John Locher/AP
Health care workers with the UNLV School of Medicine wait in personal protective equipment for patients at a drive thru coronavirus testing site Tuesday, March 24, 2020, in Las Vegas. UNLV Medicine, the clinical arm of the UNLV School of Medicine, started conducting COVID-19 testing by appointment for people who meet the Centers for Disease Control and Prevention guidelines.
Monday, March 30, 2020 | 2 a.m.
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To address the rapid rise in COVID-19 infections and minimize fatalities in Southern Nevada, health care workers and industry experts say there is more than one challenge at play — and more than one solution.
The Las Vegas area needs more COVID-19 tests from the federal government so that health officials can more accurately assess the regional scope of infections, according to several people in the industry.
Hospital and urgent care workers also need more personal protective equipment (PPE) from the federal government to protect themselves and patients from infection. And everyone in the region needs to practice social distancing and stay inside to “flatten the curve” — slow the spread of the virus in order to reduce stress on the health care system, which could save lives.
These issues must be addressed in congruency, says Maureen Schafer, president and CEO of the Nevada Health and Bioscience Asset Corp.
“If any of those things gets disrupted ... one disrupts the other,” said Schafer, former chief of staff to the planning dean at the UNLV School of Medicine.
Health District nearly out of tests, but hospitals make progress
Even as the number of confirmed COVID-19 cases in Southern Nevada increases daily, testing in outpatient settings remains “severely limited,” said Dr. Joe Corcoran, chief medical officer for HCA Healthcare Far West Division. HCA’s Las Vegas hospitals — Sunrise Hospital & Medical Center, Mountain View and Southern Hills — are only testing people who have severe enough symptoms to be admitted in order to conserve its limited tests, spokesperson Sunnye Owens-Garrett said.
As a result, Las Vegas residents have reported being turned away from hospitals after being told by their physicians to go there for a test. This also means that the number of cases in the valley is very likely underreported, said Dr. Shadaba Asad, medical director of infectious disease at University Medical Center.
“If the only people being targeted for testing are the ones coming to the ER, you’re probably capturing a small proportion of cases,” Asad said.
Meanwhile, testing at the Southern Nevada Health District’s public health laboratory is limited, according to daily reports from Nevada Health Response. Although Southern Nevada has the vast majority of COVID-19 cases in the state, only 575 tests had been conducted at the health district’s public health laboratory as of Friday compared to the 2,242 tests done at the Nevada State Public Health Laboratory at University of Nevada Reno.
On Friday, the Southern Nevada Health District announced that despite its repeated pleas for more tests, it had nearly run out, with only 119 remaining. While the state has submitted four COVID-19 testing requests to the federal government, none of those shipments had come in as of Friday, Nevada Health Response reported.
“Nevada has four pending requests for COVID-19 testing components and has been told by the federal government that these items are on an indefinite backlog,” the state agency reported.
The good news is that outpatient testing in Las Vegas is finally becoming more widely available, Asad said.
Southwest Medical has been administering tests to existing, referred patients who are symptomatic at three outpatient locations, and UMC now has the capacity to screen people who suspect they have the virus at all nine UMC Quick Care locations. After being screened, eligible, symptomatic patients are then sent to an outpatient location to get tested, UMC public relations manager Scott Kerbs said. Spokespeople from both medical groups did not say exactly how many outpatient tests are being administered daily at those locations.
Since Tuesday, UNLV Medicine has been conducting upwards of 200 tests per day at its drive-through testing facility on Shadow Lane, according to School of Medicine spokesperson Paul Joncich. That service will be available for as long as supplies last.
“As testing becomes more widespread, I think it will become a more accurate representation of the true extent of the disease,” Asad said.
Nurses worried over testing lag time, but UMC has new rapid-response test
Even when testing is available, health care workers say delays in test results create another problem, particularly for their safety and that of patients. Testing done through private companies like Quest Diagnostics or LabCorp typically take three to five days for a result, while tests at the health district come back within 24-28 hours, Asad said.
But Geoconda Hughes, a nurse at a Las Vegas hospital, said it sometimes take up to eight days or more to receive a patient’s COVID-19 infection status after a test is conducted. At her hospital, patients and their nurses cannot use N95 respiratory masks until the patient has been confirmed positive for COVID-19 in an effort to conserve protective gear, she said.
“If that person is being tested, but isn’t positive yet, nurses are only asked to wear a regular surgical mask, which is not protective gear for COVID-19,” Hughes said. “If they come back positive, we would’ve been exposed.”
Another area nurse, Zachary Pritchett, said test results at his hospital often don’t come in for three-seven days after a test is administered. Many Las Vegas hospitals lack sufficient PPE, forcing nurses to sometimes work without them until they receive a positive test result, he said.
“My fear is as we continue, nurses start to get sick. That might become an issue,” Pritchett said.
One bright spot for testing in Nevada came out of UMC this week. The hospital just launched an in-house coronavirus test that generates results within two-four hours, Asad said. More information about the test will be announced in the coming days.
“Because of that, I think we do have the ability to test more patients,” Asad said.
Hospitals prepare for peak in patients
At this time, a primary concern for hospitals in the valley is what will happen when they reach capacity, Schafer said.
As of Friday, 67% of the state’s staffed beds were in use, 72% of intensive care unit (ICU) rooms were in use, and 51% of airborne infection isolation rooms were occupied, according to Nevada Health Response. Both ICU rooms and isolation rooms are used to house COVID-19 patients, Schafer said.
“Obviously, if we look at a curve relative to what New York is facing, we would experience a similar type of upward tick,” she said. “And so Nevada in general was already at a high percentage of bed capacity with respect to our ICU beds.”
Another concern for hospitals is ventilators, which are used on critically ill patients to help them breathe. As of Friday, 40% of Nevada’s ventilators were in use. But Gov. Steve Sisolak has warned that the state does not have enough to address an anticipated surge in patients.
To help conserve and maximize resources, valley hospitals are continuously developing contingency plans, Schafer said, which could include using telemedicine when appropriate to free up in-person resources.
UMC, which is preparing for a peak in patients in late April or early May, is taking inventory of PPE and supplies and trying to eliminate unnecessary inpatient procedures, Asad said. The hospital is also considering ways to maximize space for COVID-19 patients, such as dedicating entire units for those patients and putting two patients who have tested positive for the diseases in one room.
The hospital has already developed new areas to care for patients, Asad said.
“There are lots of things that have slowly been put into place,” she said.
While Asad and Owens-Garrett said their respective hospitals have not yet run out of supplies, bed space or PPE, Pritchett and Hughes stressed that the need for protective gear is imminent. Nevada has ordered two PPE shipments “encompassing the statewide immediate need,” but the federal government has only given the state less than 25% of the PPE requested, according to Nevada Health Response.
“From what I’ve gathered, this is a problem that is paramount all over the valley, all over the state, and all over the country, for that matter,” Pritchett said.
Even as hospitals prepare for influxes of patients, the coronavirus crisis has the potential to overwhelm the most prepared facilities in the state, Schafer said. That’s why it’s so crucial for Nevadans to stay home, only leaving for essential business and keeping a six-foot distance when interacting with others.
“Sometimes it’s very hard to believe that just sitting at home and doing nothing is the most important thing you can do right now, but honestly, that is the message I’d like to get out there,” Asad said.
