Hospital Preps for Patient Influx
By John Meng Publisher/Editor As coronavirus cases and hospitalizations surge across the Lone Star State, officials at the Jackson County Hospital District have expressed concern for the increasing numbers. But it’s not the swelling number of positive cases that worries them most. It’s not even the jump in the hospitalization rate, although that statistic is a critical concern. The most worrisome number is the positivity rate, a number which has skyrocketed 400 percent in Jackson County.
“We are alarmed by the positivity rate increasing the way it has in the last few days,” said Bill Jones, CEO of the Jackson County Hospital District (JCHD).
“Hospitalization rate is a key factor. But the most important one that I really watch is the positivity rate. That’s the ratio of positive tests to the number of tests done. In Jackson County, we’ve been sitting at six percent — the lowest in our area — but that is changing. Just yesterday, of the ones we tested outside the hospital, 26 percent were positive. Every county in our nine county area, with the exception of Victoria, had their highest number of cases yesterday. We had 68 positives yesterday, and we had 1,066 tests done on JC residents. So that’s six percent.
“Texas has a positivity rate of eight percent and that is the one statistic that Gov. Abbott said he needed to keep under five percent. In Jackson County, we’re below the state, and we’re not as bad as some of the other areas. But you can see with our neighboring Lavaca County, we woke up one morning and they had tripled their numbers over the weekend. That can happen here as well. You kind of feel it knocking on the door right now because we’re seeing this positivity rate spiking over this last week,” said Jones.
While the positivity rate is a main focus for JCHD and the ever-changing number of positive cases always make the headlines, the hospitalization rate cannot be ignored.
Jones commented that the hospitalization rate is very important because if there are no beds, there is no place for people to go when they are ill.
The Jackson County hospital is licensed for 25 beds, but currently only has 15 beds which are active. The hospital typical runs with an occupancy of about four to five patients a day.
“We have room right now, but we don’t have a lot of room. An extra 10 to 12 beds and that’s about it,” said Jones.
The Jackson County Hospital still has beds for residents in the county, explains Jones. However, the problem occurs when the larger hospitals such as Citizens Medical Hospital and DeTar in Victoria cannot accept transfers of more acute patients that JCHD cannot handle here because JCHD does not have an Intensive Care Unit (ICU) or ventilators.
“Whenever we send patients over there, typically they welcome those patients with open arms,” said Jones. “But right now, they have told us to send them only our most seriously ill patients and we will have to deal with the rest as best we can.”
According to Jones, those larger hospitals in Victoria are experiencing the same problem with the larger tertiary hospitals in Houston and San Antonio.
“Houston and San Antonio hospitals are filling up, so Citizens Medical Hospital does not have any place to take care of theirs so they are having to treat what they can in-house,” he said. “That’s backing up to the rural hospitals. We’re preparing for a possible influx of patients that the larger hospitals don’t have beds for.”
However, hospitals in urban and rural areas are increasing their collaboration efforts, explained Jones. JCHD administrators have been talking with the physicians and management at Citizens Medical Hospital and DeTar on improving the management of patient care for the region. For example, noted Jones, if the larger hospitals have patients which are low acuity or they become crowded with non-covid patients, those hospitals can transfer those patients to Jackson County while simultaneously JCHD can send its seriously ill patients to the larger hospitals.
“They have the ICU. They have the ventilators. They can manage these patients better,” said Jones. ‘In the meantime, they can give us someone who is rehabbing, and we can take of them over here.
“We’re getting in a position we’ve never been in before,” he said. “We’re actually working together to try to put the people where they best need to be. We obviously cannot take a very serious, late-stage covid patient because we don’t have the ICU or ventilators.”
Jones also explained that some of the current problem with occupancy levels is not the number of actual beds available, it’s the level of staffing. Some hospitals simply do not have the staff to care of patients because the staff has become sick. According to hospital CEO, there is still more testing being done every day and the numbers are growing across the board.
“After the state began to reopen for business, it seems that some people took that as being a message just to go about their business as normal and we saw what happened. It starting spiking. We had this big surge all across Texas, and now even the rural counties are experiencing it,” said Jones.
“Obviously everybody is moving around more. As the number of cases increase, those people are going to come into contact with more and more people as places are open,” commented Lance Smiga, CFO for the Jackson County Hospital District. “So, we’re going to see the numbers go up. What we are seeing is that we previously had people come in who had symptoms; now, when people come in to get tested, we’re seeing people who have been directly exposed to someone with the virus as well as showing symptoms. I don’t think there was any doubt that the numbers were going to head in this direction.”
“I think that as these gatherings have happened – holiday weekends, Father’s Day, Fourth of July – all the things that have happened since the end of May to now have led us to where we are today.”
JCHD still had 220 tests pending last week. At the six percent positivity rate that was trending previously, that could mean 13 new positive cases in the county. However, if calculated at the recent 26 percent positivity rate, Jackson County could be looking at another 57 cases overnight.
“The overall number of people who want and need to be tested each day,” said Smiga. “Earlier during this, we were getting to 6-10 people who wanted to be tested. Now, we’re getting 20 or more every day. So, there are definitely people out there showing the symptoms, who have been exposed, and who need to be tested. Overall, we’re just seeing a bigger need for testing.”
Currently, the Jackson County Hospital District has implemented a protocol that requires people to go through Telehealth and talk to a provider or a physician in order to be cleared for a test.
“You can’t just drive up and get a test,” said Jones. He explained that rural hospitals have been looking at Telehealth for some time. The use of the Telehealth system allows physicians to virtually evaluate a patient online without that patient entering the hospital waiting room and possibly infecting others.
“The time for Telehealth has come. We can really see it,” said Jones, who noted that back on May 15, the hospital had 90 percent virtual visits and 10 percent in-person. Then that number dropped to 70 percent virtual. On June 21, Jones noted that it was almost even, 50-50, people in-person and people on Telehealth. And then that spike came. Now, as of yesterday, we’re at 72 percent virtual and 28 Telehealth.
“Telehealth has become a big part of what we are doing and people are responding to it pretty well,” said Jones. “Telehealth will never take the place of a robust in-person patient call where the doctor can poke and prod and lay hands on a patient. But, after this pandemic is done, I firmly believe that Telehealth will still be an integral part of how we conduct operations.”
The Telehealth system is yet another tool for Jackson County healthcare professionals to fight the spread of the coronavirus and to ward off another spike in the positivity rate.
“We expect to see another spike in a couple of weeks,” warned Jones. “It’s certainly happening. It’s growing, and it seems to be growing exponentially.”