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Border counties: Az rural hospitals are 'nearing collapse' & 'overwhelmed' with COVID

Cochise, Santa Cruz & Yuma seek to transfer critically ill but few beds available in Pima County

Supervisors from Arizona's four border counties — Pima, Cochise, Santa Cruz and Yuma — have asked officials to allow rural hospitals to transfer critically ill patients to larger regional facilities because providers are "nearing collapse" due to patients infected with COVID-19.

In a letter to Dan Harrington, the acting director of the Arizona Department of Health Services, and Dr. Richard Carmona, the state's senior advisor for vaccinations, the Arizona Border Counties Coalition said Tuesday that rural hospitals, emergency rooms and other medical centers in Southern Arizona are struggling with overcrowding, and have been unable to transfer patients to hospitals in Pima County — where the number of open intensive care unit beds has "been below five percent for over 40 days."

"As you know from Arizona's statewide COVID-19 dashboard data and your medical expertise, our rural hospitals, emergency rooms and other centers for medical care are nearing collapse due to serious COVID-19 infections coupled with the need for ongoing hospital care," they wrote. "The overcrowding of larger regional hospitals and emergency centers has resulted in an increasing inability for providers to ensure a timely transfer of critically ill patients from rural areas to the required higher level of care."

Pima County Supervisor Sharon Bronson signed the letter, along with Cochise County Supervisor Ann English, Santa Cruz Supervisor Bruce Bracker, and Yuma County Supervisor Tony Reyes.

"Urgent, critical care transfers from the Santa Cruz Valley Regional Hospital have not been possible," they wrote. "The same exists for the Copper Queen Community Hospital in Bisbee. The Douglas, Arizonan Clinic and the emergency room in Nogales, Arizona, Benson Hospital, and Northern Cochise Community Hospital in Wilcox are overwhelmed."

"The hospitals and emergency treatment facilities in Yuma County are having the same issues," they wrote.

The group asked state officials to allow the COVID-19 "Surge Line" to expand, allowing the transfer of non-COVID acute care patients from rural hospitals.

The supervisors also said that many of these facilities are "near financial collapse" because of the cost of treating both COVID-19 and non-COVID patients. "This stress on rural medical delivery systems has been continuous for the last 18 months, with no relief in sight. Some financial assistance to these rural hospitals, emergency rooms and clinic centers is necessary," the supervisors wrote.

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On Monday, Sept. 20, data from ADHS shows that 1,933 people were hospitalized across the state because of COVID-19, and that 538 people were in intensive care because of the outbreak, including 94 people who were intubated.

Since the pandemic began, 19,584 people have died from the novel coronavirus, and on Tuesday, 71 people were reported dead.

Across the state, just 10 percent of the total ICU beds were available, while 31 percent were filled by people suffering from COVID-19, ADHS said. The number of emergency departments beds available has declined since April, dropping from around 74 percent available to just 38 percent across the state, state officials said.

Since the pandemic began, nearly 76,000 people have been hospitalized, representing about 7 percent of cases. Just over 48,000 cases were in Maricopa County, while there were nearly 2,500 cases in Yuma, more than 8,200 in Pima County, 818 cases in Cochise County, and 597 cases in Santa Cruz.

While overall admissions declined in Pima County over the last seven days, the number of beds in use, and the number of ICU beds filled by patients remained steady, according to data from the CDC, with 109 admissions over the last 7 days.

The number of available ICU beds in all Pima County hospitals has been only about 10-15 at any one time for most of this month, with 20 available last Thursday. Some days, there have been even fewer, with just 6 open beds at some points in late August. Hospitals have added 13 more ICU beds in the county since the middle of last month, for a total of 360 beds.

In Yuma, new patient admissions also declined over the past week, however, the percentage of ICU beds in use increased 2 percent, and now more than 30 percent of ICU beds in the county are filled. In Cochise County, new admissions increased 10 percent, and hospitalizations increased 4.5 percent. The number of ICU beds in use also increased 2 percent in Cochise County.

For months, Santa Cruz County has maintained an incredibly high rate of vaccinations, with 99 percent of those eligible, and more than 87.1 percent of its total population have been vaccinated. Among the border counties, Cochise is the lowest, with just 60.8 percent of those eligible vaccinated. Pima's vaccination rate is at 66 percent, while Yuma is just slightly ahead with 66.8 percent of those eligible.

The four county supervisors praised an announcement from Arizona Gov. Doug Ducey, who said on Sept. 1 that the state would provide $60 million to health care facilities that administer monoclonal antibody treatments, and offer vaccines to patients as they are discharged. The governor's office said that with the funding, ADHS was expected to hire another 500 nurses through the end of December.

Monoclonal antibody treatment is relatively new.

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In May, the FDA granted an emergency use authorization allowing the treatment, which relies on lab produced antibodies that are injected through an IV, either during an outpatient treatment, or in an emergency room. The treatment often helps the body clear the virus faster, and reduces symptoms.

Health and Human Services said that last week, there were about 176,460 doses of monoclonal treatments distributed to states, as part of a coordinated distribution of the drugs, including about 1,800 doses to Arizona.

The coalition asked state officials to set up a system to help counties locate places that offer the treatment, and for help recruiting new sites to provide monoclonal antibody treatments. The group also asked for help creating federal health care "strike teams" that could provide monoclonal antibody treatments in rural and undeserved communities.

"We would ask for direct funding for monoclonal antibody treatment teams if a county is able to assemble professional medical staff to implement these centers and hospitals," they wrote.

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