On Friday, Springfield’s two main hospital systems, Mercy and CoxHealth, issued a stark warning to the public: they’re full, due to a wave of COVID-19 patients, and that’s starting to impact non-COVID patients, too.
At a press conference Friday, health officials said hospitalizations have skyrocketed this week. Hospitals have begun to shuffle dates of elective surgeries to maximze staffing, but the lack of beds and staffing are affecting emergency and acute care, too.
Leaders from both hospitals, as well as from Greene County and the City of Springfield, once again asked Missouri Governor Mike Parson to issue a statewide mask mandate to help control the spread of the coronavirus, saying the spiraling numbers are leading to potentially dire scenarios.
Dr. Shawn Usery is chief medical officer for CoxHealth. He cited the example of a patient from Texas County in south-central Missouri who had a neurologic emergency and almost died because all major hospitals in the region were full.
“We can’t accept those patients locally. They end up going, as I think most have heard, to other states,” Usery said.
To give an idea of how rapidly hospitals are filling up, CoxHealth had around 130 COVID patients on Monday. By Friday, that had soared to more than 160.
“We’ve worked to add capacity for a greater number of patients. Within the next few weeks, CoxSouth will have added an additional 147 beds. That’s the equivalent of a mid-size hospital,” Usery said.
Preparing for the extraordinary: rationing live-saving healthcare
Both CoxHealth and Mercy have begun to prepare for the extraordinary measure of rationing acute or critical healthcare in the event that they must. That’s where doctors have to withhold treatment from some patients in order to treat others due to a scarcity of resources.
Springfield’s hospitals are not having to ration acute or critical care yet, leaders said at Friday’s press conference—but due to the shortage of staffing and space, they are having those difficult ethical conversations since hospitalization numbers are quickly heading in that direction.
A pandemic is exactly the type of situation that could lead to shortages of trained staff, critical care beds or equipment like ventilators. When a hospital runs out of these live-saving resources, it becomes impossible to treat every patient—so hospitals are forced to “ration” their health care resources, prioritizing some patients over others based on a set of ethics criteria.
According to the National Institutes of Health, bioethicists have traditionally recommended allocating resources primarily based on a patient’s chances of survival to hospital discharge. That means that patients who fall into a demographic less likely to eventually heal and be discharged—like the elderly or those with functional impairment—could eventually be denied access to potentially lifesaving treatments while those resources go toward younger, healthier patients.
Dr. Mayrol Juarez is a critical care doctor and physician vice president of hospital-based services at Mercy Springfield.
“For now, and luckily, we still have the resources to take care of our community. But as this process progresses, we have a plan in place where we’ll have to have challenging conversations, always caring for the community and having our most ethical approach to it,” Juarez said.
As an example, Juarez said one thing medical teams are preparing for is how to approach a patient’s family to express in detail the clinical condition and prognosis of their loved one, and determine if it’s possible “to put a patient through challenging situations that would just make their life linger.”
At this point, they haven’t needed to have those conversations yet, Juarez said.
“But if we don’t take action now, we will get there soon,” Juarez said.
A Springfield COVID nurse: 'Who will care for them?'
Wanda Brown is a registered nurse at Mercy Springfield who works on one of the hospital's COVID units.
She describes herself as "just one of many nurses who have held the hands of patients who have died unnecessarily from this unforgiving virus."
Mercy Springfield has already shifted three of its units and its ICU from taking normally acutely ill patients so that it can care for COVID patients, Brown said.
“We’re running out of room. Not only for our COVID patients, but for our other acute patients as well. So we ask again: where will these patients go, and who will care for them?” Brown said.
On Friday, Brown joined the chorus of local government and health care leaders to implore the public to change their behavior by wearing masks, keeping distance and staying home when possible.
“I know we’ve all heard statements made of how hospitals are not overwhelmed, and our ICUs are not full. But this is untrue. And it is misleading. And I think it provides a false sense of security for our community. It is not representing what our realty really is. The reality is our beds cannot be occupied without staff to care for those patients. And the beds that are available are full,” she said.
Many of the COVID patients in Springfield hospitals reside in rural counties outside of the Springfield area.