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'Grim' outlook: 1 in 1,000 Pima residents has died from COVID, patients wait for hospital beds

Banner halts elective surgery, reports 600% increase in ICU patients

One in every 1,000 Pima County residents has died from COVID-19, as the number of infections continues to climb and patients are forced to wait for beds. Six of eight Tucson-area hospitals had no available ICU beds Wednesday.

Local health officials described the latest numbers as "grim and disheartening," emphasizing that people should "stay home, and if you can't, wear a mask when you're around others" to slow the spread of coronavirus infections that is jamming local hospitals.

While vaccines are being administered to doctors, nurses and EMS workers, it will be weeks yet before the rollout of the Pfizer and Moderna vaccines here reaches the elderly people who were bumped up the list this week — and months before there are enough doses of the vaccines manufactured and distributed. In Pima County, about 1,000 people daily are being given the first of two required doses of the vaccine.

The continuing wave of new COVID cases means hospitals across Arizona have been taxed. Tuesday, many Phoenix-area medical centers were forced to send ambulances elsewhere, and Banner Health officials said Wednesday that they were halting elective surgeries throughout the state.

In Tucson on Wednesday, there were 55 COVID-positive patients at hospitals who were waiting for beds to open up, along with more than 30 patients needing treatment for non-coronavirus reasons who were forced to wait for beds, Pima County officials said.

Local health officials are "walking a fine line between wanting the public to be aware that this is a crisis" and discouraging people from going to the emergency room when necessary, said Dr. Theresa Cullen, director of the county Health Department.

"If you are ill, still seek care," she said Wednesday, telling TucsonSentinel.com that area hospitals have shared concerns that some people are not going to the ER when they should, because they are hearing about the crowding.

But officials "do not want to diminish the ongoing concern that is it possible" the growing number of people with COVID infections here could "overwhelm" the ability of hospitals to care for patients, Cullen said.

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Across the county, there were just five open ICU beds Wednesday, with only two of eight hospitals having any intensive care beds available. General medical/surgical beds were also nearly all full, with just 3% of all beds open — 42 across Pima County. Tuesday, there were just 34 med/surg beds to be found.

"There were 142 COVID-positive patients admitted yesterday, the 19th day in a row the number of COVID-positive hospital admissions has exceeded 100," officials said Wednesday. "Only one day in December saw fewer than 100 CV+ admissions – Dec. 11, which had only 93. The most was Dec. 16, with 172."

Another 16 COVID-19 patients were put on ventilators in the county in the past day, officials said.

"We know these daily posts about the status of our hospitals as they fight through this current surge of COVID admissions are grim and disheartening," Pima County Health Department officials said. "But it is important information and it is our hope that it will help lead to behavior changes that will slow and stop the spread of this deadly virus."

'Record numbers' of patients at Pima hospitals

Overwhelmed and under strain, hospitals in Pima County "continue to see record numbers with no let up in sight," as the number of COVID-19 patients continues to rise, officials warned Tuesday afternoon.

Wednesday, officials reiterated that data "indicates that the number of Pima County COVID-19 cases in the month of December will surpass the total number of cases that occurred in the nine months between March and the end of October. "

Since November 29, as many as 3,931 people were admitted to hospitals in the county, more than doubling November's record of 1,772 patients, according to figures from Pima County. 

At some Tucson-area hospitals, this meant that admitted patients were treated in emergency rooms, and doctors were assessing patients in waiting rooms because in part hospitals lacked the necessary staffing.

Some Phoenix-area hospitals reported being overwhelmed to the point of diverting ambulances. Banner Health announced on Wednesday that all elective surgeries will be put on hold beginning January 1, while Tucson Medical Center — which had stopped surgeries on December 20 — has begun scheduling a limited number of procedures beginning next week, hospital sources said.

"ICU bed occupancy by COVID-19 patients increased by 600% since November 1," Dr. Marjorie Bessel, Banner's chief clinical officer, said on Wednesday. "Some of our hospitals have increased their ICU capacity by nearly 250% to meet this demand. Our ICU occupancy is now at 170% of our peak winter volume. These patients account for 58% of adult ICU beds at Banner hospitals in Arizona."

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The novel coronavirus has infected more than 19 million people in the U.S., and killed 329,605 people, according to the COVID-19 Tracking Project. Nationwide, nearly 125,000 people are currently hospitalized, and nearly 23,000 people are in intensive-care units nationwide. In Arizona, more than 512,000 people have been sickened by the virus since March, and 8,718 people have died, the state Department of Health Services reported Wednesday morning.

One doctor at a Tucson-area hospital described her facility as "constipated" on Tuesday, because patients are staying for days or weeks while they're treated for symptoms from COVID-19, and the hospital lacks the robust level of staffing — including not just nurses and doctors, but also technicians and other needed personnel — needed to fill the additional beds. 

Meanwhile, the hospital has to accept new patients, who may spend two days in the emergency room waiting for a bed upstairs, including stays in "jury-rigged" negative pressure rooms designed to keep the viral infection from spreading.

"It's truly awful" in local hospitals, said Dr. Matt Heinz, a local doctor who has been treating COVID patients. Heinz was just elected as a Pima County supervisor and takes office next week.

