South Dakota is experiencing a large increase in the number of COVID-19 cases and hospitalizations. The seven-day running average for cases has increased 393% from 80 cases per day Aug. 1 to 394 cases per day Sept. 30, while the average the number of hospitalizations has increased 420% from five to 26 hospitalizations per day.

Additionally, the state’s number of individuals who are aged 60+ years with COVID-19 has increased with close to 1,200 cases in the past two weeks. Approximately 20% of the individuals who have been diagnosed with COVID-19 in this age group may be hospitalized within the next two to three weeks based on current South Dakota hospitalization rates. There is likely going to be a significant need for hospital and intensive care unit (ICU) beds during October to meet the medical needs of South Dakotans.

The South Dakota Department of Health dashboard provides information on what percentages of hospital beds and ICU beds are COVID-19 occupied, but it is important to understand what beds they are referring to. The denominator in that percentage is based on information from the Hospital Available Beds for Emergencies and Disasters (HAvBED) database for South Dakota. HAvBED is a federally mandated program that requires states to collect and report local hospital available bed data. The system connects to the state’s Emergency Operations Center in Pierre and is linked directly to U.S. Department of Health and Human Services.

Reporting the number of hospitalized patients and number of potential beds can change daily. Hospitalized patients change due to admissions and discharges while the number of potential beds changes due to a hospital’s creation and opening of institutional surge beds. Surge beds are additional inpatient beds that are not necessarily operational nor staffed. An example is the Brookings Health System (BHS), which is licensed for 49 beds, but has the surge capability for up to 80 patient beds. Although there could be a maximum of 80 beds at BHS, it currently has the personnel to handle only 45 of these beds. If BHS initiated its surge plan, more beds would become available and the number of potential beds would change. Therefore, when looking at hospital and ICU bed occupancy percentages, it is important to realize that both the numerator (number of currently hospitalized patients) and the denominator (number of potential beds) can change.

Based on a Centers for Disease Control and Prevention clinical guidance document dated Sept. 10, 2020, 26 to 32% of hospitalized COVID-19 patients are admitted to an ICU. COVID-19 patients in an ICU require specialized care 24 hours per day from pulmonologists or critical care physicians, specialized nurses and if the patient is ventilated, from respiratory therapists. Based on a quick count for Sioux Falls and Rapid City, there are approximately 35 pulmonologists and critical care physicians, although there are additional ones throughout the state. We should not forget that other patients may need ICU beds during this time as well for heart attacks, strokes, accidents and other life-threatening events. Individuals with influenza also may need access to hospital or ICU beds. We will be entering the flu season in the near future, and it will be important to minimize the impact of flu on hospital and ICU admissions since these beds may be close to capacity.

Staffing issues are going to become increasingly important as COVID-19 hospitalizations increase and health care workers also become ill. It is important for us to do whatever we can to keep health care workers safe and hospital and ICU beds available. This can be done by following public health recommendations to practice social distancing, wear a mask to protect others when out in public, practice good hygiene and be sure to receive this year’s flu vaccine. Lives may depend it.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html