Mayor G.T. Bynum last week characterized the hurdle to be admitted into a local hospital for COVID-19 as exhibiting a respiratory system that is in “bad enough” condition or “in danger of collapse.”
Officials with three of Tulsa’s four hospital systems say COVID-19 patients who meet criteria for hospital care are admitted — the primary or first consideration being a need for oxygen. While a person’s respiratory condition is paramount, they say, other factors such as age, comorbidities, lab results and ability to function are weighed, too.
Bynum made his remarks Tuesday during a news conference in which he described the frustrating experiences recently of two city employees who contracted the novel coronavirus and sought hospital beds.
One employee who was “very ill” wasn’t accepted until developing pneumonia, the mayor said. The other was denied at one hospital and then given fluids at a second hospital before being sent home with a sustained fever of nearly 106 degrees.
“So that’s the threshold that our community is facing right now as far as the capacity for our hospitals to be able to treat people. Your respiratory function has to be in danger of collapse,” Bynum said. “Less than that — discomfort, agony — you have to go home and treat it yourself.”
On Thursday afternoon, Bynum appeared on MSNBC to discuss the matter with Chuck Todd, who hosts NBC’s “Meet the Press.” Bynum said hospitals have assured him they will continue to provide care but that they are being restrictive.
“So that’s the way that rooms are being rationed right now is you have to be one of the worst possible cases before you get a hospital bed at this point,” the mayor said.
Overall and ICU hospitalizations for COVID-19 in Oklahoma have risen and routinely set records since the beginning of October, with various hospital leaders or medical experts warning about strains on hospitals and unsustainable trends. No intensive care unit beds were available in Tulsa hospitals last Monday night, although capacity is fluid and can shift by the hour, a spokesman for the Oklahoma Regional Medical Response System said.
Ascension St. John, Hillcrest HealthCare System and Saint Francis Health System each responded to questions from the Tulsa World about criteria for admitting a person with or suspected of having COVID-19.
Oklahoma State University Medical Center in Tulsa did not respond to the questions but provided a statement noting that it had increased its COVID-19 inpatient capacity to over 30% of total staffed capacity and “continues to be committed to meet the needs of our fellow Oklahomans.”
Ascension St. John
No one is being turned away when there is a legitimate need for admission, said Dr. Anuj Malik, director of infection control at Ascension St. John.
In a telephone interview, Malik noted that a person might be held in the emergency room if a bed is not immediately available.
After nine months of the pandemic, he said, hospital officials have been able to refine admission criteria for COVID-19 to identify who is at higher risk to make decisions more rationally rather than driven by fear because of the many unknowns in the pandemic’s early stages.
“So I don’t think that anybody who legitimately deserves — based on current understanding and current judgment of the physicians — I don’t think anybody is being turned away just because there’s a surge in cases,” Malik said.
The main indicator across the globe is respiratory function, he said, but many other factors are considered, such as age, other health conditions, and whether people are able to take care of themselves at home or have family members who can help.
“What we look at are X-ray findings,” Malik said, referencing how a person’s lungs look. “If the X-ray is completely clear and the patient is interacting appropriately, they’re able to sit up in bed, they’re able to answer questions appropriately, talk to you appropriately, and they don’t require oxygen at rest, that’s a low-risk patient that can be monitored in an outpatient setting.”
Malik explained that even before admission, medical personnel will do a “full complement” of chest X-rays or lab tests or whatever treatment is deemed appropriate as soon as they recognize there is a high chance that a person has COVID-19.
He said factors include whether there is a known exposure or symptoms: cough, shortness of breath, fever, body ache, headache, sore throat. Stethoscopes can be used to listen to lungs for signs of pneumonia.
“Anybody requiring oxygen deserves hospitalization, and it might be a short hospitalization,” Malik said. “We might be able to arrange for them to get home oxygen as soon as they start to improve and we know that they’re over the hump and they’re going to head in the right direction.”
Lungs can take two to four weeks to heal from COVID-19, he said. Patients might not be ill at that point, he said, but they still might require lower levels of oxygen.
Malik said physicians tell him that it has become easy to work with insurance companies to get oxygen for home use, with case managers often able to call and get it arranged in an hour.
“We can discharge them faster these days than we used to earlier in the pandemic, and that is not necessarily just related to bed capacity,” Malik said. “Obviously bed capacity is a resource that is finite, so we have to think about that, but nobody is getting discharged prematurely.”
Hillcrest HealthCare System
Most often, the primary factor for consideration is a person’s respiratory condition, according to Dr. Guy Sneed, chief medical officer for Hillcrest HealthCare System.
Sneed, in written responses to questions, said the basic threshold is most often a COVID-19 patient’s requirement for supplemental oxygen, but also that the overall “clinical picture” is considered.
He said strained capacity isn’t causing Hillcrest to turn away COVID patients who would have been accepted during more normal times. Those who meet the criteria and require hospital care are admitted, he said.
There are instances, Sneed said, where patients appear relatively well and exhibit mild symptoms that are more consistent with an upper respiratory infection or seasonal flu. Those patients can be managed at home, he said.
“Unfortunately, some patients with COVID-19 will progress with more serious symptoms, such as respiratory compromise, and require supplemental oxygen,” Sneed wrote.
“Most often, patients who are diagnosed with or suspected of having COVID-19, and require supplemental oxygen, meet the criteria for admission. However, there can be many other considerations or criteria in the decision-making process.”
Saint Francis Health System
After evaluation by qualified medical personnel, patients with symptoms of COVID-19 or suspected respiratory illness are isolated and given a rapid test, according to Lauren Landwerlin, executive director of corporate communications for Saint Francis Health System.
Landwerlin said in a statement that patients simultaneously are provided treatment for symptoms or intervention for life-threatening complications. She said respiratory status and need for oxygen therapy are typically the first consideration for COVID admissions but that many other factors also are weighed in determining whether to admit a person.
“In some instances, physicians will hold patients in the emergency department or an observation unit to monitor symptoms or provide a course of treatment that doesn’t require inpatient admission,” Landwerlin wrote. “If at any time a patient’s condition worsens they will be transferred to the appropriate level of care.”