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Governor considering military to help Missouri hospitals

Gov. Mike Parson meets with members of the Missouri National Guard on Nov. 18, 2020.

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By KURT ERICKSON | St. Louis Post-Dispatch | Published: November 21, 2020

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(Tribune News Service) — State and local officials, scrambling to prepare for an overwhelming surge of COVID-19 patients, are in talks to stem the tide, including options such as building a field hospital, canceling all but the most urgent medical procedures and deploying the Missouri National Guard to relieve health care staffing shortages.

Hospital leaders are even discussing how to choose which patients to serve first when resources are limited.

They hope it never reaches that point, the chief of the St. Louis Metropolitan Pandemic Task Force, Dr. Alex Garza, said on Friday. But task force projections show the region's hospitals maxing out intensive care units in a matter of days.

"We are already running out of capacity at some of our hospitals and have begun having conversations we've dreaded since the beginning of this pandemic," Garza said.

The number of COVID-positive patients in hospitals here has doubled since the beginning of November, and more than tripled since the beginning of October. On Friday, the task force reported a record 881 coronavirus patients in BJC HealthCare, Mercy, SSM Health and St. Luke's facilities across the metro area, and 148 patients with suspected cases. The data lags two days.

On average here, 84% of total staffed beds at hospitals are filled, and ICU beds are at 91% capacity.

The Missouri Hospital Association and Gov. Mike Parson's administration are discussing options to address the toll the pandemic is taking on doctors, nurses and other workers involved in the surging number of cases, said association spokesman Dave Dillon.

"The governor is engaged on this. His team is looking at all options," Dillon said Friday.

Garza said the task force is working with the state to determine what assistance will be necessary. The region might need a field hospital, he said. And it might just need to open up beds in area hospitals that, right now, can't be used because the hospitals don't have enough staff.

"And, given these projections, it might be both," Garza said.

The task force is also discussing crisis standards of care, which guide clinicians in choosing who can and can't be helped with limited resources available.

More services in jeopardy

Hospitals have already begun scaling back elective procedures. But if COVID-19 admissions continue on this path, hospitals will have to turn off more services in order to care for the most critical patients, Garza said.

Dr. Clay Dunagan, BJC HealthCare chief clinical officer, said during a briefing on Friday that hospitals are already starting to cancel procedures that can be postponed for eight weeks without causing harm. For example, a patient waiting for a joint replacement could probably wait two months without a threat to their health.

"We will always reserve capacity to deal with the patient who turns up in the emergency room with a heart attack or a stroke," Dunagan said. "But almost everything else is on the table for removal as the hospital fills up with coronavirus patients."

Dunagan said hospitals soon will be equipping anesthesia recovery spaces, operating rooms and other spaces to operate as ICU rooms. In other cases, they will put two people in an ICU room that is designed for one.

Garza repeated his calls for a statewide mask mandate and "safer at home" orders, like the one in place in St. Louis County.

Parson, in his weekly press briefing on Thursday, asked Missourians to work harder to stem the spread of the deadly virus.

He also focused on addressing hospital staffing issues, rather than establishing new facilities.

"We can still put up a facility in 11 days, we know that, but I'm not sure that's the most adequate way to do it right now," Parson said. "Staffing is the major issue, not so much bed space."

Parson said the state was looking at options, including borrowing staff from other states, or deploying the military.

The Hospital Association's Dillon said the National Guard could provide some relief in non-clinical roles, whether it's directing traffic at a high capacity testing site or helping with the transfer of patients between hospitals and other care facilities.

"I don't think we're at a final solution for what those options are," Dillon said. "The guard has been helpful in the past in roles that are not clinical."

But Dillon didn't think other states would have staff to lend to Missouri.

"This is a national staffing crisis," Dillon said. "So the assets are very limited."

Foreign nurses?

Another option under consideration is recruiting nurses from other countries. That, however, would require work to ensure they have credentials and could make it through the immigration process.

In any case, Dillon said decisions will have to be made within the next few weeks if the state cannot lower capacity through social distancing, mask wearing and other practices.

Parson, who on Thursday extended a state of emergency order to March 31, did not offer a timeline for when decisions will be made.

"Everything is on the table to try to figure out solutions on the staffing challenges," the governor said.

Missouri reported 4,614 new cases of the virus on Friday, and 30 more deaths. The state's hospitalizations, again, hit a record. The Department of Health and Senior Services reported 2,734 patients statewide, and a seven-day average of 2,525 — both numbers higher than ever. The data lags three days, and not every hospital reports every day.

The seven-day average of statewide hospitalizations has hit new records every day for more than six weeks.

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