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'The explosion has to slow down': Texas hospitals on edge as coronavirus cases surge

"It’s not like I can triple my capacity overnight because we have a lot of other patients,” said a hospital administrator in Houston.
Image: FILE PHOTO: Texas faces rising coronavirus cases
Ambulances outside of Houston Methodist Hospital amid the coronavirus outbreak this week. Callaghan O'Hare / Reuters

Anxiety is setting in for Texas hospital officials as the number of coronavirus patients has surged in the last few days.

“Currently we have room, but things have to change. This is not good,” said Dr. Faisal Masud, medical director of critical care medicine at the Houston Methodist hospital system. “The explosion of patients all across, that explosion has to slow down."

Texas Gov. Greg Abbott said Wednesday that "there is a massive outbreak of COVID-19 across the state of Texas,” with over 5,551 coronavirus cases on Wednesday and more than 4,000 hospital patients with COVID-19. The latest numbers put the state's new case total at more than 11,000 over two days. The state is in its second week of record-breaking coronavirus hospitalizations.

"I think we can manage right now, but if this trajectory is what it was the last 10 days," said Masud, "when we literally had almost a tripling of our cases — we can’t do that for a couple of weeks at all."

Harris County, which includes Houston, has had the biggest jump and turned to a pediatric hospital to take in transfer patients and free up space for other hospitals.

Houston Mayor Sylvester Turner reported that the area's intensive care units are at 97 percent of their capacity.

In a statement Wednesday, the Texas Hospital Association said that hospitals are reserving 15 percent of bed capacity for COVID-19 patients and could slow or pause non-COVID-related procedures to increase capacity.

But they also warned in a statement that "if this trend continues, it is not sustainable.”

'Tremendous stress' of balancing coronavirus, other patients

In San Antonio, Dr. Bryan Alsip, chief medical officer of University Health System, one of the larger health systems in the city, said rapid increases in the number of COVID-19 inpatients are being seen across all facilities, consistent with cases reported outside the hospital in the city.

The facilities had returned to performing non-COVID procedures over the last six weeks, Alsip said. But as COVID-19 cases have risen, it's put more pressure on the hospitals for capacity.

This week they're scaling back on elective surgical cases “just to make sure we have sustainable capacity going forward,” Alsip said.

Alsip said hospitals are in the same position as businesses that had to shut down earlier in the year. As they've come back they've tried to balance reopening with safety by limiting customers and asking them to maintain social distancing and wear masks.

“Hospitals are in the same position because procedures, many of these cases are revenue sources and so it’s not easy to shut that down again as we did previously,” Aslip said.

Masud, who oversees eight hospitals in the Houston Methodist system, said facilities are under “tremendous stress” as they try to deal with the jump in cases, while trying to treat patients who have been waiting for procedures they should have had three months ago.

“We owe it to the non-COVID patient also," he said. "To me a patient is a patient. If you have a person or a loved one who has a heart attack, am I not supposed to provide care to them?”

While capacity is often discussed in terms of beds, Masud said more COVID-19 patients mean more strain on personnel and equipment. The hospital system also is helping out county hospitals.

“In March and April, all of the elective procedures got canceled so we could apply a lot more teams focused on COVID and we really got it done great,” he said. “The challenge is we have a whole set of other patients to take care of. It’s not like I can triple my capacity overnight because we have a lot of other patients.”

Personnel was furloughed, now needed

Treating COVID-19 does not just involve finding an available bed, he said, noting that “you can have a bed in the Marriott." Providing care to pandemic patents requires nurses, therapies, critical care physicians and other people and equipment.

Adding to the strain, some hospitals have furloughed personnel because of the stop or slowdown of elective procedures, which generate revenue.

“A lot of the personnel that are needed now are having to be hired back or find more people — that means more of the PPE, we need more of that coming in,” said Diana Fite, president of the Texas Medical Association and an emergency care physician.

Even if the state can manage the latest spike in cases, surges are hard on physician’s offices and some smaller hospitals that work on thin profit margins, she said.

Abbott said Wednesday that some new restrictions at the local level may be needed to protect hospital space.

There are no statewide mandates on masks and other COVID-19 preventions, but Abbott is now allowing local officials to mandate that businesses require customers to wear masks. Some Texas officials faced a harsh backlash when they tried to enforce penalties for not wearing masks.

Reaction to the surging coronavirus cases in Texas spilled onto social media Tuesday with #AbbottResign trending nationally for part of the day.

The medical personnel interviewed Wednesday were eager to make public pleas for people to return to more cautious mindsets about coronavirus.

Fite said people should think again about returning to using curbside pickup and staying inside.

"If we don’t do something different today, we won’t have a choice,” Masud said.