In her role as nursing manager at Pittsburg’s Ascension Via Christi Hospital, Jessica Cobb is normally tasked with making the emergency room and intensive care facilities run like a Swiss watch.
While hopping onto the hospital floor and helping out her staff is not unusual to her, her domain is usually that of scheduling and managing, both in Pittsburg and Via Chrsti’s emergency room outpost in Fort Scott.
But in recent days, the hospital has seen a marked uptick in COVID-19 patients, pushing the hospital and its staff in ways that they had not yet been during the pandemic.
Pittsburg saw a steady stream of COVID-19 infections throughout the spring and summer, Cobb noted.
But the return of students to the classroom, both K-12 and university, combined with rapidly increasing infection rates in Missouri and pandemic fatigue among residents to produce a perfect storm for a rise in cases.
That means Cobb is helping out her fellow nurses now more than ever, retrieving supplies for nurses deep in the trenches with COVID-19 patients or helping to flip individuals on ventilators to help improve their breathing.
"Until it has impacted you personally, it is tough to wrap your minds around what exactly this means and what exactly this looks like," she said.
The rise in cases also meant that Via Christi on Monday halted elective procedures in order to divert staff toward supporting COVID-19 patients, a step not taken since the early days of the pandemic in May.
"We had to basically gear up, to figure out how we were going to take care of those patients for our community and for our region," said Randy Cason, the hospital’s president. "And so we had to take these necessary steps to do that."
State officials say hospital capacity not an issue – yet
The number of cases began to ease slightly later in the week, Cason said, and the hospital is looking to slowly resume elective services sooner rather than later.
Officials at the Kansas Department of Health and Environment and the Kansas Hospital Association maintain there are no statewide capacity issues facing hospitals at this time.
But KDHE Secretary Lee Norman has repeatedly cautioned residents about the state’s rise in cases and hospitalizations. Kansas averaged 743 new cases a day for the seven days ending Wednesday, a new record since the pandemic began.
And while the state’s three biggest counties accounted for well over half of the state’s COVID-19 case count earlier in the pandemic, currently two-thirds of the cases lie outside of the Wichita and Kansas City, Kan., areas.
Norman said the issues in the southeast should serve as a warning shot.
"I think that should absolutely be a wake-up call that hospital capacity is strained," he said. "There's too much disease in the community and we have to do whatever we can do to push it out."
Still, he said, there is no danger of hospitals becoming overrun at this time.
"They're not pushing overly for capacity right now on either beds, ICU [beds], ventilators, dialysis machines or staff," he said. "But if the numbers continue to grow that will definitely be a concern."
‘It has burned its way into our community’
But facilities throughout the state are beginning to express those concerns about where things are headed.
Reno County last week saw the highest number of cases reported in a single day since the pandemic began.
The New York Times proclaimed Hutchinson as one of the fastest-growing hotspots in the country earlier this week, and Hutchinson Unified School District 308 made the decision Friday to transition to fully remote learning.
Hutchinson Regional Medical Center only had a handful of COVID-19 cases as recently as a month ago, hospital Vice President Chuck Welch said.
While areas like Hutchinson and Pittsburg have the benefit of learning from how the state’s large metropolitan areas handled the rise of cases in the spring, Welch said, it also lulled residents into a false sense of security.
"I compare it to a grass fire," Welch said. "Because of our location, and our lower population and relatively large geography, we benefited from natural social distancing. And it was kind of like we were sitting in Hutchinson watching the smoke and the fire off in a distance in Wichita, knowing it would probably reach us at some point."
Now the number of cases is in the "steady double digits and continue to trend in the wrong direction."
"It is here," Welch said. "It has burnt its way into our community."
The case load was manageable right now. But all it would take is the virus wreaking havoc on a long-term care facility to send the hospital reeling, he said.
Officials at the University of Kansas Health System reported last week that there were roughly as many COVID-19 cases at their Hays facility as there were at their Kansas City, Kan., campus.
About half of the cases seen in Hays came from Ellis County, said Heather Harris, director of operations at Hays Medical Center, with the other infections coming from neighboring counties in northwest Kansas.
David Wild, vice president of performance improvement at KU Medical Center, underscored that capacity is not yet an issue, with facilities able to easily adapt to cope with an influx in demand.
If the facility in Hays began to max out, patients could also be moved to Topeka or Kansas City, Kan., he noted.
