Rural Oregon hospitals buckle under strain of omicron

There are more than 700 patients currently hospitalized with COVID-19 in the state, according to the Oregon Health Authority. As the omicron variant rapidly spreads across counties, the number of available ICU beds is dwindling and causing particular strain for smaller, rural hospitals with fewer beds and resources. In The Dalles, the number of new COVID-19 cases has more than doubled in the past week. Don Wenzler, the Chief Clinical Officer at Mid-Columbia Medical Center in The Dalles, talks to us about the twin challenges his rural hospital faces as it confronts a surging caseload and frontline health workers who are falling ill or being forced into quarantine after possible exposure to the virus.

The following transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. Oregon’s hospital beds and ICU beds are starting to fill up as the Omicron variant makes its way through the state’s population. According to data from the Oregon Health Authority, no part of the state is closer to a shortage than Region Six. That’s Gilliam, Hood River, Sherman and Wasco Counties. There are only two hospitals in that Region. The Mid-Columbia Medical Center in The Dalles is one of them. Don Wenzler is the Chief Clinical Officer there. He joins us now with the latest. Don Wenzler, welcome to Think Out Loud.

Don Wenzler: Thank you so much for having me.

Miller: I’m curious, first, just what an average day, if that word average means anything anymore, but what an average day is like for you, right now?

Wenzler: The average day right now is often challenging. We spend an inordinate amount of time really determining, on a shift by shift basis, will we have enough staff to provide care to the patients we are privileged to serve? Will we have the right number of those staff by skill level, will we have the tools to protect them and ourselves from COVID – so PPE is often a challenge, which is…

Miller: Still?

Wenzler: It is, we have shortages. It seems like every week, we have other tools, there’s a shortage of blood right now, testing kits and antibody medications, and so we have to deal with those shortages and then if we need to move a patient to a higher level of care, where will that patient go? Our patterns are changing and we have now had to send patients to Bend, and as far east as the Tri-Cities in Washington and to Boise, Idaho and sometimes up to 30 calls to actually find a place that will accept a patient. And then we’re not sure if our transportation services, because of their staffing shortages, will have the ability to actually move a patient and all that on top of winter weather. So it’s a challenge.

Miller: When you say that the transfer patterns are changing, and you may go to Bend or to Boise or the or the Tri-Cities, you didn’t mention Portland. I would have thought that was a place where you’d normally send patients.

Wenzler: That is the place we would normally send; because of the COVID number of patients they have there, and the staffing issues they are also having. We used to send almost 100% of our patients to Portland, and now it’s less than 50%.

Miller: Can you give us a sense for your inpatient numbers right now? I’m thinking about non-ICU beds that are occupied and the ones that are available, and then ICU beds.

Wenzler: So we’re a 49 bed hospital but we still have some semi-private rooms. So it’s pretty hard to get all the way to 49 when we get into the high thirties. That’s probably about as much as we can handle. And our census has been hovering between 26 and 34. Today

we have 28 patients in-house, and our bed capacity for ICU is six.

Miller: And how many of those are occupied right now?

Wenzler: Three. So we’re 50% full. When you think about it, there’s only one other hospital in Region Six, and two across the river, all three of those are critical access hospitals – and by definition they have to be less than 25 beds. So the number of ICU beds in Region Six and with our sister hospitals across the river is very small.

Miller: How much of what you’re talking about right now is directly related to the Omicron surge as opposed to a lot of other things?  I mean in the last couple of weeks or months, we’ve been hearing about people… in addition to just, you know, regular needs because of car accidents or or heart attacks. We’ve also been hearing that people were finally returning to the hospital to get care that maybe they had delayed. Are you able to say this, the shortages now are directly because of Omicron?

Wenzler: I would say that is a large contributing factor because although we know that with Omicron, it seems to affect lungs in a less severe way than Delta. So we are having less inpatient care that’s of a severe nature. But we are still having inpatient care. Our problem, and it’s affecting younger people who have a better ability to recover at home. But even if you think about a smaller portion of our patients are less sick with COVID, because of the sheer absolute numbers that are skyrocketing with Omicron, that still creates a lot of in-patients for us.

Miller: Have you had to turn patients away, in the last couple of days?

Wenzler: We have not had to turn any patients away since the pandemic started. Although I must say we have come close several times.

Miller: Turning a patient away though, that’s the most dramatic version of not being able to provide care.

Wenzler: Right.

Miller: For patients who have been admitted, are you able to provide all the care that they need these days?

Wenzler: We have been able to work through that. But I will say, sometimes we will limit, when we need to, elective cases, elective surgical cases and let’s say endoscopy cases in order to redeploy that clinical staff to other units to care for in-patients. So we have delayed care, certainly, for patients. And I think everyone believes across the nation that delayed care has had meaning to individual patients.

Miller: What do you mean by that?

Wenzler: I mean that we didn’t catch their cancer as soon as they would have if they’d had a regular screening, and so it will be harder to treat them. So they’ve been impacted by even delays in care.

Miller: If you’re just tuning in, we’re talking right now with Don Wenzler, he is the Chief Clinical Officer at the Mid-Columbia Medical Center in The Dalles. I want to go back to something you said at the beginning of our conversation, because I want to make sure I heard you right. Did you say that sometimes you’re making 30 calls to other hospitals in the state or in the region to figure out where a patient might go? 30 calls?

