As St. Louis COVID-19 Cases Hit Likely Peak, Hospitals Avoid Rationing Care
In mid-April, the incident commander of the St. Louis Metropolitan Pandemic Task Force, Dr. Alex Garza, predicted that hospitalizations of COVID-19 cases in the region would peak around April 25. It’s impossible to say whether the city has hit the peak until time has passed and the overall trend becomes clear, but it could be the case that recent days have been as bad for local hospitals as it will get.
According to Dr. Kristen Mueller, an emergency medicine physician at Barnes-Jewish Hospital, St. Louis Children’s Hospital and Barnes-Jewish West County Hospital, the overall volume of patients coming to the emergency room is actually down.
“I am glad to say that we do have the resources in all of our St. Louis hospitals right now to be providing maximum services to everybody who needs them. We are not having to ration ventilators yet, we’re not having to ration ICU beds, and if things stay on their current trajectory, I think it’s unlikely that it will happen in this first wave of COVID,” she said Tuesday on St. Louis on the Air.
“If anything, our volumes, or the number of patients who come through the door everyday, has been significantly less than normal. We’re only seeing about half of our usual patients, or just a little bit above that.”
She said one of the biggest challenges of her job recently is communicating with COVID-19 patients from behind an N95 mask and face shield, with the loud sounds of the emergency department and the hum of the viral filters in the background.
“Especially for some of our patients who are older or people who may have issues with their hearing at baseline, who might rely on reading lips to communicate, it’s been a lot harder,” Mueller said.
The questions she’s needed to ask patients include: “Would you want to go on the ventilator at all? Would you want to have CPR if your heart stopped beating? Would you want other aggressive measures like strong antibiotics or medicines to keep your blood pressure up?”
“These are conversations that in an ideal world, we would be having in a calm, quiet room, we’d have family members present, we’d have support staff from palliative care and other services,” she said.
Mueller encouraged people to have conversations about preferences for end-of-life or serious-illness care right now, while everyone is [hopefully] home and feeling healthy.
“It’s tough. These are conversations that we don’t talk about at the societal level very often. These are conversations that are still hard for a lot of physicians and nurses to be having with their patients, and now it’s even trickier with all the added challenges of the COVID clinical care setting.”
Overall, Mueller is grateful that she hasn’t had to make decisions about rationing care, as other areas of the country and globe have had to do while treating COVID-19 patients.
“The fact that we’re having enough resources to keep our patients safe, to provide them with the care that we need, that we haven’t had to ration medical care, has been very encouraging and is really a testament to the work that has happened at every level of health care in the city, the county and the whole region,” she said.
Mueller added the caveat that St. Louis is not yet out of the woods.
“I would encourage you to continue to stay at home, and especially if you are privileged enough to have a place to be sheltering in place, to keep doing that, because it really does make a difference to containing the spread of COVID in our communities,” she said. “The reason our hospitals have been able to have so many resources to offer to our patients is because of the individual responsibility people in St. Louis have been taking.”
Mueller is also an assistant professor of emergency medicine at Washington University’s School of Medicine and a member of the Washington University Gun Violence Initiative.
Hear the rest of her conversation with St. Louis on the Air host Sarah Fenske:
“St. Louis on the Air” brings you the stories of St. Louis and the people who live, work and create in our region. The show is hosted by Sarah Fenske and produced by Alex Heuer, Emily Woodbury, Evie Hemphill, Lara Hamdan and Joshua Phelps. The audio engineer is Aaron Doerr.
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