Hospital crisis intensifies in Gorge; emergency care resources stretched

August 2021 is now the second highest month for new COVID-19 infections in Hood River County since the beginning of the pandemic, according the Hood River County Health Department. There were 221 new COVID-19 cases, the second highest behind December 2020, which saw more than 400 new cases.

Also in August, Klickitat County Health Department (KCHD) recorded an all time high of 337 confirmed COVID-19 cases, more than all of the total cases combined from March through July. Of the 337 cases, 134 are still active and waiting to recover.

“Two of our residents have died of COVID-19 and 20 have been hospitalized,” the KCHD reported. All that have died or been hospitalized were unvaccinated.

As the number of COVID-19 cases increase across the Pacific Northwest, the demand for acute care and intensive care hospital beds also increases as COVID-19 patients fill the larger as well as the rural healthcare centers. On Friday, Providence hospitals announced the establishment of mobile morgues in their Portland-area hospitals (see related story, A3).

Klickitat County crisis

“I recently had a patient who was quite ill and needed urgent surgery,” said Dr. Jeffrey Tanita from Klickitat Valley Health. “She had to stay in the ER for most of the day before we could find a surgical hospital bed for her due to the hospitals all being full in the Pacific Northwest.

“The delay in transportation to a hospital that could perform the surgery may have resulted in a worse outcome,” Tanita said.

Due to the shortage of hospital beds, Gorge residents are encouraged to avoid taking risks.

With more beds taken up by COVID-19 patients, there is less care available for those who seek care for other critical medical conditions including car accidents, cardiac arrest and other medical emergencies.

“In the past, we have always been able to transfer a patient in septic shock to a hospital that can provide definitive ICU care,” Peter Andress, a certified registered nurse anesthetist (CRNA) from Klickitat County Health, said in a press release. “Now, hospitals across the entire Northwest are strained beyond capacity due to high numbers of COVID infected patients, and also because of staffing shortages due to COVID infections.

“After personally caring for this patient, with the help of other KVH staff, this patient was successfully transferred to a large hospital ICU after being at KVH for about 24 hours,” Andress said.

“Care of this patient required enormous consumption of KVH staff, medications, and equipment,” Andress said. “While this care package was adequate to preserve the patient’s life, it was far less than the patient needed. KVH does not possess the staff nor the equipment to care for a critically ill patient.”

Jenna Newcomb, PA-C, a provider at Skyline Hospital, added, “There is a critical staffing and bed shortage in the region and it is affecting the ability of healthcare providers to care for all of the residents.”

“With respect to COVID-19, Klickitat County is seeing a large surge in critically ill patients, most of whom are unvaccinated and are now facing unprecedented delays in transferring to higher levels of care,” Newcomb said. “For those with heart attacks, strokes, and trauma, local hospitals can still assess and stabilize residents but transfers may be delayed because there is a critical staff and bed shortage at all of the facilities that Klickitat County hospitals transfer to regularly.

“Routine care is also being delayed due to staff and bed shortages,” Newcomb added.

On Wednesday, Sept. 1, Newcomb spoke to Washington State Lieutenant Gov. Denny Heck regarding the above concerns and requested help.

But at this time, “The best way to help your community and support your healthcare providers is to get vaccinated.”

In Klickitat County, vaccinations are readily available for anyone 12 and older at a variety of locations. Most vaccines are available by appointment only and can be booked by calling Skyline Health, Klickitat Valley Health, NorthShore Medical, or Klickitat County Health Department. If you would like to book your vaccination with KCPH, go online to us1.quickscreen.health/klickitat-county-vaccination#/screening. There are weekly vaccination clinics on Tuesdays (Goldendale office) and Thursdays (White Salmon).

Anyone with symptoms (see box, this page) can be tested in Klickitat County by calling to make an appointment at Klickitat Valley Health, Skyline Health, or Northshore Medical Group.

Wasco County cases rising

“We clearly are not done with this yet,” Health Officer Dr. Mimi McDonell told the Wasco County board of commissioners Sept. 1.

McDonell also noted the test positivity rate was high. “There are cases out there that we are not aware of, and people aren’t aware they have it,” she said.

Oregon is seeing high case counts as well, and sharp increases in the number of patients needing intensive care, or to be placed on ventilators.

“This is happening in our region as well, it’s very concerning,” she said.

Region 6 hospitals, which include Wasco, Sherman, Gilliam and Hood River counties in Oregon, as well as Klickitat and Skamania counties in Washington, are being strained by the increase, McDonell said. “We have a regional meeting every week, to review what is happening. It’s a little trickier being in another state, but we do try to work together.”

Prior to the current surge, the highest number of patients in local hospitals for COVID last winter was six. “That number now is 14 people in local hospitals,” she said. Although hospitals are restricting visitation and postponing some surgeries and procedures, that may not be enough as the surge continues, she added.

