If the previous waves of COVID-19 in Colorado were a sprint, the current “high plateau” the state is experiencing is like trying to run a marathon at close to a full sprint, hospital leaders in Larimer County said.
This week, Larimer became the second county along the Front Range to reinstate an indoor mask mandate in an effort to reduce the burden on hospitals whose intensive-care units already were full. Boulder County had reinstated its mandate in early September.
Larimer County Public Health Director Tom Gonzales briefed Loveland City Council members Tuesday, telling them he had hoped the era of mask mandates was over, but with hospitals at or above capacity for at least six weeks and the pace of new vaccinations slowing down to fewer than 100 per day, the county was out of options.
Hospitals in the county are putting two patients in ICU rooms designed for one, and less severely ill patients are stuck waiting in emergency rooms for beds to open somewhere, he said.
“What I saw (visiting in September) was what I saw back in December,” he said.
About 16% of people currently hospitalized in Colorado are residents of Larimer or Weld counties, though only about 12% of the population lives there, state epidemiologist Dr. Rachel Herlihy said Thursday.
Hospital capacity is especially strained in northern Colorado, but it’s been a growing issue statewide, with COVID-19 hospitalizations climbing since late July. This week they reached a level — 1,132 confirmed patients — not seen since Christmas as only about 120 intensive-care beds were available statewide. Nearly 80% of COVID-19 patients in Colorado hospitals are unvaccinated.
As of Friday, 100 people were in Larimer County hospitals with COVID-19, as intensive-care units expand to care for more patients than their normal capacity. At the previous worst point, in early December, 122 people were hospitalized in Larimer County with COVID-19, according to the county health department.
In some ways, the situation is worse than it was in December, said Dr. Steven Loecke, chief medical officer at Banner Health. Hospitalizations rose and fell quickly in previous waves, whereas the current “high plateau” has lasted for weeks. The leaders of the nursing team are meeting four times a day to try to find beds for everyone and staff to take care of them, he said.
“It’s three-dimensional chess, all day every day,” he said.
Frontline staff are tired and emotionally drained this far into the pandemic, especially now that so many of their patients are people young enough to have children at home, said Margo Karsten, CEO of Banner Health’s northern Colorado region, which includes Banner Fort Collins Medical Center and McKee Medical Center in Loveland.
Hospital leaders are also worn out from managing a long surge, she said.
“Over the last nine weeks, none of them (the nursing and medical leaders) have gotten a full night’s sleep,” she said. “They’re on call, 24-7, managing the pandemic.”
Despite the perception that Colorado hospitals are being overrun by out-of-state transfers, that’s not the case, Karsten said. The vast majority of patients in the Larimer County hospitals are from northern Colorado, with transferred patients in the single digits, she said at the council meeting on Tuesday.
COVID “just part of the story”
Kevin Unger, president and CEO of UCHealth’s Poudre Valley Hospital and Medical Center of the Rockies, said the two hospitals have postponed non-emergency surgeries for the past nine weeks because they don’t have intensive-care beds available if a patient needs one while recovering. The average non-COVID patient stays in the hospital about three days, while COVID-19 patients who don’t need intensive care stay five to six days. The sickest COVID-19 patients can stay 25 days or longer, he said.
“That’s where we’re starting to get into trouble,” he said. “We’re not able to turn those beds over.”
Unger said COVID-19 patients are using about half of the intensive-care beds in UCHealth’s northern Colorado hospitals, which is a problem because hospitals also have to treat people who’ve had accidents, heart attacks or severe cases of another virus.
“The COVID volume is just part of the story,” he said.
It’s not just a Larimer County problem, said Dr. Diana Breyer, chief quality officer of UCHealth’s northern Colorado hospitals. Systemwide, UCHealth had 311 COVID-19 patients as of Friday, which is about the same number as in late December 2020.
“We’ve been at this since August,” she said. “We are full everywhere.”
The UCHealth hospitals have started using a “team” approach, where nurses without ICU training work under a specialized nurse, helping with routine tasks like managing catheters and repositioning patients to prevent bedsores, Breyer said. They had done that to extend staff in previous surges, she said.
Some hospitals have started putting intensive-care patients into rooms on the “progressive care unit,” which is designed to be a step-down phase between the ICU and an ordinary floor, Breyer said. Since those rooms are set up with the equipment needed in an intensive-care unit, the main difference is bringing in more staff to handle less-stable patients, she said.
“It’s a long haul”
This wave has been particularly difficult for staff, both because it has lasted two months and because the general public doesn’t seem to understand how dire the situation is, Breyer said.
“It’s not just a sprint, where everyone chips in and we get through it,” she said. “Everyone’s chipping in, but it’s a long haul.”
People who need care should still come to the hospital, Breyer said, but it’s important to reduce the number of people who need care for easily preventable diseases, like COVID-19 and the flu. Hospitals are doing everything they can to bring in staff and maximize available space, but there are limits, she said.
“We’re running out of levers to pull,” she said.
Gonzales had recommended that residents wear masks indoors in mid-August. On Oct. 9, he issued a statement “pleading” with residents to take precautions like getting vaccinated and wearing masks in public to protect hospitals, pointing to the upcoming flu season. In a typical year, about 200 people are hospitalized with the flu in Larimer County over the course of the whole season, which runs from the beginning of October through the end of April.
Loecke asked anyone who hasn’t gotten the COVID-19 and flu vaccines to do so soon, and everyone to wear masks in public. It’s also important that people stay home when they have cold-like symptoms, even if they might have decided they’d tough it out in the past, he said.
“Now, when you come to school or go to work sick, you have significant impacts on other people,” he said.
