Kristin Murphy, KSL, File

What 'capacity' means for Utah hospitals and how they’re trying to stay ahead of coronavirus uptick

By Carter Williams, | Posted - Jul. 10, 2020 at 8:50 a.m.

SALT LAKE CITY — Utah’s rise in COVID-19 cases has continued for well over a month now, and with it the number of hospitalizations from the coronavirus has increased, as well.

The Utah Department of Health has reported 18,650 cases confirmed in Utah from May 28 — when the uptick began — through Thursday. That means that more than two-thirds of Utah’s 27,356 total COVID-19 cases through Thursday have been reported since May 28.

The number of people hospitalized has increased since then, too — from 734 total hospitalizations to 1,700 total hospitalizations as of Thursday.

That’s led to concerns about how Utah’s health care system can manage hospitalizations, which has been described by state leaders and health officials as a key factor in the decision-making process for how Utah moves forward.

So far, the state's health care system has held up strong enough to manage the uptick, but hospital leaders say there’s still plenty to be concerned about as new cases continue to be reported. spoke with experts from three of Utah’s largest health care providers to get a better understanding of what COVID-19 means for hospitals right now.

How current hospitalizations compare to what they normally would be in July

The Utah Department of Health has provided hospital capacity data for a few weeks now, and that's helped Utahns gain a better understanding of the bed space of hospitals in the state, especially as other states experiencing similar COVID-19 upticks are starting to see patient overloads.

As of Thursday, 67% of all ICU beds were occupied and 55% of all other remaining Utah hospital beds were occupied. That’s for both COVID-19 and noncoronavirus-related reasons. But overall, hospitalizations for many Utah hospitals haven’t been much different from previous years, officials at Intermountain Healthcare, MountainStar Healthcare and the University of Utah Healthcare say.

“As we’ve opened up and returned to a somewhat more normal business model, our inpatient capacity is in alignment to where it has been historically,” said Tracey Nixon, chief nursing officer for University of Utah Health’s hospitals and clinics.

Dr. Michael Baumann, chief medical officer for MountainStar Healthcare, and Dr. Mark Ott, medical director for Intermountain Medical Center, said similar things have happened at the hospitals they help oversee.

Why is it that hospitals are normal even with an average of 161 newly reported COVID-19 hospitalizations per week since the uptick began? Most of it relates to hospitalizations that normally would have happened that suddenly aren’t happening.

So even with coronavirus-related hospitalizations that didn’t exist in previous years, the balancing act is mainly credited to a drop-off of nonemergency hospitalizations, such as people putting off elective surgeries even after hospitals were allowed to undergo them. Health care providers have also continued providing virtual doctor visits.

“People are still a little bit leery out there of coming to hospitals. Some of the stuff we would normally be seeing at hospitals decreased a little bit,” Ott said.

At one point, MountainStar hospital emergency rooms saw a 30% decline from 2019 in hospitalizations; they were at 16% below this point last year when Baumann spoke with on Tuesday. All inpatient numbers for those hospitals fell by 9% below 2019 levels but have moved up to be about 2% below this time last year as people have started to become more comfortable visiting hospitals, he said.

Understanding hospital capacity

Hospital bed capacity is a complex statistic. In many ways it is and isn’t akin to, say, a container. Much like a container, it’s difficult to function after 100% capacity; but unlike a container, 100% capacity is already beyond efficiency for hospitals. Instead, hospitals stretch themselves thin after a percentage below that, Nixon explained.

That’s because there’s a process to get people in and out of hospitals. It takes time to get a bed available for a new patient after the previous one left. That creates a lag in when a bed is available, and that lag makes it nearly impossible to hit 100%.

And even when there is a bed open, it may not actually be available. Nixon likened the hospital bed process to a restaurant reservation system. You may walk into a restaurant and see three tables open but the restaurant says it's full. You can’t see reservations they have and others on waitlists that haven’t arrived yet.

“It’s similar in a hospital," she said. "What you can’t see maybe — even if I have five beds — is I have transfers coming in from outside hospitals, I have an emergency department full with 25 people who are to be admitted; you can’t see my perioperative schedule and all the patients being placed after that. It’s the same type of concept.”

With these in mind, efficiency for most hospitals typically peaks around 80-90% capacity, Utah health care experts explained. There is some variation on the peak efficiency number depending on the hospital. But after a hospital reaches its peak figure, it begins to be stretched thin and the admittance process experiences delays.

It’s something Gov. Gary Herbert brought up during a press briefing Thursday.

"I'm more concerned about the personnel aspect than I am bed space as we have more and more people going to ICUs. That includes specialized treatment and specialized skills, and there's only a finite number of personnel," he said. "We do not want our health system overwhelmed because of the COVID-19. When we get into the fall, (there is) flu season and other things that happen. We stand in danger of overwhelming the health care system."

