Covid surge stretches staff, resources at Las Vegas hospitals

As Southern Nevada hospitals rush to meet demand caused by a spike in COVID-19 hospitalizations in recent weeks, health care staff are adapting to more work, staffing changes and the possibility that the pandemic may affect Southern Nevada for months to come.

The Nevada Hospital Association reported increased COVID-19 patient hospitalizations beginning in mid-June, just as typical patients began returning to local hospitals and weeks after elective procedures resumed at many facilities in May.

Now, doctors, nurses and other staff must keep up the sometimes intensive care required by the influx of COVID-19 patients while balancing their pre-pandemic duties.

“We’re learning how to combine treating patients with COVID and carrying on the care of our other patients who don’t have COVID. We’re just learning how to do both safely,” said Deborah Kuhls, a critical care and trauma surgeon at the UNLV School of Medicine and University Medical Center of Southern Nevada.

Kuhls, president of the Clark County Medical Society, said hospital staff across the valley have adapted to extra work and extra hours as the need for skilled workers has grown greater over the past month. 

“Early on in the pandemic, there was a shortage of (protective gear) and equipment, and there was a lot of concern about running out of ventilators,” Kuhls said, “and it’s really transitioned. Most of the hospitals have adequate PPE and equipment, but I think the shortage is mostly of people.”

The strain is caused not just by the volume of patients but by the level of care necessary to treat them.

Coronavirus-positive patients can “require real attention to their pulmonary status not only in terms of oxygen but different types of therapy,” Kuhls said. “The people who are really ill, they’re intubated and then they have to be (placed on their stomachs), and they can’t really turn themselves on their stomach. It really takes a team of people to do that.”

Official numbers through Tuesday released by the hospital association show statewide hospitalizations “continue to trend upward,” but the pace of the increase has slowed.

The Valley Health System experienced a four percent increase in its COVID-positive inpatient census between July 7 and July 21, meaning about 20 percent of inpatients in the system’s six facilities are COVID-19-positive and are “receiving care in a designated medical/surgical unit or the ICU,” said Gretchen Papez, marketing director for VHS, via email.

At University Medical Center of Southern Nevada and within the Sunrise Health System, hospital officials are also seeing what they say is a manageable jump in cases.

“The amount of coronavirus cases has increased, and because of it we are seeing a surge at our hospitals. We are definitely more busy now than two weeks ago,” said Antonio Castelan, director of content and creative marketing for HCA Healthcare’s Far West Division. HCA operates Sunrise Hospital & Medical Center, MountainView Hospital and Southern Hills Hospital & Medical Center. 

Out of an abundance of caution, Sunrise Hospital has postponed elective procedures again. MountainView is also postponing surgeries that would require the patient stay in a hospital bed after surgery.

As hospitals address the increase in COVID-19 patients, they are also still grappling with financial challenges caused at least in part by lost business via lockdown orders and canceled elective surgeries in spring. Those challenges led several local hospitals to institute furlough programs in the midst of the pandemic.

The Valley Health System, or VHS, confirmed some staff were furloughed in spring and that they’ve “been able to bring back the majority of those employees,” Papez said.

Dignity Health-St. Rose Dominican Hospitals had a “limited number of temporary furloughs in some non-clinical areas,” but the hospital system has also added traveling nurses to aid clinical staff, said spokesman Gordon M. Absher via email.

At county-run UMC, about 200 of the hospital’s roughly 3,500 full-time employees applied for a voluntary separation package as of June 17, according to committee meeting minutes. A final estimate on the number of employees who applied for the package — the application deadline for which was June 30 — was not immediately available, said spokesman Scott Kerbs.

Added to the staffing changes, the additional patients and increased workload are fears over how hospitals would handle large volumes of coronavirus patients in the fall.

A registered nurse at a local hospital, who asked not to be named due to fear of potential impact on her employment, said she is anxious about the pandemic continuing and coinciding with flu season. 

The nurse, who typically works in labor and delivery but has been called on to care for COVID-19 patients, said if cases continue at current levels, not only will hospital resources be stretched, but the nurses will continue to face uncertainty each time they step into a room.

“What worries us is usually, at this time of year, we don’t see this many patients in the hospital,” she said. “If we’re running out of nurses now, imagine what’s going to happen in the fall.”

On one recent night, the hospital where she works had dozens of people waiting in the emergency room for a bed, she said.

She worries about potentially spreading the virus to her family, including her children.

“I already prepared myself mentally to live like this for the next two years,” she said.

In April, Service Employees International Union Local 1107 called upon the Occupational Safety and Health Administration to resume in-person inspections at local hospitals over concerns that facilities weren’t doing enough to protect workers or to plan for how workers could protect their families. In-person inspections related to workplace investigations resumed in early May, said Teri Williams, public information officer for the Department of Business and Industry Director’s Office.

Williams confirmed that Nevada OSHA has received 42 complaints about Nevada hospitals related to COVID-19, though the details of those complaints in open investigations are confidential.

Kuhls, who said she believes hospitals have prepared and planned well for any surges and worker safety, does not believe the hospitals will face more than they can handle.

But the longer the pandemic does continue, the harder it will be on Southern Nevada’s health care workforce, she added.

Months of caring for additional patients could take a physical and emotional toll, leading to cases of fatigue and burnout among health workers. Without the public’s help in wearing masks and maintaining social distancing, she fears the pandemic could continue into the fall and flu season.

“There’s a lot of concern,” she said. “If we don’t get coronavirus under control and flu season does come, it will be really (dealing with cases of) two diseases.”