Cases of COVID-19 are surging rapidly in southern and western states, but governments and hospitals are responding hesitantly as public health officials continue to raise the alarm about the potential for overrun facilities.
Some regions in Texas have again shut down elective procedures with an order from Republican Gov. Greg Abbott Thursday morning. But so far, states like Arizona, Florida, Oklahoma and California have not followed suit, even as the novel coronavirus shows itself to be clearly established with no signs of slowing.
HHS Secretary Alex Azar said Friday that the department is "in a much stronger position" to support hospitals fighting the virus. "America's hospitals are ready to get back to business while maintaining their readiness for COVID-19," he said.
But that's not the case in Texas or Florida, which have reinstated shutdowns to some degree. Both states, along with California, have ordered bars in certain areas closed.
Texas and Florida have also had controversy with reporting COVID-19 data. A Florida Department of Health official who was tracking information on the state's cases was fired after she said she was told to manipulate the numbers to meet guidelines for reopening.
She went on to create her own portal, which as of Monday morning shows 255 of 307 Florida hospitals reporting fewer than 10 ICU beds open.
In Houston, Texas Medical Center hospitals suddenly stopped publicly reporting hospital capacity figures over the weekend after showing 100% ICU capacity on Thursday. Some of the information was posted again Sunday.
Texas Medical Center showed 93% ICU capacity as of Sunday. That's without adjustments to increase capacity by as many as 800 beds in addition to the 1,330 normally available. The system predicts it will need to begin that process of adding beds by Wednesday if the current rate of 5.3% growth in ICU patients continues, according to its data portal.
TMC has more than 160 days worth of N95 masks, about 130 days of surgical face masks, 40 days of gloves and plenty of gowns and eye protection, all manageable levels, according to the data.
Texas, Arizona and Florida all lifted stay-at-home restrictions and allowed businesses to begin opening up relatively early as their states were well behind the country's first hotspots in coastal regions like Washington state and New York.
But, as many epidemiologists feared, those actions seem to have spurred coronavirus transmission.
Eli Rosenberg, associate professor in the department of epidemiology and biostatistics at the University at Albany, said during a panel Thursday, "at the time that many of the states that are currently surging had reopened and many which were in the lead up to Memorial Day, the epidemiologic data were not in favor of them reopening to such a liberal and broad degree."
He added: "At the time many epidemiologists, myself included, thought that we would see a resurgence after such drastic reopening about a month later and here it is."
Politics may have also played a role, as residents of these mostly red states have said they are less likely to wear a mask. And President Donald Trump held campaign rallies in Tulsa, Oklahoma, and Phoenix, Arizona. Neither events followed social distancing protocols and Trump does not wear masks.
In contrast with other states' reimposed restrictions, Arizona Gov. Doug Ducey made no indication of plans to reinstate shutdowns during a Thursday press conference.
Latest figures from the Arizona Department of Health showed that 87% of ICU beds and 85% of inpatient beds were in use across hospitals statewide Saturday.
Nonprofit system Banner Health dominates in the state with 28 hospitals, treating about half of the patients in Arizona hospitalized with COVID-19 at any given time, according to a release. It's bringing in more than 200 registered nurses via a contractor to help aid current staff during the surge.
Dignity Health, which merged with Catholic Health Initiatives to form nonprofit giant CommonSpirit Health, also has a strong presence in the area. A spokesperson told Healthcare Dive the system is halting elective surgeries for the next week at two of its Phoenix hospitals, and carefully monitoring scheduled surgeries at its other two facilities.
California also shows rising case rates, primarily in Southern California, and Gov. Gavin Newsom warned Sunday hospitals in Imperial County "are overwhelmed."
According to a Sunday release from California’s Department of Public Health, the state’s overall positivity rate — a key indicator of community spread — is trending modestly upward in the 14-day average. Hospitalization rates over the long-term are showing a slight uptick in the 14-day average statewide.
While those states show some of the most concerning situations in the U.S. currently, more than half of states show rising case rates. Other health systems are taking stock and looking at surge capacity.
Salt Lake City-based Intermountain Healthcare has reinstated visitor restrictions at its hospitals and clinics.
In Oklahoma, hospitals are on average at 75% to 80% capacity, with ICU capacity at about 80%, LaWanna Halstead, VP of quality and clinical initiatives at the Oklahoma Hospital Association, told Healthcare Dive.
The leaders of the state's major health systems believe that at the moment they are able to handle the surge. Hospitals and providers have learned a lot since the early days of the outbreak in the United States, she said.
"They're not feeling much stress as it relates to the fears about capacity right now because even though we have a significant increase in numbers, they're in the more young population — the noncritical population," she said. "So they're keeping an eye on it but they're not feeling tremendous stress at the moment."
The supply chains for pharmaceuticals and personal protective equipment have also shored up, although they aren't normalized yet, Halstead said.
Hospitals could choose to stop nonemergency care again if needed, but they would prefer to make that decision voluntarily rather than face a blanket order for the governor, she said.
Previous Healthcare Dive analysis has shown hospital capacity varies dramatically across the country, and is not always linked to population. In Texas, for example, the Victoria region has 189 people per hospital bed while Midland has 725. The median across the U.S. is about 400 people per bed.
Tulsa has 326 people per bed and Oklahoma City has 367. Tucson, Arizona, has 417 people per bed while the Lake Havasu City-Kingman area has 342.
Will Humble, former director of Arizona's Department of Health, told Healthcare Dive states that aren't considered hotspots right now should "pressure their governors to have better control measures."
"If you wanna prevent this from happening in your state, pressure your elected officials to make better decisions than ours did," he said.
|Region||People per hospital bed|
|Region||People per hospital bed|
|Cape Coral-Fort Myers||493|
|Deltona-Daytona Beach-Ormond Beach||453|
|Port St. Lucie||427|