Whatever you do in the next few weeks, don’t suffer a heart attack or have a stroke. Don’t hurt yourself so badly it requires hospitalization. Given the surge of unvaccinated COVID-19 patients filling up hospital beds across the state, it’s possible the care you need won’t be available.

Hospitals, which were already quite full, are now surging due to predominantly COVID-positive patients who have not been vaccinated. As a result, patients with other emergency medical needs from strokes to infections in rural hospitals are sitting and waiting – and in some cases deteriorating – while they wait for a bed to open somewhere.

It’s not just rural hospitals that are struggling. In Spokane, both Providence and MultiCare have announced delays in surgeries and procedures that are non-emergent in the coming weeks due to capacity limitations. This leaves Spokane-area patients needing hernia repairs, joint replacements, back surgeries and some colon procedures pushed to the backburner for weeks or even longer due to the current strain on hospitals in the region and state.

If a patient is not going to be impacted significantly by a delay of two weeks or so, it could likely be postponed. Hospitals are working with surgeons and their patients on a case-by-case basis to make these decisions, but for procedures that may require a longer stay in the hospital, those are likely being pushed back as well.

“Elective” surgeries can sometimes be more serious than the name implies.

“’Elective’ could be replacing a heart valve or removing a cancerous tumor,’” Cassie Sauer, CEO of the Washington Hospital Association told reporters earlier this month. “It’s really serious care being postponed right now.”

People needing emergency care are sometimes having to wait for it due to the current surge in COVID cases as well.

Rural facilities that often transfer patients to larger hospitals for emergency surgeries or procedures are waiting hours and in some cases days to transfer a patient.

Hospitals were operating close to capacity even before the latest COVID surge, recording some of their busiest summers in emergency rooms and rural facilities in Eastern Washington. While hospitals in Spokane are slammed, particularly for their ICU capacity, rural hospitals are feeling intense strain of a different sort.

With the delta variant, as Dr. Geoff Jones, emergency room medical director at Newport Hospital said, “this is whole other ballgame.”

“Are we admitting more COVID patients than before? Absolutely,” Jones said. “Are we holding onto patients longer? Absolutely.”

The ability for rural hospitals to transfer patients to larger hospitals is a key part of the state’s health care system. Rural hospitals in remote areas typically are not equipped to handle the most challenging cases. They will stabilize and triage those patients then send them elsewhere for higher levels of care .

That higher level of care is now hard to find. Many of those rural patients are waiting in hospital beds, sometimes in emergency rooms, for hours or days to get a bed elsewhere.

Previously, Jones could call the Spokane hospitals and then potentially Kootenai Health and find space for a patient who needed an ICU bed.

Now, that’s next to impossible.

Last weekend, Jones spent more than three hours on the phone trying to find an ICU bed for a patient on a ventilator. He called all the large hospitals in Spokane, Kootenai Health and then asked the Washington Medical Coordination Center for help, all with no luck. He reached further out. He called two Boise hospitals and even Missoula. He thought a bed in Boise opened up, but it filled in the time he was on the phone.

Finally, a bed opened up in Seattle, and they were able to transfer the patient.

At Newport Hospital, and many rural facilities, once a patient is intubated and stabilized, they are ready to be transferred to a larger facility for a higher level of care. The surge in COVID-19 cases and hospitalizations has rural facilities facing difficult situations in the near future.

With large fairs planned in the Northeast Tri-County region, Health Officer Dr. Sam Artzis is expecting a COVID surge and fallout in the region and is advising hospitals to prepare accordingly.

“We’re taking measures to get patients out to other facilities to free up staff to take care of acute cases as they start rolling in next week or maybe this week,” said Artzis, who also works as an emergency physician at Ferry County Hospital. “Things are not good, and we have no place to transfer people. And we’re gearing up to do intensive care in a hospital that is not staffed or built to do ICU medicine, but we’re gearing up for it because we likely will not have a regional hospital to send these patients to.”

Jones is looking at setting up some telehealth options to support providers now tasked with performing intensive or critical care that they are not accustomed to. A provider on the screen could help doctors and nurses walk through procedures they are performing.

“It could help us expand capacity and continue to provide good care,” Jones said.

The current surge is leading to excess deaths in people who are not hospitalized for the virus; it’s just not clear yet exactly how many.

Artzis described a person who had an infection in their lung that got worse and worse as they waited for a bed in another hospital. He said there are patients, even in some rural facilities as well as in larger hospitals, waiting to be admitted into the emergency room, nevermind the ICU.

“I have no doubt when we look back at this we will look objectively and see that there’s an increase in mortality with the delay of care,” Artzis said. “It just makes sense: if you don’t get the care you need in the golden hour, your mortality will go up.”

This week, Dr. Steve Mitchell, who runs the Washington Medical Coordination Center, said he knew of one patient dying while waiting for a bed and expects those situations to continue as capacity remains tight.

There are 1,425 COVID-19 patients in hospitals statewide as of Aug. 26, a record high for Washington facilities that are all surging at the same time.

Washington hospitals in the state are working to prevent even one from being overwhelmed, {%%note} {/%%note} as long as there is space elsewhere, and even rural facilities are making good on this promise lately.

In the past eight weeks, Pullman Regional Hospital had 22 COVID-19 patients, and seven of those were transferred in from Othello, Tri-Cities, Walla Walla and even Kellogg, Idaho.

However, the critical access hospital cannot accommodate all transfer requests, said Jeannie Eylar, chief clinical officer at Pullman Regional.

“Last weekend alone we were requested 21 or 22 times to transfer in a patient, and we did accept six of those,” Eylar said, noting that the facility has to keep an eye on their own capacity, especially with Labor Day around the corner and Washington State University football games returning.

Pullman Regional Hospital loaned out some oxygen tanks and ventilators to other hospitals in the region , but the hospital is seeing the same trends other facilities are experiencing.

“Our ER volumes in June, July and August have been the busiest we’ve ever had, and the acuity of those patients has been significantly higher,” Eylar said.

That strain paired with large events coming up in Pullman make hospital administrators wary of what the coming weeks could look like.

“Pullman might again double in size, and that will impact our ability to accept transfers late next week and the following week,” Eylar said.

The same staffing challenges seen in larger hospitals are also taking a toll on rural health care teams as well.

“We’re months and months into this, and staff are drained and tired, and morale is hard to maintain,” Shane McGuire, CEO of Columbia County Health System in Dayton told reporters earlier this month.

One nurse or nursing aide calling out sick during a shift could mean 25 to 30% of the workforce on a shift is gone.

Eylar said seven nurses recently retired from Pullman Regional Hospital.

With no staff available, services dwindle in rural settings. Jones said on a recent day at Newport Hospital, a man had to wait to be admitted because the hospital was at its staffed capacity.

The solution, health care providers and hospital administrators say, is found in the numbers.

The vast, vast majority of COVID-19 patients taking up hospital beds did not get a COVID-19 vaccine.

From February to mid-August, 94% of COVID-19 patients in hospital are unvaccinated, according to state data.

Those hospitalized with the virus are both sicker and younger than previous waves of the virus. Artzis described a 22-year-old and a 45-year-old both on ventilators after contracting the virus. COVID-19 cases in children are increasing and leading to some hospitalizations.

“It’s so clear with all the data in these hospitalized patients right now that it’s the unvaccinated people who need hospitalization, and that’s why we need to have people vaccinated,” Eylar said.

The surge is no longer impacting just those who did not get vaccinated, she added: “It’s impacting the capacity of the whole health care system.”