For months, Oregon seemed to be a national outlier, spared the worst of the COVID-19 pandemic.
But in the past several weeks, a surge in seriously ill COVID-19 patients have arrived in emergency rooms from Portland to Medford to Bend, pushing hospital bed occupancy in some regions towards 90% and straining the health system.
“For much of the last four months, we were oscillating between roughly two and eight patients requiring hospitalization with COVID-19 disease. Today we have 49 patients,” said Dr. Jeff Absalon, the chief physician executive for the St. Charles Health System, which operates four hospitals in the Bend region.
“We honestly expect that the numbers are likely to go higher than they are, and this is by far the most number of patients we have seen in the pandemic.”
Statewide, hospitals treated a record 494 patients with severe COVID-19 illness two weeks ago, the Oregon Health Authority reported, before the numbers appeared to fall slightly last week.
Oregon has relatively little margin for error when it comes to hospital capacity. It’s a state with the fewest hospital beds per capita, according to the Kaiser Family Foundation.
Hospitals making other plans
In multiple regions — the Portland metro area, Central Oregon and Southern Oregon — the percentage of staffed intensive care beds in use hovered around 85% for much of the last week. Non-ICU hospital beds were in use at a similarly high rate.
Oregon’s average hospital bed occupancy rate was roughly 60% prior to the pandemic, according to data from the CDC.
In recent days, the Southern Oregon region, which includes Grants Pass, Ashland, and Medford, reported having just 6 ICU beds available out of 57 total — about 90% are in use.
“From my conversations with other health care administrators in the last weeks, I think we’re starting to feel nervous in a way that we haven’t, up until now,” said Dr. Courtney Wilson, vice president of medical affairs at Asante Rogue Regional Medical Center in Medford, the regional resource hospital for Southern Oregon.
In response to the influx, the St. Charles Health network in Bend has started implementing parts of its surge plan. Patients from Bend with less complex medical needs may get diverted to St. Charles’s other hospitals in Redmond and Prineville. Doctors are reviewing a list of more than 800 upcoming elective and scheduled surgeries to see how many can be postponed.
The procedures St. Charles is reviewing include surgeries for cancer and heart disease, and joint replacements. The hospital system is looking for those that can be postponed for two weeks without causing a significant decline in health.
“I will say that the majority of the elective surgeries that we have are really critically important to preserve health or preserve function,” Absalon said.
Hospitals in Portland and Southern Oregon are also having to make decisions on a day to day basis about how many scheduled and elective surgeries can proceed to ensure intensive care beds are available for everyone who might need one in an emergency.
Different than the spring
Early in the pandemic, Asante’s Wilson worried about running out of masks, gowns and testing supplies. Now, the critical challenge her hospital faces is staffing.
The hospital has enough physical space to accommodate more patients, and it has applied to the state for an increase in critical care licensed beds, to prepare for the possibility of running out.
“But those beds won’t do us any good if we don’t have the staff to take care of patients,” Wilson said.
In the spring, Rogue Regional was able to hire traveling nurses, to prepare for the pandemic.
“We had really a surplus of staff, bracing ourselves and ready to meet the wave of COVID that fortunately at that point never came,” Wilson said.
Now, the hospital is in the opposite situation: Traveling nurses are in high demand nationwide as community spread of COVID-19 has led to a surge in hospitalizations everywhere.
Wilson said they’re concerned the projected spike in COVID-19 cases will arrive this time and that additional help will be hard to find. “The staff are nearly impossible to come by,” Wilson said.
The hospital’s ethics committee, meanwhile, is finalizing a triage plan that spells out how to decide which patients receive care in a situation where the hospital becomes overwhelmed.
Some good news: The flu isn’t so bad
A few hours north, Peacehealth Sacred Heart Medical Center in Springfield, the regional resource hospital for Lane, Coos, Douglas, and Curry counties, has not yet canceled elective surgeries or made other substantial changes to the care available there.
“We are managing our COVID volumes and still able to do everything we would normally be able to do,” said Dr. Jim McGovern, the COVID-19 incident commander with Peacehealth’s Oregon network.
McGovern said one thing that’s helping his region is a slow start to the flu season and fewer cases of other respiratory viruses than usual this time of year.
“I think we’re seeing less this year because of hand-washing, masking, social distancing,” he said. “It doesn’t just prevent the spread of COVID, it protects against other respiratory viruses as well.”
Oregon is not yet at the crisis point that states such as Texas and Oklahoma have reached. There are still enough beds available for patients to be treated somewhere in their region, if not at their community hospital.
Representatives from the state’s regional resource hospitals have regular calls, multiple times a week, to plan in case any hospital or region does overflow and run out of beds- and needs to start redistributing patients to hospitals hundreds of miles away that still have the capacity to treat them.
The goal in that crisis scenario is “being able to share patients and redistribute patients so that we maintain access for everyone,” said Dr. James Heilman, the chief medical transfer officer for Oregon Health & Science University, the regional resource hospital for the Portland area.
“Fortunately, we’ve not needed to do that yet,” Heilman said.
The group that was convened to plan for a COVID-19 surge did get a dry-run as to what an overflow scenario might look like earlier this fall, when multiple hospitals were evacuated due to the large wildfires that devastated communities across western and southern Oregon.
Vaccines will help, but slowly
There may be a little relief on the horizon for hospitals statewide. The first shipments of a COVID-19 vaccine could arrive in Oregon this week, with health care workers getting the first available doses.
The vaccine will offer a little more safety for doctors and nurses, and psychological relief from the fear of catching the virus at work and spreading it to family members.
“It’s something that is going to be a morale booster,” Heilman said.
But of course, there aren’t enough doses available yet to start vaccinating the general public.
Dr. Jeff Absalon with St. Charles Health said the vaccines aren’t the key to keeping his hospital system from running out of beds in the short term.
‘We know that they won’t be here soon enough to help us through this winter-slash-respiratory season,” he said.
What’s critical right now is every one of us, doing what we’ve known from almost the start can stop this virus. Stay home if you’re sick, avoid spending time with people from outside your household. And wear your mask.
Editor’s note: This story was originally broadcast on Friday, Dec. 11, 2020.