Patients who needed the ICU likely couldn't get in, said Gary Raskob, chair of the Oklahoma City-County Board of Health.
Oklahoma’s COVID-19 hospitalizations have been on a downward trajectory for about a month now but not enough to lift some limitations on levels of care available — especially in intensive-care units.
Statewide, the number of COVID inpatients has dropped 35% since the delta variant surge’s peak average of 1,607 in late August to 1,040 reported Tuesday. COVID patients in ICUs have gone from 448 to 324 — a decrease of 28%.
However, Gary Raskob, chair of the Oklahoma City-County Board of Health, said Tuesday that clinicians obviously have had to raise the threshold criteria to place a person in an ICU.
They prioritize which of the patients who need that high level of care actually get an ICU bed, Raskob said.
Some people are suffering in an over-stressed system because of the unwillingness of others to follow prevention strategies such as vaccination and masking, he said.
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“So there’s probably a lineup of people who need to go to ICU but, again, the sickest are prioritized if you have only a certain number (of staffed beds),” Raskob said. “That’s the tragedy of this — if we do better at mitigating and preventing, we don’t have really sick people not getting optimum care.”
Raskob’s comments came during the Healthier Oklahoma Coalition’s weekly briefing with reporters.
Dr. Jean Hausheer, leader of the coalition’s COVID-19 task force, said hospitals and providers who move patients to ICUs are telling the group that they are “very much struggling” still in terms of ICU bed availability and health care staff.
Several examples illustrate that persistent problem.
Oklahoma still ranks among the worst five in the U.S. for COVID hospitalizations per inpatient bed at more than twice the national rate — 17.1 admissions per 100 inpatient beds vs. 8.6 nationally, according to federal data as of Monday.
In their point-in-time reports, the four largest Oklahoma City-area hospital systems showed that only three ICU beds were available among them on Monday. The three were in only one of the four systems.
Dr. Mary Clarke, Oklahoma State Medical Association president, said Stillwater’s hospital most recently had two patients holding for ICU beds in its emergency room but it had no room for them and had nowhere to transfer them.
“I think all of the hospitals in Oklahoma are still having ICU stress and (staffed) beds,” Clarke said. “The nursing shortages are a problem — people are bummed out emotionally and physically.”
Clarke explained that if staffed beds are full, then hospital admissions numbers will look better because of a domino effect that spreads across the state. There is no room to admit more patients.
Weekly new hospital admissions for COVID-19 patients dropped to 676 as of Sept. 22, which is a 23% decline from 875 in late August, at the height of the delta surge, according to state data.
“So we’re seeing a quasi-decline in admissions because there is just no place to put anyone,” Clarke said. “It lags behind, to a certain extent.”
A factor is the COVID inpatient population has skewed younger in this surge than in previous ones, meaning individuals often are able to survive longer on mechanical ventilation because they generally start out healthier.
Dr. David Kendrick, CEO of MyHealth Access Network, based in Tulsa, has found that lengths of stays in ICUs have stretched to about 15 to 20 days from the 10 or 11 days previously. Similarly, the timeframe in general for medical-surgical beds per patient has gone up to 10 to 11 days from five to six days previously.
Kendrick said doctors must make difficult decisions about how best to maximize life and well-being amid hospital capacity woes — triage who moves to the next level of care and who doesn’t.
“But unfortunately at this point — and really especially in weeks past — we’ve had to make decisions to limit the level of care patients get simply because we don’t have that level to offer,” Kendrick said.
