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Running out of room: St. Louis hospitals forced to turn away patients from rural areas as COVID cases soar
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Running out of room: St. Louis hospitals forced to turn away patients from rural areas as COVID cases soar

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HOUSTON, Mo. — A 48-year-old married father of five, worried about his worsening headaches, walked Monday afternoon into the small emergency room at Texas County Memorial Hospital.

Nurses discovered he had a quickly growing and dangerous mass in the middle of his brain, said hospital CEO Wesley Murray. The man needed surgery at a high-level trauma center.

For the next 25 hours, frantic nurses called every Missouri health center they could. They even called hospitals as far as Memphis, Tennessee; Little Rock, Arkansas; Tulsa, Oklahoma; and Omaha, Nebraska, Murray said, but they were unable to find an intensive care bed open.

The man was losing consciousness. His blood pressure was increasing. Finally, a University of Iowa hospital was able to handle his case, sending a small plane to pick him up at nearby Fort Leonard Wood.

The nurses cried when they learned the surgery was successful and the man has no impairments, Murray said. But the close call was unnerving.

“That is just one incident, and our worst and latest incident of everything kind of grinding to a halt,” he said. “Because of the spread of COVID and so many ICU (intensive care unit) beds taken, there are no beds available for the critically and dangerously ill patients.”

‘Heat of the battle’

Hospitalizations for COVID-19 are at a dizzying record-breaking climb with no downturn in sight in Missouri and across the Midwest.

Emergency rooms are busy with patients waiting for hospital beds to open, hospital administrators say. Large metropolitan hospitals are having to turn away patients from small rural hospitals who depend on them for expert care.

The number of patients hospitalized with COVID-19 in Missouri topped 2,000 for the first time on Nov. 6 — a 247% increase since the state’s lowest totals during the middle of June, according to the Missouri Hospital Association.

Hospitalizations have continued to climb sharply statewide over the past week, reaching 2,413 on Wednesday, according to Missouri’s data dashboard.

The surge comes as hospitals see the typical seasonal increases in patients with respiratory illnesses like the flu and are trying to catch up on surgeries delayed in the spring when the first large wave of COVID-19 hospitalizations hit urban areas.

“We are in the heat of the battle right now,” said Steve Edwards, chief executive of CoxHealth, whose Missouri hospitals in Springfield, Branson, Monett and Barton County are caring for about 115 COVID-19 patients.

The health system’s only high-level trauma hospital in Springfield erected a 51-bed COVID-19 unit in April, rushed to complete a 24-bed project that was in the works and is now adding 36 rooms, with capacity to serve 72 patients, on the empty floors of an office tower, Edwards said.

His and other health systems are trying to hire temporary traveling nurses, but they are in high demand and costly.

For about two-thirds of the time over the past two weeks, Edwards said, the Springfield hospital was not able to accept transfers of patients from other areas.

Missouri’s rural community hospitals must transfer their sickest patients needing critical care to large hospitals in St. Louis, Kansas City, Columbia or Springfield, which are able to maintain the expertise and equipment necessary to take care of those patients.

Over the course of the pandemic, hospitalizations for COVID-19 patients have tended to either spike among residents from metro areas or from rural areas, allowing large hospitals to adapt to the influx of patients needing care.

Lately, demand for care is coming from everywhere, hospital administrators say.

Refusing patients

Hospitals in St. Louis and surrounding metro area this week saw record daily admissions of new patients that were double the numbers seen at the height of the pandemic in the spring.

The admissions pushed the seven-day average of patients hospitalized with COVID-19 to a record of 599 on Thursday, the St. Louis Metropolitan Pandemic Task Force reported.

“So then what happens is that patients are ending up in our ER for several days until a bed opens up because there is not a bed to move them to,” said Dr. Keith Starke, chief clinical officer for Mercy, which has hospitals across Missouri in urban and rural areas.

Metro hospitals then have to refuse patients needing care from rural hospitals.

During the week ending Oct. 31, the four Mercy hospitals in the St. Louis metro area — in Washington, Jefferson County, south St. Louis County and west St. Louis County — received 104 requests to take patients from outlying areas of the state and had to turn down 22, Starke said.

During the week ending Nov. 7, the hospitals received 123 requests and had to refuse 39.

Dr. Clay Dunagan, chief clinical officer at BJC HealthCare, said lately, the days are starting with between 20 and 40 people waiting to transfer to one of BJC’s St. Louis-area hospitals — a number he’s never seen so consistently high.

Dunagan and Starke said they are unsure what happens to those patients as they wait.

“I suspect some of them are then put in that hospital or stay in the emergency room and they may die, they may get better,” Starke said, “but their chances of recovering are less when you don’t have the same level of care available in those smaller rural hospitals.”

Waiting game

Jeff Tindle is the CEO of the small Carroll County Memorial Hospital situated about an hour and a half northeast of Kansas City. Two weeks ago, the hospital had a handful of patients extremely ill with COVID-19 who had to wait several hours, even overnight, in the hospital’s emergency room because staff could not find a nearby intensive care able to handle their cases.

In the emergency room, the staff must play a dangerous waiting game of delaying putting patients on a ventilator because transporting an intubated patient by helicopter or ambulance is more risky, Tindle said.

“That is a very stressful situation for the family and staff because that is not what we do on a day-to-day basis,” Tindle said. “It becomes a timing game, trying to figure out how long a patient can wait before getting a ventilator and how long we think it will be to get a bed.”

This week, patients are not as severely ill, Tindle said. But what keeps him up at night is not knowing when patients struggling to breathe with COVID-19 will come through the doors.

“It’s the inability to know if and when that patient presents themselves, and if we will have a place to send them to when they are beyond the care we are able to provide,” he said.

The three major hospitals in Columbia, Missouri, together issued a warning this week that their hospitals are reaching capacity because of recent increases in COVID-19 hospitalizations and are having to defer patient referrals.

Mark Wakefield, the associate chief medical officer for MU Health Care, said staff worries about having to defer patients because they don’t always know how quickly a sick person may deteriorate.

“We endeavor to be on the receiving end of referrals so that we can save and improve the lives of patients in our service area, which is a lot of central and rural Missouri,” Wakefield said. “We care very much for those patients and want them to come to our center to be taken care of because that is what we are here for, and this pandemic has put a strain on us to do that.”

BJC’s Dunagan said area hospitals are scrambling to reassign staff and switch the use of beds to whatever is the most urgent need. They are once again postponing the least-critical surgeries.

But he warned that at the current trajectory, those interventions could no longer work. He and the other administrators begged people to do their part by distancing themselves from others and wearing a mask.

“When you look at the growth of the number of infections, there is a real chance that it will start to threaten the ability to handle all the acute illness out there, so not just coronavirus, but heart attacks and strokes and other emergencies,” Dunagan said. “The resources of the health care system are finite. There is a point in which we simply won’t have capacity.”

Murray fears for his little hospital where staff care for their friends and neighbors.

He said, “It just feels like a dam that is ready to bust.”

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