Tucson medical workers face full hospitals, unmanageable patient loads

The goal since the pandemic started last March has been to keep hospitals from reaching capacity, but we’re past that now: Pima County’s hospitals are full and COVID-19 case counts keep reaching record highs.

“We’ve been talking about when the time would come when we are overwhelmed,” said Dr. Shannon Thorn, a Tucson infectious-disease specialist, “and we have reached that time.”

Thorn, who provides help at several local hospitals, said the number of available staffed hospital beds fluctuates depending on patients being discharged, transferred or dying.

On Wednesday night, one ICU bed became open. It filled immediately.

“At this point we have a critical shortage of staff. This week the ICU staff were being asked in a meeting to take on extra shifts and more patients” he said. “They are being asked to volunteer, but at some point it may become mandatory.”

For patients without COVID-19, that could mean a wait for treatment. Thorn said one case he came across recently involved a patient with a heart infection who couldn’t get standard hospital care because the resources and staff were not available.

Instead, he received treatment at home and is monitoring how he is feeling.

“We’re in a crisis”

This current spike is happening as Arizona becomes the state with the highest transmission rate of COVID-19 in the country, according to Rt.live, with an infected person now passing the virus to an average of 1.22 other people. The “Rt” is a measure of how fast the virus is spreading.

“We’re in a crisis. We’ve been in a crisis for weeks,” said Dr. Joe Gerald, an associate professor with the University of Arizona’s Zuckerman College of Public Health.

New weekly case counts recently increased by nearly 70% to 6,290 from the last week in November to the first week in December, while the number of diagnostic tests increased by 31%, according to the Arizona Department of Health Services’ chart of COVID-19 cases by date, as of Friday.

At the same time, new cases increased statewide by 46% to 41,496, while diagnostic tests increased by 21%.

The number of new cases seemed to abruptly jump from a previous two-week plateau in the state’s data, but this plateau is the result of less testing over Thanksgiving, Gerald said, adding that the virus continued infecting people, but fewer places were testing and fewer people were likely seeking tests over the holiday.

The percentage of positive diagnostic tests also increased from the last week in November to the first week in December, according to tests reported electronically to the AZDHS, as of Friday. It rose from 13% to 18% in Pima County. Statewide, it rose from 15% to 18%.

Statewide, new hospitalizations have jumped nearly 19% to 2,296 in the first week of December, surpassing a record set in the summer for the number of new COVID-19 hospitalizations in a week.

In Pima County, new hospitalizations reached 324, which set a record here for the second week in a row, according to the county’s data.

These hospitalized COVID-19 patients have been using a bigger and bigger portion of the available hospital beds in Arizona for months, according to AZDHS data. On Thursday, Dec. 10, they took up 40% of inpatient beds and 47% of ICU beds statewide, as of Friday.

Working assumption: everyone is infected

It’s difficult to explain how serious the situation is right now, said Judy Rich, president and CEO of TMC HealthCare, the parent company for Tucson Medical Center, 5301 E. Grant Road.

Rich, who is a registered nurse, said a career in nursing typically includes helping people recover far more than watching them languish, or die.

“That’s what makes it so difficult for them,” she said of her hospital’s nurses.

And with the transmission of the disease skyrocketing, she said, the staff has to assume everyone who walks into the emergency department is high-risk.

“We have to be extra diligent now, wear more PPE and assume everyone is potentially infected,” she said. “In our careers, we have never seen the kind of constraints that we’re under now.”

Last week, nurses at TMC wrote a letter to the community beseeching people to do all they can to stop the spread of COVID-19: Stay home at much as possible, shrink social circles, wear masks when out and wash hands frequently.

COVID ICU, TMC — Nurses confer about patient care in the COVID Intensive Care Unit at Tucson Medical Center on Dec. 11, 2020.
Angela PIttenger / Tucson Medical Center

The situation has been made harder, the nurses wrote, by seeing some of their colleagues get sick. TMC currently has the highest number of sick employees it has had since the pandemic started, with 64 employees home with COVID-19.

Rich said almost all of those employees got sick through community spread, and that only 17 employees since March have contracted the disease from hospital exposure.

The heartbreaking situations that are playing out now are like this from last week: One TMC nurse was at work caring for a sick, homebound colleague’s critically ill mother, said Mimi Coomler, senior vice president and chief operating officer for TMC HealthCare.

Coomler, who oversees nursing services for the hospital, said her charges have to do so much more than before.

“So much of our effort, so many resources are now going to this,” she said of COVID-19. “We’re constantly talking about how to expand capacity.”

No evidence of progress in slowing transmission

Statewide and countywide COVID-19 deaths are also on an upward trajectory, when accounting for a two-week data-reporting lag, but they are still below the number of deaths seen over the summer.

The rate of people dying who have tested positive for COVID-19 has steadily declined since the spring, according to Gerald.

