COVID-19 Testing in Big Sky

Emily Porter tests someone at the Big Sky Medical Center for COVID-19 on Wednesday, July 1, 2020.

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The state’s largest hospitals said this week that they were able to increase their capacity and develop plans to handle a potential surge in coronavirus cases, but still face supply chain challenges.

Montana saw its first cases of COVID-19, the disease caused by the novel coronavirus, in mid-March. Initial case growth was exponential in the absence of measures to slow the virus. But from March 28 to April 26, residents were told to stay at home except for necessary work and activities, dramatically reducing the spread of the virus. That was followed by a month of few or no new cases added daily as the state moved through the first phase of reopening with half capacity at bars and restaurants.

Hospitals used that lull to prepare for a future spike in cases, which the state is seeing now, and the possibility of hospitalizations from those cases. The state has set records for single-day case growth twice over the last week, and the seven-day rolling average has spiked to new highs.

Lee Newspapers sent questions to the nine largest hospitals in the state asking about their capacity and received replies from six, in addition to information from the governor’s office about how things look statewide. The two hospitals in Missoula did not respond and directed questions to the state, and the medical center in Kalispell did not reply.

Montana started reporting active hospitalizations on April 10, when there were 29 people in facilities around the state being treated for COVID-19. That number fell dramatically during the stay-at-home order and through phase one, to the point where there were only one or two people receiving in-patient care. By Thursday there were 14 hospitalized, up from one a month ago.

Monday through Friday the state gets a snapshot report from hospitals about their capacity. Earlier this week, that showed 2,973 inpatient beds, with 1,113 available. There were 193 intensive care beds with 69 available, and 12 of those were being used by COVID-19 patients.

In Gallatin County, the Bozeman Health system took some of the biggest measures to increase capacity, both tied to expansion plans that predated the coronavirus and in response to it.

At the main Deaconess Hospital in Bozeman, a new 20-bed critical care unit announced in 2018 is set to open in August. After the virus hit Montana, donors in Big Sky funded an additional four inpatient beds at Big Sky Medical Center there.

Deaconess is licensed for 86 inpatient beds, while Big Sky now has eight. Lauren Brendel, the system director for marketing and communications, said in an email this week that the hospital network has a “well-developed surge plan that can increase bed capacity to 145 beds at Deaconess Hospital should the need arise.”

Brendel said the hospital hasn’t seen any large increases in their inpatient census, and created alternative triage and testing locations for COVID-19 in Belgrade, Big Sky and Bozeman, as well as a telephone hotline.

Through March and April, Gallatin County regularly led the state in reported COVID-19 cases, and still has by far the most overall cases, though most of those people have recovered. On Thursday it reported the second-highest number of active cases in the state, at 50, trailing only Yellowstone County at 68.

The Gallatin city-county public health officer, Matt Kelley, held a press conference Wednesday to urge the public to take seriously the precautions that can slow the spread of the disease like social distancing, use of a cloth face covering and avoiding crowds wherever possible.

“As of today, right now we talk with the hospital every day. We’re feeling pretty good about where hospital capacity and ICU capacity is in Gallatin County,” Kelley said.

But that’s not a reason to be lax on following public health guidance, Kelley implored the public.

“We can’t rest on our laurels, and we have to continually reassess. But as of right now, with one hospitalization, a new ICU coming online here in the weeks ahead, we’re feeling pretty good about it,” Kelley said. “I would also say we only have one major hospital in Gallatin County, so we have to be really careful about being too complacent with it.”

Back in late March and early April, Montana hospitals were in the thick of the beginning of the pandemic and didn’t know what to expect. Some of the modeling at the time painted a dark picture. Rich Rasmussen, the president and chief executive officer of the Montana Hospital Association, said some early predictions showed there could be more than 3,000 cases in Montana, leading to overwhelmed ICUs.

“It was a very different world, or a very different lens we were looking through at that time,” Rasmussen said. “Today we have a better grasp of that. We have the protective equipment, the blood supply is coming back, and certainly we have measures in place to help us with that surge to be able to create capacity in our health system. All of that we didn’t have (in March).”

The increase in case growth now also doesn’t correlate to increased hospital demand, said Dr. Scott Ellner, the chief executive officer at Billings Clinic.

“(It’s been) very little. We have patients that have been hospitalized at Billings Clinic over the last coupe weeks ... but case growth is really more of younger patients who unfortunately we’re finding have been exposed through community spread and are not following preventive measures,” Ellner said.

The stay-at-home period and slower case growth in phase one gave hospitals time to resupply, retrain and reeducate, Rasmussen said.

By the time the state moved into the second phase of reopening, hospitals had examined their internal operations and came together regionally to develop plans to handle a surge in cases.

Plans involve the possibility of discharging or moving patients from more urban hospitals into critical access hospitals around the state to create capacity in the urban facility for COVID-19 patients. In turn, those critical access hospitals would be able to move patients or discharge them to home care, Rasmussen said.

“Those facilities that have the capacity to treat the most critically ill, you want to make sure that you have room for those patients,” Rasmussen said. “Surge plans are designed to do just that.”

In Yellowstone County, Billings Clinic already had a surge plan in place before the coronavirus that included “alternative uses of existing beds and spaces, as well as a 60-cot package that can be used to augment existing beds,” said Zach Benoit, the hospital’s public relations liaison. Benoit said the clinic also participated in creating the alternate care site in Billings.

