Health

Utah hospital staff are ‘afraid,’ monoclonal antibodies are running out and COVID-19 test sites are flooded

Utah’s supply of monoclonal antibodies and antiviral drugs for COVID-19 is running out as the number of new cases broke a new record Thursday.

Utah hospital leaders are warning that more bed shortages are imminent amid record coronavirus infections.

“Our employees are afraid to come to work,” said Tracy Nixon, chief nursing officer at the University of Utah Health. “They know we don’t have the staff to take care of patients the way we need to.”

“Three nurses have left because they can’t do it again,” Nixon said in one hospital department on Tuesday. “They feel like we’re holding back.”

More than 8,900 cases were reported Thursday, breaking Wednesday’s record of 7,200 new cases. Thirteen new deaths were recorded Thursday, including a child, said Dr. Michelle Hoffman, deputy director of the Utah Department of Health.

The number of hospital admissions for coronavirus has surged since Christmas — 530 coronavirus patients were hospitalized as of Thursday, UDOH reported, and intensive care units at large “referral” hospitals in Utah were at 96% of capacity. Intensive care units are considered to be 85% full, and major Utah hospitals have overtaken that since mid-August.

But Utah hospitals have yet to see the worst of the recent spike in cases, with patients usually not being admitted for at least a few days after testing positive.

“We’re probably looking forward to having to close more beds,” Nixon said. “This is just beginning.”

Although the variant of the omicron virus generally produces milder disease than previous dominant variants, health experts have warned that the massive number of new infections means hospitalizations are almost certain to continue to rise.

“How many patients are we hospitalizing in two or three weeks from now? And what does that do — not just COVID patients, but for people who come in the middle of a heart attack, people who are in automobile shock because of the weather?” asked Dr. Marion Bishop, emergency physician. In Brigham and Cash Valley Hospitals.

“I want to be able to take care of these patients, too,” Bishop said. Long after that peak [in cases] Falls, I see the sickest patients in the emergency room. And so we need everyone on the front end to help protect us from the back so we can be there for the people.”

(Trent Nelson | The Salt Lake Tribune) An ambulance is parked at Intermountain Medical Center in Murray on Thursday, Jan. 6, 2022.

Meanwhile, Utah hospitals are already understaffed because many employees are calling in sick or isolating because family members have fallen ill. The University of Utah Hospital reported Tuesday that more than 500 of its employees have been discharged from illness, and some scheduled surgeries are delayed.

“We were in the ambulance on a six-hour diversion last night because we [emergency department] “Patients were seeking care,” Nixon said. “We reject transfers.”

One resource the state of Utah promoted for avoiding hospitalization — monoclonal antibodies given to high-risk patients soon after diagnosis — nearly disappeared.

“Just two weeks ago, we were treating more than 1,000 people a week with monoclonal antibodies. Last month at this time we were ordering about 1,300 treatments a week,” Hoffman said in an online news conference with hospital officials. “This week we were only able to order 264.”

With only about 220 courses of oral antiviral treatments available statewide, Hoffman said, those two treatments are now available to fewer than 1 in 8 eligible high-risk patients who are infected.

This shortage is partly due to shortages across the country as more and more high-risk patients are becoming infected. Another reason, Hoffman said, was that of the three copies of the monoclonal antibodies that were available, only one was effective against the omicron variant.

“If your strategy is to hedge against vaccination and seek treatment with monoclonal antibodies in case you test positive, then it is time to rethink your strategy,” Hoffman said.

Hoffman said the caseload is likely to become more “explosive” in the coming weeks, with at least 12,000 new daily cases expected by the end of the month — if infected people can be tested in the first place.

“Our test sites are bursting at the seams,” Hoffman said. “People spend hours in their cars waiting for the test.”

Prior to this week, the highest daily number of cases was under 5,000.

Hospital directors and health officials — as well as Governor Spencer Cox — begged Utan to get vaccinated and get boosters. The Centers for Disease Control and Prevention late Wednesday recommended booster doses of COVID-19 for children ages 15 to 17.

“The only non-rare resource is vaccines,” Hoffman said.

(Trent Nelson | The Salt Lake Tribune) Intermountain Medical Center in Murray on Thursday, Jan. 6, 2022.

Cox, who did not join Thursday’s briefing, sent a written statement emphasizing that vaccines and boosters are the best way to avoid serious illness from the coronavirus.

“If, for whatever reason, you’ve been putting off getting a vaccination or a booster, now is the time,” Cox wrote.

The transmissible omicron variant produced breakthrough infection in the vaccinated people, but the vaccine and the booster proved highly effective in reducing symptoms and keeping patients out of the hospital.

UDOH reported Thursday that over the past four weeks, unvaccinated Utahns were 17.1 times more likely to die than those who were vaccinated, and 8.9 times more likely to need hospital care. They were 2.6 times more likely to test positive.

“I’ve taken more care of COVID patients over the past two years than I can count, and now I’ve seen enough patients with unprecedented infections — people who have been vaccinated, who have taken doses and sometimes a booster dose — to tell you that these are two very different diseases,” Bishop said.

“Patients who are not immunocompromised, I have to give them a very bleak expectation when they land in the emergency room,” Bishop continued. [am] Incredibly relieved to hear that a patient with COVID has been vaccinated, because we can tell them to plan for what is likely to be a much easier path.”

Bishop said vaccinations and boosters will allow hospitals to avoid denying care as the number of admissions is likely to rise in the coming days.

“I would go against my moral compass to say, ‘Don’t come to the hospital,'” Bishop said. “We want to be there. We are trained to do that. We want to stay in the fight for people, but we also need to have the ability to take care of people.”

Webb opposed the idea that the omicron variant is light enough that its wide transmission can safely achieve a degree of herd immunity.

“Although we may see some peak and decline in transmission which may end up in part due to some degree of ‘herd immunity,’ it will come at a significant cost,” Webb said. “And the cost will be borne by those who are not vaccinated and unfortunately, for the most vulnerable, immunocompromised or in the highest-risk groups.”

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