In contrast to Governor Hutchinson’s daily reassurances that Arkansas is successfully managing the COVID-19 pandemic, Arkansas hospital leaders appeared before a legislative committee on Wednesday to express concern about the potential for a surge of COVID infections in September and October that could overwhelm the state’s health care system.
University of Arkansas for Medical Sciences Chancellor Dr. Cam Patterson said that predictive models from the University of Washington’s Institute for Health Metrics and Evaluation and the UAMS College for Public Health each suggest Arkansas’s COVID peak will happen in September or October. But the models diverge significantly in terms of the estimated magnitude of the peak. Patterson said the IHME model predicts that the infection rate at the peak (with daily reports of nearly 2,000 cases) will be 10 times higher than the current rate, while the UAMS model predicts it will be 50 times higher. (Today’s new infections totaled 322.)
Patterson told the Hospital and Medicaid Study Subcommittee of the Arkansas Legislative Council that Governor Hutchinson has been correct when he answers questions from the press about hospital capacity and responds that hospitals statewide currently have sufficient capacity.
“But we do not have infinite resources,” Patterson said. “If we are not careful in managing this, if we are not careful of pushing the incidents of infection to the lower peak rather than the higher peak, we are absolutely at risk of overwhelming our health care system in the state of Arkansas.”
Dr. Jerrilyn Jones, Arkansas Department of Health preparedness medical director, and other hospital leaders from across the state described regional and hospital-specific surge plans to add bed capacity to care for COVID patients. But they said other potential “choke points” remained.
Dr. Steppe Mette, CEO of UAMS Medical Center, said dealing with the sort of surge predicted by the UAMS model would require hospitals to again postpone non-emergency procedures. Those account for a significant portion of hospitals’ revenues. When Governor Hutchinson mandated that all elective procedures be delayed in the spring, UAMS and Baptist Health lost around $1 million per day, Patterson and Troy Wells, CEO of Baptist Health, told the subcommittee. Wells said Baptist Health expected to lose between $85-$100 million this year.
Mette said maintaining sufficient numbers of health-care workers, including nurses and respiratory therapists, was also a major concern. Since mid-March, UAMS has had 1,000 employees who have had to go into 14-day quarantine because of exposure. “That is the empiric experience that has happened throughout the country,” Mette said. “Look at New York. Their primary capacity issue was related to not having enough doctors, nurses and respiratory therapists to care for critical patients. It wasn’t a hospital bed issue.”
He said UAMS had discussed creating “float pools” of nurses and other hospital workers who could help in other hospitals. Jones said the health department was looking into speeding up the licensing process for nurses and others. Health officials also talked about the possibility of recruiting volunteer nurses from other states. A number of nurses from Arkansas volunteered in hard-hit New York during the spring. But Arkansas shouldn’t expect nurses from New York or other states where cases are on the decline to return the favor, Wells warned. Health-care workers in those states are working to clear the backlog of elective procedures that were delayed during the COVID-19 peak.
UAMS has sufficient personal protective equipment and ventilators — aside from N95 masks, which continue to be in short supply across the world, Mette said.
Sen. Keith Ingram (D-West Memphis) asked Patterson if he had recommendations for the state on how to best utilize federal CARES Act money to best serve hospitals in preparation for the anticipated surge. Ingram said he was uneasy with the amount of money the state is spending on the front end of the crisis.
“Let’s focus on preventive measures to make sure we’re doing everything we can to keep the cases as low as possible,” Patterson said. “Let’s make sure that we are maintaining the services of the hospitals that would be needed in crisis. Let’s make sure hospitals are solvent and able to provide care. And … I would leave some dry powder on the table for this fall.”
Sen. Jonathan Dismang (R-Searcy) asked who was coordinating the statewide hospital response to a potential surge. Patterson said that in surge planning, hospitals around the state have done a lot of work to build relationships and share resources.
But ADH’s Jones said that, because the disease is so new, there are no established “trigger points” to tell hospitals precisely when to halt elective procedures or take other steps. “That’s where the relationships come into play,” she said.
Patterson warned the subcommittee that “post-acute” capacity will likely be an issue. He cited, for example, a homeless person who is infected with COVID-19 who is well enough to leave a hospital, but needs somewhere safe to recuperate.
Larry Shackleford, president and CEO of Washington Regional Hospital in Fayetteville, said Northwest Arkansas’s COVID spike was not simply due to increased testing. He said his hospital’s testing positivity rate had climbed from 2 percent in mid-May to 14 percent this week. He said it was important that the public in Northwest Arkansas understand that the region is amid a public health crisis, but that his hospital is safe for patients with other health needs. He said Washington Regional had seen an increase of patients who were coming to the hospital later than they should have. He said the hospital had adequate testing resources and PPE to ensure the safety of patients.
Chris Barber, president and CEO of St. Bernards Healthcare in Jonesboro, said that his hospital lacked sufficient rapid-testing kits. Those are crucial for safely performing other procedures. Barber said that St. Bernards is allotted 180 testing kits per week, but that the federal government often reallocates them.