Arizona hospital CEO warns of staff shortages during 'exponential increase' in COVID-19 infections

Arizona hospitals are facing both an "exponential increase" in COVID-19 cases and a shortage of health care workers driven by increasing outbreaks of the Omicron variant, warned the head of Banner Health Tuesday.

Doctors are warning that hospitals in the state are at the "brink of collapse."

After an anticipated "slight dip" in cases over the holidays, hospitals are facing an increasing number of people needing care because of COVID-19.  Nearly 90 percent of patients in Arizona are unvaccinated, and COVID-19 patients have filled nearly one-third of all inpatient beds, said Dr. Marjorie Bessel, chief clinical officer for Banner Health, during a virtual press conference Tuesday.

"The rise in cases that we're seeing is related to the Omicron variant," Bessel said. "It has come into the United States, as it has in other countries around the world, in a very fast and furious rate." 

"We are experiencing that right now, and specifically the state of Arizona is experiencing exponential increase of cases," Bessel said. "We are not yet at the peak."

Some local hospitals have closed in-patient care areas due to the lack of staff, and Banner has curtailed staffing at some urgent care centers. Some Tucson hospitals are asking nurses who are COVID-positive to come to work anyway, so long as they are symptom-free, because of the lack of available medical workers.

Bessel's warnings came as a group of nearly 1,300 health-care workers, including physicians, nurses and other staff wrote an open letter to Gov. Doug Ducey pushing for statewide mask mandates and vaccinations as a bulwark against the spread of COVID-19. The group warned that Arizona hospitals face a growing "crisis" and could "collapse" under the strain as thousands of people seek care against a dwindling number of staff members able to care for them.

Another 213 additional deaths from COVID-19 were reported Tuesday by state health officials, along with more than 14,000 new reported infections in the state.

'We're busy'

While Banner has hospitals in other states, Bessel focused her remarks on Arizona.

"Banner Health continues to be very busy, and that is absolutely true today," she said. "We are busy in our clinics. We are busy in our urgent cares. We're busy in our emergency departments. And we are busy in our hospitals. We also understand that we are not yet at the peak of the Omicron variant, and that will come in the upcoming weeks." 

She also added that Banner is also facing "other winter pathogens" including influenza, and a respiratory virus known as RSV.

Based in Arizona, Banner Health manages 30 acute-care hospitals, including hospitals here as well as California, Colorado, Nebraska, Nevada, and Wyoming. This includes Banner University Medical Center and Banner University Medical South, as well as the Cancer Center and the Diamond Children's Medical Center in Tucson.

Over the last several weeks, Omicron has become the dominant strain of COVID-19, accounting for more than 98 percent of coronavirus cases Tuesday, according to the CDC. Last week, the CDC said that "while early data suggest Omicron infections might be less severe than those of other variants, the increases in cases and hospitalizations are expected to stress the healthcare system in the coming weeks."

In mid-November, researchers in South Africa identified the new strain of COVID-19 through the country's robust surveillance system, and the World Health Organization classified it as B.1.1.529 or Omicron, calling the virus a "variant of concern." The previous version of COVID-19 was tagged as a variant of concern was the Delta variant, which became widespread and dramatically increased COVID-19 cases worldwide. WHO officials have followed the Greek alphabet for new viral variants, but decided to skip Nu and Xi out of concerns that the names would be confusing.

Omicron has created a singular, massive spike in new cases since the year began. On Jan. 5, there were over 705,000 new cases reported, according to the CDC, doubling the January 2021 peak. The CDC said that the 7-day moving average of new daily cases increased nearly 86 percent compared with the previous average, rising from 315,851 cases to 586,391. 

While it's clear that the Omicron variant is driving up infections, it remains unclear how much the new variant has affected hospitalizations and deaths from COVID-19. 

Since New Year's Day, there were 90,857 new cases of COVID-19 in Arizona, rising to a near peak of 18,125 cases reported on Jan. 4, according to figures from the Arizona Department of Health Services. Exactly a year earlier, the last great wave of COVID-19 cases caused cases to spike to just 12,455 cases. 

Data from Embry Health, which manages dozens of COVID-19 testing facilities in Arizona, showed that the overall positivity rate for COVID-19 tests has rapidly increased from 34 percent on Jan. 1 to nearly 43 percent on Jan. 11.

