UPDATED NOV. 25, 2020
The state’s hospital and nursing leaders in Iowa pleaded Tuesday with Iowans to take safety steps to stop the spread of COVID-19 as the glut of cases continued to tax their ability to help people with the virus.
“We have folks new in health care and those who have been around for decades who are astounded by the amount of death and serious morbidity they are dealing with on a daily basis,” Dr. Tammy Chance, medical director of quality initiatives at Boone County Hospital, said.
Dr. Hijinio Carreon, chief medical officer at MercyOne Des Moines, said, “If we don’t, as a community, rally around to supporting our healthcare systems and attempting to minimize the spread, we could be in a dire situation over the next several weeks.”
Asked what “dire” means, Kirk Norris, president of the Iowa Hospital Association, said it means patients showing up at a hospital and no staff is available to take care of them right away.
“It’s the very thing we warned about in March,” Norris told IowaWatch.
About 1 of every 4 healthcare workers at some Iowa hospitals miss a day of work because they are fighting the disease, personally or with someone at home, Norris said. Iowa hospitals have 70,000 employees.
The Iowa Hospital Association’s physician leadership group and the Iowa Organization for Nursing Leadership held a news conference Tuesday to urge Iowans to practice common steps that have been announced for most of 2020 but which some people still ignore. They include avoiding crowds and gatherings, wearing a mask and staying at least 6 feet apart from others.
The two groups crafted a statement signed by 172 healthcare leaders in Iowa and sent it to Iowa legislators, media and key local leaders and hospital staff.
Participants in the Tuesday news conference said hospitals consistently are transferring patients back and forth when they run out of available beds. The state set up six regional medical coordination centers earlier this year to manage its resources to fight COVID-19.
Chance, whose facility is a small critical care access hospital, said Region 1 that includes her hospital and those in Des Moines and Ames has been strapped.
“There were two days in the last week that we only had two or three ICU beds available in our whole region,” she said. “That is really scary. And maybe more concerning than our ICU bed challenge is the staffing challenges. We have some staff getting sick or having to stay home with quarantined or sick family.”
The hospital leaders spoke as Iowa’s COVID-19 death toll stood at 2,224. Another 47 died, bringing the total 24 hours later, the morning of Wednesday, Nov. 25, to 2,271, the state’s coronavirus data web page shows. That could more than double to a little more than 5,000 by March 1, a University of Washington health data tracker and predicter shows. (This paragraph was updated Nov. 25 to report the new number of Iowa COVID-19 related deaths.)
The predicter, based on current cases and regional trends, shows Iowa needing more intensive care beds than it has available until mid-January.
That kind of demand has created a critical scene at many hospitals. A total of 1,351 people were hospitalized with the virus on Monday, Nov. 23. That’s up from 839 people on Nov. 5. Iowa has 247 available ICU beds.
Jennifer Nutt, vice president for clinical services at the Iowa Hospital Association, said smaller hospitals are transferring patients needing higher level of care to large hospitals, while larger hospitals send healthier patients to the smaller ones.
“It does vary day by day on where ICU beds are available across the state,” she said. “And hospitals, on a daily basis, are having to make the decisions on what surgeries are going to happen, based on the beds available.”
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For all of that, having enough healthy care providers is a bigger concern than having enough hospital beds, industry leaders said. “We’re going to run out of staff before running out of beds,” Dr. Michael McCoy, chief medical officer at Great River Health System in West Burlington, said.
Iowa Gov. Kim Reynolds said Tuesday the increase in demand at hospitals — which peaked, for now, on Nov. 17 with 1,527 hospitalizations — has increased demand for personal protective equipment (PPE) that hospital workers need to work safely but that the state planned ahead for. “Iowa’s PPE stockpile is strong,” she said.
While demand for intensive care unit beds continues, overall hospital numbers have dropped since last week, Reynolds said. “While these are positive signs, it’s too early to know if they’re indicators of a trend,” she said.
Jacob Nicholson, the response division administrator for Iowa Homeland Security, said the state has in its stockpile a pandemic-level glove supply of more than 16 months and a disposable gown supply of more than 18 months. The state also has contracts with supply companies for more to be delivered in the next seven months, he said.
