All three counties in the Roaring Fork Valley are experiencing their highest rates of new COVID-19 cases since the pandemic began about nine months ago. Area hospitals are worried that increasing spread of the virus could bring an overwhelming burden in the coming months and bracing for a grim road ahead.
“We're absolutely concerned that as the virus continues to spread and the incidence rate climbs that we are going to be seeing hospitalizations that at some point are going to overwhelm local hospitals, perhaps regions and perhaps the state,” said Dave Ressler, CEO of Aspen Valley Hospital.
The realities of the pandemic have left Ressler and his staff feeling tense and frustrated. The latter, he says, is a feeling that some virus transmission is not being prevented as pandemic fatigue sets in.
“We're sick of wearing masks and we're sick of Zoom and sick of all the restrictions – and I'm totally sympathetic,” Ressler said. “I feel the same way. It’s more a frustration of understanding that it's not that people are malicious or just want to ignore it. We just have to have some compassion and say we're tired, we're frustrated, and we wish we didn’t have to do this.”
But the longer and more severely this virus sticks around, it will deal a blow to hospitals’ ability to take care of people in many capacities. If Aspen Valley gets busy enough with COVID-19 patients, it will force Ressler to make tough decisions, like cancelling surgeries and necessary screenings such as mammograms.
“There's a reason we do stuff in healthcare,” he said. “And when you have to make those difficult decisions to say, ‘We're not going to do them so that we can take care of our COVID patients and keep the virus out of the hospital.’ Those are gut-wrenching. They’re tactical, they're important, they have to be made – but they're gut-wrenching. That's what keeps me up at night.”
Hospitals and public health officials everywhere are concerned about what might happen in the next few months, as family gatherings for the holidays could spread the virus and make things worse.
In spite of the worsening virus numbers and bleak winter outlook, there is perhaps a silver lining in just how far hospitals have come.
“COVID has been a continual process of learning, evolution, improving what we're doing, reflecting and moving forward,” said David Brooks, chief medical officer at Valley View Hospital in Glenwood Springs. “Across the whole system we've evolved for better care, more efficient care and safer care for our community.”
Brooks cited a number of small steps in day-to-day care that add up to better outcomes for COVID-19 patients. Doctors know the best time to use a ventilator, they have new drugs for treating symptoms, and they know how to position patients to help their breathing and make them more comfortable.
One thing that hasn’t changed, however, is that many rural hospitals will need to transfer patients out to facilities that can give them a higher level of care. The practice has been common for local patients who reach a level of severity that demands more intensive care from a more resourced hospital. But rising COVID-19 rates in almost every part of the state mean that they could have nowhere to go.
“There is always the hypothetical situation – which hopefully we never get to – where they're simply is nowhere to transfer to in the whole state or the country,” Brooks said. “That has always been our biggest concern.”
Brooks says that outcome is not likely. But the hospitals that usually take patients from the Roaring Fork Valley – hospitals in Grand Junction and on the Front Range – are already seeing plenty of patients in their own backyards.
“I don't think you'll find a hospital administrator that isn't concerned about being able to send their critically ill patients somewhere – that we get logged jammed,” Ressler said. “What that means for our population and for our community is very scary in terms of not being able to get the care that you need.”
To help prepare for a situation where those hospitals are overwhelmed, the Colorado Hospital Association is setting up a transfer network.
“It gives us a way to use data and a process that makes sure patients are moved to places where they can get the right level of care,” said Cara Welch, a spokeswoman for the organization, “And that our hospitals don’t reach their capacity, or it doesn't further exacerbate any capacity issues.”
The hospital association has drawn up a routing center that simplifies the transfer process. Previously, transfers would start with a direct call from one hospital to another. Under the new system, requests for transfer are put into that statewide system and a team of experts figures out the best place to send a patient. It is not up and running yet, but could be put into motion as soon as it is needed.
It could also result in patients leaving hospitals in urban centers and coming to a place like Aspen.
“As patients start to get better, but still need some hospitalization before they're ready for discharge, we may be moving some of those patients back out,” Welch said. “Those may go to some of our rural hospitals where they can still receive excellent medical care, but may not need to be in an ICU bed.”
With current projections for virus spread, that system could end up being tested as the winter wears on.