The hospital is licensed for 304 beds, including 24 ICU beds, and reported 253 inpatients this week with one open ICU bed, though those numbers change hourly, Benoit pointed out.

Ellner said Thursday that while the local public health entity has categorized their hospital’s capacity as stressed, the clinic can “turn around within hours” to make beds, negative pressure rooms, pulmonologists, respiratory care therapists and critical nurses available. It can also look to the other hospitals and facilities that are part of its network around the state to increase capacity.

Ellner said that there are a high number of patients at Billings Clinic because of pent-up demand for care that built when hospitals voluntarily put a pause to elective procedures. The hospital saw its busiest days on record over three days in June, Ellner said.

”It may be interpreted that we’re at capacity, but by no means does that indicate that we could not take several sick, COVID-hospitalized patients,” Ellner said. He urged people to continue to seek out care for emergent and chronic conditions.

St. Peter’s Health in Helena is licensed for 99 beds, with 24 behavioral health unit beds and eight ICU beds. Public relations specialist Katie Gallagher said the hospital has surge plans for its emergency department and additional plans to double the number of ICU beds if necessary.

“Developing and refining surge plans at St. Peter’s Health was a team effort. It required us to think outside the box to develop plans to transform other units, like same-day services (outpatient and surgical preparation), into acute care beds that would provide a safe, healing environment for patients,” Gallagher said.

She added the hospital hasn’t needed to activate its surge plan and has not had an inpatient admission tied to COVID-19 since March.

At Benefis Health System in Great Falls, the hospital has 220 operational beds and 21 beds in the ICU. Whitney Bania, senior communications specialist, said 18 beds can be designated as a COVID-19 unit if internal triggers are reached. The hospital hasn’t added bed capacity but can re-purpose areas of the facility if there’s a high volume of patients who need to be isolated.

St. Vincent Healthcare in Billings and St. James Healthcare in Butte are both part of the Sisters of Charity of Leavenworth network.

In Butte, communications manager Tanner Gooch said St. James is licensed for 98 beds and staffs for 68, including 11 ICU beds. Surge plans there include the reactivation of unused patient rooms.

Angela Douglas, the communications manager at St. Vincent, said that facility is licensed for 286 licensed beds and 24 ICU beds. The hospital has returned to “more normal levels of operations,” Douglas said, and developed a multi-tiered surge plan that allows for expansion of ICU beds and medical beds as needed.

Like many hospitals, Douglas said while the hospital is currently adequately staffed and supplied, those two things could be hurdles to increasing capacity beyond the work done to identify physical locations.

“Space and the staff and supplies to support additional beds are the biggest challenges health care organizations face as a result of COVID-19 … ” Douglas wrote

Rasmussen said that finding adequate staffing is nothing new for the more rural and critical access hospitals around Montana. Licensed bed capacity does not reflect sufficient staffing, and often hospitals have many more beds than they can staff.

“If a hospital has any of their clinical team that are impacted by the disease, or it doesn’t have to be COVID, it can be any other health condition they’re dealing with or a family emergency, and you don’t have enough staff to appropriately staff your beds, you’re going to trim back on the number of beds you have,” Rasmussen said.

Montana has not been immune to cases among health care workers, though to date health care-associated infections are less than 1% of total cases. Under the emergency declaration in Montana, Gov. Steve Bullock eased things like the licensing process to allow people to come into the state to provide health care, and Rasmussen said longer-term solutions will be necessary.

“For policy-makers going forward, the challenge is how are we going to develop state policy that helps us to further provide opportunities to grow our health care workforce,” Rasmussen said.

Some hospitals like Billings Clinic have the option of bringing on additional staff or relocating employees. In Butte, Gooch said St. James has contingency plans on how to partner with area medical professionals. St. Peter’s is continuing to recruit and hire, Gallagher said, and is also taking additional measures to keep staff safe like instituting a limited visitor policy.

“We firmly believe that keeping our caregivers healthy is going to be key to our ability to maintain adequate staffing levels,” Gallagher said.

The pause in case growth gave hospitals an opportunity to restock personal protective equipment, Rasmussen said. And hospitals say while the situation is much better than it was in March and April, they’re not out of the woods yet given global and national supply chain challenges.

While St. Peter’s is “cautiously optimistic,” Gallagher said “many PPE items are still on limited allocation.”

Billings Clinic has found ways to decontaminate PPE and create surgical masks and gowns in-house, Benoit said. Bozeman Health still does not have guaranteed supply resources for several items and gets only partial allocations from their normal supply lines.

That facility has worked with additional sources to meet needs and keeps a small amount of PPE in reserve in the case of a surge and demand has increased along with coronavirus cases, Brendel said.

While Benefis has sufficient PPE for now and hasn’t had an increase in hospitalized patients that would drive up demand, Bania said the facility is “currently allocated to receive 30 percent of our typical monthly order” of supplies.

With that uncertainty and an increasing number of active cases in the state, Rasmussen also wants people to be cautious given a scenario that’s perhaps easier to anticipate — the confluence of the pandemic and traditional flu season.

Communities need to “take it personally to be a part of this effort to beat back the disease in our state,” Rasmussen said.

“Wear a mask. If all of our businesses in our state approached this just like your neighborhood Costco does, we would be almost impenetrable from this virus. That’s going to be part of our challenge is having individuals follow the science on masks.”

Ellner echoed that sentiment. “I highly, highly recommend that people please wear a facial covering. ... That’s a critical, critical, important step in preventing the spread of COVID.”

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