COVID-19 Hospitalizations in Whatcom County

[Updated 4/6/2020: From a friend in Kennewick, I discovered that a long-time hospital in Pasco (Franklin County) is still open, contrary to the data from the American Hospital Directory I found that showed no hospital in Franklin County. I checked the AHD again and found the hospital was listed but at a different site than the one I originally used that was for all hospitals in Washington but did not show any for Franklin County. The hospital was started by the Sisters of St.Joseph (sound familiar?) and originally named “Our Lady of Lourdes,” a designation it kept for many years. It is currently owned by RCCH/Capella, a corporation headquartered in Brentwood, TN (south of Nashville) and known as Lourdes Medical Center. In a letter dated August 8th 2018, The Washington Department of Health approved the corporation’s request to convert Lourdes from a non-profit to a for-profit facility.]

In this article, I combine information from four sources to get an idea of the number of hospitalizations we can expect in Whatcom County from the COVID-19 pandemic. The first source is in the form of the baseline COVID-19 surge peak forecast published by Northwest Citizen on March 30th. The second source is found in my reply to a comment by Steve Abell on the baseline forecast, namely that the average hospital stay of a COVID-19 patient is about four days. The third source is the COVID-19 forecast update published on April 3rd, and the fourth source comes from the state of Minnesota, which shows that 21 percent of all confirmed COVID-19 cases are hospitalized. Minnesota’s hospitalization rate is applicable to Washington State from the perspective of an important demographic indicator of COVID-19 hospitalizations - age structure. As of 2018, Minnesota’s median age is 37.4 years and Washington’s is 37.7.

As I go through this exercise, keep in mind that Whatcom County has 253 beds, all of which are at PeaceHealth St. Joseph Hospital.

The hospitalizations are discussed relative to April 25th, the expected date that the surge will peak in Whatcom County. Two caveats described earlier also apply here, namely that the rate of testing and the accuracy of the tests will remain the same.

First, I combine the information from Minnesota with the forecasted new “daily” cases expected under the baseline scenario for the four-day period, April 22nd-25th (respectively, 541, 627, 726, and 841 cases, which sum to 2,735). From this combination, under the baseline scenario, we would expect a total of 574 COVID-19 cases needing hospital beds at the peak of the surge (where 574 = 2,735*.21). St. Joe’s would be overwhelmed. Having 574 cases needing beds when only 253 are available is akin to what is happening in New York City right now, albeit on a smaller scale. Even if temporary beds were added (WWU’s Carver Gym?) to accommodate this surge, staff and supplies would likely be already exhausted by the time the surge reaches its expected peak on April 25th.

Fortunately, the updated forecast suggests some relief. Under it, the forecasted new daily cases expected for the four-day period, April 22nd-25th, are, respectively, 215, 243, 274, and 310, which sum to 1,042 cases. From this number, we can expect a total of 219 hospitalized COVID-19 cases under the updated scenario as the surge peaks (where 219 =1,042*.21). These results suggest that with “only” 219 cases needing beds and 253 available, staff and resources will be highly stressed, but not overwhelmed.

The 355 case reductions in hospitalizations suggested by the updated scenario underscores a statement I made in the update published on April 3rd. Small reductions in the rate early in the surge will lead to substantial reductions in case numbers by the time the surge reaches its peak. In this case, the 2.47 percent reduction in the daily rate of change in positive cases between the dates when the baseline and the update were produced (March 29th and April 3rd), leads to a 62 percent reduction in the expected number of hospitalizations.

Whatcom County is bordered by only three counties: Okanogan, San Juan and Skagit. This relative isolation from the rest of the state makes it highly probable that the vast majority of our hospitalizations will come from cases within the county itself (with maybe a few from San Juan County). Not many, if any, are likely to come from Skagit County because it has three hospitals with a total of 228 beds. And even though Okanogan County has no hospitals, the Cascade Mountains and the paucity of roads through them, effectively preclude the transfer of COIVID-19 cases to Whatcom County.

This will not be the case in other counties. For example, there are no hospitals in Asotin, Garfield, and Columbia counties, all of which are to the east of Walla Walla in the far southeast corner of the state. Counting neither the state prison’s hospital nor the Veteran Administration’s hospital, Walla Walla has 97 hospital beds. In addition, Franklin County, which borders Walla Walla to the northwest has no hospital. Having four bordering/close-by counties lacking hospitals and a combined population of approximately 123,600 will likely generate high demand for the 97 beds in Walla Walla County.

