Dr. Joe Gerald just finished his weekly COVID epidemiology and hospital capability report. As always, there are many informative charts and graphs that depict the profound trajectory of COVID-19 cases and the resulting hospital capacity and capability crisis. It’s now clear that as a system, our hospitals are operating under Contingency Standards of Care approaching the “Crisis Standards of Care” threshold.
I probably sound like a broken record- but I feel compelled to say again that the situation we now find ourselves in is not because of fate as the Governor and state health director suggest. It is largely because they have been unwilling to implement evidence-based interventions this fall including authentic enforcement of the existing “required” mitigation measures for bars, restaurants and nightclubs. A requirement without enforcement is merely a suggestion.
Below are some excerpts from this week’s report from Dr. Gerald:
Arizona hospitals’ safety margin continues to erode in the ward and ICU. Most hospitals have cancelled scheduled procedures to ensure adequate capacity for patients with Covid-19 care. We are now undergoing the great “displacement” such that hospital services are now being rationed so that patients with severe Covid-19 illness are displacing others who have slightly less severe non-Covid medical conditions.
Hospital Covid-19 occupancy continues to increase with each day setting new records for ward and ICU occupancy. By early-to-mid January hospital capacity could be overwhelmed by new Covid-19 cases. Hospitals continue to postpone scheduled procedures to create additional capacity for Covid-19 patients at the expense of others with serious medical conditions. This coping mechanism could be exhausted soon if admissions continue to increase.
Health professionals are being asked to work additional hours and assume new duties. Shortages and burn-out will degrade our capacity to provide critical care services over the coming weeks.
The test positivity rate for traditional PCR testing remains at record levels, 26% this week. The mismatch between testing capacity and demand indicates viral transmission is growing faster than estimated.
As Covid-19 illness continues to increase, delaying others’ care will become ever more difficult. At some point, hospitals will have to expand their physical capacity. Make no mistake, the Covid-19 crisis is now placing a greater share of Arizonans’ at-risk, not just those unfortunate enough to contract Covid-19.
It is also important to recognize that hospital admission and discharge practices are changing in concert with management of nonCovid-19 patients. Covid-19 patients are likely being discharged home sooner and must have higher average severity to be admitted to the hospital and ICU. Furthermore, many who would have been transferred to a tertiary care facility are being managed at smaller, more rural hospitals.
The week ending December 13th has now seen 525 recorded deaths (Figure 7). This number will rise further over the coming weeks as more deaths are made known. Covid-19 deaths are expected to exceed 500 per week for the foreseeable future and may reach a new record by late December. Recall that deaths lag new cases by 14-days and are often only known weeks later. As a rule of thumb, multiplying the number of weekly cases by 1.5%, the case fatality rate, will approximate the number of Covid-19 deaths in 2 – 3 weeks’ time.