COVID-19 presents a potential problem because it’s unknown when there will be a spike in hospitalizations that quickly move a hospital to its peak capacity. That’s what happened to hospitals in New York at the beginning of the pandemic in the U.S. and what hospitals in Texas and Florida started reporting in recent weeks.

Utah has seen a dip in the percentage of hospitalizations from cases of the coronavirus. Prior to the post-Memorial Day COVID-19 spike, health officials reported that hospitalizations were steadily at 8% of all cases. As of Thursday, that figure had dropped to 6.2%.

Since it’s been documented that there’s a delay from a new case becoming a new hospitalization, it’s still possible that an uptick in hospitalizations could occur. Dr. Angela Dunn, the state’s epidemiologist, said Thursday she’s hopeful that the falling hospitalization statistic reflects that Utah’s new cases involve people who are less likely to be hospitalized.

Should there be a spike in hospitalizations, Utah’s health care leaders say hospitals are prepared. They have plans in place for that possibility.

Baumann said plans account for bed space, support staff and personal protective equipment supply chains, as well as surge bed capacity — the additional beds that could be added from the normal bed capacity — and staff available from health care partners in other states.

Younger people are still being hospitalized

Since the beginning, health experts have said people aged 60-65 and older and those with pre-existing conditions are most vulnerable for severe illness. Of the 1,700 total hospitalizations as of Thursday, only half had at least one pre-existing condition and about 61% were considered high-risk.

Statistically speaking, those 65 or older are more likely to be hospitalized. As of Thursday, the state’s data shows 23.1% of individuals 65 or older who contract COVID-19 have been hospitalized. That’s compared to 5.1% for individuals between ages 15-64.

While it’s true older Utahns are much more likely to be hospitalized after contracting COVID-19, the vast majority of hospitalizations — some 7 out of 10 — are of people between 15-64. As of Thursday, the average age of a person hospitalized was 53.3 and the median age is 54.5, which both fall a few years below the high-risk age guidelines.

Those in that broad 15-64 age range account for about 85% of all cases to date. Since the bulk of the cases have been in that range, it shouldn’t be surprising that it has more hospitalizations. And those between 15 and 64 years old have accounted for more hospitalizations since Utah started releasing hospitalization data.

The scale between people 15-64 and those 65 and up has remained steady. The state health department reported 167 hospitalizations three months ago on April 9. At that time, 68% of hospitalizations were people aged 15-64, while 32% were those 65 or older.

Those aged 45-64 have the stronghold in terms of total hospitalizations. People in that age range now account for nearly 40% of all hospitalizations. But those aged 25-44 and those aged 65-84 both account for about 25%. Those aged 15-24 account for close to 6% of hospitalizations, those above age 85 account for nearly 3.5%, and those under age 15 account for 1% of cases.

Statistics apply to groups, they don’t apply to individuals. If you’re the one 22-year-old who gets really sick with COVID and ends up in the hospital, it doesn’t that it’s certainly unlikely — it can certainly happen to anybody.

–Dr. Mark Ott, medical director for Intermountain Medical Center

But at MountainStar hospitals, patients aged 20-34 are now outpacing patients aged 55-64, Baumann said. He did note that younger individuals are typically hospitalized for shorter time periods than older patients.

“Younger people are getting sick; they’re coming into the hospital and, yes, even some of our younger patients are dying,” he said. “It’s still true that patients who are older are more apt to die and more apt to end up in the ICU.”

Ott added there’s an important caveat to the statistics: a hospitalization is still a hospitalization.

“Statistics apply to groups, they don’t apply to individuals,” he said. "If you’re the one 22-year-old who gets really sick with COVID and ends up in the hospital, it doesn’t matter that it’s certainly unlikely — it can certainly happen to anybody.”

There’s another way to view the growing gap in total hospitalizations between those 15-64 years old and those above 65. Nixon said it’s possible that those who are at higher risk for COVID-19 hospitalization are heeding the warnings and messages by government leaders and health experts. In turn, they aren't getting sick and later hospitalized.

“I think we’ve done a super good job informing those populations with the greatest risk about their risk,” she said. “I think maybe what those numbers show us is that there is a sense of ‘I’m not in that at-risk population’ (from younger Utahns). Has that other group been as thoughtful around the ways they can keep themselves and others safe as much as that older, more at-risk population has?

“We’re all at risk,” she added. “We should all be taking the recommendations on how to stay safe incredibly seriously not only for ourselves but for the sake of the communities and all of the people we interact with and come across every day.”

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