Walla Walla County is not alone in facing the possibility of high demand for its resources from other counties. Only 18 of the state’s 39 counties have hospitals and, unlike Whatcom, many of them are bordered by one or more of the 21 counties that lack hospitals. Grant County is a case in point. It has one hospital with 48 beds and six of the nine counties that border it have no hospital. These examples suggest that the number and distribution of hospitals relative to the number and distribution of expected hospitalizations due to COVID-19 is a topic to be explored in more detail.

About David A. Swanson

Posting Citizen Journalist • Member since Mar 31, 2020

David A. Swanson is Edward A. Dickson Emeritus Professor of Sociology, University of California Riverside. He served as a member of the U. S. Census Bureau’s Scientific Advisory Committee [...]

Comments by Readers

Steve Harris

Apr 05, 2020

Perhaps I missed this in your analysis, but it appears that a giant assumption in your data is that the number of beds at our hospital are actually availalabe for new COVID-19 patients. It seems you would have to consider the current and expected “vacancy” (for lack of a better word) rate of the hospital, not the total number of beds in the hospital.

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David A. Swanson

Apr 05, 2020

The current and expected census numbers of  patients already in beds represent details I avoided, given the details I already had on other subjects in the article. Taking them into account yields an even grimmer picture in terms of turmoil. In many hospitals they run around 70-75 percent on a given day.  With what we see in, e.g., New York City, the daily patient census is probably running at 150 percent and more in some hospitals. In addition, re the comment made by W.Lee and my reply, we are stuck at this point with “confirmed cases” and their sequelae, which proivde, in my opnion, a “best case” scenario in terms of the total number of infected folks already here and those that will be here in the future. Given that 21 percent of the total inumber of infected people will need hospitalization and at some point 100 percent of the beds are already occupied, a very grim picture starts to take shape,.Imagine how girm it will be  if the current rates of testing are such that the confirmed cases we see now represent only 25 percent  - or less - of infected people. It would be apocalyptic. Hopefully, something on the ratio of confirmed cases to total infectins will emerge.

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Steve Harris

Apr 05, 2020

I agree, it does present a much grimmer posibility, but it’s a factually accurate data point.  You simply can’t assume that there are 253 beds available for new hospitalization, when it’s more likely going to be around 15-20% of that number (considering current occupancy). 

Fortunately, (and IMO) as testing becomes more widespread and available, I believe you will see the hospitalization rate dramatically decrease (relative to the number of total infected).  These statistics (21% hospitalization rate) seem extremely skewed as the vast majority of those being tested are already extremely ill, displaying symptoms (or are a VIP). I believe that there are many many people already infected in Whatcom County that will never be tested as they will never be extremely ill. To that point, Dr Fauci commented today that the current projection is that there are an additional 25%-50% of persons infected above the current positive test subjects. 

Thank you for the work you’re putting into this…but, I hope your wrong and I’m right ;) 

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David A. Swanson

Apr 05, 2020

Hi Steve,

I also hope you are right.

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Tip Johnson

Apr 05, 2020

I agree that actual available beds should be known. I have been unable to find any hospital daily census reporting. 

Staff attrition is another concern. If we are at risk, just going about business, imagine the risk nurses and doctors face. Let’s hope we don’t run out. 

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Steve Harris

Apr 06, 2020

As of March 31st the info provided for St Joseph Hospital:

Census - 143*; Ventilator use 3 of 23 in use; ICU beds - 12 of 24 in use; 22 suspected and 11 confirmed COVID-19 cases.

*I’ve learned that hospitals don’t typically have the full-time staff to treat the max number of beds available.  As such, the max number of patients a hospital can treat is based on their current staffing level which fluctuate based on the census.  

https://www.bellinghamherald.com/news/coronavirus/article241686001.html

The report is imbedded in the above linked article. 

Stay Safe, Stay Well, Stay Sane

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Ryan Knowlton

Apr 06, 2020

Be careful with “average age”. We have a large student population that offsets a large retiree/elderly population. While the average age may be close to the same, a higher number of elderly will be more susceptable to the virus and a larger % of them may require hospitalization. My last number crunch showed that the stay home order is flattening the curve, but the total # of hospitalized folks is likely to stay the same(offseting the slowdown in the spread of Covid-19).

