Community Hospital

Covid cooperation: Community Hospital in Grand Junction (above) coordinates care with its partner hospitals, including St. Mary's. (Photo courtesy of Community Hospital)

Across the Western Slope, COVID-19 cases are rising — and they are predicted to go even higher.

Over the past two weeks, pandemic response dials have been raised to Level Orange, for “High Risk,” on the state’s coronavirus dashboard in Ouray County and San Juan County.

Montrose County moved into ‘high-risk’ territory earlier this week.

In Mesa County, La Plata County, and San Miguel County, meanwhile, the risk of contracting the novel coronavirus is now “Severe.” All three counties now register “Red” on the state’s dial.

If there is anything to be thankful for this Thanksgiving season when it comes to the virus, it is this: At press time, no county in all of Colorado was in Purple territory on the state’s dial (the color means ‘Extreme Risk).

Speaking of risk, it’s not only people who are at risk from the coronavirus. Hospitals are, as well. Small, rural medical centers — such as those on the Western Slope — have only so many intensive-care unit (ICU) beds to spare. These beds are needed not only for patients who need lifesaving treatment for coronavirus, but for other sorts of medical treatment requiring intensive care. Earlier this week, there were still enough ICU beds to go around. Yet Mesa County “reported more than 200 cases of the virus on Wednesday,” the Grand Junction Daily Sentinel reported, “and tallied another 155 on Thanksgiving.” Even so, the county data on hospital capacity “held steady” from Wednesday, the paper went on, with 60 percent of beds overall in use, and 68 percent of ICU beds.

These days, regional hospitals are busy strategizing how to allocate ICU beds.

“We have a four-tier surge plan,” said Joe Gerardi, the chief operating officer and chief nursing officer at Grand Junction’s Community Hospital. The plan allows medical personnel at CH to determine what options there are for freeing up (or preserving) ICU resources. For example, just down the hall from the ICU unit is what Gerardi called “progressive-care beds, a step down from ICU-level care,” but perhaps suitable depending on a patient’s health status. These beds are still contained within the same unit, and overseen by similar staff, “with a higher level of skill sets” than might be found elsewhere in the hospital.

Another option for care is the Medical-Surgical unit, “where all patients requiring a medical diagnosis first arrive,” Gerardi said. This tiered plan “helps people evaluate how many beds you have, and where you can move patients to before you have to start transferring them to other hospitals.” Should that need arise, “We have partner hospitals, including St. Mary’s,” the region’s largest medical center.

Yet another option to help free up beds might be to send certain patients — not those with severe cases of coronavirus, or any one requiring intensive medical treatment, but those steadily recuperating — home a little earlier, Gerardi added. “When we evaluate bed capacity, we’re looking at those who might get discharged a little sooner,” he said.

“Every department at Community Hospital joins in on a safety meeting by phone every day at 10:15 a.m.,” Gerardi said. (Another meeting takes place every afternoon.) “I think this makes us an organization that is really prepared to meet the demands” of the virus “because we’re all on the same page.”

Hospital staff is not alone when it comes to the overall question of how many beds are available: there’s an algorithm for that. Hospital capacities statewide “are managed by the Colorado Hospital Association Transfer Center” on the Front Range, Gerardi explained. And on the Western Slope, “we have the Western Health Alliance. We work with both; we want to know what our resources are, both from a community perspective and from a global (meaning statewide) perspective.”

“We’re doing extremely well managing our PPE,” Gerardi went on, “and we’re in a good place managing” the surging number of cases overall. “But the situation is always fluid,” he added. “We’re always thinking ahead with our workforce, doing everything we can to keep them healthy, looking at potential staffing gaps. All things considered, things are going well. Over the last week, and the week before, there were some challenges. But today we’re moving in the right direction. It could change tomorrow. It could change overnight.”

The fact that it can change “overnight” led Gerardi to make a similar plea to what Dr. Sharon Gundy of Telluride Regional Medical Center requested of Telluriders earlier this week.

“We want to care for patients who need our services as appropriate,” Gerardi said. “Otherwise, it’s about screening, staying home if you’re sick, and us delivering the care that’s needed. Wear your mask, practice respiratory etiquette, and avoid large groups.”

Grundy announced that she would see exactly one friend on Thanksgiving and planned to spend much of her time outside. “If you absolutely must travel,” she wrote in a letter to the community, “limit contact with other households, opt for take-out and order-in dining, and when you return home, consider an earnest quarantine effort for 14 days.”