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Washington hospitals describe 'worst' level of operational crisis since start of COVID

News Tribune, Tacoma, Wash. logoNews Tribune, Tacoma, Wash. 1/14/2022 Debbie Cockrell, The News Tribune (Tacoma, Wash.)

Jan. 13—Story has been updated with governor's Thursday announcement.

State hospital officials on Thursday said the overflow of patients seeking care amid the latest COVID-19 surge has hit the highest levels ever reached in the pandemic. Coupled with that demand is a serious blood shortage, further restricting medical procedures.

"This is the worst situation hospitals in Washington state have been in compared to any prior point during the pandemic," Washington State Hospital Association executive vice president Taya Briley told reporters.

She noted hospitalizations are currently at an average of 1,800 for the past week and "have now exceeded our previous high of 1,700 in September of 2021."

Statewide, hospitals have seen about a 65 percent increase in COVID-19 cases in the past week, with an average of 226 new COVID hospitalizations each day and roughly 12 to 20 COVID deaths of those hospitalized.

The average number of patients on a ventilator is at 149, up from last week's average of 129, Briley said.

Dr. Michael Anderson, chief medical officer for Virginia Mason Franciscan Health, said that system's eight Puget Sound region hospitals including Pierce County, described it as "an unprecedented tidal wave of patients."

"When we look at 1,000 percent increase in the number of individuals showing up in the emergency department, it truly is super hero effort to try to find out who is really sick in that crowd and to attend to their illnesses," he said.

"Our emergency departments are absolutely full and their treatment bays and therefore a lot of our care is being provided in the waiting areas and in additional tents that are spread across the system," he said.

"We probably currently have just over 100 patients in temporary bed locations across our eight hospitals right now, waiting for an inpatient stay."

Officials pointed to a multitude of factors that have persisted for weeks: More staff being out sick or who are no longer working amid the current surge in cases; patients not in full emergency mode still showing up for COVID tests or treatment; and a serious backlog of patients remaining that hospitals are unable to place in other facilities.

Briley said WSHA had been in communication with state officials to seek immediate relief to the backlog to allow for more patient transfers and easing guardian requirements in place now.

"We have provided the governor's office with a draft of a proclamation that would address this need and be compliant with federal law that would allow for decision makers who are actually there at the bedside with the patient who are capable of consenting to major treatments like surgery or even withdrawal of life sustaining treatment to be able to consent to long-term care treatment," she said.

"For these patients right now under the current interpretation of the law, those patients that aren't able to make their own decisions need a guardian."

Anderson said VMFH had "well over 200 patients" waiting for placement in a skilled nursing facility. "But we have we are unable to get them out the door to those facilities, and therefore we have the backup all the way through our emergency departments," he added.

Dr. Elizabeth Wako, chief executive with Swedish First Hill in Seattle, told reporters King County had seen a 94 percent increase in hospitalizations in the past seven days.

"At Swedish, our cases are up over five times what we were in December," she noted.

Dr. John McGuire, chief of the Division of Pediatric Critical Care Medicine at Seattle Children's Hospital, said that COVID cases among younger patients were rising, with the fear that cases of MIS-C (multisystem inflammatory syndrome in children) could also be on the rise in the coming weeks as a result of those infections.

"Typically we see the multisystem inflammatory syndrome in children rising three to four weeks after the peak of COVID in the community," he said.

"We have the highest number of positive inpatients that we've had, but most of these kids are coming in for other reasons, not COVID," he noted. "And the kids who are being hospitalized with primary COVID disease are kids with underlying health conditions and co-morbidities that increase their risk."

Officials also acknowledged that the crisis and contingency staffing levels meant some workers were pulling shifts not long after facing own COVID infections.

Earlier this month, the state Department of Health updated interim recommendations to allow for reduced quarantine/isolation periods for staff based on CDC guidance.

Last week, local hospitals started operating under either crisis or contingency staffing levels.

"I want to be clear that when staff test positive staff in these models are still sent home," Briley said. "The question is how quickly they return to the bedside to work.

"If somebody who has had COVID is back at work, the first place that they will be working is with patients who have tested COVID positive," she added.

"At this time, crisis standards of care is not something that is imminently on the table. However, as I described, we are at these levels of crisis staffing," she noted.

Briley said WSHA also asked the governor's office "to immediately deploy staff whether it's through the National Guard or agency contract into long-term care facilities ... so that the the facilities are well staffed, and that the patients can be cared for in those facilities and not in hospitals."

Gov. Jay Inslee on Thursday announced the activation of 100 non-clinical National Guard personnel to assist hospitals with "various non-medical tasks" and to provide COVID testing teams to testing sites outside of hospitals. Measures to help with transfers also were announced.

He dismissed the WSHA draft proclamation submitted regarding guardianships, he said, on the advice of the state attorney general, adding "What they've actually asked me to do is ignore the law."

"I've been very clear that I want to help," he said. "And we're doing that by increasing the number of guardians. This is something that needs to be improved and I've dedicated myself to do that in a lawful way."

"Because of the intersection between federal law and state law here, you have to comply with federal law to admit somebody into a long-term care facility. I cannot waive federal law," he said Thursday.

The hospital officials also implored members of the community who were able to donate blood to do so now. Bloodworks Northwest said Wednesday it had less than a full day's supply for the region.

"We ask our own staff to go out and donate because they understand how big the problem is," Anderson of VMFH said. "And when you're exhausted and you're also literally giving blood, that just makes the situation worse."

This story was originally published January 13, 2022 12:14 PM.

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