair to say that hospitals are already stretched to address pent-up demand for health services that were curtailed last year, and into spring,” Dillon said.
McCoy, with Mercy, said, “Obviously, we’re pushed. We do have a high ICU census… COVID is spiked up (and) at the same time we’ve got a lot of other non-COVID things that are going on.”
Mercy is able to pull in “virtual resources” from its headquarters in Chesterfield to help share the load in Springfield, he said.
Mercy president: ‘I don’t understand why people won’t get vaccinated’
The patient transfers come despite the reality that vaccines are available at no charge within five miles from home for more than 80 percent of Missourians, as Gov. Mike Parson said on Twitter last week.
The News-Leader asked the Missouri Department of Health and Senior Services’ acting director, Robert Knodell, for comment on southwest Missouri patient transfers to big cities. He responded with a prepared statement relayed through a spokesperson:
“The Department continues to work with our partners at the CDC, local public health agencies and healthcare systems across the state to provide all available resources and analysis. We continue to promote and encourage vaccination as the most effective mitigation step the public can take to stop this virus in its tracks.”
Dillon, with the state hospital association, said Missouri is a “mixed bag” as far as vaccination rates: Some communities approach 60 percent, others are less than 20 percent.
He explained, “The virus doesn’t respect the boundaries of political subdivisions like counties, states or regions, and with the greater chance of transmission with the Delta variant, hot spots will be inundated with patients.”
Dillon added that because effective vaccines are now available, COVID-19 hospitalizations are “largely unnecessary.”
Hospital executives agreed.
“I don’t understand why people won’t get vaccinated,” said McCoy, Mercy Springfield president. “I haven’t heard a good reason yet.”
Mercy is planning for the pandemic to continue, though McCoy said “we’re certainly hopeful that we get a reprieve.”
Cox’s Edwards appealed to a skeptical public to consider whether to vaccinate not in terms of political discourse, social media misinformation or judgmental attitudes, but in terms of personal trust between an individual and their primary doctor.
He said he’s in favor of “the idea of trying to remove all these competing, angry sort of sentiments and go to that one person that really cares about your health care, that doesn’t judge you, is your doctor — not Dr. Fauci, you know, but your doctor. I think that’s a message that we’re learning in our community.”
Edwards pointed out the rate of unvaccinated folks in the area is far higher than the rate of people without health insurance who may not have ready access to a primary-care physician.
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Reach News-Leader reporter Gregory Holman by emailing [email protected] Please consider subscribing to support vital local journalism.