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From Chaffee County to statewide, the proliferation of the Omicron variant of the COVID virus has been so rapid it often defies tracking in any useable time frame.

With what used to be reliable case reports for earlier variants, surveyed weekly or even daily, cases now can change hourly. Along with the availability of at-home tests with results infrequently reported to health authorities, Omicron counting is a fast-moving target.

Statewide, health authorities have asked health providers to develop and have in place, plans for staffing in the event a facility is overwhelmed and has to undertake difficult decisions; for instance, which patients presenting for treatment get priority.

Heart of the Rockies Regional Medical Center (HRRMC) has such policies developed, and April Asbury, Vice President of Patient Services, was asked if state health guidelines for crisis healthcare standards for healthcare centers like HRRMC were very helpful.

Asbury said that, as with a lot of questions about COVID for nearly two years, “It’s yes – and no.”

She said the hospital has to customize its policies regarding crisis levels of care and received some legal expertise with that.

One of the biggest challenges?

“Not to make any dramatic, sweeping changes and to be as nimble as we possibly can, with the big picture of community wellness at the forefront,” Asbury said.

“We do have certain departments with staffing challenges, we do have some employees out with COVID. We have had to be really flexible and adaptable and make kind of more ‘moment/today’ choices versus sweeping decisions like to make rapid decisions to shut something down or not allow for a clinic to be open…” she added. Some decisions are based on staffing levels, not necessarily on COVID volumes.

“Because our COVID volumes have been pretty low based on the recent months, just in the last three to four weeks we’ve had pretty good volumes. But it’s really just about working with each individual leader and each individual department to see what their individual needs are and then prioritizing the patient that’s going to be the least disruptive to their health and wellness; to make sure we’re not having knee-jerk reactions ….”

HRRMC CEO Bob Morasko and the management team have been meeting frequently to ride herd on not only the issue of patient volumes but like many other healthcare facilities, trying to solve staffing issues related to employees who contract the virus or other illness and the previously existing skilled staff shortages.

“We have our weekly incident command meeting and then we also have a small group of us that gets together additionally every week, and then at times we have dailies, so it’s just we’re really flexible and available to make quick decisions based on our current needs. So I feel like that’s the biggest challenge now; just trying to be positive and  respect people’s ‘right to be sick’ … Keeping everybody’s sense of perspective in line so the people don’t get too worked up, that’s our biggest challenge.”

A recent Chaffee County Public Health report found the Salida hospital was at more than 75 percent capacity, but Asbury said there have been instances where they’ve been at 100 percent; every bed full, with the exception of a few birthing center beds available.

On one such day, she said the hospital was expecting to see seven patients discharged, but only a couple were, meaning two patients at the Emergency Room had to wait until more patients were released later in the day.

When the pandemic first broke out nearly two years ago, and some elective surgeries and other treatments were canceled, HRRMC worked to quickly develop a staffing reassignment model that made the most efficient use of employees outside their normal work areas, which also avoided staff layoffs.

“With crisis standards of care, in the very beginning … it was more like an ethical dilemma, surrounding who gets a ventilator and who doesn’t; that kind of thing…” she said.

Over time, as crisis standards of care and crisis staffing standards were evaluated, they’ve shifted. 

Staffing shortages as elsewhere, are a challenge; there are a total of 79 staff openings currently. 61 are clinical jobs with patients in some capacity, but there are some that involve clerical work. Some positions are held by other employees in the interim until permanent candidates are hired.

Contrary to the initial outbreak, now it isn’t so much a situation with seriously ill people needing intensive care units and ventilators.

“We’re able to make those scenarios relevant to our area and our availability of resources and what we have and that’s been really great,” she said.

One plus is not having to go down the path of moral/ethical dilemmas, deciding who gets what care.

“… we haven’t had to go that route. We’ve been able to either provide everybody with a ventilator or the treatment that they need, or get them shipped out to the appropriate level of care – we haven’t had to go there.”

“It’s been a ‘kinder, gentler’ variant as far as long-term implications and/or acute implications, which makes it so we really don’t have to, at this point, think in that way anymore. We’re not seeing the critical nature of it anymore – it’s just not there,” she said.

With Omicron still peaking, she noted there are flexible care options that can be utilized.

“Our big issue now is sometimes we get full because we’re not able to ship those patients out because the other facilities are dealing with staffing issues too, or trying to isolate the condition. There’s a lot of variants out there but at least we don’t have ventilated patients,” Asbury noted.

“If we were to get to a point we were trying to achieve maximum level care with critical patients, we would be able to do that pretty easily, because we would have to close down our OR (operating room) for sure…”

The hospital, she said, would be able to use ventilators normally used for surgery and other equipment along with medication and treatment protocols already in place.

“….we would be able to manage quite nearly anything that came our way. We have some transport beds and we might have to transfer some people if we got beyond capacity but our capacity, if we needed to, could be two to three times what our capacity is right now,” she added.

As far as the spread of the Omicron virus itself, while Asbury feels hopeful, there is a new concern.

“I’m feeling fairly comfortable with the fact that we’ve got the vaccines, that people are betting boosted, we’ve got immune therapies that are keeping people out of the hospital — that has made a huge difference. We’ve got anti-virals on the horizon that some places already have and those anti-virals are highly effective.” 

“I’m actually in a place right now of hope, and feeling like we may go into spring and summer in a different place than we’ve been in the last two years. I’m actually starting to feel hopeful for the first time.but,” she adds, “my fear right now is how this may begin to affect our children; our kiddos.”