As of Monday, March 30, Yavapai County had confirmed 18 cases of COVID-19, the disease caused by the novel coronavirus sweeping the country and the globe.
Six of those cases are in the Verde Valley, with the remaining cases in the Prescott area on the other side of Mingus Mountain.
Officials in Coconino County, which has so far confirmed 71 cases, have warned that hospitals in Flagstaff and Tuba City could soon be overwhelmed. While Yavapai County remains far away from its neighbor to the north in spread of the virus, Cottonwood’s Verde Valley Medical Center has been preparing for the worst and stockpiling supplies in the expectation of being overrun.
“Unfortunately, none of us know what’s coming,” Northern Arizona Healthcare Chief Medical Officer Leon Pontikes said. “That’s the worst part of all this. We don’t know what to prepare for, so we’re preparing for a potential worst-case scenario and hoping for something better than that, of course.”
The hospital is licensed for up to 99 beds and currently has 74 operating for everyday use, including those in the OB/GYN department. The average daily number of patients requiring hospital beds has been in the mid 50s.
“We’re looking at all possibilities,” Pontikes said. “We have plans to potentially expand patient care to little-used or previously used areas in the hospital that are now repurposed for other things. We can perhaps increase our active capacity right up to that hundred patients by using all available space in our facility.
“As we look at what we call the critical influx or the surge in influx, we’re looking at contingency plans to meet that higher influx. We’re looking at every option.”
The fear of hospital administrators goes beyond COVID- 19. If coronavirus cases surpass the amount of beds that the hospital has to spare, that also means that patients suffering from other issues — from cancer to car crashes to the maternity ward — will have trouble getting adequate medical care. Pontikes said that the hospital is making efforts to separate anything related to COVID-19 to different parts of the hospital away from the facility’s normal activities in order to limit the potential for infection.
Pontikes said that in the case of the pandemic overwhelming VVMC capabilities, it would probably have similarly affected other hospitals in the area, making the potential to send patients to Flagstaff or Phoenix not a serious consideration in the hospital’s planning.
He said that while hospital staff had discussed the possibility of requisitioning space from outside the hospital for use with patients, there are currently no plans to do so.
The hospital says it is well-equipped with ventilators, which have proven essential to caring for patients with severe respiratory issues from the virus.
Pontikes said that VVMC has 44 ventilators, with more on back order, though nationwide ventilator shortages could make obtaining more than that difficult. Though some locations with extreme outbreaks have attempted to split the use of ventilators among multiple patients, Pontikes said that the difficulties of different patients having different respiratory needs makes that unlikely.
According to Pontikes, the main shortage the hospital is now facing is in PPE, or personal protective equipment for medical staff — surgical masks, higher filtration masks, gowns, goggles and other forms of equipment.
“The biggest hindrance to what we’re trying to do has been national shortages of things we’re trying to inventory,” Pontikes said. Hospital staff have taken to reusing and re-sterilizing masks when possible.
“We currently have enough stock and inventory for our present needs, but we have no idea how long this will last,” he said.
There is currently no cure for COVID-19. Patients are given what Pontikes refers to as “supportive care,” ensuring that they are in good condition while their body fights the disease. As such, the hospital is providing refresher courses for all its medical staff in how to deal with cases, expecting that staff that do not normally deal with infections like it are able to help.
With the expectation that some medical staff will become infected, the hospital is making efforts to cohort staff, keeping people working with patients who do not have the virus separate from those who are, and planning to shift different teams in to allow for maximum coverage of COVID-19 cases even as staff begin to get sick. The hospital is also reaching out to retired physicians and nurses in the area to take refresher courses in order to possibly help if things get really bad.
“It’s the uncertainty of the situation that’s most stressful,” Pontikes said. “If it comes to the point where we have a critical influx of patients, our 300 physicians and 3,000 staff overall will shine, but right now it’s like we’re going into battle. There’s so much uncertainty of what’s going to happen.”
The hospital, along with Spectrum Healthcare and the county health office, is now offering tests to those who display symptoms. There remains a testing shortage nationwide, so tests are still only being administered to those who have symptoms, not everyone who has been in contact with someone who tested positive. Tests are sent to labs in Phoenix, which are themselves also overwhelmed by the volume of tests, meaning that they take several days between initial tests and results.
In addition to the hospital, Vitalant, a nonprofit that collects blood donations in Arizona, has warned of a potential shortage of blood as the crisis worsens. According to Sue Thew, Public & Media Relations for Vitalant, the nonprofit has had to cancel 200 blood drives since March 19, resulting in the loss of an estimated 6,000 donations.
Vitalant is continuing to hold blood drives in the Verde Valley during the pandemic, and Thew urged anyone healthy to go to bloodhero.com to set up an appointment. Since the coronavirus spreads through the respiratory system, there is not a risk of transmitting it through blood donations from asymptomatic carriers.
However, individuals with symptoms are urged to stay away to stop the spread of the disease. Thermometers are being administered to check for fevers at all blood drives, and workers are taking extra precautions to enact social distancing and prevent the spread of infection.
In the midst of the crisis, VVMC transitioned as much of its outpatient services to telemedicine as possible, with any meeting that does not require direct contact by a physician — such as follow ups, reordering medication and scheduling tests — done remotely. The hospital has also suspended elective surgeries to focus hospital resources and avoid infections. For most hospitals including VVMC, elective surgeries represent a significant portion of the revenue of the hospital.
“It is a very difficult situation financially,” Pontikes said. “But in making every decision in this situation and in all other situations regarding patient care, our first priority is serving the community, and at this point in time, what the community needs is services with respect to this disease in the community. Our patient safety, our community safety becomes the utmost priority in our decision making.”