“Back in March, the case fatality rate was around 5%. This June, mid-June, it was around 2.5%. And right now it’s hovering around 1.5%. And so, there’s been this steady decline in case fatality rates, such that fewer people who are recognized as having COVID-19 ultimately end up dying from this” he said.

This is likely due to several factors, he said, adding that, for example, doctors are probably getting better at treating the virus and we are doing a better job at keeping it out of long-term-care facilities, which is where a large portion of COVID-19 deaths occur.

“So, it’s not a silver lining that there are fewer deaths. It’s definitely good that for whatever reason fewer people are dying now, but that’s probably not much solace to the 500 or so people who are going to die during the Christmas week due to COVID,” Gerald said. “It’s still a potentially preventable tragedy for those 500 that end up dying because public-health experts like me have been saying, for quite some time now, ‘Hey we got a real problem here. We’re in trouble. We need to do something to slow this down.’ “

On the state’s current trajectory, the pandemic will get worse before it gets better, he said, adding that there’s no evidence we’re making progress in our fight against viral transmission. And more people will die as a consequence.

“We have no indication that we are at the peak of our illness here at all,” Thorn said of Pima County. “After that, we have to start rationing care and decide who has the best chance of survival.”

Some hospitals in New Mexico have already started taking steps toward that process, commonly called triaging care, which means those with the best chance get the limited care.

“What’s terrifying is that we don’t really see an end in sight; we’re just seeing an acceleration,” he said. “We’re not seeing any kind of real public awareness about the severity of the issue.”

Triaged care, once unimaginable, is near

Across town, the ICU at Banner University Medical Center Tucson was already at 90% capacity when this most recent spike hit, said Dr. Christian Bime, a pulmonologist in charge of critical care medicine for the hospital, 1625 N. Campbell Ave.

“We started to see an uptick before Thanksgiving but certainly after Thanksgiving it has increased,” he said, adding that sometimes there are no ICU beds at all. “It’s fluid, but every day is very, very tight.”

Over the summer, when that surge started, the ICU was at 65% capacity, he said, and that made a big difference in terms of balancing the workload.

Currently, people sometimes have to stay downstairs, in the emergency department, until space opens up. And that’s a challenge itself, since emergency rooms are typically busy at this time of year with the usual winter viruses, emergency care, heart attacks and other unexpected crises.

What makes all of this that much more difficult, Bime said, is that they are not able to provide the standard of care they are accustomed to providing.

“That bothers the nurses and the doctors very much,” he said. “We hold ourselves to a high standard.”

Like other medical professionals, workers at Banner are also worried they will soon need to implement triaged-care protocols.

“That’s not something we ever imagined we would have to do,” he said. “Each and everyone of us has to play their part to make sure we do not get to that point.”

The role the community plays in stopping the crisis is vital, said Dr. Melissa Zukowski, medical director for the emergency department at Banner Tucson.

“Hopefully we can hold the line here in Pima County so we do not get to that point,” she said of triaged care. “We need everyone to do their part, to help us get through this.”

Zukowski said there is “hope on the horizon” with the vaccine and so she hopes people begin to follow the CDC guidelines more closely, for just a while longer.

Arizona COVID-19 cases

PHOENIX — Arizona on Saturday reported over 8,000 additional known COVID-19 cases, one of the state's largest daily case figures since the pandemic began.

There were 8,076 additional known cases and 77 additional deaths, increasing the state's totals to 402,589 cases and 7,322 deaths, the Department of Health Services reported.

The additional 8,076 cases reported Saturday eclipsed Friday's report of 6,983 additional cases as the third largest daily case report, behind 12,314 on Tuesday and 10,322 on Dec. 1.

In Pima County, 1,215 additional known cases and 23 additional deaths were reported Saturday, increasing the county's totals to 50,852 cases and 799 deaths.

COVID-19 hospitalizations as of Friday reached 3,534, up from 3,482 on Thursday and topping the summer surge’s high of 3,517 on July 13, according to the state's coronavirus dashboard. Of the patients hospitalized Friday, 799 were in intensive care unit beds, down from 809 on Thursday.

Nine percent of all hospital beds and of ICU beds in Arizona were available, according to the dashboard.

Updated May 27, 2020

Tucson Medical Center, coronavirus drill

Updated Apr 16, 2020

Arizona governor touts COVID vaccine coming soon; spurns calls for curfews, other rules

Updated Jan 8, 2021

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PHOENIX — Arizona is expected to receive “hundreds of thousands” of COVID-19 vaccine doses by the end of this month, with priority for health-care workers, teachers, vulnerable populations and long-term-care residents, the state’s health chief said Wednesday.

The announcement came as Dr. Cara Christ also disclosed that 1 person out of every 7 who got tested for the virus last week in Arizona was infected. She also reported a new one-day record for cases.

