Social distancing is working in Bend. But because rural areas in Oregon lag behind larger cities on the timeline for peak COVID-19 surges, lock down may continue through the summer. Scientists who use data from Central Oregon to make future COVID-19 projections predict an increasing but manageable caseload by the end of the month.
“While the peak is still coming, your efforts are really making a difference,” said Joe Sluka, president and CEO of St. Charles Health System, during a virtual press conference Thursday afternoon. “It has given us precious time to prepare. Now is not the time to let up on social distancing… it is time to double down and continue to stay home.”
So far, St. Charles has been underwhelmed by COVID-19 cases but is ramping up for the worst-case scenario.
“So far [St. Charles Medical Center in Bend] has discharged six patients from the ICU and currently has nine COVID-positive patients who are hospitalized, and four who are in the intensive care unit,” said Dr. Jeff Absalon, the chief physician executive for SCHS. More people have been coming into the hospital this year for general respiratory illnesses but testing negative for the virus, he said. He expressed some concern that new patients were delaying trips to the hospital because of fear of the illness or the belief that the hospital is overrun, but he emphasized the hospital is still open for people with health concerns other than COVID-19.
We [now] have the opportunity to test anyone that has worsening symptoms. – Jeff Absalon, the chief physician executive for St. Charles Health System
The hospital has three to four weeks of supplies of personal protective equipment based on today’s usages but could come up short in the event of a COVID-19 surge, Absalon said.
“We continue to be impacted by disruptions in production and high global demand,” Absalon said. “N95 masks [medical grade masks] and isolation masks are our most challenging items to source.”
Absalon said the hospital was grateful for all the PPE donations from the community. Since launching its 10,000-masks campaign last week for hand-sewn masks, it has received over 3,800 homemade mask donations.
Testing ramps up
St. Charles has tested nearly 1,000 people so far and confirmed 801 negative results, 33 positive cases (nine who are currently at the hospital), and it is waiting for 137 pending test results. As the Source reported last week, St. Charles has to send samples to the University of Washington and does not get results back for 48 hours. It has been difficult for the hospital to obtain testing supplies because Central Oregon has not been a high-priority region, officials there said.
Starting Friday, St. Charles will be able to do some tests on site. While it had this capacity for some time, it was waiting for re-agents (chemicals needed to mix with throat/nose samples) to arrive at the hospital. Once its own testing is up and running, the turn-around time for results will be just a few hours, Absalon said.
With the new testing capacity, St. Charles is expanding its testing criteria. So far, it has used the guidelines from the Centers of Disease Control and Prevention.
“We [now] have the opportunity to test anyone that has worsening symptoms,” Absalon said. “We encourage you to go to your doctor. This will help us identify who has it, how we isolate them, and how we can manage this disease.”
In addition to worsening symptoms, the patient must have also had a fever above 100.4 F in the last 24 hours and either a cough or chest pain.
The hospital will test for COVID-19 antibodies in the asymptomatic population in the future, but this is part of a long-term strategy and will not be available in next two weeks, Absalon said.
Preparing for a Surge
The hospital is prepared with adequate workforce and medical supplies if COVID-19 cases surge in the region. It can increase capacity and convert rooms to COVID-19 patient rooms at all four of its locations in Central Oregon (Bend, Redmond, Madras and Prineville). It is prepared to repurpose outpatient and visitor spaces and can double the inpatient beds in the hospital, Absalon said.
“We are very early in this battle with COVID-19,” said Mike Johnson, the senior data scientist at St. Charles. “[Some people are worried] we are lagging behind the rest of the state. Lagging is a good thing because we were able to jump on it by changing public behavior, adhering to social distancing and canceling large events, closing schools and washing hands.”
“We will not see our peak resource use in the next three weeks,” Johnson said while presenting a chart showing that Central Oregon is at a flat point in his projected local case curve. “By the end of April, the curve is on an upward trend.”
“Now is the time to double down,” Johnson said. “Early efforts return an exponential payback if you do it early enough in this curve. Although we’ve done very well, we do have room to improve; we could flatten the curve even more.”
Will St. Charles survive?
St. Charles Health System has enough cash and liquid investments on hand to run for eight months without revenue, according to Jenn Welander, St. Charles’ chief financial officer. Since March 16, the hospital system’s revenue dropped by 45%, largely as a result of delaying elective surgeries. It recently drew on its line of credit.
At the same time, the hospital’s expenses went up as it paid for COVID-19 preparedness and continued to pay employees for their scheduled shifts.
