Intermountain Healthcare official sounds alarm about intensive care unit utilization
Echoes of March and April are being felt in November as the COVID-19 situation in Summit County, like in Utah and the nation at large, approaches what happened in the early days of the pandemic: a seemingly out-of-control spike in cases and officials warning of catastrophic consequences if the disease’s spread isn’t checked.
Scientists, though, have now had several months to study the virus. Public warnings have become more specific, both about what to do to bend the curve — masks, distancing, handwashing — and what happens if the number of new cases continues to grow, with overcrowding at hospitals leading to the potential of diminished levels of care for all patients.
The Summit County Board of Health on Monday heard from an Intermountain Healthcare official who reported that 93% of the intensive care unit beds were full at the hospital system’s five COVID-centric hospitals, and that new patients coming into the state’s hospitals are exceeding the rate of patients being discharged.
Members of the public should wear masks, maintain social distance and wash their hands often, officials said, repeating the same refrain that they’ve offered for months.
Accompanying that guidance Monday was a sense of the consequences of what would happen if the state is unable to slow the virus’ spread. As of Sunday, 1,647 new cases statewide were being reported daily, according to a seven-day rolling average.
Dr. Paul Krakovitz was invited to address the Board of Health Monday. He is vice president and chief medical officer for specialty-based care at Intermountain Healthcare.
“The case counts that are happening in Summit County and the case counts that are happening around the state are beyond alarming,” Krakovitz said. “… When it gets above 85% (of capacity being used) in our ICUs, that’s when we really start to get nervous about our supply. We are now in the 90s at Intermountain. So, I want to be clear: Last time I looked, we were at 93% occupancy in our ICUs. Now, when that number gets that high, it affects our ability to be able to take care of other patients. We are not doing that yet.”
The state’s other large health care system, University of Utah Health, has reported similar numbers in recent weeks.
Krakovitz went on to clarify that the 93% utilization rate referred to the intensive care units at the five Intermountain hospitals that have been designated to receive the most seriously ill COVID patients, and was not a systemwide number. The system has 23 total hospitals, including Park City Hospital.
Total intensive care utilization statewide climbed above 75% last week, according to Summit County Health Director Rich Bullough.
Krakovitz described the steps Intermountain would take before it would be forced to alter the level of care it delivers patients, something that has been referred to as rationing care.
The mitigation efforts start with altering schedules and escalate to moving patients between hospital departments to moving patients between hospitals, then moving patients between hospital systems, then converting areas of the hospitals into makeshift wards, and then finally into a crisis level of care in which hospitals would be forced to change the way they take care of patients.
Krakovitz indicated Intermountain was already moving patients to different hospital systems, a complicated step that shows the hospital system is getting closer to contingency and crisis levels of care.
“We are not in a crisis in our hospitals, meaning we’re still giving the same care that we always give,” Krakovitz said. “But if the demand keeps outstripping the supply of what we can provide in our hospital, that’s going to change.”
The warning came on the heels of record-setting numbers of new COVID cases in Summit County. County Epidemiologist Louise Saw reported consecutive days of 31, 30 and 36 cases; the previous high was 30 new cases on March 22. Saw said the percent of COVID tests returning positive results was at a seven-day average of 16%, but had recently hit a daily high of 23.8%
Bullough told the Board of Health the increase in new cases was largely being driven by small gatherings or family groups.
New state guidelines mandate masks in all but six of Utah’s 29 counties and limit social gatherings to 10 people.
Ilyssa Golding, the chair of the Board of Health, asked Bullough about further steps that could be taken to stem the spread of the virus, like imposing a stay-at-home order or closing down businesses as was done earlier in the year.
“We know it works, even if we don’t have the data,” Golding said. “So, we’re kind of running out of options here.”
Bullough said that the contact tracing data does not tie the disease’s spread to any particular business sector, like bars or fitness centers. If that link was there, he said he would consider mitigation steps like increased regulations or seeking permission to shut down those industries.
But absent that data, Bullough said he does not think such a move would be justified.
Deputy Health Director Phil Bondurant added that shutting down a business based on anecdotal evidence rather than hard data would go against the Health Department’s data-first approach.
“Whether or not we believe that there are exposures occurring in those businesses, if we start considering closures of businesses without data and we do close them, we may not see an impact on our numbers and we have essentially impacted the livelihood of somebody, the ability to earn money and feed their family. … That, to me, is almost shooting from the hip,” Bondurant said. “I don’t think we’re in a position, as Rich has said, to do that as a health department.”
In the months since the pandemic began, there has been resistance against governmental efforts to control the pandemic, with anti-mask protests and movements in the state Legislature to wrest control away from Gov. Gary Herbert and local health officers.
Bullough indicated Monday that even if he wanted to order another shutdown, he would not be able to.
“It’s going to be extremely, extremely difficult to go back to a closure. We are as a society in a different place right now than we were in March,” Bullough said. “We are also, we have additional information about COVID than we did in March. And we also have a change in laws. When I issued that initial closure, I had the authority to do so. I no longer have that authority.”
Bullough and Summit County Attorney Margaret Olson later clarified that local health officers are still empowered to shut down individual businesses for violating public health orders, as happens when a restaurant does not comply with certain regulations, for example.
Broader measures, like stay-at-home orders or shuttering entire industries, would need the authorization of elected officials, including the Summit County Council and the Governor’s Office, or the Utah Department of Health.
“That doesn’t mean that there aren’t additional regulations coming,” Bullough said. “And I can say that there are ongoing continuous discussions at the state level about further restrictions.”
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