Where are the hospitalizations?

Brookings Health System photo: Inpatient Care Nurse Kimberly Gray, RN, consults with Respiratory Therapist Janie Isham directly outside an intensive care unit room at Brookings Hospital. While the number of COVID-19 cases are rising in Brookings County, hospitalizations have not. Brookings Health warns that hospitalizations and fatalities from COVID-19 lag from the time people contract the virus. A recent visualization from Harvard shows most deaths occur two to eight weeks after COVID-19 symptoms began. If Brookings County follows the same course, hospitalizations and deaths will increase later in September and October.

Health system warns of lagging hospitalizations, deaths from COVID-19 spike

BROOKINGS – On Aug. 31, Brookings County entered a new classification: substantial spread for COVID-19, meaning the county has greater than 100 cases per 100,000 people. 

To date, the county has had 538 positive cases and currently has 140 active cases. But, according to the publically reported data, what hasn’t increased much is the number of hospitalizations among county residents.

“Hospitalizations from Brookings County residents are difficult to publically track due to patient transfers and referrals. Thus, it is not the best indicator on the severity or spread of this virus,” Brookings Health System’s President and CEO Jason Merkley said. “Bottom-line, if people are being hospitalized and beds are filled with COVID patients, we are too late at stopping the spread. If the day comes when Brookings Hospital has over 40 inpatient hospitalizations due to COVID, I predict our community and region will be devastated by this virus. We will all look back in hindsight and be very disappointed in our lack of immediate and timely action when it could have really made a difference.”

As more people become infected and their disease progression worsens, the chance they will become hospitalized – or die – increases. A data visualization recently created by the Harvard T.H. Chan School of Public Health illustrates most deaths occur two to eight weeks after COVID-19 symptoms began. If Brookings County follows the same course, COVID-19 resident hospitalizations and fatalities will start to increase later in September and October.

“Hopefully the most vulnerable in our population, such as the elderly, immunocompromised and pregnant women, are sheltering-in-place,” Infection Preventionist Bunny Christie said. “I hope they’re taking extra precautions during this wave to safeguard themselves against the virus. However, there typically is a lag between the time we start seeing a spike in cases to the time we start seeing an increase in reported hospitalizations and fatalities of any disease.”

In April, Brookings Health System released its bed management plan for handling a medical surge capacity of hospitalized patients in the event the community’s health needs exceeds Brookings Hospital’s normal medical infrastructure due to COVID-19. That surge capacity is 80, above the hospital’s standard 49-bed licensure.

“To date, we haven’t gone above our first-tier level in the bed management plan, defined as housing one to five COVID-19 patients at a time,” said Medical, Surgical and Emergency Department Director Karen Weber, RN, who worked on the logistics for the bed management plan. The health system routinely updates their patient-occupied bed range on their website at brookingshealth.org/COVID. 

“Part of the reason we haven’t climbed in our surge capacity is because Brookings County hasn’t seen a spike in cases until now,” said Weber. “Another factor is the larger hospitals in Sioux Falls have capacity. COVID-19 is known for causing cardiopulmonary issues with peoples’ hearts and lungs. If a patient develops these issues and the Sioux Falls facilities have the space, physicians will transfer the patient if the patient can benefit from the close proximity of cardiology and pulmonary specialists. But if the Sioux Falls hospitals reach their capacity, we’ll need to care for those patients here and rely on telemedicine capabilities for the additional specialty expertise.”

However, as the hot zone of cases continues to grow, it won’t be just Brookings County residents the hospital cares for during a time of surge. Residents from adjacent counties and Minnesota will also dawn the health system’s doors, increasing the burden on health care providers.

“What I do not want to do – what none of us want to do – is to close down our doors again,” Merkley said. “I don’t want to have to put a hold on elective procedures because our beds are overfilled with COVID patients. I don’t want to tell families they can’t visit their loved ones at all while in the hospital or nursing home. And I don’t want our care team overwhelmed, unable to effectively care for everyone who is sick in the population we serve. At this time, we need people in our community to take all the precautions they can to stop the spread of COVID-19.” 

According to the Centers for Disease Control and Prevention (CDC), the COVID-19 virus spreads mainly from person-to-person contact. The virus is primarily carried by respiratory droplets which are formed when an infected person coughs, sneezes or talks. The droplets can land in the mouths or noses, or possibly be inhaled into the lungs, of people within 6 feet of the infected person.

There is currently no vaccine to prevent COVID-19. The best prevention for COVID-19 is to avoid exposure to the virus. Infection control precautions to prevent exposure include: 

• Practice good respiratory etiquette and hygiene. Cover your coughs and sneezes with a tissue. If a tissue is not available, cough or sneeze in your upper sleeve. 

• Avoid touching your eyes, nose and mouth with unwashed hands. 

• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based sanitizer that contains at least 60% alcohol.

• Practice social distancing when out in the community by trying to stay 6 feet away from other people. Do not hug, kiss, shake hands or make other unnecessary contact. 

• Wear a cloth face covering that snugly covers both your mouth and nose in public settings, especially in situations where you may be closer than 6 feet to people.  

• Clean and disinfect high-touch surface areas, such as counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, etc. every day. COVID-19 is easily cleaned by household cleaners or soap and water.

• Monitor your health. Be alert for COVID-19 symptoms and take your temperature if symptoms develop.

• Stay at home if you’re sick and self-isolate to prevent the spread of illness.

According to the CDC, COVID-19 symptoms may appear two to 14 days after exposure to the virus. Most people typically experience mild to severe respiratory illness with symptoms of fever, cough and shortness of breath. Other symptoms may include: 

• Chills

• Fatigue

• Muscle or body aches

• Headache

• New loss of taste or smell

• Sore throat

• Congestion or runny nose

• Nausea or vomiting 

• Diarrhea

People who experience these symptoms are encouraged to contact their primary care provider.

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