Despite rising coronavirus case numbers around the state, Alaska’s healthcare capacity on the state dashboard still is mostly in the ‘green.’ But physicians have recently been raising concerns, saying that state data doesn’t show the full picture.
“If you look at the whole state, it looks green. But even that doesn’t tell the whole story,” said Dr. Nick Papacostas, president of the Alaska Chapter of the American College of Emergency Physicians late last week.
The state’s Coronavirus Dashboard, the online site where the state gives a daily picture of new cases and hospital capacity among other stats, there’s a row about halfway down the page with three gauges, kind of like speedometers. They’re color-coded based on how close to capacity the state is on three metrics: inpatient bed capacity, ICU capacity, and ventilators. So far, they’ve remained in the green throughout the pandemic.
But physicians say there are reasons to be concerned about each of those numbers.
One issue is regionality. While the statewide numbers show inpatient bed capacity in the green, that’s not the case for the state’s largest city.
“The state inpatient beds dashboard specifically for Anchorage, many times in the last few weeks has actually been in the red zone. Even though, if you look at the whole state, it looks green,” Papacostas said in an interview.
Papacostas said he’s heard from hospitals that have been “boarding” more and more patients in emergency rooms after their inpatient bed and staffing capacity gets exhausted. That’s something that all hospitals do on a limited scale to deal with surges in patients, though it’s generally something they try to avoid.
Dr. Dan Safranek, medical director of the emergency department at Providence Alaska Medical Center, Anchorage’s largest hospital, agreed that boarding has increased with recent cases but it hasn’t reached levels seen in recent years. That’s good news, but it could change with a surge in cases, he said.
While inpatient bed capacity can cause problems for patients who don’t need a particularly high level of care, there are also concerns with running out of ICU capacity, according to researchers who have been modeling the outbreak. Dr. Thomas Hennessy, an epidemiologist at UAA, said that ICUs are expected to reach capacity by September 20.
“These are conservative estimates because they do not include patients transferred to Anchorage from other parts of the state,” he said, at a recent House Health & Social Services Committee meeting.
That’s a mathematical reality if behavior around the state doesn’t change. A weekly state summary of the transmission rates said that without more physical distancing and masking, cases are expected to continue to “rise rapidly.”
Finally, there’s the third number on the state’s dashboard: ventilators. Papacostas says that the number is meaningless without understanding the number of respiratory technicians qualified to operate them, as well as ICU nurses who can monitor the patients.
‘If we’re using all of them, but in settings that they weren’t really meant to be used, you know, the state’s in crisis mode,” said Papacostas.
The skills needed to operate a ventilator as respiratory therapists take a lot longer to develop than simply building a ventilator.
Papacostas says it all comes together in an intricate teamwork led by the ICU doctor.
“The actual bedside care is delivered by the respiratory therapists running the ventilator. And then the nursing staff and techs making sure the patient is turned carefully and, and all those things,” he said.
Experts think part of the reason the early figures for COVID-19 mortality for patients on ventilators were so high — up to 90% by some measures — was because there simply weren’t enough skilled nurses to properly calibrate ventilators. Now, that rate is believed to be closer to 30% according to a study published in late May by Critical Care Medicine.
Staffing doesn’t just apply to ventilators, staffing is essential for ICU beds and regular inpatient beds as well, says Papacostas.
So why doesn’t the state track it’s staffing in its dashboard instead of using numbers of beds and ventilators that experts say overestimates true capacity?
It’s because the number of medical professionals available is almost impossible to track down, says Jared Kosin of the Alaska State Hospital and Nursing Home Association, which helps compile numbers reported to the state.
“There’s just too many variables to keep track of. You couldn’t do it,” he said.
A patient in an ICU, for example, might require a nurse with a particular specialty. For some specializations, there might just be a handful of nurses qualified, making the system susceptible to shortages.
“On any given day, if you have people who are sick, people who are going on vacation, other call-outs that are unexpected, you’re going to have holes in your staffing patterns,” he said.
The state says it has been doing daily check-ins with hospitals to verbally monitor staffing, something that helps officials get a sense of what the situation is like on the ground. Alaska’s Chief Medical Officer Dr. Anne Zink said that there wasn’t a lot of clarity around staffing numbers, but says those daily check-ins are filling in that gap.
“What is displayed on their dashboard just represents the beds, it doesn’t really represent staffing and that’s why those day-to-day check-ins to get a lot more of that variability is really important,” said Zink at a recent news conference.
So far, there haven’t been any real shortages, but Zink says that if they happen, Alaska will have to rely on staffing from Outside, something that it has done in the past. But, she says, the ability of that staff to arrive can be restricted by surges elsewhere in the country.