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Active COVID cases reach 9,721 statewide; St. V's reduces elective surgeries

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During the last seven days, 45 more Montanans died of COVID-19, and 6,404 new cases have been added, bringing the active case count to 9,721.

Yellowstone County has the highest number of active cases with 2,066 and Missoula County follows at 1,262 active cases.

There are 358 active hospitalizations in the state, seven more than the previous week. In the last two months, there has been a 418% increase in hospitalizations. The last time there was a comparable increase was from Sept. 18, 2020 to Nov. 16, 2020, with a 405% increase. The two dates mark the lowest number of hospitalizations and the highest during the fall surge.

The sustained influx of COVID patients has pushed St. Vincent Healthcare to reduce the number of inpatient elective surgeries by 50% per day, effective Tuesday, Sept. 21, according to Jennifer Graves, director of quality at St. V’s.

“We looked at what variables are within our control,” Graves said. “The number of patients in the emergency department and urgent care, we need to care for those patents when they present…. We’re trying to impact the bed availability.”

If postponing a procedure would be detrimental to patient care, the procedure will still be carried out. The situation will be reevaluated every week, Graves said. No changes to out-patient procedures will change at this time.

On Monday, St. V’s had 46 COVID-positive inpatients, and 10 COVID patients in the ICU with nine intubated. Of the 46 patients, 40 are unvaccinated. Graves said this is a slight decline in hospitalizations over the last several weeks, but it is too soon to say if the decline will continue.

Montana has entered a severe risk rating by COVID Act Now as the state reaches numbers last seen in early Dec. 2020. Before that, similar numbers were seen in early Nov. 2020 as Montana climbed to its peak with the highest case numbers falling on Nov. 20. The average daily new case count at the time was 1,292.7.

As of Monday, Montana has averaged 857.9 new cases a day.

From July 6, 2021 to Sept. 17, 2021, a 2,193.85% increase in cases occurred in 73 days. The last time a similar increase was recorded, it took 133 days from July 1, 2020 to Nov. 10, 2020.

Intensive care units are moving in and out of critical levels, as 86% of the state's ICU capacity was utilized on Sept. 9. On Sept. 19, 79% of the state’s ICU capacity was being used with 83 beds used for non-COVID patients and 107 being used for COVID patients.

ICU use has been steadily climbing since early September, pushing Billings Clinic to its breaking point. Last Wednesday, the hospital announced its move towards crisis standards of care amid a spike in unvaccinated COVID patients requiring hospitalization.

Crisis standards of care allow health care providers to give scarce resources, like ventilators, to the patients most likely to survive.

On Monday, Billings Clinic was treating 55 COVID positive patients, with 25 in the ICU. Of those, 14 are on ventilators. Out of the 55 patients, 45 are unvaccinated.

Since Sept. 1, Billings Clinic has seen 28 COVID-related deaths in the hospital. This includes 14 deaths over the last seven days, said Billings Clinic Communications Coordinator Zach Benoit. From Feb. 20, 2021 to Aug. 20, 2021, Billings Clinic recorded 32 COVID-related inpatient deaths in the hospital.

As of Sunday, the state is averaging 6.1 COVID deaths per day, numbers not seen since April when there was an abrupt increase. In the first 18 days of September, 75 Montanans died of COVID.

A Monday press release from RiverStone Health reported seven Yellowstone County residents died of COVID-19 over the weekend.

“The victims ranged in age from 20s to 90s. All had underlying medical conditions; none were vaccinated against COVID-19,” according to the press release.

Though the number of COVID vaccine doses is on the rise with 18,504 doses administered in the last week, and 52% fully immunized, it takes six weeks to develop antibodies through the Pfizer and Moderna vaccines that result in less severe illness. Billings Clinic has seen some patients come in who had received one dose of the vaccine, but had not developed sufficient immunity to avoid hospitalization, said Nancy Iversen, director of patient safety and infection control for Billings Clinic.

For those who are in the process of getting vaccinated or are fully vaccinated, it is still important to continue masking and social distancing as vaccines do not provide 100% immunity.

“You can still catch it and spread it,” Iversen said in an interview last week.

Of the Billings Clinic staff, 63% are vaccinated.

Last Wednesday, the state reported 154 kindergarten through 12th-grade schools with COVID cases, with 311 cases reported in the last two weeks. School-aged kids make up the least vaccinated population in the state with 37% vaccinated.

With the Monday announcement from Pfizer and BioNTech that the vaccine was safe and effective for use in children ages 5 to 11, and is awaiting FDA emergency approval, RiverStone Heath is preparing for the roll-out of vaccines for this age group in fall or winter, according to Barbara Schneeman, vice president of communications for the facility.

The health center is also preparing for the rollout of booster shots for those 64 years old and older.

“The Food and Drug Administration and the Centers for Disease Control and Prevention are considering recommendations for a booster shot for people over age 64 and some additional people who have certain medical conditions. The agencies’ decision is expected in coming weeks. RiverStone Health will follow the CDC guidelines in providing doses of COVID-19 vaccine,” according to a press release from RiverStone Health.

Yellowstone County’s case investigators continue to be overwhelmed with the number of positive cases.

On Monday morning, 1,500 people were in the queue for case investigations. To try to make up for the discrepancy, each individual with a positive COVID case receives a letter in the mail with instructions on isolation and the need to contact close contacts.

“We continue to work weekends as well as prioritize people who are of school-age for case investigation,” Schneeman said.

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