Leaders of Bend-based St. Charles Health System say they see signs of hope that so-called “social distancing” is slowing the spread of COVID-19 infections, which could prevent them from becoming overwhelmed.
But they’re also facing a shortage of masks and other supplies, and are developing worst-case scenario plans that would guide who gets treatment – and who is left to die – if diagnoses climb faster than they can manage.
St. Charles operates hospitals in Bend, Redmond, Madras and Prineville, serving a massive 32,000-square-mile swathe of central Oregon.
Joe Sluka, the nonprofit's president and CEO, told OPB's Think Out Loud that St. Charles has been preparing for weeks – including canceling elective procedures in order to preserve hard-to-come-by masks and other protective equipment, and changing where patients are treated to create a COVID-19 epicenter.
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“We’re looking to bring sick patients with COVID-19 disease into the Bend hospital,” which has 26 intensive care unit beds, Sluka said. That would free up system’s much smaller hospitals for other patients.
When Sluka spoke Monday, there were 23 cases of COVID-19 in Deschutes county, and 19 coronavirus patients at the hospital in Bend. One more person had tested positive by midday Wednesday.
St. Charles Bend is looking to increase the number of beds for patients who are on ventilators by expanding into two additional units beyond the ICU, he said.
Those preparations are based on forecast models that anticipate a surge in Central Oregon COVID-19 diagnoses, peaking in mid-to-late April, said Jeff Absalon, chief physician executive for St. Charles Health.
“What we’ve been doing is, taking our number of patients, aligning those with predictive mathematical models to see where we are going in this journey,” Absalon said. “At this point in time, we appear to be at about half the volume of what we would have predicted with what was occurring last week. So we do think that social distancing actions may be having an effect.”
But Sluka cautions against that more people are going to get sick before the coronavirus recedes from central Oregon.
“It’s hard to know how high the peak is going to be,” Sluka said.
With 26 ICU beds, St. Charles Bend typically has eight to 10 people on ventilators, at the most. “In the worst-case scenario, our models predict many multiples of that. It’s hard to know how high the peak is going to be,” he said.
“We’re preparing, getting our ventilators together and getting our workforce together in order to be able to handle several multiples of what we already have.”
Those preparations also include the bleak task of deciding who will be given life-saving treatment, and who will only receive pain-killers, if more sick patients arrive than St. Charles is able to treat.
It's a challenge that hospital systems have been facing around the globe. Reports out of Italy say that some hospitals have declined to offer ventilators to older COVID-19 patients, so that younger people deemed more likely to survive can be treated in their place. Last week, a memo from the Henry Ford Health System in Michigan drew headlines when that hospital system's outlined its own plans to ration care.
“We have a bioethics committee that’s been engaged in this work, and we’ve looked at what outside systems have done,” Absalon said. “There are some criteria that can be used that will assess a patients’ likelihood of survival based on their comorbidities, how sick they are coming in, and this will help us to, essentially, triage where to apply our resources if they get to the point where they are severely constrained.”
St. Charles Health has not yet finished drawing its care-rationing plan, and Sluka said he does not know if the hospital system will make the document available once it is complete.
“It’s a surreal feeling, to have to go through a process like this,” he said. “It certainly something that I don’t think any CEO would ever want to have to even think about.”
Already, St. Charles is beginning to ration personal protective equipment that nurses and doctors wear to protect themselves from infections.
While some health systems across the country have ordered staff only to use professionally manufactured protective equipment, and have limited use of masks, St. Charles has embraced community efforts to supply its employees.
“We have a great outpouring of support from our community, in helping to develop homemade masks according to a template that we provided,” Sluka said. “We’re starting to see our community really step up.”
Homemade masks can’t replace the higher tiers of protective gear needed in many situations – but they do increase options for health workers.
“Respirator masks or N95 masks, as well as surgical masks, have been an issue,” Absalon said. “What we have come to understand is that some of the national supplies are diverted to areas where there is extreme high need at this point in time. And Oregon is not on that list.”