Pandemic Chronicles: COVID cases surge

patients cared for in garage; Sisolak urges Nevadans to stay home

PHOTO/FRANK X. MULLEN: Workers on Nov. 11 prepare Renown's parking garage for an overflow of patients, the first of whom arrived five days later.

Renown Regional Medical Center Nov. 16 moved 10 patients into its COVID-19 overflow area in a parking garage, five days after setting up the emergency facility and the same day Washoe County officials announced that one-in-86 residents has an active case of the virus.

The patients were experiencing “mild to moderate symptoms,” officials said, and are in the emergency facility to free up hospital ward and intensive care beds for more critical cases.

Northern Nevada has become the state’s hot spot for what is developing as a second wave of the pandemic. Active COVID-19 cases in Washoe County totaled 1,352 per 100,000 people as of Nov. 15, second only to Carson City, where the active case ratio was 1,860 cases per 100,000 people. The state average is active cases 930 per 100,000.

A total of 219 people have died in Washoe County from COVID-19 as of Nov. 15.

Washoe County had 5,425 cases on Nov. 15, five days after its record-setting 4,000 cases. On that day, workers at Renown Regional Medical Center in Reno were setting up hundreds of beds and patient stations in a hospital parking garage to prepare for what may be the pandemic’s winter tsunami.

“We’re seeing an absolute increase in the number of patients presenting with COVID or COVID- like symptoms that require hospitalization,” said Dr. Paul Sierzenski, chief medical officer for Renown’s acute care unit said Nov. 11. “…There’s been a rapid escalation in the numbers of new cases and hospitalizations. We’re preparing these areas should we need them.”

The numbers tell a grim story. On Nov. 11, the county had 4,141 active cases of the virus, up from 3,844 the day before. That was more than than 400 new cases in 24 hours. At the same time, the Nevada Hospital Association reported that 84% of the county’s 1,254 staffed inpatient beds were in use, up from 80% on Nov. 10. Occupancy of beds in intensive care units was listed at 63%, the highest percentage since July 17. Ventilator use also increased, with one-in-four of the available machines in use, the highest level since Sept. 7.

In a conference call Nov. 10, Reno Mayor Hillary Schieve said the convergence of the data amounts to a “perfect storm.” She said late November to January will be a critical period, with people more prone to staying indoors, holidays on the way and people suffering from “COVID fatigue” who want to attend gatherings.

Cases increase by a factor of 4

With virus cases already climbing, if people get lax in observing pandemic precautions, hospitals would be in danger of becoming overwhelmed with patients. She noted that in September hospitals were averaging 50 cases a day, but now they are averaging more than 200. “If I were to tell you right now if we have a tsunami coming, we would all be running for the hills,” she said. “… This is not the time to have COVID fatigue.”

Nevada reported 1,107 new cases the morning of Nov. 11. It’s the same story nationwide. Case numbers increased this week in all 50 states. New COVID-19 daily cases in the U.S. hit another record high Nov. 11, with 140,543 reported in the morning, according to data from Johns Hopkins. It also was the ninth straight day of new cases topping 100,000. The second highest number, 136,325, was reported Nov 10.

Above, COVID-19 cases soar in the U.S. As of Nov. 11, Nevada has reported 110,982 cases and 1,852 deaths statewide since the start of the pandemic.

Gov. Steve Nevada Gov. Steve Sisolak on Nov. 10 said the state “must see a significant reversal of the current trends” if the state is to avoid another “shelter-in-place” lockdown, which would be a withering blow to the Silver State’s already ailing economy. He told Nevadans to avoid going out in public unless absolutely necessary. Sisolak encouraged employers to allow employees to tele-commute from home whenever possible and asked that local jurisdictions increase enforcement against businesses that aren’t following the state’s virus prevention measures.

Another business shutdown possible

When the virus began sweeping across the nation in March, Sisolak ordered the closure of all “nonessential” businesses and mandated stay-at-home orders. Those precautions were rolled back as the case count began to flatten in July. In two weeks, those mandates could be back.

“Nevadans need to change behaviors immediately,” he said. “… If we don’t make progress over the next 14 days, I will be forced to take stronger action.”

Meanwhile, first responders are preparing for a deadly wave. The hospital spent $11 million on the emergency facility equipment. The first floor’s 700 beds can be expanded to 1,600 beds across other garage floors if needed.

PHOTO/FRANK X. MULLEN: A row of patient stations in the Renown parking garage Nov. 11.

Parking garage gets transformed

In Renown’s parking garage, workers ran red, green, yellow and purple electrical wires along concrete ceiling beams. They arranged new plastic-wrapped beds, small tables and monitoring equipment into individually numbered patient care stations. Those beds would be used by people with milder cases of the virus, but because of their risk factors would still need to be in a hospital setting.

Workers wheeled in scores of blue bins for soiled linens and trays full of electrical connections.

Sierzenski said the repurposed garage space has medical grade negative pressure air filtration system. The first floor of the garage can accommodate 700 beds. Another 700 can be set up in a floor above, he said.

He said although the hospital is taking similar measures to deal with a possible overflow of patients as it did in the spring, the staff has some advantages this time around. “We know a lot more (about the virus) than we did in March,”  Sierzenski said. “We know a lot more about how to care for patients.”

PHOTO/FRANK X. MULLEN: A patient station in the Renown parking garage.

Some changes since spring

He said the facility also is better prepared with a good supply of personal protective equipment, such as N-95 masks, which are rated for filtering out 95 percent of virus-sized particles. In the spring, there was a nationwide shortage of those masks and doctors and nurses were reusing what were supposed to be single-use face coverings for days at a time.

“Now we can issue (them) a new N-95 every shift,” he said. In addition, Renown has acquired “positive pressure devices,” which are helmets that supply medical workers with fresh air. “We’ve been able to catch up,” he said.

Renown also set up a heated tent at its emergency department entrance as a triage station for patients with COVID-19 symptoms. That will keep patients who are presumably carrying the virus separated from people who came to the trauma center with conditions unrelated to the pandemic.

PHOTO/FRANK X, MULLEN: Dr. Paul Sierzenski, chief medical officer for Renown’s acute care unit, on Nov. 11

Surgeries remain scheduled

Sierzenski said acute surgeries at Renown, such as heart procedures, will continue as scheduled. Elective surgeries at its facilities also remain on the calendar, but “will be evaluated on a daily basis.”

He said if people stay at home whenever possible, wear masks in public, maintain social distancing and wash their hands frequently, those precautions will help stem the spread of the virus and keep hospitals from being overwhelmed with patients – as happened in New York City in the spring.

Heather Heinz, a registered nurse at Renown, said if large numbers of patients arrive art Renown’s doors the facility is ready to deal with an increased demand. “We’re back at it,” she said. “We’ve learned a lot in the last eight months. We’re ready.”

But Heinz and Sierzenski said everyone would rather avoid having to use the overflow area in the parking garage. They urged Truckee Meadows residents to heed Sisolak’s warnings and follow his advice.  “People should only be out if they really need to be out,” Sierzenski said. “We really need to flatten the curve here.”

EDITOR'S NOTE: This story was originally written on Nov.11 and updated on Nov. 16.

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