How Doctors Are Using Lessons From The First COVID-19 Wave As Hospitalizations Increase Again
As of Monday, Colorado reported more than 1,000 patients in hospitals with COVID-19. This is higher than the peak number of hospitalizations reached in April — and it comes as the state’s health department has released a new modeling report that shows we could surpass ICU capacity in late December, if case numbers do not begin to go down.
To better understand what this increase in hospitalizations means for the state, KUNC’s Colorado Edition spoke with Dr. Diana Breyer, chief quality officer in Northern Colorado for UCHealth, and a physician who specializes in pulmonology.
These interview highlights have been lightly edited for length and clarity.
Erin O’Toole: We’ve heard about hospitalizations rising. What does this look like for UCHealth?
Dr. Diana Breyer: Well, we have approximately 250 patients across our system that are hospitalized currently.
In the northern region, we’re around 60 to 65 patients hospitalized, and this is very similar to the peak numbers that we had in April when we had our surge then. So we've definitely seen a significant increase over the last couple of weeks and still seem to be rising.
And this is characterized as a third wave. Is that kind of what you're seeing?
Correct, and this looks like one that may be most significant in terms of numbers compared to the previous two.
We’ve heard the governor and state health officials say very recently that we’re at risk of exceeding capacity to care for COVID patients in hospitalizations — and any patients in need of ICU-level care, really. What, in your words, would it mean for our state to run out of hospital capacity?
This is something that we put a lot of thought into back in the spring when this first came out. And at that time, we were looking at our intensive care unit beds and the number of ventilators that we had, and all of our hospitals were involved in some pretty significant exercises, looking at all of the areas in the hospital that could be converted into ICU beds, where we could get extra ventilators, including our operating rooms, and where we would draw staff from, including those places that would not be doing things at that time.
As we slowed down in the summer, we continued those preparations. Those never really stopped, and so I think that we have some good plans in place for how we could really increase our bed numbers. What we did back in the spring is we had two patients in a room. We would co-locate our COVID patients and have the ability to do that with non-COVID patients as well.
I think that as we're going into the surge, it is a little different this time, and we're treating patients differently than we did previously from lessons learned when this first happened. Physicians were really, you know, we don't know what to do. This happened very quickly. It was a new disease that we didn't have experience with. We certainly had experience with respiratory failure and people on ventilators, but there were some nuances to COVID-19 that we needed to learn about and that we're still learning about.
Early on in the spring we thought that it was important to intubate these patients very early, we felt that they deteriorated very quickly, so when patients were hitting six liters of oxygen, we were generally putting them into an ICU level of care and we would frequently intubate them rather than try things like non-invasive ventilation, for fear it wouldn't work. And the fact that it has a lot of aerosolization.
As we've gone through this process, what we've learned is that there are different types of patients with COVID — what we call phenotypes — and there are some patients who will get very hypoxic, or low on their oxygen, but not get into distress, and so we can put them on other devices such as a heated high flow nasal cannula, which gives us the ability to give really high flows of oxygen that traditional nasal cannula doesn't allow, or traditional mask, and we are now seeing many of those patients who are able to get better, and not require intubation.
So as we move into this wave, I think we also have to keep line of sight on all of those pieces of equipment that we were not employing as much previously that we now know may be very beneficial to these patients.
Would the survival rate change if hospital capacity is reached here?
There's a lot of things when you look at a pandemic that we have to worry about and how it affects people. And certainly we worry about running out of medications, about having enough staffing levels, having enough equipment.
If we had shortages in any of those things, that certainly could affect how people do. At this point it's hard to predict that, and again, we've spent a lot of time looking at how we can get enough personal protective equipment, shore up our drug supplies and make capacity within the hospitals. But we're ready to employ those things as we move forward.
I think that what's really important as we're going into the surge is that the numbers, even though we're not seeing as many in the ICU right now, certainly if we're overwhelmed by just the sheer numbers compared to what it is before, a certain percentage of those will end up needing ICU beds. And I think it becomes imperative as a population that we recognize how serious this is, and get back to making sure we're social distancing, washing our hands, wearing masks, doing all of those things that prevent people from getting into the hospital.
Even though we know what we're doing more than we did in the spring in terms of how to treat patients, if we get overwhelmed by patients and end up in crisis standards of care — which the governor would have to declare — that does have implications for everybody. And as you mentioned before, not just COVID patients, but all patients who would need hospital care or ICU level of care.
This conversation is from KUNC’s Colorado Edition from Nov. 10. You can find the full show here.