Logan Health has joined a growing list of major Montana hospitals to request assistance from the National Guard amid record-breaking COVID-19 hospitalizations, while also once again readying an alternative care unit constructed by the U.S. Army Corps of Engineers last year on the vacant third level of the Kalispell children’s hospital.
The 25 Guardsmen assigned to Logan Health Medical Center (LHMC), beginning Oct. 2, are among numerous National Guard requests in Montana since Sept. 15, in response to COVID-19 patients straining hospital capacity and staff across the state. The Guardsmen will assist Logan Health with non-clinical duties.
On Oct. 4, two additional Guardsmen will be assigned Logan Health Whitefish, formerly North Valley Hospital, which has seen more than half, and at times over 70%, of its available beds occupied by COVID-19 patients recently. The Whitefish hospital stopped all inpatient surgeries two weeks ago due to the COVID patient surge.
Local hospital and public health officials say younger unvaccinated patients are representing a larger share of both COVID hospitalizations and deaths. Dr. Cory Short, a hospitalist at LHMC and physician lead of the acute care service line, said the patients in their 30s and 40s have not had diagnosed underlying conditions but share the common traits of being unvaccinated and severely ill.
“This time around we’ve seen a younger unvaccinated population,” Short said. “They’re probably the sickest patients we’ve seen. These are very sick, young patients in their 30s and 40s who require prolonged hospitalization with high-flow oxygen or mechanical ventilation.”
Short, speaking on Sept. 23, could think of four recent COVID-19 deaths of people in their 30s or 40s, an age range when “some of us still feel we can be invincible to a certain degree.”
“It’s tough; it’s really hard to see,” he said. “It’s hard when you see patients with young families at home. It’s hard to hear about distrust in vaccines, vaccine hesitancy. Holy smokes, we’re seeing some really, really sick individuals who have not been vaccinated. I can’t help but think, ‘Boy, data has demonstrated that if they had been vaccinated, they wouldn’t have had to come into the hospital.’”
Between LHMC and Logan Health Whitefish, there have been between 54 and 57 COVID-19 hospitalizations in Flathead County each day this week. Before the current surge, the county’s previous single-day record for hospitalizations was 39 on Nov. 30, although the county has regularly exceeded that number in August and September.
Flathead County also experienced its third-deadliest month of the pandemic in August with 18 COVID-19 deaths, trailing last November and December, which saw 20 and 25 deaths, respectively, although nursing-home outbreaks contributed heavily to the late 2020 numbers while the current deaths are overwhelmingly coming from the general population and trending younger.
On the heels of a deadly August, nine COVID-19 deaths occurred in a recent two-week period this month, while five additional deaths were added to the tally this week, bringing the county’s death toll to 32 in August and September, and 141 total since the pandemic began, as of Sept. 24.
Led by the county’s record-breaking COVID-19 hospitalizations, Logan Health has been routinely operating above 90% capacity of its Kalispell adult acute care beds, including days over 100%. The hospital has made adjustments to accommodate the overflow, including boarding patients in the emergency room and at times using pediatric intensive-care unit (ICU) beds.
“We’ve been utilizing some of our clinic spaces that haven’t been historically used for adult patients,” Short said.
The hospital has also been forced to be “very selective” in which elective procedures it approves, Short said, and has rescheduled or canceled some procedures.
“Fortunately we haven’t gotten to the point that we’ve had to use hallway space like you see in other hospitals,” Short said.
Between 30% and 40% of all 126 available adult acute beds at Logan Health’s Kalispell campus have regularly been dedicated to COVID-19 patients, an exceptionally disproportionate number for a single malady at a large regional hospital.
“In my career, I’ve never seen anything like this,” Short said. “I’d prefer not to have to ever see this again.”
Meanwhile, at Logan Health Whitefish, COVID-19 patients have frequently been occupying 10-13 of the hospital’s 18 available beds in recent weeks.
“That team has done an incredible job working with their COVID patients,” Short said.
Riley Polumbus, a Logan Health Whitefish spokesperson, said the hospital has averaged nine COVID-19 patients over the past week, although that number has climbed to 13. The hospital has 25 beds overall, but seven are in The Birth Center, putting the hospital’s actual number of available beds at 18 total, which means at times COVID patients have occupied more than 70% of all available beds.
Polumbus said 15 of the 18 rooms have been converted to treat COVID patients, while the remaining three will be converted next week. In addition to ceasing all inpatient surgeries, the Whitefish hospital has converted its cafeteria dining room into an overflow waiting area to accommodate symptomatic patients for the emergency department, while constructing a respiratory screening facility on campus and establishing a walk-in clinic for overflow and symptomatic patients who want to see a provider.
The Whitefish hospital also has 15 travel nurses currently working.
“They have been a huge help, a relief to our staff and we are grateful they are here,” Polumbus said of the traveling nurses in an email.
Logan Health requested assistance from the National Guard this week to assist with non-clinical duties such as screening and other tasks. The hospital joins St. Peter’s Health in Helena, Billings Clinic and St. Vincent Healthcare in Billings, St. James Healthcare in Butte, Bozeman Health, Benefis Health System in Great Falls, and Missoula County, among others, in requesting National Guard assistance since Sept. 15.
“On behalf of a grateful state, I thank the men and women of the Montana National Guard who are stepping up within their communities to serve their neighbors,” Gov. Greg Gianforte said in a Sept. 22 statement. “As we face a surge in new cases and hospitalizations, the best long-term solution to this crisis is for Montanans to talk with their doctor or pharmacist and get vaccinated. While we will not mandate vaccination in Montana, vaccines are safe, they work, and they can save your life.”
At least four Montana hospitals, including St. Peter’s Health in Helena, have implemented crisis standards of care, a rarely used emergency declaration that means treatment and resources may be rationed for patients.
“For the first time in my career, we are at the point where not every patient in need will get the care that we might wish we could give,” St. Peter’s Health Chief Medical Officer Shelly Harkins said last week. “By almost every single measure we are in a far worse position than we ever were in the winter of 2020, during our first surge.”
Short said Logan Health is working on a plan to implement crisis standards of care if necessary.
“Fortunately we’re not at that point yet, but we’re definitely putting a plan in place,” he said.
This week the hospital is preparing its alternative care unit, constructed last May in preparation for a potential spike in COVID-19. The U.S. Army Corps of Engineers (USACE), under a mission assignment from the Federal Emergency Management Agency (FEMA) in support of the state of Montana, oversaw construction, which transformed the 26,250-square-foot empty space located on the third level of Logan Health’s children’s hospital into a nearly 100-bed facility.
Logan Health officials said the state of Montana took back the facility’s medical equipment after the state of emergency declaration, put in place by former Gov. Steve Bullock, was revoked by Gianforte in January.
Logan Health is now equipping the alternative care unit with its own equipment as a proactive measure. If activated, the unit would treat non-COVID-19 patients to create more capacity for treating patients infected with COVID-19 in the hospital system’s acute care settings.
“Keep our fingers crossed we don’t have to get to that point,” Short said. “But if we do, we’ll be prepared for it.”
Short and other medical officials say the single best way to slow and begin reversing the current trend is widespread vaccination. Combined across all four of LHMC’s weekly status reports since Sept. 1, 34 of the 35 COVID patients in the ICU and all 19 on ventilators have been unvaccinated.
Vaccination saves lives and reduces strain on hospitals, thus reducing stress on the frontline staff, Short said.
“Morale continues to be challenged daily, but resiliency is the word I would use, an incredible amount of resiliency,” he said. “From ER nurses and physicians, respiratory physicians, hospitalists, the ICU, there are lot of people stepping in to help each other out.”
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