“Building and maintaining a large stockpile of supplies, alone, cannot meet the need of Iowans and our frontline pandemic responders, however,” Nicholson said. State and local partners in business and the Iowa Department of Public Health remain necessary, he said.
In the meantime, Iowans hold hope for vaccines going through the approval process at the federal level. Reynolds said vaccinations for COVID-19 could begin as soon as in a few weeks as vaccines get approved and distributed. Initial supplies will be limited so first in line to get vaccinations in Iowa will be people working to treat and abate the virus, she said.
NATIONWIDE PROBLEMS
The problems Iowa faces are nationwide.
Michael Osterholm, a member of President-elect Joe Biden’s coronavirus policy team, said hospitals are having what he called “the trifecta of shortages” in health care workers, personal protective equipment (PPE) and drugs to treat people who have COVID-19.
“The quality of care that people are going to get in hospitals – patients – is obviously going to be compromised just by the lack of adequate staffing,” Osterholm, a professor and McKnight presidential endowed chair at the University of Minnesota School of Public Health, said during a Nov. 18 National Institute for Health Care Management (NIHCM) Foundation webinar. He is a Waukon, Iowa, native and Luther College graduate.
Osterholm said shortages exist for three of every four of the 40 critical drugs such antibiotics that are used to treat patients with COVID-19.
“Unfortunately, I believe we are at the single greatest public health crisis in the world since the 1918 pandemic,” he said. “What we’re seeing here, particularly in the United States and Europe, is an out-of-control pandemic transmission of what we call exponential growth.”
He added this advice to quell the pandemic: “Bottom line is, stop swapping air.”
Earlier this month, Reynolds approved sending $25 million in CARES money Iowa has received to hospitals for COVID-19 relief. She cited overworked health care workers when making the announcement.
PROBLEMS AT RURAL H0SPITALS
The Nov. 24 assessments by Iowa hospital leaders covered all hospitals in Iowa but most hospitals in the state are small, rural facilities with 25 or fewer beds. IowaWatch previously has reported that already faced a financial crisis going into the COVID-19 pandemic.
Safety Measures
The Iowa Hospital Association physician leadership group and Iowa Organization for Nursing Leadership ask Iowans to take the following safety measures:
— Avoid crowds and gatherings.
— Cover your mouth when you cough.
— Stay at least 6 feet apart.
— Stay home if you are experiencing any respiratory or unexplained symptoms, such as a fever, chills, cough, shortness of breath, loss of taste or smell, or other common COVID-19 symptoms.
— Wash your hands frequently.
— Wear a mask.
— Get a flu shot.
An IowaWatch review of certified financial data last spring showed that 44 of Iowa’s 118 hospitals ended the last fiscal year for which they reported with a negative balance and that most were in small, rural regions.
A news analysis earlier this fall by IowaWatch, Reveal with the Center for Investigative Reporting, Wisconsin Watch, Side Effects Public Media and the Institute for Nonprofit News showed that 3 out of every 4 of the nation’s small, rural hospitals had negative operating income going into the pandemic. Nationally, 134 rural hospitals have closed since 2010, the Cecil G. Sheps Center for Health Services Research reports in its database of hospitals at risk. The center reports that 17 of those closings have been this year – two were added this past month.
Iowa Hospital Association projections earlier this year showed that Iowa’s 118 hospitals could lose as much as $2.17 billion in revenue by the end of this year.
HEALTH AND HUMAN SERVICES PROVIDER RELIEF FUND ALLOCATIONS IN IOWA
More than $500 million in aid through the Coronavirus Aid, Relief, and Economic Security (CARES) Act recouped some of that anticipated income, as did Paycheck Protection Plan forgivable loans and up to $928.3 million in accelerated and advance Medicare payments that 77 Iowa hospitals could access last spring, an IowaWatch analysis of Centers for Medicare & Medicaid Services data shows. The advanced payments have to be paid back.
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The story was republished by the Ottumwa Courier and the Red Oak Express under IowaWatch’s mission of sharing stories with media partners.