But officials were beginning to revisit their contingency plans for ramping up capacity.
"I would anticipate more [hospitalizations] 10 days from now than we see now, which is the reason that the signals we currently see are absolutely causing us to pay attention and think about what we do next," Wild said.
Other states in the Midwest have already hit a crisis point.
In Wisconsin, the state was forced to open a field hospital in Milwaukee after hospitals in the region became overrun with cases. South Dakota, meanwhile, has set records for new cases and hospitalizations in recent days.
Closer to home, Missouri reported 1,200 residents in hospitals with COVID-19 throughout the state.
"I'm worried," Wild said. "I'm worried because of what we're seeing on the map in Central Missouri, and Iowa, North Dakota, South Dakota, Wisconsin, all of those Midwestern states. What we're seeing now is that this is not healthy people who don't need hospitalization getting infected at this point."
‘You just don’t want to burn out your staff’
While many in the spring worried about physical resources, such as hospital beds or ventilators, now the biggest concern might be staff.
Cindy Samuelson, senior vice president for member and public relations for the Kansas Hospital Association, noted that no hospitals were needing additional help with staffing or even physical resources at this time.
But with COVID-19 spreading in the communities, nurses and technicians were not immune from exposure when they go about their daily errands, just like anyone else.
"We're continuing to watch [staffing levels] daily," Samuelson said.
And even if the staff does not contract COVID-19, there is the simple fact that many are exhausted from six months of pandemic response.
That’s especially true, hospital officials say, as individuals with COVID-19 require more attention from workers than a normal patient.
Ensuring adequate staffing levels played a big role in briefly halting elective procedures in Pittsburg, Cason said.
The concern is if a surge lasts for an even longer period of time, especially with worries about flu season arriving, which is a time when hospitals are stressed even in a normal year.
"That nurse will take that extra shift and we kind of get through this hump but if it sustains for two, three, four weeks, it gets to a point where that staff person just needs a break," Cason said. "You just don’t want to burn out your staff."
There are downstream effects to this, as well.
Girard Medical Center sits in a small town of 2,800 northwest of Pittsburg. The critical access hospital only has a daily census of around three patients per day on average, CEO Ruth Duling said, and it has seen only a few COVID-19 patients.
But the facility has begun to take non-COVID-19 patients from Via Christi in Pittsburg to help them refocus on fighting the pandemic.
The problem is the rotating pool of nurses in the region that the hospital often leans on are working elsewhere as case counts rise.
"Sometimes it isn’t about how many beds you have, it is about how many beds you can staff," Duling said.
And in southeast Kansas, facilities are increasingly limited in their ability to send patients to southwest Missouri or Kansas City, Kan., with facilities there filling up as well.
The same is true out west, with Hutchinson unable to leverage its relationships with other facilities in the region, Welch said.
"Our partners that we would typically send patients to are in somewhat of a more dire situation than we are at this point," he said. "And so we are acting as the recipient of patients from other hospitals right now."
Officials: Southeast Kansas a cautionary tale
It wasn’t supposed to be this way in Pittsburg, said state Rep. Monica Murnan, D-Pittsburg.
Crawford County health officials had been careful to lay out a plan to protect students coming back to K-12 schools and Pittsburg State University.
After lengthy debate among local officials in July, the county also opted to continue with Gov. Laura Kelly’s mask mandate, something they have stuck with ever since.
The easing of cases of Via Christi needed to be a "learning opportunity" for communities, both in southeast Kansas and across the state, she said.
"Other counties can learn from us," Murnan said. "That you can do all of these things right. You can have good communication. You could have solid plans in your hospital. You can have the right people, the right decisions, and you can still get to capacity. If it can happen to us, it can happen to anybody."
Other hospital officials underscored the same theme: residents need to lose pandemic fatigue and take the virus seriously or else the situation will continue to worsen.
Welch said "we’re at the tipping point" in Reno County.
"We're entering the third quarter of probably the most important game of our lives," he said. "And we have a really critical decision to make right now. We're going to come out of halftime and fight this thing with every tool that we have. Or we are going to continue to lose family members, friends and people that we love and know."
Cobb, the nurse manager in Pittsburg, and her team understand that better than perhaps anyone else.
"I just wish people knew if they can continue to help slow the spread, not get rid of it but slow the spread, they can help hospitals and health care workers to have the resources they need to take care of people when they have emergencies," Cobb said.