Reno area hospitals on the verge of being overwhelmed by COVID-19 surge – Reno Gazette Journal

See how Renown Regional Medical Center is preparing for a surge of COVID-19 patients. Reno Gazette Journal

Reno area hospitals are enacting emergency measures, including setting up temporary beds and putting surgeries on hold as a spike in COVID-19 cases threatens to overwhelm available capacity.

Several hospitals in Reno, Sparks and Carson City are reporting a surge in COVID-19 cases during the last couple of weeks, describing it as the largest number of COVID-19 hospitalizations they have seen overall since the pandemic started.

Were seeing a fairly significant increase in the number of COVID patients that we are taking care of, said W. Allen Fink, chief medical officer for Carson-Tahoe Health. It fluctuates every day but weve had the highest number of patients within the last two to three weeks.

The observed increase in cases is backed by the data. Coronavirus hospitalizations in Washoe County and Carson City totaled 40 patients as recently as Sept. 7, according to the Nevada Hospital Association. By Nov. 11, however, coronavirus hospitalizations in Washoe and Carson have more than quadrupled to 195.

The surge is resulting in hospital emergency departments seeing an influx of patients who are presenting with COVID-19.

Northern Nevada Medical Center, for example, typically sees two to four patients coming into the emergency room each day for COVID-like symptoms, said Elena Mnatsakanyan, Director of Quality, Risk Management, and Infection Control at NNMC. In the last week, however, that number has shot up to between 25 to 30.

Not all of them need hospitalization, but its definitely much higher than what we saw in the beginning, Mnatsakanyan said.

The spike in cases led to a highly charged plea from Gov. Steve Sisolak on Tuesday asking community members to take the situation more seriously. Sisolak, who described his proposal as Stay at Home 2.0 urged Nevadans to avoid venturing out from their homes unless necessary for the next two weeks in order to flatten the curve and prevent business closures once again.

We might be getting COVID fatigue, but the virus is not getting infection fatigue, Sisolak said. Im not asking for the world, 14 days is what Im asking for.

Were on the verge of being overwhelmed, Sisolak added

The latest surge of the pandemic is hitting Carson City and Washoe County especially hard.

Carson City led the state with a 30-day case rate of 1,293 per 100,000 people as of Nov. 12. The state capital used to have one of the lowest infection rates in Nevada earlier this year. Washoe County was not far behind with a rate of 1,211 cases per 100,000 people the second-highest in the state. Both are significantly above the state average of 840cases per 100,000 people.

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The spike in cases is part of a COVID-19 resurgence that started in September. The increase coincided with the beginning of school as well as the continued easing of tougher restrictions on businesses statewide.

The impact of the surge is being reflected by the number of available hospital beds in Washoe County. At the end of August, 64% of staffed hospital beds and 45% of ICU beds were occupied, according to the Nevada Hospital Association. By November 4, hospital occupancy jumped to 88% for staffed beds and 60% for ICU beds. Ventilator use in hospitals, meanwhile, rose sharply within the last week from 20% on Nov. 4 to 27% by Nov. 11.

Back-up hospital beds are seen in the parking garage at the Renown Regional Medical Center in Reno on Nov. 11, 2020.(Photo: JASON BEAN)

Although the statewide occupancy rate for staffed beds was at 78% as of Nov. 11, Carson and Washoe continue to exceed the average for Nevada.

Carson reported the highest occupancy rate at 87% followed by Washoe at 85%. The ICU occupancy rate for Carson City is especially concerning. While Clark and Washoe reported 66% and 65% occupancy respectively for ICU beds, Carson was at 83%.The occupancy rate includes all patients, not just those with COVID-19.

Carson Citys surge has led to more patients showing up at Carson-Tahoe Regional Medical Center.

We have far more COVID-19 patients in the hospital now than we did in the spring and summer, Fink said.

Anthony Slonim, president and CEO of Renown Health, described the situation as serious during Sisolaks Tuesday press conference. Should the current pace of infections continue, the communitys health care system will end up being overwhelmed, Slonim warned.

People are being hospitalized and dying at higher rates than before, Slonim said. I am very, very concerned.

This is new, Slonim added. Were unable to keep pace with the virus in the way that it is currently presenting itself in the community.

In response to the surge in COVID-19 cases, Renown Regional Medical Center is working to open the alternate care site it built in a nearby parking garage earlier this year.

The deployable medical structure can accommodate up to 1,600 additional beds should a continued surge in COVID-19 cases overwhelm existing capacity. Its the second time that Renown has set up the emergency site, which ended up not being used the first time. The move was described as a precautionary measure by Dr. Paul Sierzenski, chief medical officer of Renowns acute care division.