'Help us avoid the breaking point'

For most of the year, Bessel has repeatedly asked the public to help the network's hospitals by using masks and seeking vaccinations, and on Tuesday, she reiterated her comments. 

"My top ask of the community continues to be the same," she said. "It is for all who are eligible to get vaccinated and receive your boosters if you have not yet done so. This is the best way to prevent serious COVID illness that requires hospital-level care." 

"In addition, please mask when you are indoors and stay home when you are ill," she said, adding that "fitted masks" such as KN95 or N95 masks should be worn because the Omicron variant is increasingly acting like an "airborne transmissible disease, versus prior variants that acted more like a droplet transmissible disease."

"We ask all of you to help us," she said. "You can help us avoid the breaking point—push it off into the future—by helping to take care of yourself. Please, get vaccinated if you have not yet done so. If you're ready for a booster and you haven't gotten one, please do. Wear a well-fitting mask, like a KN95. And please, if you are feeling ill, stay home." 

Bessel asked for people to get tested as soon as possible if they have COVID symptoms and to seek "outpatient treatments such as IV monoclonal antibodies or oral antivirals" if necessary. 

She also asked the community to "please be patient with us in the days and weeks to come. You may experience longer waits or delays due to the significant strain on our health care system." 

"Please also be kind and respectful to your health care workers. They have been under immense pressure for the past two years and especially during this most recent surge," Bessel said. 

The lack of staff forced Banner to close some urgent care locations, resulting in longer wait times at sites that remain open, Bessel said. 

"There continues to be a national shortage of health care workers," she said, adding that "due to the prevalence of COVID in our community" doctors, nurses and staff were also getting hit with the virus. "This has resulted in further strain on our hospitals and urgent cares," she said. 

As a result, some health-care workers have been asked to return to work after just 5 days after testing positive for COVID-19. In December, the CDC shortened the isolation time for COVID-positive workers who are asymptomatic. The move was widely blasted by health care workers, including National Nurses United, which demanded the CDC keep the 10-day isolation guidance. 

Bessel said that Banner was following the CDC's guidance, and adopted the "return-to-work criteria." 

"Our current return-to-work process includes allowing individuals to come back to work if they are asymptomatic or mildly symptomatic after a COVID-positive test and infection on day five," she said. "Our return to work process includes those individuals going through a screening, through an occupational health process, to make sure that they are well enough to return to the workplace." 

"Banner maintains a structured return-to work-evaluation process to ensure the safety of our team members, patients and visitors," she said. 

Last week, the director of nursing with Banner University Medical Center and Banner University Medical Center South, wrote an email to staff members asking them to shift the staffing of nurses and other staff to replace traveling nurses. 

In the email, Mellissa Davis, a registered nurse, wrote that Banner was spending $300 million a pay period for travel nurses, and while that was largely covered by federal funding and emergency funds from Banner, but "the longevity of this pandemic has exhausted these resources to continue to support the rates being requested by travel nurses.

"The asks will be uncomfortable and feel like a step back," Davis wrote.  

Bessel said that she wasn't "familiar" with the email in response to a question from the Tucson Sentinel, but that Banner Health has "thousands of external contracted labor individuals who are currently working in our care settings." 

"This is in addition to the core staff that we also have in place to meet the needs of our communities," she said, adding that Banner expects to have "continued external contracted labor needs throughout the rest of this surge and the winter pathogen season." 

She added that Banner will "continually evaluate" the network's needs on a "day-by-day basis" and "make adjustments accordingly." 

Other hospitals in the Tucson-area have shuttered in-patient units because of a lack of staff, while others have told nurses to work if they are COVID positive, but asymptomatic. 

Shortage in treatment continues

Banner faces a shortage in Sotrovimab, a version of the monoclonal antibody treatment that has been effective against Omicron. Monoclonal antibodies are a new treatment that uses cloned antibodies produced in lab, which are then infused into infected patients, creating a defense against COVID-19 much faster than the body's own attempts to marshal a response. The treatment can be used to treat patients early in their infection, especially those who are especially vulnerable. 

However, on Dec. 28, Bessel warned that Banner faced a shortage of Sotrovimab to treat people outside of the hospital. On Tuesday, she reiterated her complaint that the treatment was in short supply, and said it was being distributed by the federal and state government. When available, Banner has three sites in Phoenix and one location in Tucson to provide the treatment, which requires a referral and an appointment. 

