‘Plenty of runway’ for COVID-19 surge? Medical pros, state data contradict Gov. Stitt’s characterization

Click here for updates on this story

    Tulsa, OK (Tulsa World ) — Gov. Kevin Stitt describes having “plenty of runway” — hospital capacity — for the state to monitor and adjust as COVID-19 surges in Oklahoma, but medical professionals are asking for an immediate course correction.

Stitt on July 10 touted there are “5,000 COVID beds to be able to access throughout our state.”

However, that figure is based off the state’s surge plan developed in the spring and doesn’t account for routine or elective procedures taking place now. Those procedures were temporarily halted during quarantine. Medical professionals also question the ability to staff beds because of nursing and physician shortages.

State Health Commissioner Dr. Lance Frye on Wednesday doubled down, saying the state hospital association and hospital CEOs assure him that “we have capacity still — that we’re doing well.”

Frye said state models project there would have to be 100,000 cases in 14 days — or 7,200 cases per day for 14 days — to reach the 5,000-bed capacity of Oklahoma’s hospital system.

The state’s seven-day moving average reported Friday was 721 cases per day, a record for the 12th consecutive day.

Other medical leaders describe a statewide hospital network that is starting to fill up, with a need “to do something tangible” now. The state’s hospitalizations for COVID-19 are at all-time highs, first topping the 600 mark on Wednesday at 638 before dropping back below by Friday to 547.

Deaths in Oklahoma are beginning to rise, with seven reported Friday and six reported Thursday. That’s the largest two-day total since early May. There were four apiece reported on Tuesday and Wednesday. The four-day total of 21 is the highest since 23 deaths were reported in a four-day span in early May.

“The runway involves — we’re talking about patients’ lives. We’re talking about the fact that people are dying,” Dr. George Monks, president of the Oklahoma State Medical Association, told the Tulsa World on Friday. “Even the statistic that we touted as being a strong point for Oklahoma — that we have hospital capacity — is no longer true. It’s rapidly shrinking. …

“Instituting a mandatory face mask statewide policy is really the middle road. It’s choosing the best option available, not letting this virus go unchecked and say, ‘We’ve got enough beds for you,’ and let the virus burn things down.”

LaWanna Halstead, vice president of quality and clinical initiatives for the Oklahoma Hospital Association, said hospitals are “very concerned” about the surge, with capacity “becoming strained” as hospitalizations rise.

Halstead, a registered nurse, said Oklahoma for many years has had a nursing shortage, along with one of the lowest physician rates per capita in the nation. A room is of no use if it can’t be staffed, she said.

“We do not want to get into a situation where we do not have the staff, equipment or space to care for Oklahomans in need of any type of health care,” Halstead said.

There were 167 of 983 ICU beds — or 17% — available in Oklahoma, according to the state’s weekday bed survey snapshot Friday. The hospital survey response rate was 83%.

There were 1,269 medical-surgery beds open of 5,746 total, or 22% available. ICU and medical-surgical beds combined were 1,436 available of 6,729, or 21%.

“I thought it was a curious statistic, and we just don’t have 5,000 COVID beds,” Monks said. “We don’t have it.”

Hospitals divert patients
Monks spoke to the Tulsa City Council on Wednesday during discussion about a mask mandate for the city. He told councilors that he has assembled a weekly COVID-19 task force of experts to “keep our finger on the pulse of what is going on so that we can better handle this crisis.”

Monks said that he hears from his colleagues in emergency rooms and intensive care units that many hospitals are going on “divert.” He explained “divert” means that their ICUs might be full for a period of time, so the hospital directs ambulances to go elsewhere if possible.

Specifically, he said Oklahoma County started the week with only 5% of ICU beds available and the counties surrounding it were down to 2%.

“What we bragged about early on and what is true is Oklahoma is blessed with a large hospital capacity,” Monks said. “But I’m afraid to tell you that that capacity is quickly strained.

“It’s getting tight in our hospital system.”

Bruce Dart, executive director of the Tulsa Health Department, said current trends aren’t sustainable — hence his recommendation for the city to implement a mandatory mask ordinance.

Dart said he speaks with local hospital CEOs or senior executives on a weekly basis.

“They’re starting to become concerned about capacity,” he said.

Dr. David Kendrick, CEO of MyHealth Access Network, also spoke to Tulsa city councilors Wednesday before the governing body ultimately voted 7-2 in favor of a mask mandate.

MyHealth Access Network is a nonprofit health information exchange in Oklahoma. Kendrick said its data show the infection rate continues to go up and that the virus’ spread requires that “we need to do something tangible” to combat it.

He said that over time, the more people who test positive will translate directly into more hospitalizations.

A person on average is hospitalized for six to seven days if they don’t require an ICU bed, according to MyHealth data Kendrick presented councilors. A person in ICU stays for 10 to 20 days, if they survive to leave the hospital.

“The fatality rate for anyone admitted to the hospital is over 21%, so that’s a sobering metric to think about,” Kendrick said.