“It may come to the point where they will not be able to take care of other emergency needs,” McDonell said.

Commissioner Kathy Schwartz, a retired nurse, noted the region’s hospitals were very small, and now people cannot always be transfered, either. “There is nowhere to transfer to. Bend is full, the metro area is full.”

Commissioner Scott Hege noted that not long ago, there were zero ICU beds in use, and now they are at 100% usage. “It sure doesn’t take long to go from zero to ‘fully utilized,’” he noted.

McDonell noted hospital capacity changes rapidly from day to day, and hospital staff are under a lot of stress. “Low staffing, more beds, dressing in protective gear — it’s a tremendous strain on the staff, the healthcare system and their families.”

Vaccinations in the Gorge are improving, however. Wasco County is at 68.7% vaccinated, and Hood River County is 72% vaccinated. Klickitat County is at 38 or 39% vaccinated, however, which impacts the Gorge region. “As a regional hub, we are trying to help with those numbers,” McDonell said. “Our care providers take care of people from Klickitat and Skamania county.”

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When asked about employers requiring a negative COVID test to return to work, McDonell said that should not be happening. “Employers should not require a negative test before coming back to work. No employer should require that negative test. After 10 days without a fever, the chance of spreading the disease is low. A negative test is not helpful for employers, its just a burden on the healthcare system,” she said.

That’s because it’s possible for people to shed virus at detectable levels for up to three months after they’re infected, even though they are unlikely to still be infectious, said NCPHD Epidemiologist Jeremy Hawkins in a NCPHD press release Friday. Studies have not found evidence that clinically recovered people with detected levels of virus have transmitted the disease to others. “If that’s the strategy employers want to use, their employees might be out for a long time, much longer than is necessary,” Hawkins said.

He added, “NCPHD’s testing capacity has been strained during the latest surge. Generally, the CDC does not recommend a test-out strategy for ending isolation, so we are focusing our resources on people who are recommended to be tested: those who currently have symptoms of COVID-19, or who have been in close contact with someone who tested positive, and who have not yet tested positive themselves.

Following CDC guidance, NCPHD advises that people who test positive can end isolation if: At least 10 days have passed since symptom onset, at least 24 hours have passed since fever has ended without use of fever reducing medications and other symptoms have improved.

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Asked how best to encourage others to be vaccinated, McDonell encouraged those “on the fence” about vaccines to get their information from healthcare providers, not social media. “There are bad actors deliberately promoting misinformation on social media. It is not correct information, please get your information from a healthcare provider.

“Those who are unvaccinated are 29 times more likely to be hospitalized than those who are vaccinated. We truly, truly do not want our residents to suffer, but to be vaccinated.”

Vaccinations are available at every local pharmacy on a walk-in basis, at local doctor’s offices, One Community Health and at NCPHD. Call NCPHD at 541-506-2600 to book an appointment. Wasco County residents get a $50 VISA card for the first dose while supplies last. Local pharmacies put stickers on vaccine cards, which must then be taken to NCPHD to get the gift card.

McDonell encouraged everyone, even those who are vaccinated, to “take care of yourself, and take care of others around you.” She said it can be a hard discussion, at times. “It’s hard for me to understand why people would not protect them (children to young to be vaccinated) by being vaccinated and wearing a mask,” she admitted.

McDonell noted the current surge in cases, driven by the delta variant, has included outbreaks at long-term care facilities, workplaces and gatherings as well as spontaneous or untraceable contact. “They are happening everywhere,” she noted. “The delta variant is much more transmissible than smallpox or measles.

Improved treatment

For those who are infected by COVID, and have a high risk of complications, a monoclonal antibodies treatment that can be given as an injection is becoming available, McDonell told the board. “NCPHD is trying to make it more available in the region,” she said. “But our care providers are so swamped right now, and this is another thing to deal with. It’s an outpatient procedure, and that’s a heavy lift.” Getting a vaccine is much, much easier, she said.

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At the end of the board meeting, hours later, board members expressed their support for vaccination and mask use, encouraging residents to pursue both.

“If you haven’t reconsidered getting the vaccine, please do so,” said Commissioner Steve Kramer. “It’s proven, its scientific. Think about your neighbors, think about you’re friends. Think about your family.”

“People are being cautioned to dial back their activities and to stay home as much as possible, especially if you are unvaccinated. And really work to mask up, keep a social distance,” said Schwartz. “Those of us who are vaccinated, we need to think about it when we are around unvaccinated children, and friends and family. Those are the vulnerable folks right now. Maybe we are OK, but around children we need to protect them.”

“Lets support each other, lets care for each other, lets get through this,” concluded Hege.