Record numbers of COVID-19 patients hospitalized two weeks after Oklahoma declined to renew overflow contracts

As flu season nears, public health and medical professionals are concerned about strained hospital capacity and staffing shortages in Oklahoma, especially regarding intensive-care beds. Oklahoma posted a record 738 hospitalizations overnight Monday, topping the prior record of 699 set only a day earlier.

The high before this week was the 663 hospitalizations reported July 28. COVID-19 hospitalizations consist of confirmed cases and those suspected of having the illness.

The numbers of COVID-19 patients in state ICUs the past two weeks have been relatively stable, bouncing between 220 and 245. However, state data released Tuesday showed 258 COVID patients in ICUs — the third highest number yet. The peak was 281 on April 2.

Of the state’s 1,021 ICU beds, 143 — or 14% — were available as of the latest hospital census by the state. The percent of ICU beds available has steadily declined since elective surgeries resumed April 24, with the highest percent available reported May 8 at 45%.

“We have a shortage in Oklahoma of nurses and physicians, and what we’re seeing is from time to time hospitals are going on divert (sending new patients to other hospitals) because they just don’t have that capacity either for ICU beds or COVID beds,” Dr. George Monks, president of the Oklahoma State Medical Association, said Tuesday. “That situation can change hourly, but it shows us that things are under strain.

“Staff, nurses, doctors are being asked to work longer hours and pick up more shifts because we have so many people in the hospital right now.”

Deputy Health Commissioner Travis Kirkpatrick said the Oklahoma State Department of Health is monitoring whether the record hospitalizations numbers are outliers or a trend that might “warrant further consideration or response.”

In a written response to questions, Kirkpatrick said ending the overflow contracts was a fiscally prudent move to build “something more sustainable” before federal CARES Act funds are exhausted by Dec. 31 rather than use them on the “short-term bed contracts.” He said the decision will be revisited if necessary and that there are “back-up bed options” if a surge of patients goes beyond capacity.

Previously, state officials had described the overflow contracts as a good insurance policy for the state to be open and not risk overwhelming the hospital system.

Overflow contracts with seven hospitals were designed to pay each to guarantee the necessary staffing should an overflow bed be needed by underwriting overtime or bonuses, new staff or contract workers. The contracts — $1,000 a bed per day or $3,000 if occupied — were funded by the CARES Act.

“We cannot and will not turn patients away,” said LaWanna Halstead, vice president of quality and clinical initiatives for the Oklahoma Hospital Association.

Halstead explained that hospitals still retain their internal surge plans but no longer are supported by state funding since the end of September.

She said some nursing staff, especially temporary staff, go to COVID-19 hot spots for more money. She said the largest concern confronting hospitals in Oklahoma is the ability to appropriately manage capacity through staff.

“We do hear from hospitals that their staff is pretty weary of the extreme capacity and conditions that they’re dealing with, having to always wear the (personal protective equipment),” Halstead said.

“We don’t want to wear a mask for an hour, and yet hospital staff wear it for eight- or 12-hour shifts at a time. The full PPE, with masks and gowns and gloves. So it is wearing on the staff.”

She noted that hospitals probably will need to work closely with their specialty partners, such as rehabilitation or skilled nursing, on a more rapid basis. They also might have to eliminate elective surgeries, which no one wants to do because that isn’t good for public health, she said.

Lt. Col. Matt Stacy, who coordinated the state’s surge strategy, acknowledged that the optics of the timing are unfortunate. He said the state gave 10-days’ notice to hospitals that the overflow contracts would end Sept. 21.

Stacy said the state felt it had given hospitals enough financial support with the $1,000 per bed per day standby rate during the initial 60-day contract term.

Stacy, who is on the Governor’s Solution Task Force, said hospitals are “in good shape” and that it’s important to remember that they are still performing elective or nonemergency surgeries.

“I’m not saying the COVID patients don’t stress them to some extent, because it does. It does stress them,” Stacy said. “But it’s not detrimental to the health system. Our intent with the surge money was to make sure that we didn’t have a situation that was detrimental to the health system.

“We felt like they were able to manage with the resources that they have and the resources that we provided them over a couple months.”

Monks said the state’s high test positivity rate is an indicator that more hospitalizations loom.

The White House Coronavirus Task Force in its Sept. 27 report ranked Oklahoma No. 3 in the U.S. for weekly test positivity rate. Oklahoma’s rate was 11.8% while the national average was 4.3%.

Monks said Oklahoma City and central Oklahoma currently seem to have the hospital systems or regions under the most pressure.

Dr. Dale Bratzler, OU’s chief COVID officer, on Friday described how recently a few patients from the Oklahoma City area were transferred to Tulsa hospitals because finding ICU beds there “was getting difficult” for a short period of time.

Bratzler also said Stillwater Medical Center had been taking transfers from smaller community hospitals that don’t have the capability or ICU beds to care for COVID-19 patients, prompting the facility to open about five more beds.

Gov. Kevin Stitt routinely says the state has plenty of surge capacity. So how did Oklahoma City-area hospitals fill up enough, albeit for a limited time, to prompt patient transfers to Tulsa?

Fitzpatrick said each hospital “has the flexibility to adapt based on the circumstances every day” and that the state monitors data but doesn’t control or mandate transfer decisions, patient treatment decisions or daily hospital staffing.

Surge plans are in place for Oklahoma City that can be activated if needed to increase hospital capacity, he said.

“We work closely with our hospitals to help manage capacity statewide,” Fitzpatrick stated. “We have ample capacity currently to ensure all Oklahomans who need to be hospitalized are able to receive top-notch care.”

Monks also pointed to what he called the “consistently high” seven-day average of new cases in Oklahoma, with the state topping 1,000 on Tuesday for the 16th time in 18 days.

After two days of lower numbers, 1,364 new cases were reported Tuesday — the second most in a day yet. The record is 1,401 reported July 27.

The seven-day average on Tuesday was 1,018, down from the record 1,136 on Sept. 25.

The longest consecutive stretch of seven-day averages above 1,000 was 15 days, from Sept. 19-Oct. 3. The previous longevity mark above 1,000 was six days from July 27-Aug. 1.

“One more worrisome statistic is in September we saw the rise in new cases in young patients,” Monks said. “We are now seeing a shift to those older, more vulnerable age groups making up these new cases, which is concerning. Those are people more likely to maybe need a hospital bed.”

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