Slowing COVID-19 spread is only way to fix El Paso’s hospital crisis, emergency medicine expert says
As El Paso’s COVID-19 crisis continues, an emergency medicine expert warns hospitals may run out of space to treat those affected by the pandemic.
State and federal agencies have sent a wave of medical personnel and resources to El Paso during the dramatic spike in cases, but hospital officials worry those resources will no longer be available if cases begin to spike in other parts of the state.
Dr. Edward Michelson, chair of emergency medicine at Texas Tech University Health Sciences Center El Paso, gave El Paso Matters a candid view on Tuesday about what may happen if cases do not decline significantly. He treats patients at University Medical Center.
Concerns about the growing hospital crisis
I’m just worried that the community is not taking seriously the recommendations that are necessary to stop the spread.
I think people believe that if they get COVID they will be fine, that they won’t be very sick. I believe they think that if they get COVID they will know it, and then they will take precautions. Except we know many people are asymptomatic carriers and could infect their family members and their friends.
I think people believe that if they get sick enough to have to go to the hospital that they don’t have to worry about the hospital having capacity to take care of them.
I think all of the hospitals have done a great job of trying to put out a positive light in this pandemic, and they have done a great job. I mean, how many hospitals can add 150 beds to their operation in a fairly short period of time?
But I think folks take for granted the idea that there is a limitless capacity for them to receive care if they need it for COVID and we are getting to the point where it’s not going to be true.
Maybe we have done a disservice to the community by not being frank with them about how serious the problem really is. I don’t want to create panic and I don’t want to scare people, but there is a fine line between making people understand how serious the pandemic is versus creating a sense of panic.
How else do you get people to do the right thing?
I don’t know if ‘overwhelmed’ is the right term because when I think of overwhelmed I think back to images we saw of New York — of some of the emergency departments where you literally were tripping over people and always racing from room to room — we’re not there.
What we are seeing, though, is more and more people with symptoms of COVID-19 who are sick enough that they need to be hospitalized, and we are really filling up all of the hospitals.
We are approaching the point where we can’t take more patients.
(Tuesday) morning we had 230 patients with COVID. Last spring we were operating a total of 240 beds.
Obviously we have non-COVID-19 patients in the hospital. I dont have the exact number, but we added about 150 beds to this hospital to take care of the COVID patients and all of the people who come for care.
We had roughly 60 ICU beds last spring and we are now operating — we now have around 100 ICU patients in the hospital. We have added to that capacity almost 40 ICU beds.
I would say that we have been mostly keeping up with the increasing numbers of patients with COVID who need to be in the hospital, but we are running out of places to add more beds.
Right now we have six tents outside of UMC for patient care.
There’s a tent behind us in the Texas Tech lot courtesy of the Emergency Medicine Task Force from the state of Texas with 14 patient beds in it and full staff and equipment. They are taking care of strictly COVID patients.
We have three more tents that we have had since the spring for taking care of COVID patients and others, and today we should be finishing installation of oxygen lines in those three tents with three new oxygen cylinders outside.
There’s two additional tents in front where we moved our triage so that the area inside the hospital where we normally do triage can function to take care of predominantly non-COVID patients.
The second tent can quickly become a 10-bed inpatient unit to take care of COVID patients.
There’s probably around 60 potential beds of additional capacity, although we are operating our emergency department patients who don’t have COVID out of some of those; so it’s not just all COVID care.
We have added a tremendous capacity.
We now have over 250 staff who have flown in to assist at UMC. In the city that number is over 1,200 medical workers here in El Paso helping who have come from a variety of sources who have come to care for patients in the hospital.
I think UMC has done an amazing job of ramping up, I wouldn’t say it’s overwhelming, but it sure isn’t normal business.
Truthfully, there is not a lot more room to expand care. Patients, at least 60, have been flown out for care in other cities.
We have taken over one floor of (El Paso) Children’s (Hospital) and by taking over I mean they have graciously lent us the use of their ninth floor for non-COVID patients and we have beds in the hospital for non-COVID patients, but we are rapidly running out of beds.
Treating non-COVID emergencies
Patients who do not have COVID go to areas of the hospital where all of the patients do not have COVID.
There is room to take care of those patients. We are a level one trauma center and we are still operating as one, so we are not turning away any patients who are trauma patients. They also get tested for COVID when they come in, but they are being cared for.
Women are still coming here to deliver their babies and they are getting care, but what is running out are the COVID beds.
It’s very safe for patients that don’t have COVID to come get care because we are taking all of the precautions in the ER to keep them away from patients with COVID.
Patients who have elective surgery, which is considered the same day and are expected to go home after their operation, by and large those cases are going to happen.
Patients who need surgery where they are expected to need to stay in the hospital, fewer of those are being done out of concern for using up too many of the beds that are needed with exceptions.
There are patients where really you cannot delay surgery. Some of the cancer patients where you really shouldn’t be waiting weeks or months for their operation and we are managing to continue to do those.
But some of the things that are very elective and require an overnight stay are being delayed when it’s safe to do so.
If something went amiss and someone had to stay overnight they would, and we’d have beds. We have beds now for patients who are non-COVID who need to be in the hospital for all of the other reasons people are here.
Rushing to the hospital
For patients with symptoms of COVID, they are folks who should probably think twice about coming to the hospital unless they are short of breath, light headed or have fevers. Many of them will be seen, evaluated and sent back home.
But the patient who is having symptoms of a stroke, who is having chest pain and could be having a heart attack, who has a bad infection and is trying to wait — they are doing themselves harm by staying home.
The number of total emergency department visits is still low for non-COVID problems.
I’m still seeing some patients with some serious medical problems not related to COVID who are delaying coming in — that’s a concern because when they do come in they’re sicker.
When they come in late for their heart attack, or late for their stroke, there is simply less we can do to help — the outcome is not as good if they delay.
Patients with the cough, runny nose, maybe they have a cold, maybe they have flu, maybe they have COVID — those are good patients to talk to their doctor before just coming.
If they don’t have a need for supplemental oxygen, we’re going to see them, we are going to assess them, but there’s a good chance they are simply going to be sent home.
Not following guidelines
A lot of people are ignoring the recommendations.
We are still hearing about parties with 40 or 50, 60 people (and) large family gatherings that are still taking place.
We know that wearing masks and staying away from others very much slows down the spread of the disease, but we see a lot of people ignoring that.
The only reason I can think of people ignoring is that either they assume they are not going to get it, they won’t infect others, or if they do get it they will be guaranteed that there will be care available to them — and I think we are getting to the point where those things may not be true.
We are blessed that the rest of Texas is not seeing this rise yet.
If Austin and Houston and Dallas were experiencing this, I don’t think El Paso would be getting all of these resources.
I hope we can get over this and be on the downward slope when it starts going up in the rest of the state, because they are going to take back all of these resources we now have that we need.
Cover photo: An auxiliary medical unit behind University Medical Center was constructed and staffed with assistance from medical and support personnel from around the state. (Corrie Boudreaux/El Paso Matters)