In the last seven days, 31 more Montanans have died of COVID-19, bringing the total to 1,842 deaths. The week also brought 85 more hospitalized COVID patients into overflowing facilities. There were 351 active COVID hospitalizations as of Monday, Sept. 13.
On Monday, St. Vincent Healthcare had 54 COVID inpatients, 48 of which were unvaccinated. Of those, 11 patients were in the ICU, all of whom were intubated.
Billings Clinic is caring for 70 COVID patients, the most since the first week of December 2020. There are 25 patients at the ICU level with 13 on ventilators. Six ICU patients are receiving care in overflow spaces.
And more cases keep piling on, with 4,230 more cases added since last Wednesday, bringing the active case count to 7,589.
“It’s gotten to the point that we are in a crisis,” said Billings Clinic CEO Dr. Scott Ellner. “The patients we're seeing are not only sicker, they’re younger, we’re being depleted with our workforce, and we’ve lost several people across health care. People are tired and incredibly frustrated. We’re worried that the public doesn’t understand.”
This time last year, Montana was averaging 101 new cases per day and marked the beginning of the state’s initial wave. From September to November 2020, cases increased 1,085%. From July to September 2021, cases have increased 1,514%, according to data from COVID Act Now.
Statewide, intensive care units are on the cusp of critical levels with 79% of beds filled by both COVID and non-COVID patients, according to COVID Act Now. In the last week, Montana has averaged 89.9 COVID patients hospitalized in ICUs, levels last seen in early December 2020 just after Montana hit its peak of 93.3 patients on average in the ICU a day.
This time last year, the positivity rate was 7.2%. Now, the positivity rate is 14%, indicating that not everyone who is sick is being tested, said Nancy Iversen, director of patient safety and infection control at Billings Clinic.
Billings Clinic has far exceeded its ICU capacity. Typically the unit has 28 beds, but as the Delta variant bears down on the region, more than 40 ICU beds have been made available to patients. The ICU overflow is tipping into the cardiovascular unit, the emergency department and more. Age ranges in the ICU start at 24 years old and climb up to 69.
“They used to be in the 70s to 90s,” said Iversen. “Young people are fighting for their lives.”
The inpatient medical floor at Billings Clinic is completely dedicated to COVID patients as well as portions of the orthopedic unit. Overflow areas will be cropping up in psychiatric spaces, waiting rooms and any other spaces that could support patients. In total, Billings Clinic has added 41 additional beds.
Of the COVID inpatients, 54% are under 60 years old. Eight are patients in their 20s and 30s, Iversen said.
With expanding capacity, staffing issues are becoming even more exacerbated.
Two weeks ago Billings Clinic requested National Guard assistance from Gov. Greg Gianforte’s office. On Monday, Billings Clinic got that news that the hospital will receive 10 National Guardsmen to help with indirect patient care, according to Ellner.
Monday evening, Gianforte announced that the 10 Guardsmen volunteered to assist at the Clinic.
“Over the last year, soldiers in the Montana National Guard have consistently stepped up to the plate, and today is no different,” Gianforte said. “We’ll continue working with hospitals to address their individual needs as the state responds to COVID-19.”
The governor’s office has been inundated with requests for support as the pandemic intensifies staffing shortages in many areas, but governor’s office has been helpful in identifying and securing other resources, Ellner said.
Soon, 20 paramedics affiliated with a company called Best Practice Medicine out of Bozeman will arrive to help transport patients, clean and help with more indirect patient care, Ellner said.
This week and next, 15 traveling staff will also arrive on the Billings Clinic campus that will include nurses and hopefully respiratory therapists.
Ellner said that the added support is a start, but even the promise of 45 more workers probably won’t be enough to completely ease the strain put on nurses and doctors.
Patients at risk of heart attacks and strokes are coming in with more advanced disease and cancer patients can’t get the care they need, said Ellner.
“We’re seeing people with heart attacks and strokes, we’re seeing really sick patients who are COVID positive,” Ellner said. “We’re completely overwhelmed.”
And after a weekend of both Billings hospitals moving on and off bed divert, “there is nowhere else (for patients) to go,” Ellner said. “People with cancer can’t get the care they need.”
Billings Clinic is getting calls from all over asking if the hospital can take more patients as facilities in the region are at capacity and beyond.
Billings Clinic is working closely with its partners to discuss ways they can move patients in order to absorb more the incoming cases, communicate availability and work closely on transferring patients to swing beds.
Ellner said the governor’s office has expedited the transfer process for patients moving to critical access hospitals where they can receive post-acute care and has secured funding for patients who are underserved with insurance.
The Clinic also plans to implement a limit of one visitor per patient in the near future.
“We adjusted the visitor policy to have fewer people in the building,” Iversen said. “We need people to not sneak their kids in.”
St. Vincent Healthcare
Interim President and Chief Operating Officer for SCL Health Montana Michael Skehan acted as the administrator on call last week and said he described it as “one of the busiest weeks (the hospital) ever had.”
“Some of it is good because we like it when people get calls. We’re managing a very dynamic and complicated situation,” Skehan said.
The hospital’s ICU was at capacity on Monday, but Skehan stressed that the situation is fluid, saying that patients should not avoid care because the hospitals are full.
But high patient volumes mean staffing is an hourly focus and the St. V’s administration has tried to provide support for the health care teams.
“What I continue to observe is heroic efforts. (Health care workers) are coming back every day. We’re now into this wave of COVID for several months and individual people are experiencing fatigue,” Skehan said. “I would add that we have a big focus on the set of circumstances. We tried to create a long list of services available to (workers).”
Skehan listed physical support, financial support, and said the hospital recently hosted a pancake breakfast and brought in pizza for health care workers.
Despite strained staff, Skehan said hospitalized COVID patients are very understanding of the shortages and the primary feedback is that they are satisfied with the care they are receiving.
"This is a very busy and challenging time for everyone in health care," Skehan said. "We're trying to be as attentive as we can to the team."