About a month ago, Dr. Keith Woeltje’s initial projections plotting the curve of COVID-19 cases in the St. Louis region looked bleak.
“For a couple of days there, it actually looked like we had a steeper curve than New York City. Then things started to flatten out a bit,” said Woeltje, vice president and chief medical information officer at BJC HealthCare.
St. Louis-area hospitals are expected to take on the peak of COVID-19 patients late this week, around Saturday. Updated models from mid-April, which use local data from previous weeks, show that in the most likely scenario, about 700 people will need to be hospitalized at that time. Nearly 180 of those patients will likely be in intensive care units, and around 125 will need ventilators. In a worst-case scenario, those numbers double.
As of Sunday, actual numbers were tracking slightly above the most likely scenario projections.
That’s according to data from the St. Louis Metropolitan Pandemic Task Force, a group bringing together the largest hospital systems in the region — BJC HealthCare, Mercy, SSM Health and St. Luke’s Hospital.
Dr. Alex Garza, who leads the group, said he’s encouraged by the data, but it’s too early to celebrate. “We're happy with not being overrun, but let's not let that dictate what we're going to be doing going forward,” he said.
In the region, there are about 5,500 hospital beds, 1,000 ICU beds and 900 ventilators, Garza said. He added that if things continue at the same rate, hospitals will operate within their capacity during the pandemic’s peak.
That’s because social distancing is working, he said.
“People are paying attention. They're staying at home. They're washing their hands; they're wearing those masks out in public. And all of that is having a big impact on the transmission factor,” Garza said.
But if stay-at-home orders are relaxed too soon, he warned that a second peak could be more deadly than the first.
Preventing a second peak
While things aren’t as bad as initially forecast, hospitals are still operating at crisis standards of care.
Elective surgeries have been canceled, doctors and nurses are being redeployed to help care for COVID-19 patients, and personal protective equipment is being conserved.
Last week, an alternative care site opened in Florissant. Transferring patients there who are improving, but may need to isolate for a few more days, could free up space in hospitals for sicker patients. Data from the task force show COVID-19 patients can be hospitalized for up to two weeks.
Dr. Tiffany Osborn, a Washington University critical care physician at Barnes-Jewish Hospital, has been working with a high volume of COVID-19 patients for a while now.
Things seem to be leveling off, but Osborn still worries about just how sick patients are when they do come in. “I've been doing this for 20 years, and some of these patients are the sickest patients that I've taken care of. When they get sick, they get sick very fast,” she said.
Many patients coming into her emergency room need to go straight to an ICU. Once there, data from across the region show that about 70% of those patients will need a ventilator. About half of those who do will ultimately die.
Osborn and her team are trying new therapies that might improve survival rates, and some seem to be working. But she stressed that they have not yet undergone rigorous trials.
“The most effective way of treating COVID-19 is to not get it, and the way you don't get it is by honoring the shelter-in-place mandate, washing your hands, covering your cough — all of those hygiene things that we've been talking about over and over,” she said.
Last week, St. Louis Mayor Lyda Krewson and St. Louis County Executive Sam Page extended stay-at-home orders indefinitely, adding they would revisit them mid-May.
Garza said it would be too soon to open the local economy up before then, despite the economic devastation such orders have had on jobs and local businesses.
“My concern, though, is we can't let the desire for returning to normality override what is a health issue of spread in the community. Because otherwise, we will end up in a worse place than we initially started,” he said.
Before things open up, a lot of testing needs to happen, Garza said, to better understand who still has COVID-19 and who has immunity. By the end of April, he anticipates 71,000 people in the region will have been infected by the coronavirus.
The long view
St. Louis will experience the peak of COVID-19 cases around the same time as many other parts of the state and the Midwest. But it’s unclear exactly what things will look like on the other side.
Shelly Schwedhelm is the executive director of emergency management and biopreparedness at the Omaha-based hospital Nebraska Medicine, and she oversees educational programs that help hospitals across the country prevent infections.
Cities and states are experiencing the surge differently, she said, but for the most part in the Midwest, early efforts to encourage social distancing and to free up space in hospitals are starting to pay off.
“We stopped elective surgical cases and elective ambulatory visits and things like that very early. So I think we’re not seeing the massive numbers that they’re seeing on the West and the East Coasts,” she said.
But even with fewer cases, Schwedhelm worries about nursing homes, which have been a hotbed for the coronavirus. She also expects rural hospitals to struggle financially.
Missouri hospitals are collectively losing about $32 million a day in revenue from canceled elective surgeries, outpatient care and other sources, according to the Missouri Hospital Association. Dave Dillon, vice president of public and media relations at the association, said about 25% of Missouri hospitals are in severe financial jeopardy.
“The things that we're doing to ensure we can protect our patients, our staff and communities is weakening the viability of hospitals over time without at least another significant effort on the state, on the federal part, to deliver funds to keep them open,” he said.
The good news, he said, is that St. Louis is home to a lot of existing hospital infrastructure, with systems that have multiple hospitals to handle the influx of patients.
Faced with a pandemic, those systems are working together in ways they never have before to share resources and information, Garza said.
“We realized at the very beginning of this pandemic that there was no way that we could handle what we were seeing coming at us all on our own. We had to come together to work through these issues,” he said.
But the coronavirus outbreak isn’t just a health care issue, he said. Much of what happens next and how bad the situation gets depend on what happens in communities.
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