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Tucson medical workers face full hospitals, unmanageable patient loads
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Tucson medical workers face full hospitals, unmanageable patient loads

A nurse assists a COVID-19 patient at Tucson Medical Center. Dozens of TMC employees are home with COVID.

The goal since the pandemic started last March has been to keep hospitals from reaching capacity, but we’re past that now: Pima County’s hospitals are full and COVID-19 case counts keep reaching record highs.

“We’ve been talking about when the time would come when we are overwhelmed,” said Dr. Shannon Thorn, a Tucson infectious-disease specialist, “and we have reached that time.”

Thorn, who provides help at several local hospitals, said the number of available staffed hospital beds fluctuates depending on patients being discharged, transferred or dying.

On Wednesday night, one ICU bed became open. It filled immediately.

“At this point we have a critical shortage of staff. This week the ICU staff were being asked in a meeting to take on extra shifts and more patients” he said. “They are being asked to volunteer, but at some point it may become mandatory.”

For patients without COVID-19, that could mean a wait for treatment. Thorn said one case he came across recently involved a patient with a heart infection who couldn’t get standard hospital care because the resources and staff were not available.

Instead, he received treatment at home and is monitoring how he is feeling.

“We’re in a crisis”

This current spike is happening as Arizona becomes the state with the highest transmission rate of COVID-19 in the country, according to Rt.live, with an infected person now passing the virus to an average of 1.22 other people. The “Rt” is a measure of how fast the virus is spreading.

“We’re in a crisis. We’ve been in a crisis for weeks,” said Dr. Joe Gerald, an associate professor with the University of Arizona’s Zuckerman College of Public Health.

New weekly case counts recently increased by nearly 70% to 6,290 from the last week in November to the first week in December, while the number of diagnostic tests increased by 31%, according to the Arizona Department of Health Services’ chart of COVID-19 cases by date, as of Friday.

At the same time, new cases increased statewide by 46% to 41,496, while diagnostic tests increased by 21%.

The number of new cases seemed to abruptly jump from a previous two-week plateau in the state’s data, but this plateau is the result of less testing over Thanksgiving, Gerald said, adding that the virus continued infecting people, but fewer places were testing and fewer people were likely seeking tests over the holiday.

The percentage of positive diagnostic tests also increased from the last week in November to the first week in December, according to tests reported electronically to the AZDHS, as of Friday. It rose from 13% to 18% in Pima County. Statewide, it rose from 15% to 18%.

Statewide, new hospitalizations have jumped nearly 19% to 2,296 in the first week of December, surpassing a record set in the summer for the number of new COVID-19 hospitalizations in a week.

In Pima County, new hospitalizations reached 324, which set a record here for the second week in a row, according to the county’s data.

These hospitalized COVID-19 patients have been using a bigger and bigger portion of the available hospital beds in Arizona for months, according to AZDHS data. On Thursday, Dec. 10, they took up 40% of inpatient beds and 47% of ICU beds statewide, as of Friday.

Working assumption: everyone is infected

It’s difficult to explain how serious the situation is right now, said Judy Rich, president and CEO of TMC HealthCare, the parent company for Tucson Medical Center, 5301 E. Grant Road.

Rich, who is a registered nurse, said a career in nursing typically includes helping people recover far more than watching them languish, or die.

“That’s what makes it so difficult for them,” she said of her hospital’s nurses.

And with the transmission of the disease skyrocketing, she said, the staff has to assume everyone who walks into the emergency department is high-risk.

“We have to be extra diligent now, wear more PPE and assume everyone is potentially infected,” she said. “In our careers, we have never seen the kind of constraints that we’re under now.”

Last week, nurses at TMC wrote a letter to the community beseeching people to do all they can to stop the spread of COVID-19: Stay home at much as possible, shrink social circles, wear masks when out and wash hands frequently.

Nurses confer about patient care in the COVID Intensive Care Unit at Tucson Medical Center on Dec. 11, 2020.

The situation has been made harder, the nurses wrote, by seeing some of their colleagues get sick. TMC currently has the highest number of sick employees it has had since the pandemic started, with 64 employees home with COVID-19.