"We are probably around halfway through this winter surge compounded by holiday travel behavior, and already our hospitals are effectively at capacity (or far beyond) with regard to nursing staff and bed availability — especially critical care," said Heinz on Tuesday, who just finished a seven-night stretch working in a local hospital.

"January is going to be particularly awful for those with severe coronavirus infections — and even people suffering from unrelated illnesses like strokes and heart attacks due to the strain the pandemic is placing on the healthcare system," the new Democratic supervisor told TucsonSentinel.com.

Banner Health, which operates 28 hospitals statewide, announced Tuesday that over the previous 48 hours, hospitals in Arizona experienced an "influx of patients," forcing several Phoenix-area hospitals to begin diverting patients by refusing incoming emergency transports and hospital transfers.

Officials at Banner Health said the diversions do not apply to "walk-in patients who need emergency care." 

"This is a very fluid situation and status. Hospitals may go on and off diversion within hours if they are able to free up enough capacity and resources within that time, while others may remain on diversion for longer," they said. "It is not uncommon for hospitals to go on diversion during the winter when volume is higher, but it is unusual for so many to be on diversion at the same time—with the length of stay and complexity of care for COVID-19 patients adding to the challenge that this presents." 

Banner Health officials told people not to delay care if they were experiencing a "life-threatening medical event." 

"It is important that everyone experiencing a medical event be evaluated by a health care professional who will determine what level of care is needed. 

"This is a situation that must be quickly and carefully addressed through balancing of patients and resources between hospitals, increasing staffing, pausing elective procedures and expediting discharges for those who no longer need hospital care," they wrote. "We would ask that all those in the community do their part to help Arizona hospitals and health systems as we manage this COVID-19 surge. Do not gather. Shrink your circle to include only those you live with. Wear a mask at all times when around those who are not part of your circle. We need every Arizonan to help us in this fight against COVID-19." 

The nearly 4,000 COVID patients admitted to Pima hospitals eclipses the 1,227 in July and 1,220 attributed to the month of June, when the first wave of infections was hitting a peak in Arizona.

Wednesday, another 5,267 infected people were reported in the state, with 78 new deaths added to the total of nearly 9,000 Arizonans who have died from COVID-19. More than 1,000 Pima County residents have died, with 16 more added to that fatal total Wednesday, and 40 the previous day. On Tuesday, 2,799 new infections were reported in Arizona, with 171 additional deaths.

Hospitals 90% occupied across United States

On Monday, the U.S. Department of Health and Human Services released new data that shows how thousands of hospitals are dealing with the COVID-19 pandemic, NPR reported. 

The information provided by HHS and compiled by the University of Minnesota's COVID-19 Hospitalization Tracking Project shows that in 126 counties, the average hospital is at least 90 percent occupied. 

On average, about 36 percent of the adult in-patient beds in Pima County were filled by COVID-19 patients, and nearly 82 percent of all available beds were occupied. 

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Statewide about 91 percent of hospital beds were occupied, leaving only 154 beds available, according to data from the Arizona Department of Health Services.

On December 4, the Institute for Health Metrics and Evaluation, an independent global health research center at the University of Washington, analyzed the case load and warned that cases and deaths would continue to increase steadily. IHME said that having more than 20 percent of hospital beds full at a hospital represents "extreme stress." 

Despite vaccination start, half-million deaths possible nationally

The group also warned that in the next several months, the U.S. will likely see far more deaths from COVID-19 despite large-scale vaccination efforts. 

"Lags in reporting artificially depressed cases and deaths over the Thanksgiving holiday, and very large numbers in recent days are due to catch-up reporting," the IHME said. 

The group warned that despite a scale-up in vaccinations, the U.S. could endure as many as 539,000 deaths by April 1. In mid-to-late January, the group expects deaths to hit a peak rate of 3,000 per day. All this acceleration of deaths will occur even after a "scale-up" in vaccinations. 

"Vaccination is likely to speed the transition back to normal later in the year but will prevent only 9,000 deaths by April 1 in the reference scenario," the group said. "A further 14,000 lives can be saved with more rapid vaccine scale-up targeting high-risk individuals."  

Pima County officials said they were "working as fast as we can" to get vaccines out to vaccination partners in the county. Health care workers who have the highest-risk of exposure to COVID-19 began receiving vaccines on Dec. 17, at inoculation sites at Tucson Medical Center and Banner University Medical Center's North Campus. 

By Monday, 10,773 people had received the first dose of the vaccine produced by Pfizer. 

County officials said they have 44,525 doses allocated, and of those, about 29,000 had arrived.

PCHD's Cullen said Wednesday that about 1,000 people are being vaccinated daily in Pima County.

Meanwhile, the Pascua Yaqui Tribe announced their own vaccine program on Tuesday using the vaccine produced by Moderna. The tribe said they chose Moderna's vaccine for tribal members in the Tucson area because it was "less complicated to administer," because it doesn't require the vaccine to be kept at extremely low temperatures using specialized coolers, or dry ice. Tribal members in the Maricopa and Guadalupe communities will need to rely on Maricopa County's health department for vaccinations. 

"Avoiding even larger death tolls depends critically on state governors implementing packages of mandates as hospital stress becomes high," IHME said, adding that "Scaling up mask use to 95 percent can save 66,000 lives by April 1."

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