COWBOY MEDICINE TRIP #2, DAY 5

The situation at the hospital is evolving but fundamentally boils down to the following: The hospital had been trying to gradually cease operations in anticipation of a move to a new hospital building. Their previous capacity was about 850 beds but was down to about 200-250 staffed beds prior to COVID-19. COVID surge happened three weeks ago, and the hospital had to abruptly reopen those 600 beds. They had successfully opened three new ICUs for unstable patients on ventilators. They are now in the process of opening up a few long-term ventilator units. The long-term ventilator units are for patients who are alive and at least somewhat functioning, neurologically speaking — they are stable enough to be taken out of ICU, but can’t get off the ventilator. Those patients need a place to go so they’re not unnecessarily taking up ICU rooms and blocking out patients who need the treatments that can only be done in an ICU.

The long-term ventilator units are supposed to be operational in the middle of next week, pending some additional staff onboarding. My understanding is the long-term ventilator unit will be working toward managing and rehabilitating patients who are vent-dependent for more than two to three weeks. The damage to the lungs of most of our COVID patients is extensive, far beyond what a normal respiratory failure causes, so many are having difficulty going off the vent. Some of those long-term ventilator patients will end up on a ventilator for the rest of their life due to the damage to their respiratory system, and some may consequently never return to their homes. Some may be able to return home, perhaps vent-dependent only at night, but will need rehabilitation to relearn how to brush their teeth, walk, or perhaps even care for their own tracheostomies and ventilators. Others will have to undergo further surgeries to repair the tracheostomy and restore their previous airways.

These people have nowhere to go without a long-term vent unit, and they’ll likely be in the hospital for months. The hospital I’m at is expecting to keep these patients at least through June, possibly into July and later. I imagine other hospital systems are contending with the same issue — what do you do when COVID surge is over, you’ve got thousands of people who are alert and cognitively intact, and you can’t take them off the ventilator? What happens if your ICUs and vent units are full and a second surge happens because the state has released shelter-at-home restrictions? I wonder what the death toll will be like during the second surge, when we’ve absolutely exhausted ICU resources.