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Coronavirus

Colorado struggles to keep hospital beds staffed as omicron sends COVID cases soaring

The number of hospital beds in the state appears to be decreasing as infections rise, but the virus is only part of the equation

A sign outside Saint Joseph Hospital in Denver, photographed on Oct. 22, 2019. (John Ingold, The Colorado Sun)
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Colorado’s omicron variant-driven surge in coronavirus cases appears to be biting into one of the state’s most precious resources for battling the virus: the number of hospital beds available to treat patients.

On Monday, the state reported that it had a total of 1,468 intensive care beds and 7,089 lower-level beds known as acute-care beds in hospitals across the state. Those are not the number of beds open for accepting new patients – those numbers are significantly smaller. They’re the total number of staffed beds in hospitals.

And they’re among the lowest numbers the state has reported during the pandemic.

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One year ago, on Jan. 10, 2021, the state reported 1,787 ICU beds and 9,372 acute-care beds. At their respective high-water marks of the pandemic, the state reported 1,977 ICU beds, on Oct. 12, 2020, and 9,590 acute-care beds, on Aug. 25, 2021.

So, as coronavirus-related hospitalizations surge anew, where are Colorado’s hospital beds going?

In interviews with multiple hospital representatives, it becomes clear that a number of factors go into why the number of hospital beds in Colorado appears to be declining – some of it is related to how data is reported to the state and how beds are classified.

But, more recently, it’s an omicron issue. As the number of new infections reported per day in Colorado soars to heights more than twice as high as that of any previous wave of the virus, multiple Colorado hospital systems say they are seeing an increase in the number of workers testing positive for COVID and needing to step away from work. And that, in turn, puts a strain on the number of patients a hospital can treat.

“What we see most recently it’s likely staff out for quarantine times that’s impacting that total number” of hospital beds, Cara Welch, a spokeswoman for the Colorado Hospital Association, said.

Despite the concerning trends, hospitals say they are still able to provide high-quality care to patients and are encouraging people to go to the hospital when needed.

Presbyterian/St. Luke’s Medical Center, a hospital in the HealthONE system in Denver. Photographed on Oct. 22, 2019. (John Ingold, The Colorado Sun)

“There is no question that the ongoing increase in patient activity coupled with the tremendously contagious omicron variant have put an enormous strain on staffing across Colorado, the region and the entire nation, but we are grateful that our hospitals have been able to meet the needs of our patients,” Stephanie Sullivan, a spokeswoman for the HealthONE hospital system, wrote in an email.

But the staffing challenges highlight another reason the omicron wave – despite, on the whole, resulting in less-severe illness for individuals – could create a catastrophic situation in Colorado.

Once again, Colorado’s hospitals are trying to bend but not break

On Monday, 1,402 people with confirmed cases of COVID were in Colorado hospitals – 384 more COVID-positive patients than there were two weeks prior. The state’s ICUs were 89% full, and acute care wards were 92% full, according to data from the Colorado Department of Public Health and Environment.

Most significantly, 51% of the state’s hospitals said they expect to experience a staffing shortage in the coming week. And Welch, the hospital association spokeswoman, said that number underplays the concern around staffing.

“Even if they’re not anticipating a shortage, it doesn’t mean they’re not struggling right now with staff out,” she said.

Ambulances sit parked outside Denver Health on March 18, 2021. (Kevin Mohatt, Special to The Colorado Sun)

Rachel Hirsch, a spokeswoman for Denver Health, said about 40% of the hospital’s staff who report COVID-like symptoms and get tested are coming back positive for the virus.

In addition to people missing work due to COVID, hospitals have also been struggling to hang onto staff that might be lured away by the promise of better pay elsewhere. Dan Weaver, a spokesman for UCHealth, said hospitals in his system have provided 4% merit pay increases to staff, as well as a 4% annual performance bonus and a $1,000 retention bonus. Clinical staff who pick up extra shifts caring for patients are eligible for up to $3,200 in incentives, he said.

“It’s certainly been a priority for us both to recruit new employees and to retain our current employees,” he said.

Operating in a crisis

The issues have become so acute that Colorado is operating under so-called crisis standards of care when it comes to hospital staffing. The decision to authorize crisis staffing standards – which happened during the previous delta wave – means hospitals gain liability protection if they don’t meet normally required staffing levels.

On Friday, the state announced it was activating crisis standards of care for emergency medical services like ambulance companies. Those standards give EMS providers guidance on how to prioritize calls during a time when there is high demand and not enough workers to respond to all the calls. It will, for instance, help keep ambulances ready to respond to emergencies when there are a large number of calls for them to assist in patient transfers.

Dr. Eric France, chief medical officer of the Colorado Department of Health and Environment, makes a point during a news conference about Colorado offering coronavirus vaccinations to children, Thursday, Oct. 28, 2021. (AP Photo/David Zalubowski)

“With increasing demands on hospitals and EMS, we need to make sure we can provide care to anyone who needs it immediately,” Dr. Eric France, CDPHE’s chief medical officer, said in a statement Friday.

The federal Centers for Disease Control and Prevention issued updated guidance last month for how long health care workers should stay home from work following a COVID infection. Under normal operating circumstances, workers should stay home for at least seven days. In more pressing times, they can return to work after five days, so long as they are asymptomatic or have mild symptoms that are improving.

But, in recognition of the risk that omicron poses to the ability of hospitals to have enough staff to treat patients, the CDC said that, in a crisis situation, health care workers who have COVID can stay on the job, with priority given especially to workers who are asymptomatic or who have only mild symptoms.

Welch, the hospital association spokeswoman, said Monday that some hospitals in Colorado have updated their policies to align with those CDC crisis standards – allowing COVID-positive workers to return to treating patients if they have at most mild symptoms and feel well enough. She did not specify which hospitals. News of the crisis policies was first reported by The Denver Post

The curious case of Colorado’s diminishing hospital capacity

None of this, though, quite explains why Colorado has seen such an apparently dramatic decline in the total number of hospital beds – especially not at a time when state officials have been working to expand bed capacity.

Scott Bookman, CDPHE’s COVID-19 incident commander, said the total number of beds in the system – and the number of open beds – can change quickly as patients and staff move around. He noted that the state has provided close to 200 staff members to facilities around Colorado to help worker-crunched hospitals.

“We continue to evaluate any additional staffing resources we can bring in,” Bookman said.

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Some hospitals say they have not seen a decline in their capacity. Weaver, the UCHealth spokesman, said his system has increased its total number of ICU and acute care beds over the past six months. Sullivan, the HealthONE spokeswoman, said any decline in capacity her system has seen would only be temporary and related to short-lived staffing challenges.

“We have not had the need to transfer ICU patients as a result of staffed-bed capacity,” she wrote in an email.

Welch, the hospital association spokeswoman, said data-classification changes are part of the issue. She said the state in December asked for hospitals to take out certain kinds of beds – like labor and delivery beds or psychiatric beds – from the total numbers of beds they report to the state each day. As a result, the reported total number of acute care beds in the state dropped by about 1,000 in the first few days of that month.

Welch also said hospitals periodically reclassify beds as needs require – switching them from acute-care beds to ICU beds or back again. So that could also be a cause of some of the fluctuations.

But omicron’s impact has now become clear, as well, a problem that’s not likely to resolve all that quickly.

“When the community level of spread is so high,” Welch said, “that really impacts our workforce.”