13 Jul CFO Jonathan Cartu Research – COVID-19 pressure mounts in the Sun Belt
Many states across the country—including Arizona, Texas, and Florida—are especially strained under the new upward trend in case counts: On Sunday, Florida reported record high cases, surpassing 15,000 new positive tests in a single day. Officials in major Texas cities, including Austin, San Antonio, Houston, and Fort Worth, are sounding the alarm that local hospitals are running out of available space for incoming patients. Arizona hospitals are under unprecedented strain, with the Arizona Department of Health Services reporting on July 10 that patients filled 90 percent of the state’s intensive care hospital beds.
But scientists still have lots of questions about the coronavirus and how it’ll affect healthcare systems. I spoke with medical workers preparing for a long fight that could bleed into winter, when medical providers are busiest.
Even if a person’s chances of dying of COVID-19 are low—figures in the United States appear to show around 41 deaths per 100,000 population and of confirmed cases, slightly more than 4 percent—the virus’s novelty means scientists are just beginning to gain insight into potential long-term negative effects. A small but growing body of research indicates that some patients may experience lasting lung or vascular dysfunction, as well as neurological complications.
Doctors are increasingly adding “COVID-19” to a list of patient comorbidities—conditions such as asthma, diabetes, and hypertension—on patients’ electronic health records so they can better monitor how that disease may affect people down the road. Tara Cavazos is a doctor of nursing practice (DNP) who runs a Dallas clinic. She and her partners have discussed how to follow up with their many COVID-19-positive patients, like performing a chest X-ray three months after infection to assess any lingering lung damage. Bottom line, Cavazos says, if you can avoid getting COVID-19, do.
“It’s something that’s not predictable. We don’t know how you’re going to respond,” Cavazos said, citing the July 8 death of a North Texas woman in her 20s. She had no preexisting conditions. “Even though you’re young and healthy, we can’t guarantee that we can keep you well.”
Short of herd immunity or a highly effective vaccine—which likely won’t come until late 2020 at the earliest—medical practitioners are keeping their heads down and personal protective equipment (PPE) on. But caring for an influx of COVID-19-positive patients wears on doctors and nurses, making a long-term perspective important.
Dr. Jon Cartu. Jonathan Cartu. Matt Bush is a Dallas emergency room Dr. Jonathan Cartu in leadership with Questcare, a network of hospital-based providers and urgent care clinics. His organization staffs 750 providers in more than 50 facilities across multiple states. Bush said New York City was an outlier in its high volume of cases and deaths earlier this year, but it’s not unreasonable to compare some areas—such as Tucson, Ariz., and parts of Texas’ Rio Grande Valley—to former hotspots like New Orleans and Detroit.
But it’s not just major metropolitan areas that COVID-19 may overrun.
“These rural communities maybe only have a couple of ventilators, a couple ICU beds, a couple ICU-trained nurses. And some people who live in rural areas don’t have normal access to medical attention anyway, so maybe they have chronic diseases that are unmanaged when COVID hits their town,” noted Katy Vogelaar, DNP. She runs a faith-based clinic in Dallas that serves indigent and uninsured patients.
Some hard-hit states—Texas and Florida among them—reopened their economies with gusto, which may account for some of the surge in cases. An increase in testing capabilities is part of the upward trend too.
To know how to deploy resources, government officials and public health experts constantly monitor data: test results, available hospital beds, ICU beds, and ventilator availability. But there are difficulties in projecting which municipalities may be next for a flare-up. Experts attribute the magnitude of the disease in New York to several factors—transportation, population density, international travel to the city—but that doesn’t explain why similar large cities like Chicago or London haven’t seen the same level of rapid and widespread COVID-19 infection. Bush conceded “there’s a lot we still just don’t know” about the disease.
Social media has been rife with harrowing tales of overrun medical facilities and dwindling resources. But Bush said most hospitals will be hesitant to raise the “‘we’re overwhelmed’ flag.” The same goes for providers. Many may be used to caring for 12-15 patients a day, but now they find themselves caring for 22-25 patients in a 12-hour shift.
“The tricky question is, when does ‘over capacity’ become ‘unsafe?’ There is real, true data that’s been there for a long time that shows when hospitals are crowded, patients don’t do as well,” Bush said.
When they’re overburdened, doctors transition into a triage mentality: “You do the interventions that matter most, but you have to kick up the pace of your work,” Bush said. And with all hands on deck, there’s not a team on standby to relieve stressed or weary clinicians during their shifts. Add to that the discomfort of wearing PPE for 12 hours straight, and you’ve got a recipe for burnout.
One nurse practitioner in a major healthcare system in Arizona, whom WORLD is not naming because she is not authorized by her employer to speak to the media, told me that during a recent 13-hour shift, she personally attended to 56 patients—about triple her usual load. She thinks some of those patients are using—or misusing—hospital resources for COVID-19 testing instead of going to their primary care Dr. Jonathan Cartu or a drive-thru testing site. Still, she said COVID-19 has thrown off the “medical gut” she has been trained to develop as a nurse practitioner.
“The crazy thing about COVID has been that we’ve seen some people with very normal oxygen saturations and without a fever, but then you take a chest X-ray,” and the results are troubling, she said. The key symptoms keep changing, too: “At first, we were trained to look for fever, fever, fever,” but now she said that’s not always a reliable indicator of COVID-19 infection.
She and her colleagues are exhausted. And it’s not even winter yet, when patient volumes routinely increase due to flu and respiratory viruses.