On the verge of crisis, Kootenai Health converts classroom into COVID-19 unit

Until Thursday, a room in the Kootenai Health Resources Center hosted nursing students and valuable training equipment. On Friday, employees spent the day pulling out carpets and putting in beds as they prepared for a surge of COVID-19 patients that showed no sign of slowing.

“On a typical day, we’re admitting 12 to 16 patients, and we’re able to only discharge, eight to 14 of those,” said Karen Cabell, chief physicians executive officer at Kootenai Health, referring to those sick from COVID-19. “So we’re going up by one, two or five patients a day in total numbers in the hospital.”

That’s why hospital officials decided to open a new COVID care unit in the Kootenai Health Resources Center.

With 22 beds inside and seven nurses assigned to the room, the hospital is now “scrounging” for both staff and medical resources, said Jeremy Evans, Kootenai Health chief regional operations officer.

Most people needing hospitalization are unvaccinated, Cabell said. They have seen a few vaccinated patients, but those patients came in with pre-existing conditions that made them more vulnerable to breakthrough cases.

About 50% of the hospital staff is vaccinated, Evans said, adding that the hospital likely will not implement a vaccine mandate unless one is set at the federal level.

In Kootenai County, about 39% of people ages 12 and up are vaccinated. Evans said he would urge his community to get vaccinated, wear a mask in public and avoid large gatherings.

But as Kootenai Health has entered previously unseen levels of COVID-19 cases, and many health officials are warning conditions could worsen, elected leaders have mostly declined to institute mask requirements that were common in earlier periods of the pandemic. Large events are moving ahead with crowds largely unmasked, including the North Idaho Fair.

While Washington Gov. Jay Inslee has instituted a statewide mask mandate, Idaho Gov. Brad Little has only encouraged them.

On the school level, Coeur d’Alene Public Schools has not included a mask or vaccine mandate into its reopening plan as of Wednesday, according to its draft reopening plan. And while North Idaho College reinstated a mask mandate for people on campus, most schools in Kootenai County have not.

The room for the new Kootenai hospital unit is not meant to host COVID patients, but it was one of the only rooms big enough to hold the beds, Evans said. It used to be a classroom where students would do hands-on learning, but a lot of those classes were canceled or made virtual, Evans said.

And while 22 beds will help, Evans said with current COVID projections, the hospital will probably need many more.

“Now this gets us a little closer to that 125-bed mark, but there could still be a gap in the future that we’ll need to address in terms of additional field surge capacity,” Evans said.

They knew it would get to this point long before they opened this unit, Evans said. This surge has seen more patients over the age of 60 than before, he said.

Younger people are also getting sicker faster, Cabell said. Three people under the age of 45 have died at Kootenai Health in the last few weeks, she said.

At the peak of the pandemic in winter 2020, Kootenai Health had 91 COVID patients. They met that record Tuesday, and then broke it a day later when they saw 96 COVID patients at one time. Of those 96, 34 were in critical care, Evans said.

“The other thing that’s different about this surge is we’ve gotten to this max capacity much sooner,” Cabell said. “Last time, it took us about two and a half months to climb to a census of 91, and then we started going down. This time, we’re only about three or four weeks in and we’re already at 96. And we don’t know how much higher that’s going to go.”

But this is only the first step. Converting one classroom won’t do much, as the community faces more potential spreader opportunities like the uncanceled North Idaho Fair, kids going back to school and an upcoming Labor Day weekend where people are expected to be going out, Cabell said.

“A situation like this, using conference rooms adjacent to hospitals, really that’s the first tier,” Evans said. “Beyond that, we’ll continue to explore whether we need to do other field hospitals, buildings, tents or how we may access additional beds throughout the community in the other hospitals.”

This also comes as Kootenai Health and other medical centers face staffing shortages, Cabell said.

Those on the frontline work long shifts and overtime as they try to keep up with the influx of patients, Cabell said.

“Our team is very tired,” Cabell said. “We’ve been using various incentives to bring more into the hospital to try to help them.”

It also means elective procedures, or surgeries not considered urgent, have to be put on hold while the hospital uses surgical beds as COVID beds, Cabell said.

Idaho health officials also recently asked for more FEMA funding to combat the spike in cases, citing a statewide nursing shortage as a priority.

“Staffing is the predominant factor stressing hospitals out in terms of their capacity, and we are exploring lots of different community channels and problem solving channels with hospitals,” said Elke Shaw-Tulloch, Department of Health and Welfare Administrator for Division of Public Health, during a news conference Tuesday.

They will also have to wait to declare a critical standard of care until the state does so, Evans said. Currently the hospital is under a “contingency standard” of care, which means they can use different rooms to house patients they normally couldn’t use under a normal standard of care.

“If we need to continue to add more beds and stretch our resources thinner – our staff in particular – we may reach a point where we need to request crisis standards of care,” Evans said.