Hospital officials say they’ve seen an uptick in respiratory cases and welcome state efforts to increase staffing in the face of the new coronavirus, after state regulators loosened requirements for medical professionals in Colorado.
State regulators will allow medical professionals licensed in other states to immediately start practicing. The state plans to bring in contract nurses from out of state to help the hardest hit communities. And it will tap into students and faculty at the University of Colorado School of Medicine.
Gov. Jared Polis has also asked former health workers to consider coming back to work. He said that will ease the burden as some workers may get sick from the virus.
“Part of the issue is, as health care workers are diagnosed, they will be out of the workforce for 14 days, so we need to backfill those positions,” the governor said. He noted sick workers, or those caring for ill family members, could be out for weeks at a time.
“The preparations have been pretty solid,” said Dr. Jason Persoff on Friday. He's the assistant director of emergency preparedness at the UCHealth University of Colorado Hospital at the Anschutz Medical Campus in Aurora.
“In a general sense, I think all the hospitals are seeing a marked increase in respiratory illness that meets the definition of COVID, for a person under investigation,” he said, although he couldn’t disclose specific numbers. “We are seeing far more people who do not have the disease,” based on testing.
Colorado health leaders and staff have taken their cues from seeing what’s happened with high levels of the illness in Washington state and Italy, Persoff said. “We feel like we're ahead of the curve because we know what is probably coming,” he said.
What’s expected in the coming days is a “logarithmic” increase in the number of cases of COVID-19, the disease caused by the new coronavirus.
In Italy and elsewhere, that steep spike in COVID-19 cases has forced medical professionals to make choices about how to allocate resources to patients, and limited hospitals ability to treat other health conditions. Health officials worry that could lead to higher fatalities and worse outcomes and want to prevent a similar phenomenon here.
The goal, public health officials say, is to “flatten the curve” or spread out the outbreak so it doesn’t exceed hospitals’ ability to respond at any given time. They’ve encouraged people to stay home if they feel ill, to work from home where possible and avoid large gatherings to prevent the spread of the disease. Polis has banned gatherings of more than 250 people and schools have closed. While children are at low risk from the disease, schools may be a way it could spread.
Hospitals are also working to beef up their resources to meet a possible spike in patients.
“I think that if we reach the levels (of illness) that we'd seen in Italy, I think anybody who has medical qualifications that can come back into the workforce will be greatly appreciated,” Persoff said.
Persoff said the health system needs to be ready for perhaps 15 or 20 percent of medical staff to either get ill themselves, needing time away to recover, or need time to tend to illnesses in their family.
He said a plan is in place at UCHealth, one of the state’s biggest hospital systems, to “stretch” staff as needed and that there are backup measures already built into planning. Hospitals should anticipate, based on the Italian experience that “we're going to need to be able to bring other people in,” particularly to treat patients that don't have COVID, but have medical conditions that need to be treated in a hospital.
“At this point we are doing well with the influx” of patients with respiratory systems, many being assessed for coronavirus, said Dr. Devin Bateman on Friday. He's the chief medical officer for the Parker and Castle Rock Adventist Hospitals. Both are part of the Centura hospital system. “The numbers have not been overwhelming.”
Still, he said, “They have put more of a strain on resources, and I would presume every hospital across our city and state is certainly feeling a similar strain.”
Both Bateman and Persoff said their hospitals were setting up special sections, with consistent staffing, to deal with anticipated surge of COVID-19 cases. Bateman said there may be a time soon where the new coronavirus is so pervasive in incoming patients that medical staff will begin treating a patient with serious symptoms as if they have COVID-19, even if there’s no positive test yet.
That would be for “the sake of community safety,” he said.
Colorado has thousands of doctors potentially ready to step in.
Colorado has about 20,000 licensed doctors working full-time in hospitals or clinics. Roughly 6,000 more could be tapped to assist with the coronavirus emergency, said Dr. David Markenson, president of the Colorado Medical Society, a top state doctor’s group. That includes those who have retired or, like him, have moved to other areas of medicine like teaching, training, research or administration.
“That's what you do as a physician,” Markenson said on Friday. “If there are patients that need care, like all physicians, I would step up and provide care.”
Those physicians could return “most likely in places they've previously worked because they have relationships, know the system, know the approach.”
Bateman said the potential to add additional medical staff, if needed, would be welcome.
“I think having the ability to ramp up the provider resources is a wise move,” Bateman said. However, he said it would be important to thoroughly vet the additional prospective workers as part of an emergency credentialing process.
Markenson said Colorado's system for emergency response is already strong, with many emergency plans put in place after the 9/11 terrorist attacks and when the H1N1 pandemic hit in 2009.
“The planning for this and the thoughts about this are not unprecedented,” he said. Hospitals are required through their accreditation to have plans to bring on supplemental physicians during disasters and emergencies. Also, public health departments have plans for a surge in workforce. A national disaster medical services system is being ramped up as well, he said.
Will all that be enough now?
“I think it's at this stage fairly hard to tell,” Markenson said. “I'm optimistic that our methods will control it, but we have to have always, as we do as physicians, a little bit of concern.”
Colorado also has options to expand nursing resources. One example is a Greenwood Village-based company called Fastaff that deploys traveling nurses around the country. It’s gearing up to send nurses where they are needed. It keeps a database of almost 200,000 nurses nationwide who are licensed in all 50 states and ready to go, said Lauren Pasquale, vice president of marketing.
These nurses “really are the special forces of nurses,” she said, noting they can work in a variety of settings, like emergency rooms, intensive care units, pediatric units, and hospital sections focusing on cardiovascular, labor and delivery. “They're a special breed of people, but these ones run into the fire.”
The backgrounds for the traveling nurses “run the gamut,” she said, from people recently out of school, to those who’ve taken time off to raise kids, to empty nesters.
Pasquale said traveling nurses would be ready to help in Colorado, or other states, where needed and requests are coming in. She said traveling nurses could typically be in place within 48 hours. “The nurses are ready to go, they have their credentials, we have all of their licenses on file,” she said.“They might get a day or a day and a half of orientation, but they don't get that typical two week onboarding.”
The bottleneck on testing could make it harder for hospitals to use supplies effectively
The Colorado Hospital Association said the state’s roughly 100 hospitals are working with state officials to track bed space, supplies like ventilators, personal protective equipment like masks, and staff. A formal agreement allows hospitals to move ventilators around as needed between facilities to meet the need. The state has also opened a state cache for supplies, which includes protective equipment.
Another priority now is decreasing the time it takes to return testing results, according the association. That will help hospital staff reserve necessary protective gear currently being used on patients in isolation, awaiting results. “We made great progress” on the testing front Friday, said Julie Lonborg, a hospital association spokeswoman.
“We have escalated planning with hospitals on a number of topics, as we begin to see more positive patients and more patients with respiratory conditions,” said Lonborg on Friday.
Polis also announced last week that more than a dozen members of the Colorado National Guard are being trained to do coronavirus tests. Part of their mission will be to help local public health departments start testing.
The state health department has also OK’d every EMT and paramedic in Colorado to administer the test.
Still, some health departments are already stretched too thin. In Pitkin County, where the new coronavirus has sickened several people, they have stopped testing and are redirecting their limited resources, according to the Aspen Times.