Right now, we havent activated our alternate care site, Sierzenski said. The simple fact of the matter is that we are preparing as best as we can to be able to care for the community, whether it be COVID, a heart attack, stroke or a patient needs surgery.

A temporary deployable medical structure is seen being erected at the Renown Regional Medical Center in Reno on Nov. 11, 2020.(Photo: JASON BEAN)

Sierzenskis comment strikes at the heart of the matter as to why hospital capacity is a big deal in the midst of the pandemic. COVID-19 does not only affect the number of available beds for those with coronavirus, it also creates competition for space with other patients who need care for non-COVID-19 emergencies, such as cardiovascular health events or serious accidents.

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At the Reno VA hospital, three surgeries that required an inpatient stay were rescheduled this week amid concerns about their impact on available patient beds. The hospital cited an increase in COVID-19 patients. The VAs medical-surgery unit is at 65% capacity while its ICU and COVID-19 isolation units are at 75% and 63% capacity.

One month ago, we had zero COVID patients, Glenna Smith, spokeswoman for the VA Sierra Nevada Health Care System, said on Wednesday. Today, were at 12 COVID-positive patients.

Carson-Tahoe Regional Medical Center, which is running at about 80% to 90% capacity, is also rescheduling some procedures after it decided to curtail certain surgeries during the previous week. Carson-Tahoe typically runs at high capacity during the winter months but COVID-19 is further adding to the hospitals already busy workload.

Last week, we had some capacity issues, Fink said.

We havent had to expand into our surge capacity that we planned for and were still able to maintain a normal hospital situation. Were taking a look at that in the next week or so and see.

Carson-Tahoe could surge over 300 additional beds, which while manageable also comes with challenges, Fink added.

Dr. Richard Bryan, chief medical officer for Saint Marys Health Network, agreed.

In response to what Bryan described as a fairly dramatic increase in COVID-19 patients in the last few weeks, Saint Marys Regional Medical Center has moved patients within the hospital to basically create an isolation unit. Although the medical centers contingency plans allow for significant surge capacity by using its parking lot should the spike in cases continue,adding beds is just one part of the equation when dealing with an influx of patients.

A lot of surge capacity has to do not just with physical beds but the staff, Bryan said. Its one thing to generate 100 extra beds but if you dont have staff, thats meaningless.

As the people working on the front lines of the COVID-19 wave, health care staff have paid a high price since the pandemic started.

There have been nearly 259,000 infections as well as 1,700 deaths among U.S. health care workers as of Sept. 16, according to a report by the National Nurses United union. In addition to the personal cost, COVID-19 infections among health care workers are also affecting how hospitals are able to respond to the threat of the pandemic.

We are working around the clock to provide care that is becoming increasingly difficult, Renowns Slonim said.

The Reno VA hospital has seen the deadly impact of the coronavirus on staff firsthand, with three employees dying from the virus this year. Two were health care workers nurse Vianna Thompson and medical technician Alex Gousev.The hospital, which also serves patients from Northern California, currently has four nurses from another VA site working in Reno for the next couple of weeks to help with staffing.

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We have deployed fourteen two-week missions, primarily nursing staff, during the last year to assist VA and private sector nursing homes and hospitals throughout the US, Smith said. (We are) proud of our staffs resilience and professionalism every day.

One difference from the beginning of the pandemic is that all hospitals reported having sufficient amounts of personal protective equipment this time around. One of the big challenges earlier this year for hospitals nationwide was the lack of PPE such as N95 masks. The shortage was cited by Renown as a key reason for suspending elective surgeries earlier this year.

At the same time, PPE supplies could become an issue once again if the current surge in COVID-19 cases continues, according to Fink of Carson-Tahoe.

The (national) supply chain was destabilized in the beginning of the pandemic and we still havent normalized our restocking mechanisms, Fink said. We dont expect them to be back in play until late 2021, so its taking a long time to get everything back to where it was.

Even with hospitals enacting stricter protocols in their facilities to prevent health care workers from getting infected by patients, those efforts do not prevent infections from the community when members of the staff leave work and go out to buy groceries or do their errands. This makes following basic, common-sense actions very important, all hospital representatives agreed. Such measures include staying at home as much as possible, hand-washing, minimizing social gatherings, and wearing a mask and observing social distancing when going out.

Yes we have PPE (for our health care workers) but the community spread is so wide at this point that everybody, including health care workers, has a high risk for exposure, Mnatsakanyan said. We encourage the community to follow the governors recommendations and take it very seriously because at this point, its more important than ever to do so.

Jason Hidalgo covers businessand technology for the Reno Gazette Journal, and also reviews the latest video games. Follow him on Twitter @jasonhidalgo. Like this content?Support local journalism with anRGJ digital subscription.

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Reno area hospitals on the verge of being overwhelmed by COVID-19 surge - Reno Gazette Journal