State modifying its plan
The state’s surge plan in April determined through a statewide hospital bed survey that Oklahoma’s capacity was 4,633 available medical-surgical and ICU beds in case COVID-19 got out of hand.

That 4,633-bed cap was derived from a total staff beds figure of 8,611, of which the state reduced to account for specialty hospital beds, non-coronavirus patients and non-elective care patients. Elective or routine procedures weren’t happening until the temporary ban was lifted by Stitt on April 24.

The Tulsa World asked Stitt’s office by email how accurate or inaccurate the governor’s 5,000 figure is now, given that elective surgeries are ongoing again.

Donelle Harder, a spokeswoman for the state for COVID-19 matters, responded that the surge plan is being modified. Additionally, she said, the state is working to add overflow hospitals beyond just OSU Medical Center in Tulsa and Integris-Baptist Medical Center Portland Avenue in Oklahoma City:

• Mercy Hospital in Oklahoma City

• SSM Health St. Anthony Hospital in Oklahoma City

• OU Medical Center in Oklahoma City

• Norman Regional Hospital

• AllianceHealth Midwest in Midwest City

Harder said the five additional hospital overflow contracts aren’t yet signed, but Harder said the state hopes to get them done next week.

The 125 overflow hospital beds at OSU Medical Center and 110 overflow beds at Integris weren’t included in the state’s bed capacity figure from the spring surge plan.

While all 125 rooms have been renovated at OSU Medical Center, only 10 were equipped and ready for patients last week. Another 40 beds could be “quickly converted to COVID treatment when needed,” according to an OSU Medical spokeswoman.

The U.S. Army Corps of Engineers did the renovation work to prepare the overflow rooms at OSU Medical and Integris, but the state had been waiting for prices to drop on the surplus market before outfitting the rooms with equipment.

“Any renovations that are needed will be on the part of the hospital,” Harder said of the five overflow hospitals in the works. “There are no discussions at this time for renovations through (the U.S. Army Corps of Engineers).”

Monks, who has been president of the Oklahoma State Medical Association since April, said he is skeptical about the state’s ability to flex up to an extra 40%, per the surge plan.

“Those plans are based on the assumption that we’re going to have military people and contract labor to be the staffing on the additional 40%,” Monks said. “And there’s no pool of extra health-care workers out there.

“We can’t hire nurses from Texas to come up here and help us. They’ve got their own problems down there; they’re in bad shape.”

If a crisis demanded it, Harder said, the surge plan would limit or restrict elective surgeries.

“In accordance with OSDH’s new color risk map for COVID-19, once statewide bed capacity reaches 95%, orange counties move into the red risk zone in which the State will consult with local officials to consider action steps such as limiting elective surgeries,” Harder wrote.

Alert system scrutinized
Stitt on July 9 released the state’s county-by-county COVID-19 alert system: new normal, low risk, moderate risk and high risk.

The first three levels are based on each county’s rate of new coronavirus cases, but the high-risk category is only activated when hospital beds or personal protective equipment drop below 5% on a statewide basis, not in the individual counties.

Baylee Lakey, spokeswoman for the governor, said Stitt and Frye cited the White House Coronavirus Task Force report in rolling out the alert system that recently became public in a Center for Public Integrity news article.

The document is dated July 14 and lists 18 states in a “red zone” for daily rate of COVID-19 cases, with Oklahoma being one of them.

The report recommends, among several actions, that counties in the red — Tulsa, Oklahoma, Okmulgee and Ottawa last week — close bars and gyms, as well as limit social gatherings to 10 or fewer people.

Lakey wrote that the colored alert system is based off White House methodology in looking at new cases per 100,000 population. She said that Oklahoma doesn’t have the same types of urban centers that many other states do, such as Texas, California and Florida.

“The governor will continue to monitor recommendations issued by the White House,” Lakey wrote. “In the meantime, the governor and OSDH are actively providing local communities with critical data so they can make informed decisions on the local level.”

Dr. Dale Bratzler, chief COVID officer for University of Oklahoma, participated Friday in a live streamed media interview.

Bratzler said the state’s COVID-19 alert system “is not helpful at this point.” He pointed to how the state is mostly one color, even though there are ongoing and specific hot spots in the state.

“It looks at the entire state’s capacity of medical-surgical bed and ICU beds, and, honestly, I don’t think we’re going to transfer patients from an academic medical center — or a Saint Francis in Tulsa — out to some small rural hospital because they have a med-surg bed available. I think it’s just unrealistic.”

Bratzler framed the situation in stark terms.

In Oklahoma during the 2019-20 influenza season, he said, there were only 85 confirmed flu deaths. Since March, the state has reported 445 COVID-19 deaths as of Friday.

There were 137,864 deaths overall in the U.S., according to CDC data on Friday.

“When’s the last time you remember hospitals commissioning refrigerated trucks to hold bodies during flu season? I just don’t remember that,” Bratzler said. “But that’s what’s happening in these hotspots around the country with COVID-19.”

Please note: This content carries a strict local market embargo. If you share the same market as the contributor of this article, you may not use it on any platform.