But Gov. Doug Ducey, standing by her side, refused to put any new mitigation measures or restrictions in place to get the state to the point where a majority of Arizonans can be inoculated.

He specifically rejected a proposal by the chief medical officers of several Arizona hospitals to put in place a curfew, close restaurants to indoor dining and cancel group athletic activities. Instead, Ducey said he is relying on the idea that Arizona will have sufficient hospital beds to treat those who get ill in the interim.

However, that assumes hospitals can find the qualified medical personnel to staff these beds.

Earlier Wednesday, Marjorie Bessel, chief clinical officer for Banner Health, said the problem now, unlike this summer when virus cases peaked here, is that Arizona is no longer the state with the biggest surge. That makes it difficult to recruit help from elsewhere.

And while Banner is in the process of filling 1,500 positions, she said efforts are still underway to hire 900 more.

Ducey did agree Wednesday to provide an additional $60 million to Arizona hospitals to help them find the staff they need to handle the surge of people needing medical care. That is on top of a $25 million infusion less than a month ago.

“Grim” forecasts for this month and next

Bessel said the picture in Arizona is “grim,” predicting that Banner hospitals will hit 125% of bed capacity this month and exceed that, at least briefly, in January.

That trend is not unique to Banner.

Intensive-care-unit bed use is already at 90% of capacity in the state, the most recent data from the Arizona Department of Health Services shows.

Hitting 125% is not necessarily a problem as hospitals are required to have plans in place for such a surge, including converting non-ICU beds and other facilities for intensive-care use.

But the Institute for Health Metrics Evaluation predicts the demand for ICU beds will hit 300% of capacity in Arizona by the middle of January unless there are additional steps taken to curb the spread of the virus.

It was for that reason that Bessel and medical officers from Mayo Clinic and Dignity Health specifically asked Christ this week to impose the additional restrictions.

Bessel specifically praised Tucson Mayor Regina Romero and the City Council for voting Tuesday to impose a 10 p.m. curfew for three weeks.

“A curfew is mitigation that absolutely can work,” Bessel said. “It can work and it will work if we deploy it.”

Ducey is not willing to take such steps, even as he conceded that the vaccines, which will only start to be available later this month — and only for those in the highest priority classes — won’t make any immediate dent in an increasing trend in cases.

“We are in for a tough several weeks here,” the governor said at his news conference Wednesday.

He said he was giving his “most sincere condolences” to the families of the 6,739 people in Arizona who have died so far from COVID-19.

“We grieve every death in Arizona and want to continue to do everything we can to contain the spread of this virus and protect lives,” Ducey said.

Ducey: Curfews “not the right approach”

But that won’t include the kind of new restrictions being urged by the hospital medical chiefs and others, and not the kind of curfew that takes effect Friday, Dec. 4, in Tucson.

“I don’t think it’s the right approach,” Ducey said. “We want to do things that will allow businesses to operate safely.”

He said the continuing restrictions imposed in late June, like occupancy limits on in-house restaurant dining, movie theaters and fitness centers, along with enforcement, “will be the best things we can do to continue to slow the spread.”

He brushed aside questions about the fact that the spread is not slowing, even as Christ acknowledged that 15% of the tests for the virus conducted last week are coming back positive.

“This week we’re trending higher,” she said.

The number of new cases reported per day hit a record on Nov. 23 in the state. Figures for more recent dates are still being updated.

For Ducey, the focus is on the economy.

“I don’t think the right answer is to throw hundreds of thousands of Arizonans out of work before the holidays to slow this spread because I don’t think it would slow the spread,” he said.

He said there are other complications of restrictions, “like suicide attempts, like depression, like emotional and social disconnection, like child abuse and like domestic violence.”

Safety measures for large events

The lone new regulation of sorts that Ducey did impose Wednesday is not anything the state would enforce.

His current executive orders prohibit gatherings of more than 50 unless local governments approve. Now, he said, these governments will have to have a written agreement with event organizers that they will require and enforce certain safety measures, like distancing and the use of masks.

Nothing in Ducey’s orders affects activities he said are protected by the First Amendment, like the rallies the governor attended this year during President Trump’s campaign.

That, then, leaves the vaccines.

More financial help for restaurants

Ducey said first priority will go to health-care and essential public-safety workers, residents of long-term-care facilities and other “vulnerable” populations.

He is specifically including teachers in that first group.

That dovetails with his often-repeated argument that he wants more in-classroom teaching and less online education. The premise is that once teachers have immunity, they will be more willing to return to work in classrooms.

The date for vaccines for all Arizonans has yet to be determined.

Ducey issued an executive order Wednesday spelling out that all residents will be able to get inoculated “without financial barriers.”

Ducey also set aside $1 million in grants to help restaurants and other dining facilities expand their outdoor dining operations.