Wenzler: That is correct. That was the most dramatic case. But in the past, pre-COVID we could make one call to a transfer center in the Portland area and then we would get a bed at some point shortly after making that call. And now, because they’re so inundated, we have to make all the calls. So you call, talk about the patient you have, what they need and if that hospital doesn’t accept, you call the next one, or you recall back one that you called four hours ago because you still haven’t found a bed, to see if anything changed.

Miller: Are other hospitals also calling you?

Wenzler: Yes.

Miller: I imagine everyone’s saying, ‘No, not here,’ and then you call the other person, and then they say that to you.

Wenzler: And that is absolutely true. We have accepted patients from our sister hospitals in the Gorge, when we can do it, and we collaborate quite well as a four-hospital group. It is sort of what can you do today, versus what can we do today? And how best can we serve the needs of this individual patient in front of us?

Miller: Let’s turn to staffing. How many staff members have been getting symptoms or are actually testing positive in the last few weeks?

Wenzler: So we have had, in the last few weeks, several, and I’m talking probably about 15-20 staff. Not all of them necessarily have symptoms or COVID, but they’ve been exposed to someone in the community, a family member or a friend that has COVID. Then we need to quarantine them for a period of time if they haven’t been vaccinated, or, the new term is you’re vaccinated if you’ve got two shots of Pfizer or Moderna. But up to date means you’ve had the two shots plus the booster. So we have to keep people away from work even though they’re not exhibiting symptoms, because there’s that period, generally of about two days before you’re symptomatic, that you’re contagious and you don’t know it.

Miller: Governor Brown is once again deploying National Guard troops to help out in hospitals around the state. Will any of them be coming to help you?

Wenzler: We have asked for National Guard help and also, through the state, we’ve asked for traveling clinical people, because they’re trying to create contracts, and having the ability to get, even traveling clinical workers through the state. We have received no help yet. But we’re hopeful,

Miller: Did you get help before?

Wenzler: We haven’t so far in this pandemic. I will say, earlier, it wasn’t as bad as it is, in the last couple of weeks.

Miller: During the Delta surge. It’s worse now for you, than it was during the Delta surge?

Wenzler: Yes

Miller: Because that’s not yet true for many other hospitals in the state.

Wenzler: Yes. What we’re seeing is just the sheer numbers of people that are contracting the disease. It is worse for us than it was with Delta. It’s more contagious, although it’s not as virulent as Delta, meaning people don’t get as sick.

Miller: Nationally, the vast majority of people who have been hospitalized over the last few months are people who are not vaccinated. Is that the case at your hospital right now?

Wenzler: Yeah. Before this call, I went back and looked at our numbers of admissions from the first of August to current, and we’ve had, of that percentage of patients, only 23 percent were vaccinated, and 77 were unvaccinated. As we look specifically at those who have been admitted to our intensive care unit, It’s about 80% unvaccinated that end up needing care in the ICU.

Miller: If those people end up getting better, end up leaving the ICU and leaving the hospital, and as unvaccinated people, have you found that hospitalization has changed their minds or their family members’ minds about the virus and about vaccines?

Wenzler:  Anecdotally, in talking to patients, everyone said, ‘You know, I just didn’t believe it would happen to me, and now that I’ve experienced it and it was not a fun experience.’ They do get vaccinated and I think they try to encourage their family and friends to also get vaccinated.

Miller: You mentioned at the beginning, in terms of all the different shortages, among the different shortages that include staffing and PPE and hospital beds. You also talked about blood. That’s something that we heard about yesterday, that the Red Cross declared a blood crisis saying that nationwide there is not enough blood. What does that mean in the Gorge right now?

Wenzler: What that means for us is we get an allocation every week and we get what we get. And so we had our medical staff meet this morning, to talk about what kind of blood products will we have in-house, and who will get them, 1st, 2nd and 3rd, you know, sort of what’s the clinical criteria for usage?

Miller: But does it mean that some people who need blood right now are not getting it?

Wenzler: It hasn’t meant that yet. But this just came out yesterday and we don’t know how long this will last. So it very well could.

Miller: I want to provide a statement that we got this morning from Jeanie Vieira, the Chief Executive of the other Oregon hospital in the region, Providence Hospital, Hood River. She told us that they are actively managing their bed capacity inpatient census. She wrote this: ‘We do have challenges at those times when sicker patients need a higher level of ICU. We’ve been able to accommodate and transfer those patients through our Providence Logistics Center and in partnership with Oregon’s Hospital Capacity System which allows healthcare systems to share real time status data. These tools help all hospitals find the beds  we need to serve our patients inside and outside of our Providence system. As of today,’ she wrote, ‘we haven’t had to fully implement our surge plan which includes multiple bed expansion.’ Don Wenzler, before we say goodbye. I’m just curious, how staff morale is right now. As we near the third year of this pandemic?

Wenzler: I have to say I am amazed at the strength and resilience of the staff we have, but I will say people are tired. This particular pandemic, we keep having these surges and we never recover our energy from the last one we just had and the next one always seems to be worse. So it becomes a little discouraging that you have to actually make decisions about how you’re going to care for patients every single day. I think people are disheartened because they know part of the inpatient census are the unvaccinated and that we may be needing to postpone care of other patients. And that comes with a bit of moral distress on the part of clinical staff. So I understand that we’re doing our best to obviously support them in their work and support them in their decision making. But this is a rough time.

Miller: Don Wenzler, thanks for joining us today.

Wenzler: Thank you.

Miller: Don Wenzler is the Chief Clinical Officer at the Mid-Columbia Medical Center in The Dalles.

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