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Opinion >  Column

Sue Lani Madsen: COVID-19: Unasked questions

Rarely does one get an answer to an unasked question. When the media is dominated by a single narrative, stifled questions shut down critical conversations about public health and the health care system.

As an alternative voice on The Spokesman-Review editorial page, I hear from the frustrated. When merely asking questions will get you publicly lambasted as a COVID-denying anti-vaxxer who doesn’t care about other people’s health, it’s no surprise they wish to remain anonymous.

One health care worker at Sacred Heart questions why we have patients living in the hospital for over a year. On average, 10-15% of all acute care beds are occupied by a category called “difficult to discharge,” according to the Washington State Hospital Association. Spokane’s hospitals are no exception. These are patients who should be discharged to a long-term care facility, an adult family home or go home with family. They significantly reduce hospital capacity for acute care.

She describes these patients as suffering from dementia, developmental disabilities or psychiatric problems who either have no family or no family able or willing to take them. “There is no place to put them, so they sit in the hospital. We need a system that takes care of everyone.” Some were functional alcoholics until another illness landed them in the hospital, but they are no longer acutely sick.

How many patients in Spokane hospitals are ready to be discharged but have no place to go? How many more acute care beds would be available if this hard-to-fix problem were addressed? How do we restructure the health care system to better care for those who cannot care for themselves? Why have we lost capacity in the long-term care system?

Staffing shortages at every level of health care are a part of the problem. Hospitals have been close to the edge for a long time, well before COVID. Washington and Idaho both had a shortage of just over 10 nurses per thousand population in 2018, according to NurseJournal.org. A registered nurse working in a Spokane ICU said she constantly receives calls asking her to take extra shifts, noting the entire hospital is short-staffed in all units at every level. It’s a prescription for burnout.

Like every other industry, it’s hard to fill basic but invisible jobs. The hard-working nursing assistants who provide much of the hands-on personal care are critical for staffing beds. And anyone who has waited in a hotel lobby for a maid to flip a room can understand how “environmental aides” with health care housekeeping experience are critical to finding a bed.

Did staff nursing layoffs in 2020 accelerate reliance on “travelers?” Are the memes claiming 500 job openings at some local hospitals true? Were staffing levels in 2019 higher or lower compared to 2020 throughout the system? Has the ratio of staffing to population kept up with population growth?

And then there are the patients. Contrary to sensationalized national news, previous reporting in The Spokesman-Review affirmed the data does not show COVID patients from Idaho overflowing into Spokane hospitals.

Tracking addresses is easy. A more difficult question is whether a patient testing positive for SARS-CoV-2 virus actually has COVID-19. An ED physician at Sacred Heart pointed out every patient coming into the hospital is tested because staff must logically take precautions to limit cross-contamination.

But that means a woman brought to the ICU for head trauma and asymptomatically positive is counted as a COVID patient, with the hospital gaining a bump in Medicare payments intended to cover additional isolation costs. And it leaves families telling now common tales of loved ones erroneously listed as dying from COVID when their problem was a heart attack or trauma. One medical coding professional who started to answer questions before remembering corporate protocol about talking to the media said, “Don’t get me started, it’s all screwed up.”

How many patients have COVID as a primary diagnosis, and how many are merely identified as COVID patients for appropriate in-hospital quarantine? Will or should new rules from insurance companies related to a COVID diagnosis affect coding? Is there Medicare billing fraud driven by a perverse incentive to overdiagnose COVID?

The nurse who turns down extra shifts at Holy Family to preserve her mental health said she doesn’t follow the news because she doesn’t know whom to trust. What she currently sees in her ICU is about three-fourths of the patients coming in with a primary diagnosis of COVID, a higher proportion than last year. “Half are intubated and half of those won’t make it.” While she said about 80% of her ICU patients are unvaccinated, 20% are vaccinated and many of those “got super sick and died from COVID.”

She wants to know, why aren’t we talking about the effectiveness of natural immunity compared to vaccination? And since hospitals are already short-staffed, how are they planning to safely care for patients after losing staff when the vaccine mandate deadlines kick in?

These are real people in the Spokane community, with real lived experience. Respect their voices. Don’t be afraid to ask their questions.

Contact Sue Lani Madsen at rulingpen@gmail.com.

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