In order to conserve cash, the hospital suspended all capital projects unrelated to safety, regulations and preparation for the COVID-19 surge. All non-essential spending has stopped and contract work discontinued. The hospital suspended employee educational travel through the end of August. It is trying to get discounts and payment extensions from its vendors.
“We are continuously evaluating all available [funding] opportunities,” Welander said.
Funding opportunities include advanced payments from Medicare and a 12-month interest-free loan from Medicare, emergency funds from the Federal Emergency Management Agency and funds for worker safety through the State Accident Insurance Fund Corporation. The hospital is also trying to settle contracts with insurance companies from last year instead of waiting until the end of the standard collection period.
Welander is waiting on the details from the federal government about how to apply for the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but said she expects to find out within the next few days.
The president of St. Charles, Joe Sluka, closed the meeting by encouraging people to donate to the St. Charles Hero Fund run by the St. Charles Foundation or to the Deschutes First Response Fund managed by the Deschutes County Sheriff’s Office.
Have questions about how St. Charles is handling the coronavirus crisis? Put them in the comments below! We are in frequent contact with sources at St. Charles.
In the meantime:
COVID-19 local trivia – Quiz your friends!
(Answers provided by Dr. Jeff Absalon of St. Charles Health System)
- Can St. Charles help patients from other places if that region’s hospitals become overloaded?
St. Charles is the designated regional hospital by the Oregon Health Authority for region seven in Oregon which includes Central Oregon’s four hospitals as well as Sky Lakes Medical Center in Klamath Falls, Lake District Hospital in Lakeview, Blue Mountain Hospital District in John Day and Harney District Hospital in Burns. This consortium can sent patients and resources to one another when needed.
- Are employees at St. Charles who are not working on COVID-19 laid off? Are St. Charles employees safe at work?
St. Charles has not laid off any medical workers even though elective surgeries have been canceled for the coming months. All caregivers who provide direct patient contact at the hospital must wear masks, and the hospital is working hard to conserve its supply of PPE.
- Are doctors in Central Oregon prescribing their patients the anti-malaria drug hydroxychloroquine along with the antibiotic azithromycin? President Trump has touted this as a miracle cure, but some people in Central Oregon need these drugs for other illnesses and are worried there may be a shortage.
St. Charles is using this combination for some patients at the hospital with COVID-19. The Oregon Board of Pharmacy does not allow doctors to write prescriptions for these drugs for outpatient use.
- What percentage of people with COVID-19 are carrying the illness but present no symptoms?
Twenty percent of COVID-19 carriers have no identifiable symptoms, 60% will have symptoms consistent with the flu, 20% will have significant illness and require hospitalization and 5% will end up in the ICU.
- What is the mortality rate for COVID-19?
Mortality rates range by country from 1-12%, but the global average is 3%.
See all our Coronavirus coverage at our Coronavirus HQ.
This article appears in Mar 25 – May 20, 2020.
MAKE LOCAL JOURNALISM HAPPEN
Republish our articles for free, online or in print, under a Creative Commons license.
Are people aware that the hospital is considering cancer surgery as elective and not performing them? Cancer patients are left waiting with cancer that can spread while waiting months for their surgery. This is criminal and these cancer patients are an additional victim of Covid19.
“but he emphasized the hospital is still open for people with health concerns other than COVID-19.” If thats the case, why are people with cancer and other serious medical needs denied the surgery and treatment they need?! People are going to die while we wait for something that “might” happen!
the only cancer treatments suspended right now are those that waiting will have no medical outcome on. it is a decsison made between the MD and the patient. plenty of cancer patients are still getting surgery, chemo and radiation. this is fake news, the source should deal with these comments.
Its not just cancer. There are many others with serious, debilitating needs who are being ignored. There is such a simple common sense answer to this its just crazy this cant be worked out.
Greg Ouellette, You are lying…not me. Try telling a cancer patient they have no medical outcome. Diagnosed in February, waited 2 months for available surgery date, only to find out (by calling to confirm) that our surgery was canceled by the hospital. Nobody informed or consulted with us. Now we have to wait months again. Cancer can spread. So how dare you tell me there is no medical outcome. I guarantee, if you were the one with a cancer diagnosis, you wouldn’t have such a cavalier attitude.
Its obvious Greg’s butt is not on the line and he has no first hand knowledge or experience with this. The fake news is being put out there by Greg. When you are told at the doctors office the hospitals are not taking patients and will not schedule your surgery the position of the hospital becomes very clear. They don’t want you and they have made that quite clear to the doctors. Again, there is such a simple, common sense solution to this matter I have a hard time believing its an issue. I wish the staff mentioned in this article were available to approach about a solution.
