Missouri hospital bed capacity in ‘dire state,’ association warns

Deaths from COVID-19 in Missouri are much higher than previously reported, and available hospital capacity is much lower, after two adjustments to statewide data were made on Monday.

The grim news comes as many cities and counties are considering ordinances requiring face masks, following action last week by Joplin and Franklin County and as KFVS television in Cape Girardeau reported that the health director of St. Francois County in eastern Missouri resigned amid threats to herself and her family.

The state Department of Health and Senior Services on Tuesday reported 189 additional COVID-19 deaths on Tuesday, including 161 found during a weekly review of death certificates matching the information with known COVID-19 cases.

Of the 161 previously unreported deaths, one was from September, 41 were from October and 119 of the patients died earlier this month, agency spokeswoman Lisa Cox wrote in an email.

“This is a reminder that not all deaths reported each day occurred in the previous 24 hours,” Cox wrote.

It is at least the 10th time since early September that the department has made an adjustment after reviewing death certificates, adding dozens – and on many occasions more than 100 – deaths to the previously reported numbers.

Cox did not respond immediately Tuesday to an email requesting additional information about the review and why so many adjustments have been necessary.

The adjustment brought Missouri’s death total for the COVID-19 pandemic to 3,750. The health department reported 3,764 new coronavirus infections Tuesday, the 20th consecutive day of more than 3,000 new cases. There was at least one new infection in 114 of 117 local health jurisdictions reported Tuesday.

The positive rate on tests continued to decline, to 20.3 percent, the sixth day it has gone down. The Centers for Disease Control has said that a rate of 5 percent or more indicates significant community spread.

The state has recorded 278,661 COVID-19 infections since March. With the adjustment, 1.35% of those infected have died of the contagion.

The other adjustment is to change reporting on hospital data to show only staffed beds rather than licensed beds.

The revised data reported Monday on the Missouri Hospital Association’s COVID-19 dashboard shows that fewer than one in five of the state’s approximately 2,600 staffed intensive care beds were available on Friday. The association also tracks total beds and ventilator availability. Just over one in five of 15,303 staffed hospital beds are available.

That is a decline in availability of 12 percentage points for available ICU and general inpatient beds from Thursday, Dave Dillon, spokesman for the hospital association, wrote in an email.

“These data have been moving for the last month as hospitals have been making this transition, but this release does frame the dire state of ICU and medical-surgical bed capacity in the state,” Dillon wrote. “What we are seeing now — approximately half of the capacity we reported over the weekend — is illustrative of what we have been hearing from the front lines.”

Hospitals have been warning for weeks that they are being overwhelmed by a flood of patients ill with the disease caused by the coronavirus that arrived in Missouri in March. In a conference call Oct. 29, hospital CEOs asked Gov. Mike Parson to issue a statewide order requiring face masks in public places, something he had refused up to that point and which has not changed.

In the four weeks since that call, hospitalizations for COVID-19 have increased by more than 1,000 patients, peaking at 2,851 on Thursday before falling to 2,680 on Saturday, the most recent day with confirmed data. The seven-day average of total hospitalizations has increased from 1,520 on Oct. 29 to 2,708 on Saturday.

As a result of that surge in admissions, BJC HealthCare in St. Louis has postponed elective procedures, Boone County adopted a color-coded system to warn the public about capacity issues and the hospital association sent a letter to Parson renewing its plea for him to act.

And though Parson has not issued the requested order, hospitals are working with his administration “to address the staffing crisis in hospitals that is creating a significant choke point for our ability to maintain and build capacity,” Dillon wrote. “We have beds available, but we don’t have the staff to activate them.”

Hospitals are experiencing staff shortages not just related to the high levels of utilization, but because our staff are sidelined with the virus, through quarantine and because of the influence of COVID-19 on their lives.

Hospital leaders are worried that Thanksgiving gatherings this week will cause a new surge in cases and urge Missourians to be careful, Dillon wrote.

“The hospitalization challenges reflect high transmission rates,” Dillon wrote. “And, with Thanksgiving this week, we can expect that if Missourians don’t take public health precautions seriously, transmission and the need for additional hospital care will soar.”

A new local mask ordinance was passed Monday in Clinton in Henry County, which has had 154 new infections, 22nd highest per capita in the state, in the past seven days.

And in Boone County, where masks have been required since early July within Columbia, the county commission will meet Dec. 1 to review a countywide ordinance, assistant Health Director Scott Clardy said. Boone County, which had seen its rate of new infections cool in September and October, has reported more than 100 new cases on all but five days this month, with more than 200 cases on three occasions, including Sunday.

The steps that will provide relief to hospitals are up to individual Missourians, Dillon wrote.

“Hospitals may be the front-line of care, but every Missourian is now the last line of defense in making sure that we can treat the critically ill — those with COVID-19 and all Missourians needing lifesaving care,” he wrote.

In St. Francois County, Amber Elliott, health director since January, told the Cape Girardeau station that she had received threats from people who were following her and her family. The St. Francois County Health Department issued a mask order in September but withdrew it a month later because of public opposition.

“My family were photographed in public, which included my daughter. I think it raises safety concerns, especially for my kids. I can take a lot of scrutiny, I think it’s expected as a public figure, but it has bled onto my family,” Elliott told Nexstar Media.