CHEYENNE – The current spike in COVID-19 cases in Laramie County and across the region continues to push the limits of Cheyenne Regional Medical Center.
On Wednesday, the hospital had 20 patients on mechanical ventilation – the highest number the hospital has seen during the pandemic, hospital President and CEO Tim Thornell said. Thirteen were patients hospitalized with COVID. Of these, two were fully vaccinated, and 11 were unvaccinated.
Thornell said this was “truly a call to action ... for the entire community to come together and really take care of one another” by wearing masks indoors and getting vaccinated, for those who are eligible.
As of Wednesday, the hospital had 24 patients in its intensive care unit and ICU overflow – just one patient shy of capacity. Fifteen of the hospital’s COVID-positive patients were in the ICU – two who were fully vaccinated, and 13 who were not. The hospital typically has 15 ICU beds, but asked for and received authorization from the state to add 10 additional ICU beds.
The same day, CRMC reported 57 patients hospitalized because of COVID, with 11 of those fully vaccinated, and 46 unvaccinated. These patients made up close to 50% of the hospital’s medical and surgical beds.
There were 230 people hospitalized for COVID-19 across the state on Tuesday, according to the Wyoming Department of Health.
Thornell said that although the hospital was close to being short of rooms, finding more physical space for patients was something that could be managed. An additional unit of eight beds was set to be available for patients early next week.
Dr. Jeffrey Chapman, the hospital and health system’s chief medical officer, said, “We have or are in the process of creating more than 24 beds” to replace a 24-bed inpatient unit currently being remodeled as part of a 10-year master facility plan.
The larger challenge is staffing, both Chapman and Thornell said, especially when it comes to nurses and other frontline caretakers. More than 40 temporary agency nurses are currently helping out, whereas the hospital would typically have fewer than 10 at any given time.
“We’re still stretched very thin on having enough staff to care for patients, as our influx of COVID–positive patients just continues to increase, but it’s all our other staffing as well: housekeeping, dietary staff, nursing assistants, the list goes on,” Thornell said. “That’s really one of the primary challenges that we’re facing today, in terms of being able to treat and manage patients in our community.”
CRMC also is a referral center, meaning the hospital routinely gets patients from elsewhere in Wyoming, from southwest Nebraska and parts of southeast South Dakota, plus others from outside the county who happened to be passing through when they got sick or who were transferred to CRMC for a higher level of care.
Dr. April Kranz, an internal medicine and pediatrics hospitalist at CRMC, emphasized how exhausted and overwhelmed the hospital’s doctors are. The six doctors tending to the adult hospitalist service’s 121 patients are each responsible for about 20 patients, which Kranz said is “way more than they can comfortably do,” and has been happening since the hospital saw a large influx of COVID patients last year.
What’s happening in Laramie County isn’t unique, though, Thornell said. With COVID-19 hospitalizations rising across the region, CRMC is also limited in its ability to transfer patients to a higher level of care because hospitals in northern Colorado and the Denver metro are facing very similar situations.
‘It is all connected’
Beginning Tuesday, CRMC said it was limiting elective, non-emergency surgeries to help manage its staff’s workload.
In an effort to take some of the stress off the emergency department, on Wednesday, the hospital began doing its monoclonal antibody treatment therapy at an outpatient area at its 20th Street location on Mondays, Wednesdays and Fridays. A patient must have an order from a provider to receive this therapy and must schedule an appointment in advance. This treatment takes about three hours per patient, Thornell said.
“As we have an influx of COVID patients coming in, either symptomatic or having had COVID and seeking treatment, it certainly does put a burden on the ER and makes it more challenging for us to see and treat every other patient that we need to,” Thornell said. “And there’s certainly a whole category of patients coming in with emergencies, with trauma, that never stops, and we continue to address that.”
Hospital staff also asked that people seek out COVID testing from urgent care clinics or CRMC clinics, rather than going to the emergency room.
Dr. Adam Crilly, medical director of CRMC’s emergency department, said the strain put on emergency department staff made it difficult for them to bounce back.
“We signed up for stress for a living ... but it is reaching an unhealthy level of stress for staff, and we’re struggling with resiliency,” Crilly said.
On a recent day, Crilly said he came in to work at night after working all day because the emergency room was “historically busy,” with around 40 patients in the waiting room. Some left, frustrated that they hadn’t yet been able to receive care.
Crilly moved to Cheyenne during Frontier Days this year. He said he was struck by the immense amount of volunteerism required to pull off such an event. He said he wondered why Cheyenne, Laramie County and surrounding areas couldn’t look at preventative measures for COVID-19 in the same way, as volunteering to help out fellow members of the community.
“If COVID were a multiple-choice question, the answer cannot be neither – you can’t skip a mask and skip a vaccine,” he said. “That can’t be the answer, because then we’re right back in February and March of 2020, when this outbreak occurred: we have no defense, and no idea what to do. And that’s kind of what we’re seeing now, and that’s why we had this surge of patients. It is all connected.”
Kranz said that, during the first year of the pandemic, the hospital saw very few pediatric patients for COVID-19. Last winter, there was an “unprecedented” low number of pediatric patients because mask use among children was so effective at preventing all kinds of respiratory diseases, she said.
But as the highly transmissible delta variant continues to spread, the number of COVID cases in children is rising, Kranz said. CRMC typically transports its critically ill pediatric patients to Children’s Hospital Colorado, which also is getting full, she said.
Kranz said children who get very sick from COVID often don’t present with respiratory disease, as adults tend to, but instead come to the hospital with dehydration, diarrhea or viral muscle inflammation, called myositis.
Still, “the number of children who get very ill from COVID is very small relative to the number of kids who are infected and contagious with COVID,” Kranz said.
The hospitalist said the biggest issue that should be talked about regarding pediatric COVID is the lack of masking in schools.
“Not only does (this) put children at increased risk for COVID infection and all of the complications that come along with it, but it’s also a very serious hotbed of transmission for COVID throughout the community, because these children go home to their parents, to their grandparents or their extended families, and children are much more likely to have absolutely no symptoms from COVID and still be extremely contagious,” she said.
On Wednesday, Laramie County School District 1 reported 77 active student cases and 15 active staff cases. The district had 182 total confirmed positive cases since Aug. 18, according to its online dashboard.
On Wednesday, the Laramie County School District 1 Board of Trustees held a special meeting, during which it planned to vote on whether to require masking among students and teachers when the county is in a “red” or “orange” level of risk for COVID-19 transmission.
Kranz urged residents to tell school board members and local government leaders that they want children to wear masks in schools and all individuals to wear masks in indoor public spaces.
“They’re not hearing from the silent majority out there who are doing the right thing, but who are not being as vocal as the anti-mask and anti-vaccine instigators,” she said. “I think to be more vocal and to tell your elected representatives and community leaders what you think and ask them to support doing the right thing is needed, as well.”