I’m sorry, Greg, but I am still fuming over your comments. Yes, it is obvious you have zero first-hand knowledge on this subject. What possible cancer diagnosis has no medical outcome? Really? And, your comment that the hospital couldn’t have canceled this surgery and it’s a decision between the doctor and the patient….how do you know this? I, on the other hand, have first-hand up close and personal knowledge that some cancer surgeries are being canceled….without any consultation from the hospital. The following letter was written in the Bend Bulletin…..Obviously, from another very unhappy cancer patient that had his cancer surgery canceled out from under him. You, Greg, owe me an apology….
Gov. Brown has ordered hospitals to cancel all elective surgeries and procedures due to the demands placed on our medical system due to the war against COVID-19. This is certainly understandable in light of the demands on personnel, the shortage of protective gear and the predicted onslaught of seriously ill patients. These measures are designed to save lives and prevent our medical system from being overwhelmed.
I am concerned about which surgeries and procedures are deemed “elective.” This is because I am diagnosed as having a high-grade cancer that had failed to respond to first-line treatment. The “gold standard,” potentially lifesaving treatment for my cancer is radical surgery, which was scheduled to take place later on this month and then canceled. I have waited four months to have the procedure. If I am not operated on in a timely manner, my cancer has the potential to spread and end my life. I can understand that delaying procedures for non-life threatening conditions such as joint replacements and colonoscopies is justified.
Surgeries and procedures that are time-sensitive and potentially lifesaving should not be classified as “elective.” In the event my cancer spreads and takes my life, I and others like me should be considered “collateral damage” in the war against COVID-19. I urge our leaders to take note of this situation and allow hospitals and clinics to schedule these surgeries and procedures as soon as possible.
— Donald B. Barber, Redmond
And another thing, Greg….you state that “plenty” of cancer patients are having surgery. What percentage is “plenty” to you? 50% of cancer patients? 75% of cancer patients? To me, it’s not enough until 100% of cancer patients are receiving their life-saving surgery. Every cancer patient matters…not just “plenty” of them. All cancer is life threatening….it should NOT be considered elective by the hospital.
Unfortunately folks, we accomplish nothing here trying to convince Greg of the realities we all face. The real issue is St.Charles. They established a monopoly and control all hospitalization options. Its my belief they should be more accountable to the the people they supposedly serve. One thing that would help is if they set established some clear guidelines about what is considered “elective” and what is not. Does a person have to be so bad off that 911 is called or an emergency room visit required? Do they have to be suffering in agony? Seems like we are closer to that standard than a more reasonable and compassionate approach. A person would think some sort of standard could be established to treat people before their condition reaches a level that will require even greater time in the hospital with possibly more complications. And a clear standard defining elective vs needed would be helpful to all. Unfortunately the decision makers at the hospital appear to just be running in fear of what might happen instead of responding to whats right in front of them. That’s sad and a poor demonstration of the leadership all of us expect.
I heard from a couple of medical providers that recently there have been 3 or 4 deaths in Central Oregon that post mortem were determined to be CV 19 but those post mortem positive deaths do not get counted as CV 19 deaths here in the county because officially we have none? One of those victims had been in to an urgent care twice and was sent home not having severe enough symptoms to be sent to intensive care AND not having severe enough symptoms to be tested because those are in short supply and he was not in a high risk category. (The guy was “healthy” and in his 30s I believe I heard) Does anyone out there know anything about the possibility that post mortem positive tests for CV 19 deaths not being counted? Are the parameters of the stats determined by the state or the CDC or? One of those deaths was from a staffers husband and the other two were determined buy calling the coroner I was told.
A follow up to what I just posted I have a right wing conspiracy nut tenant who informed me that the postmortem positive tests were just a fraudulent conspiracy to defraud insurance companies because they get big payouts. He has extensive internet research proof! This guy thinks the whole CV 19 thing is a government conspiracy. I am not exactly sure what our evil government would stand to gain. (giant bungeling bureaucracies would not stand to gain much either that I can think of)
This is the first time I am hearing about cancer patients not getting the treatment/surgery that could help them tremendously… I lost my biological father to pancreatic cancer in 2015, and my stepdad passed in 2018 from lung cancer, so hearing that news is definitely concerning and I can see why people would be upset… My only question is are they postponing surgeries due to the fact that the doctors want to limit their exposure to the coronavirus? Their immune system is already at a much higher risk for diseases and such, so maybe that is why they are postponing surgeries? That is the only logical (somewhat) explanation I can think of for the hospital to make that call… Again, not trying to downplay the issue, just trying to understand the medical providers reasoning….
Prayers to those affected by this virus!