Rich said almost all of those employees got sick through community spread, and that only 17 employees since March have contracted the disease from hospital exposure.

The heartbreaking situations that are playing out now are like this from last week: One TMC nurse was at work caring for a sick, homebound colleague’s critically ill mother, said Mimi Coomler, senior vice president and chief operating officer for TMC HealthCare.

Coomler, who oversees nursing services for the hospital, said her charges have to do so much more than before.

“So much of our effort, so many resources are now going to this,” she said of COVID-19. “We’re constantly talking about how to expand capacity.”

No evidence of progress in slowing transmission

Statewide and countywide COVID-19 deaths are also on an upward trajectory, when accounting for a two-week data-reporting lag, but they are still below the number of deaths seen over the summer.

The rate of people dying who have tested positive for COVID-19 has steadily declined since the spring, according to Gerald.

“Back in March, the case fatality rate was around 5%. This June, mid-June, it was around 2.5%. And right now it’s hovering around 1.5%. And so, there’s been this steady decline in case fatality rates, such that fewer people who are recognized as having COVID-19 ultimately end up dying from this” he said.

This is likely due to several factors, he said, adding that, for example, doctors are probably getting better at treating the virus and we are doing a better job at keeping it out of long-term-care facilities, which is where a large portion of COVID-19 deaths occur.

“So, it’s not a silver lining that there are fewer deaths. It’s definitely good that for whatever reason fewer people are dying now, but that’s probably not much solace to the 500 or so people who are going to die during the Christmas week due to COVID,” Gerald said. “It’s still a potentially preventable tragedy for those 500 that end up dying because public-health experts like me have been saying, for quite some time now, ‘Hey we got a real problem here. We’re in trouble. We need to do something to slow this down.’ “

On the state’s current trajectory, the pandemic will get worse before it gets better, he said, adding that there’s no evidence we’re making progress in our fight against viral transmission. And more people will die as a consequence.

“We have no indication that we are at the peak of our illness here at all,” Thorn said of Pima County. “After that, we have to start rationing care and decide who has the best chance of survival.”

Some hospitals in New Mexico have already started taking steps toward that process, commonly called triaging care, which means those with the best chance get the limited care.

“What’s terrifying is that we don’t really see an end in sight; we’re just seeing an acceleration,” he said. “We’re not seeing any kind of real public awareness about the severity of the issue.”

Triaged care, once unimaginable, is near

Across town, the ICU at Banner University Medical Center Tucson was already at 90% capacity when this most recent spike hit, said Dr. Christian Bime, a pulmonologist in charge of critical care medicine for the hospital, 1625 N. Campbell Ave.

“We started to see an uptick before Thanksgiving but certainly after Thanksgiving it has increased,” he said, adding that sometimes there are no ICU beds at all. “It’s fluid, but every day is very, very tight.”

Over the summer, when that surge started, the ICU was at 65% capacity, he said, and that made a big difference in terms of balancing the workload.

Currently, people sometimes have to stay downstairs, in the emergency department, until space opens up. And that’s a challenge itself, since emergency rooms are typically busy at this time of year with the usual winter viruses, emergency care, heart attacks and other unexpected crises.

What makes all of this that much more difficult, Bime said, is that they are not able to provide the standard of care they are accustomed to providing.

“That bothers the nurses and the doctors very much,” he said. “We hold ourselves to a high standard.”

Like other medical professionals, workers at Banner are also worried they will soon need to implement triaged-care protocols.

“That’s not something we ever imagined we would have to do,” he said. “Each and everyone of us has to play their part to make sure we do not get to that point.”

The role the community plays in stopping the crisis is vital, said Dr. Melissa Zukowski, medical director for the emergency department at Banner Tucson.

“Hopefully we can hold the line here in Pima County so we do not get to that point,” she said of triaged care. “We need everyone to do their part, to help us get through this.”

Zukowski said there is “hope on the horizon” with the vaccine and so she hopes people begin to follow the CDC guidelines more closely, for just a while longer.

Contact reporter Patty Machelor at pmachelor@tucson.com or 806-7754.

On Twitter: @pattymachstar


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Data/Investigative Reporter

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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