'Exponential' COVID-19 case growth stresses Mitchell hospital

The serious nature of COVID-19 is hitting home in Mitchell.

The community has nearly doubled the amount of active COVID-19 cases since the start of the month two weeks ago and has added more than 600 overall cases in that time, or about one-third of the cases since the battle with COVID-19 hit South Dakota in March.

Battles are fought every day at Avera Queen of Peace Hospital, where the number of hospitalizations related to COVID-19 is now around 20 daily. According to data available on Friday, 19 individuals were hospitalized in Mitchell, with seven more hospitalized in Parkston and six more in Platte, which are regional locations in Avera Queen of Peace’s footprint. As of Friday, Davison County had 767 active cases of the virus, adding almost 55 cases a day and bringing the overall case count above 1,700 for the year, or one confirmed case for roughly every 11 county residents.

There may be fatigue related to COVID-19 but now is the time for the Mitchell area to buckle down and take the precautions necessary to slow the spread of COVID-19, said Dr. Hilary Rockwell, an emergency medicine physician at Avera Queen of Peace Hospital.

“This year has been tough and nobody wants it to be the way it is right now,” she said. “We need people to realize how sick people are and how hard the health care teams are working to take care of people. We’re getting full and we’re getting overwhelmed.”

A high level of community spread, which is seen as the primary cause for this recent surge in cases, typically means that the area’s hospitalization numbers will have an increase in hospitalizations two to three weeks later, said Doug Ekeren, Avera Queen of Peace’s interim CEO.

“There’s kind of that lag time,” he said. “Even if there’s a small percentage of those who turn positive that need to be hospitalized, the ones that do can be very ill and can take a lot of resources.”

Rockwell said COVID-19 in Davison County is dealing with exponential growth, where for example, three people infect another three people and it grows quickly from there. She said the region can count on another month of dealing with the current number of cases and if mitigating action is taken now, that can allow a drop-off after that.

“Unfortunately we’re following the model that was put out in front of us about a month ago that said we’d have a 50 to 100 percent increase in hospital patients in the next month and we’re there,” she said. “We’re still following that and until we see the number of positive cases in the community start to drop, it’s going to keep rising."

Ekeren said the hospital’s staff should be commended for adjusting their schedules and personal lives to cover additional shifts and hours to take care of patients.

“That phrase about being health care heroes is very relevant for Avera Queen of Peace. And at the same time, we can only keep up that pace for so long, and that’s our concern,” Ekeren said. “The continued number of cases in the county, are we going to be able to keep doing this? And that’s where we ask for the community’s help on this.”

When asked about what patients in the Mitchell hospital are experiencing when dealing with COVID-19, Rockwell said that many of them are coming in 7 to 10 days after first experiencing symptoms and often times after a period where they’ve felt better. In the second week of symptoms, infected patients often feel very weak.

“They’re short of breath, people are scared,” she said. “It requires a lot of oxygen and that makes people very anxious and some of that is just not being able to breathe. It adds another element to taking care of them.”

Employees have gotten used to the full set of personal protective equipment needed to treat patients with COVID-19, equipped with gloves, face shields, gowns, masks and in some cases, small respirators. She said it can be hard for doctors and nurses to hear each other in that case. All of the COVID-positive patients are isolated in a specific wing of Avera Queen of Peace.

“It makes care for the patients a little more difficult and it makes it difficult on the employees, as well,” Rockwell said. “The other difficult thing is for our staff, once we know you’re positive for COVID, we only do virtual visits. Our nurses are doing a good job of spending as much time as they can with patients. It’s not the same as having someone there to hold your hand.”

As of figures through Thursday, 48 of the state’s COVID-19 patients were on ventilators, and 25 of those individuals were at Avera McKennan Hospital. Almost all of the state’s ventilator patients are at the flagship hospitals for Avera and Sanford Health in Sioux Falls, and Monument Health in Rapid City. The same can be said for intensive care patients, with about two-thirds of the state’s COVID-positive patients needing that care at those three hospitals.

Ekeren said patients needing ICU care are staying in Mitchell, keeping “enough of them that we’re challenged from a staffing perspective,” but some transfers are made to Sioux Falls.

Rockwell described the decision-making on where to put patients as “traffic control.” She said some patients with specific needs, such as dialysis, could be transferred to Sioux Falls, where there are more beds and a larger facility. Once again, some elective surgical procedures have been delayed, as well.

“Without our whole system working together, I don’t know what we would do,” Rockwell said. “There are some critical-access hospitals that have taken transfers from us and they’re keeping some pretty sick people.”

Avera Queen of Peace has also started to increase promotion of a Mitchell-based mask campaign, featuring local residents pictured with their mask and advocating why they wear a mask. Ekeren said the hospital is working to humanize the virus, with real people impacted rather than just numbers of cases.

“I think there’s a frustration with staff when they’re taking care of some really sick patients in some instances, and patients who don’t make it,” Ekeren said. “And we still have people say this isn’t real and this is exaggerated. I can speak for our frontline staff, this isn’t exaggerated.”

Ekeren said there have been plenty of people who have responded appropriately to the demands of the pandemic by wearing masks, socially distancing and washing their hands.

“We want to thank those people,” he said. “But we need more of those people to help support those actions because it does make a difference.”

Rockwell said right now, it’s hard to know how long this fight will last.

“People look at it and they want to have an end,” she said. “You can work through anything as long as there’s an end in sight. If there’s not, it adds pressure to our staff to say, ‘I’m not sure’ when the end is coming.”