Tip, for the first time in 100 years it’s the doctors and nurses on the front lines of this battle. The hospital having enough PPE for them to function without getting infected themselves and becoming unavailable…or worse yet dying…is VITAL. Lets hope that local government and the hospital have prepared for the “storm”.  As we head into the next couple weeks, we’re about to see how hard we will get hit. 

 

 

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David A. Swanson

Apr 06, 2020

Hi Ryan Knowlton,

Fortunately for us, the median age of Whatcom County is 37.2 years, which is close to that for the state as a whole (37.7)  and even closer to that for Minnesota (37.4).  See The Census Reporter for this and other demographic characteristics of Whatcom County (censusreported.org/profiles/05000US53073-whatcom-county-wa/). Maybe the near-equivalence  of the two median ages has something to do with the fact that the bulk of Minnesota’s population is in the Minneapolis-St Paul area (60 percent or so), which is the home to the flagship campus of the U of M as well as many small universities and colleges (e.g., Augsburg, Hamline, Macalester).

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Dick Conoboy

Apr 06, 2020

RCCH is Resources for Cross Cultural Healthcare a firm that has been gobbling up other health care firms such as Cappella, Life Point,  and Trios.  It has its mitts also into supply chain consolidation.  Read more here.

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Kay Kammerzell

Apr 07, 2020

Thank you for this article. These numbers are more optimistic and not as gloomy as others….in particular I had heard that if we have an estimated 222,000 people living in Whatcom County (and if we use CA estimates that 54% of the population will get Covid19 over the next 8 weeks - CNBC article - dated March 19th.) that means an estimated 119,880 people will get Covid 19 here in Whatcom County - and if 14% of those that get Covid 19 will need to be hospitalized (based on data from WHO) that means 16,783 potential hospitalizations here in Whatcom County.

An added concern is Saint Joseph Hospital only has “24 ICU beds” - and many if not most Covid 19 patients would need ICU.  Also, a concern is it seems they don’t have nearly enough ventilators (only 23) and their staff is diminishing (testing positive with Covid). 

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Ryan Knowlton

Apr 07, 2020

David, I was more pointing to the fact that whatcom county has a fairly sparse middle age demographic and a higher numbers of students and elderly than the typical town. So while the average age may be very close to the same ,we could have a higher hospitalization rate for our larger elderly population and need to plan accordingly. With Minnesta’s student population offering a similar “offset”, it sounds like it’s an apples/apples comparison. 

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Ryan Knowlton

Apr 07, 2020

Kay, the biggest difference is that the “stay home” order came out when we only had a few cases here in Whatcom county, so it’s limited the spread of the virus immensely by niping it in the bud so to say. Other more dense cities had cases in the 1,000+ range before “stay home” was ordered. Unfortunately it is out and spreading in the local nursing homes and staff and continues to do so as those essential staff go home to family and shop for necessities:(  So, we aren’t in the clear yet and won’t be any time soon, but we’ve slowed the spread enough that it’s *possible* that it could remain at a level that won’t overwhelm our local medical system.

We have to continue isolating, staying home, and even staying out of grocery stores if possible. Think about everything you touch out in public and minimize that…I’ve been using a plastic bag over my hand when I get gas for example, then aferwards I throw the bag out. Plan ahead and order groceries for delivery or pickup, or consider curbside takeout from one of the many resturants. I feel that the grocery store just has too many people touching the same items when you go inside and then checkout normally, and it’s probably the largest point of spread besides the hospital and nursing homes.   

 

 

 

 

 

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Ryan M. Ferris

Apr 08, 2020

It is good to have such discussions here and elsewhere on this virus. Key points:

(1) Because neither Pandemic data collection or prediction nor the virus itself are well understood, any current predictions will have wide margins of error both here and globally.

(2) it is not known whether ‘social distancing’ or other strategies will have a positive or negative effect on reducing viral spread. This is especially the case because transmission  for this virus is not well understood.

We have an aging population in many parts of this planet. We can assume that much of that aging population will die until a treatment is found. It is not known how far we are from a treatment, although many efforts and much spending is underway. In addition, the conditions that created this virus will probably bring more such viruses in the future.

There is much energy, time, money being put into understanding and ameliorating the effects of this virus. But for many different reasons, I don’t have confidence yet those efforts will succeed. It is however likely that this Pandemic will not destroy all of our current civilization. The next one could though.

 

 

 

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