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Viral Vigil Follows Hospital CapacityLock Icon

5 min read
Chris Barber Hospital Capacity 133159
Chris Barber, president and CEO of St. Bernards Healthcare in Jonesboro. ( Graycen Bigger)

Concern that the COVID-19 outbreak could overwhelm Arkansas’ health care system remains a brooding cloud. The pandemic scenario is a possibility with a likelihood that’s elusive to gauge.

Forecasting how the virus could impact health care providers in the state has proven to be a hit-and-miss exercise in statistical analysis during the past six months.

Arkansas hospitals should be bracing for the possibility of more than 1,000 new COVID-19 patients during Sept. 20-Oct. 5 based on projections modeled by the Boozman College of Public Health at the University of Arkansas for Medical Sciences in Little Rock.

But as of Sept. 30, the actual admission of new COVID patients was tracking well below that 15-day forecast on the way to a possible peak in February.

In terms of the day-to-day ebb and flow of serious cases, the statewide bed count of COVID patients stood at 490 at the end of September.

That’s an increase of fewer than 100 since Sept. 20. However, the tally does reflect a climb back toward the statewide peak of 526 reached on Aug. 4.

A dramatic escalation in the number of COVID patients requiring intensive care forecast for October isn’t materializing so far. A July 3 UAMS outlook indicated that COVID-19 patients could inundate the state’s 970 ICU-bed capacity by the end of this month.

However, as of Sept. 30, the ICU bed count of COVID-19 patients stood at 218. The biggest concentration was 62 in central Arkansas, home to the biggest concentration of hospital beds and people in the state.

“I thought there would be more of a peak after Labor Day, but we haven’t seen that,” said Louise Hickman, chief nursing officer at Jefferson Regional Medical Center in Pine Bluff. “We thought there would be one after school started, too.”

While future probability analysis is proving tricky, number crunching on the frontlines is much simpler and much more time sensitive.

At the command center at JRMC, big-screen monitors follow the real-time fluctuations in the patient census. A color-coded tracking of bed space is broken into three categories. Red is a confirmed COVID-19 patient. Blue is a possible COVID-19 patient awaiting test results. Green is for all others.

A shuffle of rooms and staff is put in play when the emergency room takes in a new patient and when blue patients transition to red or green.

“Every two hours, we get a report from the ER about what we might need bedwise and for staffing,” Hickman said. “It’s a constant management situation.”

The December opening of a $102 million 245,000-SF surgical and intensive care tower proved a timely addition to the campus of St. Bernards Medical Center in Jonesboro. The ensuing pandemic has engendered a greater appreciation for the facility.

The tower’s 46-bed intensive care unit as well as its raw space presented the largest hospital in northeast Arkansas with expanded flexibility to deal with COVID-19.

“For us, we had a highwater mark of 44 [COVID patients] in the June time period,” said Chris Barber, president and CEO of St. Bernards Healthcare. “But in the last two weeks, we’ve seen the highest number since then. On Sept. 18, we had 55 in-house confirmed cases. We’re still running in the mid 30s and low 40s.”

As of Sept. 30, the headcount of COVID-19 patients in northeast Arkansas hospitals was 83. Of those, 44 were ICU patients.

“We started with 45 rooms for COVID patients,” Barber said. “We opened up a second phase recently, and we can go up to 186 in-house. We’re in good shape with that and good shape with ventilators.”

One of the biggest challenges Barber cited is having enough test kits to take full advantage of the speedy PCR processing equipment. The polymerase chain reaction test, which can detect the genetic presence of the virus despite the absence of symptoms or antibodies, is considered highly accurate.

“It can turn the panel around in 45 minutes and run multiple tests versus send-outs to a commercial lab in Memphis, where the best turnaround is 24 hours and sometimes 36 or 48 hours,” Barber said. “The limited supply of antigens for the test is afflicting the nation. We’re getting our allotment, but we could do more with more resources.”

Weekly conference calls on Thursday with his northeast Arkansas peers keep him plugged in with developments in the battle with COVID.

“We’ve been working together as a region on how best to deal with these patients: lessons learned, what are you seeing, what can we do working collaboratively,” Barber said.

It’s an ongoing dialogue replicated around Arkansas and the nation.

COVID 19 hopitalizations chart 133159
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Starting Point

March 11 at 9:01 a.m. marked the official beginning of the COVID-19 odyssey in Arkansas. That’s when the staff at Jefferson Regional received confirmation of a positive test result from the Arkansas Department of Health.

“We were the fortunate hospital to have the first patient,” Brian Thomas, president and CEO of Jefferson Regional Medical Center, said sarcastically.

In the weeks that followed that first case, 125 employees at the Pine Bluff hospital contracted COVID-19, largely through work exposure before more stringent protocol was in place to thwart the spread. It was a scenario that visited other Arkansas hospitals early on as well.

The average daily headcount of hospitalized COVID patients at Jefferson Regional quickly increased to between 20 and 22. “We had a highwater mark of 28 COVID patients in the hospital last week [Sept. 20],” Thomas said. “We’re still in kind of our second wave here.”

If push came to shove, the only acute-care facility in southeast Arkansas could take on a maximum of 75 non-ICU COVID patients. “If we have the staff,” added Hickman.

Staffing is a challenge echoed by many health care professionals across the nation. It’s a variable often cited as more of a concern than bed space to accommodate patients.

“Our highwater for COVID patients was 46 on July 16,” said Larry Shackelford, president and CEO of Washington Regional Medical System in Fayetteville.

At their busiest point this summer, hospitals in northwest Arkansas had a combined headcount of 110 COVID patients. The Sept. 30 tally of hospitalizations for Benton, Washington, Boone, Carroll, Madison and Newton counties stood at 53.

“A third of our patients originated out of ERs from surrounding counties,” Shackelford said, noting that most of the region’s acute care capacity is in Benton and Washington counties. “We’ve all tried to work together as it’s ebbed and flowed with who has open resources.”

A backlog of non-COVID patients who delayed going to the hospital because of the viral outbreak has filled previously empty beds at Washington Regional.

“We’re licensed for 345 beds, and there’s been days this week where the census has been above 300,” Shackelford said. “We’re seeing patients that are coming into the ER who are non-COVID sick. Now, they tend to come in a lot sicker.”

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