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Arizona hospitals bracing for crisis as COVID-19 cases surge
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Arizona hospitals bracing for crisis as COVID-19 cases surge

From the June's Tucson-area coronavirus coverage: Bars, gyms face shutdowns; Tucsonans worried telemedicine might disappear series

ICU units approaching full capacity in Phoenix, Tucson

Tucson-area, Coronavirus (COVID-19)

Cynthia Carsten, assistant chief nursing officer at Tucson Medical Center, talks with Bill Fleming, director of security for the hospital, inside TMC’s COVID-19 command center.

The coronavirus pandemic is intensifying in Arizona, mounting evidence shows, with hospitals seeing sharp increases in patients and emergency-room visits.

Last week marked the largest week-to-week increase of coronavirus cases in both Arizona and Pima County since the pandemic began, and Banner Health is reporting its ICUs are at full capacity in Maricopa County and rapidly approaching full capacity in Tucson.

New, confirmed cases in Arizona totaled 4,500 from May 24 to May 30, according to the Arizona Department of Health Services, as of Saturday morning. That’s nearly a 50% increase from the week before.

In Pima County, cases totaled 481 over the same period, marking an 85% increase from the previous week.

The county Health Department is watching closely to see if these cases will turn into hospitalizations, visits to intensive care units and ultimately deaths, said Dr. Francisco Garcia, the county’s chief medical officer.

“The jury is still out,” he said. “This is top of mind for all the hospitals and certainly for us here.”

But Dr. Marjorie Bessel, Banner Health’s chief clinical officer, said on Friday that COVID-19 hospitalizations are rapidly increasing and that, if these trends continue, Banner will soon need to start surge planning and increase bed capacity.

Most concerning, she said, is the steep incline of COVID-19 patients on ventilators. As of Thursday, Banner had 116 COVID-19 patients on ventilators statewide.

Across all Arizona hospitals, 34% of ventilators were in use on the same day, according to the Arizona Department of Health Services. In late March, by comparison, 20% to 23% of ventilators were in use.

“A few weeks ago, we had a nice drop in the number of critically ill patients, but over the last couple of weeks there’s been a slow uptick,” said Dr. Christian Bime, a pulmonary disease and critical-care doctor at Banner-University Medical Center, 1625 N. Campbell Ave.

Bime said what’s happening at Banner is the same as what’s being reported by the Arizona Department of Health Services.

The changing trends are worrisome, he said.

The health department’s data show cases increasing at a faster rate than diagnostic testing. The week ending on May 30 saw tests increase by about 14% statewide, compared to the 50% increase in cases. The same week saw tests increase by about 34% in Pima County, compared to the 85% increase in cases.

“The increased testing alone doesn’t seem to be a plausible explanation of why so many more cases were identified,” said Dr. Joe Gerald, an associate professor with the University of Arizona’s Zuckerman College of Public Health.

The rate of positive test results is also trending upward. As of Friday, it had doubled between May 10 and May 31.

At the same time, the number of tests have been increasing, Gerald said. “Finding a positive case is just now easier to do.”

While there’s no “right or wrong” positivity rate, ideally it would decrease over time, he said.

The percent of positive tests is a relative measure that can also be compared with testing in other locations, he said. “If you have a much higher positivity rate than other locations, then the suggestion is you’re not testing enough.”

The increase in testing and percent of positive tests is “concerning” and “should give us all pause,” Garcia said.

There’s also a clear, upward trend in the number of inpatient coronavirus patients in hospitals statewide, up from 818 on May 25 to 1,234 on June 4.

The data suggest that the number of these patients is increasing at a faster rate over the past seven to 10 days than was seen prior to May 25, Gerald said, adding that the number of coronavirus patients in emergency rooms across the state is also increasing.

It’s “a little bit interesting,” however, that the recent number of coronavirus patients in intensive care units has not mirrored this upward trend in inpatient patients, he said. “Normally, we would expect a those to be highly correlated.”

Even so, Gerald said, “I’m becoming more convinced that conditions are worsening.”

Multiple things are making viral transmission more likely, he said. The expiration of Gov. Doug Ducey’s stay-at-home on May 16 is among several factors, like general quarantine fatigue, that have pushed more people to interact with each other.

In Pima County, the number of coronavirus cases has increased most among younger age groups who presumably have less severe cases, Garcia said. But he said he still worries about every coronavirus case.

Next week he will pay close attention to how many people are hospitalized and who they are, he said. “That’s when we’re going to know how bad this peak is.”

Right now coronavirus deaths represent the racial and ethnic breakdown of the community, he said. Most deaths have been older white patients.

But new cases are increasing among Latinos.

“So will that change if all these other young people who are browner end up being in hospitals? Absolutely,” he said. “That’s where I’m spending time stressing.”

Bime cautions people to remember that the virus is unpredictable and can be hard on otherwise healthy individuals, not just those at high risk due to preexisting medical conditions or age.

“We are hoping that people will continue to be responsible,” he said. “We are hoping that people will continue to avoid gatherings larger than 10, that they will stay home as much as possible and that they will wear a mask when they are in public near other people.”

“We were able to flatten the curve and to get to a point where we were able to begin to open up our community, but we must do that responsibly,” he said.

Banner is still treating patients who were initially hospitalized in April and early May, he said, and there are also more patients hospitalized for other medical needs and previously postponed surgeries.

“COVID-19 is still here with us. It hasn’t gone away, and it won’t go away for a long time, and we must learn to live with it in a responsible way until we have a vaccine or a cure.”

As of Thursday, regular inpatient hospital beds were at 83% capacity statewide, up from 64% capacity toward the end of March, due to both COVID-19 and patients receiving medical care and surgeries they’d previously postponed.

While cases have increased countywide, hospitals across Pima County have reported a variety of trends among their own patients.

Northwest Medical Center and Oro Valley Hospital have not seen a big decline or spike in COVID-19 inpatients, said Veronica Apodaca, director of marketing for Northwest Medical Center, 6200 N. La Cholla Blvd., and Oro Valley Hospital, 1551 E. Tangerine Road.

But the numbers fluctuate daily, she said. “Our census has remained relatively stable over the past few weeks. Each patient is different, and we have treated patients who have had relatively short stays that have not required ICU care and have also had patients who are more seriously ill and have been here for a month or longer before discharging.”

Tucson Medical Center, 5301 E. Grant Road, has seen an increase in cases.

“Though we have seen an uptick in cases these past couple of weeks, patients seem to be less sick than what we saw in the beginning,” said Angela Pittenger, spokeswoman for TMC. “We think this is because people are more aware of symptoms and are seeking care sooner.”

Pittenger said the severity of coronavirus cases varies at TMC.

“Some present at the emergency department and go home right away, whereas others might be in the hospital for 30 days or longer,” she said. “One commonality is those with the most severe cases tend to be over age 65 or have preexisting conditions such as diabetes and heart disease.”

Carondelet hospitals are seeing COVID patient admissions “consistent with the trends being reported by public health,” said Angela Martinez, communications specialist with Carondelet Health Network, which includes St. Joseph’s Hospital, 350 N. Wilmot Road, and St. Mary’s Hospital, 1601 W. St. Mary’s Road.

“It’s a good reminder to all of us that we cannot let our guard down and must remain vigilant about our safety precautions and social distancing.”

Contact reporter Patty Machelor at pmachelor@tucson.com or 806-7754. On Twitter: @pattymachstar

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Alex has been with the Star since June 2019. He previously wrote about the environment for the Arizona Republic and he's a graduate of the University of Arizona.

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