OKC in Tier 3 of COVID-19 surge plan

As the number of Oklahomans hospitalized due to COVID-19 continues to hit record highs, the Oklahoma City metro area on Thursday entered Tier 3 of the state's hospital surge plan.

Although the change indicates the situation for metro-area hospitals is getting worse, state officials have no immediate plans to implement additional measures to reduce the spread of COVID- 19 or free up hospital beds.

Oklahoma City is the first of eight Oklahoma hospital regions to reach Tier 3 of the four- tiered surge plan, and the shift indicates hospital capacity for COVID and nonCOVID patients is growing limited in the area. Earlier this week, Oklahoma surpassed 1,000 hospitalizations due to COVID-19 for the first time.

The State Department of Health is monitoring the situation and working with local hospitals to ensure they have capacity for all patients, Hospital Surge Plan Coordinator Matt Stacy said in a statement.

“We are working with the Oklahoma Hospital Association and hospital partners to closely monitor the situation, and we are confident the hospitals are proactively working on strategies to create additional capacity so every Oklahoman who needs a hospital bed has access to one,"

he said.

A spokesman for the Oklahoma State Department of Health confirmed the percentage of COVID-19 patients in metro hospitals has exceeded 20% of the admitted patients for three days — the trigger required to move the region into Tier 3 of the surge plan. The metro area reported Monday 20.1% of hospitalized patients were COVID-19 patients.

Some patients who are not in need of immediate care may see delays or be transferred to other hospital facilities in the state, said Dr. Dale Bratzler, professor and chair of the health administration and policy department at the Hudson College of Public Health at the University of Oklahoma.

“For patients, this likely would mean deferred or delayed care,” he said. “Some elective operations — particularly those that are more complex that might require transient ICU care could be delayed. Patients with lower acuity illness might be transferred to specialty surgical hospitals or post-acute facilities (such as rehab hospitals, skilled nursing facilities, etc) to receive care. Patients could be transferred to other communities or regions where beds may be available.”

Slowing the spread of COVID19 is the best way to reduce the need for these measures, Bratzler said. Bratzler and other Oklahoma health officials have urged Gov. Kevin Stitt to adopt a statewide mask mandate to reduce the spread of COVID-19.

In Tier 3 of the surge plan, hospitals can cancel surgeries and transfer patients to postacute care facilities to free up beds. The surge plan also gives Stitt options to improve hospital capacity through an executive order limiting elective procedures.

Stitt spokesman Charlie Hannema said the governor does not plan to sign an executive order limiting elective procedures. Nor does he plan to request the Oklahoma Legislature implement the Catastrophic Health Emergency Powers Act, which would give Stitt additional powers for 30 days.

Hannema said the governor's office is in close communication with the state's hospitals to help with any needs they might have.

"We have met with the hospitals and are working to assist them with staffing, patient transfers and other needs they are seeing," he said.

In the spring, the Legislature twice approved giving the governor emergency powers to help the state's response to the COVID-19 pandemic. The Legislature is not in session, and would have to be called into a special session to act on a request for emergency powers.

Although the surge plan lists the emergency powers as an option for Stitt, it does not recommend specific actions for the governor to take under the health emergency act.

The Oklahoma State Department of Health on Thursday reported 2,101 new COVID-19 cases. The state's cumulative number of cases during the pandemic is 129,873.

Oklahoma's 7-day average of new infections is now nearly 1,400, the highest rate yet during the pandemic. Oklahoma's death toll from COVID-19 is 1,413.

LaWanna Halstead, vice president of quality and clinical initiatives with the Oklahoma Hospital Association, said while the region meets qualifications for Tier 3 protocols, moving to that designation is up to the individual hospitals.

“The numbers of hospitalizations indicated on the surge plan are a guideline to assist hospitals and state leaders to gauge the percent of COVID-19 in Oklahoma hospitals," Halstead said.

"Not all hospitals will be at the same percentage at the same time. The most important thing is whether they have enough beds available to care for all types of patients, whether they have COVID or not."

Halstead said each region also triggers its different tier protocols individually and if one region has higher numbers than another, patients would be moved to where capacity exists and where the appropriate care is available.

Tier 4, the final tier of the plan, will be activated if more than 39% of hospital patients in a region are COVID- 19 patients and that trend holds for at least three days. Hospital officials have indicated hospital capacity will be extremely limited at that point.

If that occurs, the surge plan allows hospitals to take urgent action to address the surge in patients and gives the governor the option to issue an executive order halting elective surgeries statewide.