"Due to the limited supply at this time, not all eligible patients will receive the treatment," Bessel said. 

She noted that two oral antivirals, Paxlovid and Molnupiravir, have become available and will be distributed at 32 retail pharmacies, but they wouldn't be available at Banner Family Pharmacy. "Like Sotrovimab, there is a limited supply of both drugs," she said. 

'Brink of collapse'

At least 1,258 health care professionals in Arizona, including physicians, nurses and caregivers, signed an open letter to Gov. Doug Ducey, health care leaders, city mayors and county supervisors, asking for immediate action to blunt what they called a "crisis" caused by the latest surge of COVID-19 cases in the state.

The group asked for leaders to respond to the "current crisis by implementing preventative measures that will dramatically reduce the spread of COVID-19 and protect our communities." 

Among the requests, the group pushed for mask mandates for all public spaces, including schools, while Arizona's hospitals are "in contingency and/or crisis standards of care." to maintain these mandates whenever the available number of inpatient and ICU beds fails below 20 percent. 

The group also asked for the elected leaders to provide free high-quality masks, including N95 and KN95 masks, for community members, and for a rapid expansion in testing capacity and accessibility. 

They also pushed for vaccine requirements for entry into public establishments where masks may be optional, pushed for a widespread campaign to provide boosters, and asked for the return of the mass vaccination sites that were largely closed during the summer. 

"As members of the Arizona healthcare and public health workforce, we need our healthcare employers, state, county, and municipality leadership, state legislators, and our governor to take definitive action to prevent the collapse of our state healthcare ecosystem and to avoid further social and economic damage to our state," the open letter said. 

"Without immediate action and intervention, the impending omicron surge will cause many preventable deaths, for both patients infected with COVID-19 and those seeking care for non-COVID life-threatening illnesses," the letter says.

“We are in a crisis. The hospital systems will collapse,” said Dr. Ruth Franks Snedecor, a physician with the University of Arizona College of Medicine Phoenix, during a virtual press conference Friday.

"Enough is enough. We demand action. It's not too late at this point in time to change course," said Dr. Cadey Harrel, a family physician based in Tucson. "We are on the brink of collapse and we don't have a backup plan."

"Health care is completely different now that it was two-years ago," said Dr. Kara Geren, a Phoenix-area emergency room physician. "We have more patients with fewer staff and resources." 

“I think what we are asking for is a back-up plan. We have burned through all of our back up plans," said Snedecor.

Ducey avoids COVID in annual address

Remarkably, as the number of cases spiked this week, Ducey largely avoided talking about COVID-19 and vaccinations during his "State of the State" speech, referring only to the subject to punch at the Biden administration, claiming that it mismanaged, and noting that "nearly 100 percent of citizens 65 and older with at least one shot of the vaccine thanks to a national model for distribution" of shots. 

In fact, while the state once had large-scale vaccination site across the state, the state has increasingly fallen behind on vaccinations, and now has one of the highest death rates in the nation, including one of the highest rates of death among children from COVID-19.  

Overall, 207.8 million people have been vaccinated in the U.S., covering about 74 percent of the U.S. population. Among those who be vaccinated, which includes everyone over the age of 5, the vaccination rate is just over 79 percent. Another 75 million received booster shots, covering about 36.5 percent of the population.

Statewide around 70 percent of those eligible to be vaccinated have got their shots —which includes anyone over age 5. And, the state has vaccinated more than 3.9 million people, including another 19,700 doses administered Monday, according to the Arizona Department of Health Services. 

However, the vaccination rate varies significantly by county, ranging from just 45 percent in La Paz County to 130 percent in Santa Cruz County, which has successfully vaccinated not only its eligible population, but also distributed thousands of doses to neighboring counties, and vaccinated hundreds of people from neighboring Sonora. 

Arizona ranks below 27 other states in its overall vaccination rate, falling far behind Vermont, which has managed to vaccinate 82 percent of the eligible population. Alabama is in last place, vaccinating just 51.2 percent of those eligible. 

Among neighboring states, Arizona has managed to fall to last place, dropping behind Utah and Nevada. California leads with 71.2 percent, just ahead of New Mexico which has 71 percent, and Colorado, which has covered 70.8 percent of those eligible.