In March, as COVID-19 overwhelmed hospitals in cities across the country, Sky Lakes Medical Center staff knew it would only be a matter of time before the pandemic would strain their resources, too. They anticipated an influx of COVID-positive patients needing respiratory support and developed protocols to isolate them from others.
But for most of the spring and summer, COVID-19’s spread in Klamath County — and its subsequent hospitalizations — crept along without spiking.
“We prepared for a hurricane,” said Sky Lakes spokesperson Tom Hottman. “We got a few sprinkles.”
But as cases have spiked over the past couple weeks, the storm has picked up. And the forecast isn’t looking good.
On Tuesday, Sky Lakes saw its first ever double-digit admissions for COVID-19, prompting the hospital to open a second isolation unit for virus patients. And Sky Lakes Primary Care Clinic closed for most of this week because of positive cases among its staff.
Dr. Grant Niskanen, vice president for medical affairs at Sky Lakes, said an increasing percentage of patients over the past week were there because of COVID-19. Having enough equipment and space to accommodate them isn’t as big of an issue as making sure there’s adequate staff to treat them.
“We can put heads in beds pretty easily, but we need people to take care of them,” Niskanen said.
Nurses and physicians have certainly become more familiar with treating COVID-19, and Niskanen said they went through drills back in March to train for a flood of patients. But last weekend’s outbreak at the Primary Care Clinic demonstrated that those preparations mean little when staff members themselves become infected.
Niskanen said at least 13 people at the clinic have tested positive since last Thursday. While most of those cases weren’t among providers themselves, they affected crucial support staff. Five out of six communication specialists, who work the facility’s phones, were out of commission.
At the hospital, several drug refill coordinators, medical assistants and providers also tested positive this week. Niskanen said few of the approximately 20 cases of Sky Lakes employees have had severe symptoms, but all of them can’t come into work for the next several weeks as they isolate. That’s the same time period when cases and hospitalizations are expected to rise even further.
Both of Sky Lake’s COVID-19 isolation units combined can hold approximately 20 patients. They’re split between two floors and connected by a staff-only staircase, which Niskanen said has helped free up space for nurses and providers. The unit’s rooms are ICU-compatible, meaning patients don’t need to be transferred to a separate intensive care unit to receive more involved respiratory support. The hospital has around 20 ventilators, potentially life-saving devices that help patients with acute COVID-19 symptoms breathe, and can likely survive for a month without another shipment of personal protective equipment like masks, gloves and gowns.
Right now, about a sixth of Sky Lakes’ hospital space is dedicated to treating COVID-19. Niskanen said they could theoretically turn the entire building into a COVID-19 ward (though the county’s low population likely won’t warrant that), but there wouldn’t be enough staff to run it. At a certain point, nurses, who must go through the ritual of donning new masks, gloves and gowns each time they enter the isolation unit (up to 12 times a day in some cases), wouldn’t physically be able to care for all the patients. If staff numbers start to dwindle as the county’s hospitalizations pile up, it’s a recipe for disaster.
“We’re very close to not having enough nurses,” Niskanen said. “Staffs across the nation are really stressed, and it’s really difficult to (hire) anyone into your hospital.”
Because Klamath County’s hospitalizations are surging several weeks later than other hospitals in the region, it’s virtually impossible to borrow traveling nurses to bolster Sky Lakes’ numbers. That also means particularly severe COVID-19 cases needing more involved respiratory support, which Sky Lakes providers have typically transferred to larger hospitals in other counties, now have nowhere to go. Niskanen said they’ve transferred at least six patients to other hospitals throughout the past eight months — but those facilities, like St. Charles in Bend, are now full.
COVID-19 patients with ICU status have a much higher number of nurses assigned to their care compared to non-ICU patients. But if there are fewer nurses available, that ratio will lower. Niskanen said that will cause a “significant increase” to the stress of the nurses that are still working, each of whom will consequently be responsible for more patients.
To free up staff and space at Sky Lakes, COVID-19 patients who only need oxygen support and are otherwise stable are now being sent home with oxygen tanks and pulse oximeters. They measure their blood’s oxygen saturation four times a day and check in remotely with a doctor until they either recover or return to the emergency room with worsening conditions.
“If they can be safely at home and still be treated just like we’re doing in the hospital, the hospital is going to be reserved more for the sicker patients,” Niskanen said. Those include people who have underlying conditions that are made worse by COVID-19.
Niskanen said looking at the county’s case spike concerns him, since statistically between 5 and 10% of positive cases will need to be hospitalized at some point. It took Klamath County nearly seven months to reach 300 cases of COVID-19 — but the county has added more than that in November alone. Niskanen said he expects roughly 200 COVID-positive hospital admissions over the next four to six weeks.
Sky Lakes Medical Center does run a robust healthcare system, but its effectiveness hinges on the health of the people who work there. As staff members start to succumb to the COVID-19 storm along with their patients, there’s only so much they’ll be able to do to help Klamath County.
“I think the winds are increasing and the floodwaters are rising,” Hottman said.
Alex Schwartz is an environmental reporter for the Herald and News and a member of Report for America, a national service journalism corps. He can be contacted at email@example.com or at 541-885-4477.