There is a separate $100,000 going to the Arizona Restaurant Association for the same purpose, and another $100,000 to the Arizona Lodging and Tourism Association to aid hotels and their restaurants in strengthening their sanitation and mitigation practices to protect patrons and staff.

Not everything being done for restaurants is financial.

Ducey is suspending a provision in law that says restaurants can serve alcoholic beverages only to patrons dining in-house or at an outdoor patio directly connected to the business. That has proven to be a barrier for restaurants that have received local permission to operate in parking lots and on cordoned-off areas of the street where there is a sidewalk in between.

Photos: April coronavirus patient drill at Tucson Medical Center

Tucson Medical Center and the Tucson Fire Department held a drill on April 10, 2020, to help establish procedures and solve problems when hand…

Pima County keeps voluntary curfew, enhances penalties for violating COVID-19 rules

Updated Jan 11, 2021

The Pima County supervisors voted Friday to strengthen penalties related to noncompliance with COVID-19 regulations, including the potential suspension of restaurant licenses and civil penalties for people not wearing a mask in public.

In addition to several new enforcement actions, the Board of Supervisors also endorsed a strengthened public-health advisory by the Pima County Health Department that now requires businesses to report any known coronavirus cases.

The county’s voluntary curfew, which began Nov. 24, will remain in place each night from 10 p.m. to 5 a.m. through Dec. 31. Even as other areas of the county are asked to adhere to the voluntary curfew, the city of Tucson voted to implement a mandatory curfew earlier this week, which will be in place from Friday, Dec. 4, to Wednesday, Dec. 23.

“The point of an advisory is to really ensure that people understand the severity of what we are dealing with,” said Dr. Theresa Cullen, the county’s public-health director. “We are in a crisis situation.”

The increased enforcement measures come as new coronavirus cases reach unprecedented levels throughout the county and state. In the first four days of December, there have been close to 2,900 new infections in the county, exceeding the total number of cases in March, April and May combined.

Hospitals also continue to deal with a record number of COVID-19 patients, reporting only one available ICU bed in the county on Dec. 3. Officials throughout the state continue to see an accelerated growth curve with no signs of slowing down without serious statewide intervention.

“We in the hospitals are being stretched to the limit, even as we speak,” said Dr. Clifford Martin, an infectious-disease specialist at Tucson Medical Center, when addressing the board. “I ask you and the community to do whatever you can to help us in the hospital at this point.”

Based on action taken by Gov. Doug Ducey earlier this week, the board decided to enhance enforcement on a number of coronavirus regulations already in place.

Here are the actions that were taken by the board, in 3-2 votes with Republican supervisors Steve Christy and Ally Miller voting no on them:

Business regulations

In July, supervisors adopted a number of temporary measures applicable to restaurants, public pools, gyms, fitness centers, hotels and resorts, such as employee temperature checks, masks and gloves, occupancy limits, social distancing and cleaning requirements.

Under an amended proclamation, the county will now enhance its enforcement of these measures, allowing only one incidence of noncompliance before facing repercussion by the county Health Department. A second violation by a business could result in the possible suspension or revocation of the establishment’s license or operating permit.

Mask compliance

While the county has had a mask mandate in place since June, there were previously no penalties in place for noncompliance. On Friday, the board asked that all county jurisdictions and law enforcement agencies assist in enforcement action, which includes a $50 civil fine for not wearing a mask in public areas.

In addition, the board made it mandatory for businesses to refuse service to anyone entering their establishments without a mask, unless specific exemptions apply. A business could be fined up to $500 if they do not comply.

Event regulations

Anyone wishing to hold an event with more than 50 people will now be required to pay a $1,000 or more compliance deposit, depending on the size of the proposed event. If mitigation strategies are followed during the event, organizers would be entitled to get their deposit back.

There will be on-site inspections of these events to determine compliance.

Curfew

The voluntary countywide curfew, intended to curb evening social gatherings at bars and other places, will remain in place through Dec. 31.

After two weeks, the board will review whether the voluntary curfew and other measures are working by analyzing the number of infections per 100,000 residents as well as the percent of positivity within the county. If the county is still over 100 cases per 100,000 people and over 10% positive, the board will consider moving to a mandatory curfew.

“We don’t know what the next two weeks will bring,” County Administrator Chuck Huckelberry said. “We are at over 350 infections per 100,000. If that continues to increase, we will be back with more measures within the next two weeks.”

Older adults asked to shelter in place

In addition to the curfew, the Health Department is also asking for older adults and people with underlying medical conditions to voluntarily shelter in place, except to seek medical care, purchase food, attend work or other essential activities.

The enhanced public-health advisory also requires businesses to report any confirmed COVID-19 cases within their establishment and further comply with any contact tracing efforts by the Health Department. A website will go live next week for businesses to report these cases to the county.