Northern Missouri hospital worries rural COVID surge may lead to rationing care

An expected surge of COVID-19 cases may be treated like a “mass-casualty event,” with the patients most likely to live receiving the most care and those likely to die made as comfortable as possible, the chief medical officer of a small Missouri hospital said Monday.

In an interview with nemonews.net, Dr. Jeff Davis of Scotland County Memorial Hospital said he is expecting people infected during Thanksgiving events to start getting sick this week and people who will need hospital care to arrive at his emergency room starting this weekend.

“It is when all those people reach that seventh, eighth, ninth, 10th day of their COVID illness that they’ll be in the Emergency Department, when they’ll need to be admitted to the hospital for this care, so we are really looking at early to mid-December,” Davis said to the six-newspaper group that includes the Memphis Democrat and the Edina Sentinel.

The 25-bed hospital is already near its capacity for COVID-19 patients, Davis said, and often finding it difficult to transfer patients in need of more intensive care or turning away people at the emergency room.

When hospitals in New York were overwhelmed in April by the first wave of coronavirus victims, he said, hospitals had to make difficult life and death decisions. Now, Davis worries that is what his hospital may face.

“There was triaging that had to occur where the minimal services that were available were given to those who were most likely to survive and had the longest survival longevity left,” Davis said. “Those are hard things to think about, they are are hard things to talk about, but they are the kind of things we need to think about, or be aware of might happen if we continue to practice our social life as usual or our economic life as usual.”

Scotland County Memorial Hospital serves patients from seven small north Missouri counties and counties in southern Iowa. During November, the number of coronavirus infections doubled, and in a few cases tripled, in those counties.

Because of limited space, both in the hospital and in receiving hospitals that would ordinarily take transfer patients, Scotland County Memorial is often sending patients home who come to the emergency room after providing them with oxygen to stabilize them, Davis said.

“They get discharged back to home and a day or two later they come back because their condition may continue to worsen,” Davis said.

November was the worst month of the pandemic statewide in Missouri, with 116,576 new infections, more than one-third of all cases since the first was reported in March.

On Tuesday, the Department of Health and Senior Services reported 2,929 additional cases, which is below the average of 3,886 per day in November and the average of 3,632 per day last week.

There have been 302,691 total cases since March. On Tuesday, the department reported 177 additional deaths, pushing the state total to 4,006. The additional deaths include 138 found in regular reviews of death certificates to link them with COVID-19 cases, with 25 additional deaths from October and 113 additional deaths from November, the department stated in an email about the adjustment.

There were new cases reported in 110 of the state’s 117 local health jurisdictions on Tuesday, and the seven-day positivity rate on tests, which had been declining, has risen for the past two days. It stood at 20.5 percent Tuesday, well above the 5 percent rate that the Centers for Disease Control indicates community spread. There were 77 counties at or above the statewide positive rate on Tuesday.

Hospitalizations, which dipped in the week before Thanksgiving, have started climbing again. Preliminary data on the state health department’s dashboard showed 2,736 inpatients on Monday, 145 above the number hospitalized as of Friday. The peak for hospitalizations occurred Nov. 18, with 2,851 inpatients.

The pattern after past holidays, Davis said in the interview, is for new infections to peak about two to three weeks later. That happened in late July after the Independence Day holiday and late September after Labor Day, he noted.

Some health departments around the state are issuing warnings to residents about ways to limit the spread of infections related to holiday events.

In a Facebook post Monday, the Stoddard County Health Department in south Missouri asked people to limit their activities.

“If you hosted or attended Thanksgiving with people you do not live with, be careful for the next two weeks,” the post stated. “Avoid prolonged contact with people outside of your household in the event you contracted COVID-19.”

Stoddard County, which had 937 cases at the end of October, had 1,666 cases in the Tuesday state report, with 148 cases in the past seven days.

And in Warren County in east-central Missouri, which has added 112 cases in the past seven days and has had a total of 1,656 infections, notified residents that it would not adopt new guidelines from the state intended to keep school buildings open. The new guidelines state that teachers and students who are in close contact with an infected person do not have to quarantine if the contact and the infected person were both wearing masks.

The new state guidelines don’t align with CDC recommendations, the health department stated.

“These guidelines could reduce the effectiveness of one of our best mitigation strategies to reduce the spread of COVID-19 in our community- especially at this time of increased cases,” the post stated.

At Scotland County Memorial, staff are working mandatory overtime and the hospital has put out a call for retired nurses and other providers to work, Davis said. The hospital has set up a room with wifi and volunteer monitors for children of staff who are now in virtual learning so their parents can continue to work, he said.

“We have that level of shortage that we need every worker on hand that we have available,” he said.

In the early months of the pandemic, the hospital had few COVID0-19 patients and other procedures were curtailed. The hospital had to furlough workers, Davis noted.

Some staff even questioned whether COVID-19 would have a big impact in their lives, he said.

“Now that they are taking care ofd these patients and seeing these patients and they are community members, it is shocking to them,” he said. “We have had more fatalities that employees have witnessed in a short time than many have seen in their careers as a nurse.”