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State breaks record for most hospitalized with COVID-19

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More Montanans were hospitalized for COVID-19 on Wednesday than at any point previously in the pandemic, according to data from the state.

There were 510 Montanans reported hospitalized Wednesday morning, topping the previous high of 506 last November, before a vaccine was available.

A person’s vaccine status plays a strong role in the likelihood of them falling ill with COVID-19 and being hospitalized. A report from the state Department of Public Health and Human Services found from Feb. 7 to Sept. 4, nearly 90% of those hospitalized for COVID-19 were not fully vaccinated.

Vaccines became widely available for Montanans after the start of the year. Since February, just 10.5% of the state’s new cases were among those vaccinated and 11.4% of those hospitalized were fully vaccinated.

From July to September, cases were 4.4 times higher for those not fully vaccinated and hospitalizations were 5.1 times higher.

“These data indicate that COVID-19 vaccination is the best protection against SARS-CoV-2 infection and at preventing severe COVID-19 outcomes, such as hospitalization and death,” the report found.

RiverStone Health, the public health agency in Yellowstone County, said Wednesday 142 of the statewide hospitalizations were at either Billings Clinic or St. Vincent Healthcare.

Of those patients, 119 were not vaccinated. There were 43 people with COVID-19 in the intensive care unit and 31 on ventilators.

In recent weeks, hospitals around the state have warned of the strain COVID-19 patients have placed on their resources, with St. Peter's Health in Helena saying in mid-September it was using crisis standards of care. Hospitals have reported not being able to accept patients who need care for non-COVID-19 emergencies because of the increased demand on intensive care units.

“Unfortunately at this time virtually every hospital is at or near capacity, and that’s their staffing capacity,” said Rich Rasmussen, the president and CEO of the Montana Hospital Association. “Where we are today is we are still in the midst of our surge and many believe we will remain in this surge for the next six to eight weeks.”

Facilities are basing that estimate off last fall’s numbers and that surge, which ran from October until about February, Rasmussen said. Hospitals are also looking to southern states that saw huge spikes in cases when people moved inside to escape the heat of the late summer and what that might mean for Montana, where people will be indoors more as winter hits.

Nearly 150 members of the Montana National Guard have been sent to hospitals and other facilities that requested assistance, and at least eight locations have asked for extensions for Guard members to stay longer. Rasmussen cited that and other flexibilities granted by the state and federal government as helping address some of the problem.

Hospitalization numbers have dramatically increased since the start of summer. According to the state's data, there were 56 hospitalizations during the week that ended June 4.

By the week ending Aug. 6, that grew to 128 and represented a 35% increase from the week prior. That number reached 248 the week ending Sept. 3 and was 419 by the week ending Oct. 1.

A monthly epidemiology report produced by the state also noted the increase in hospitalizations.

“Average weekly hospitalizations due to COVID-19 peaked mid-November 2020, during the same time as the greatest numbers of new cases were reported,” the report from Oct. 1 read. “Average hospitalizations have steadily declined since December 2020. Hospitalizations remained stable in spring 2021 but have begun to increase again in July 2021 and continue to climb.”

Deaths have also increased along with hospitalizations. While seven were reported for the week ending June 4, the state saw 49 deaths reported for the week ending Oct. 1.

There were 86 deaths reported the week ending Sept. 24.

Hospital employees are exhausted from working at such a high level of intensity for such a long time, Rasmussen said. Facilities are also facing staffing challenges, especially as patients who require intensive care because of COVID-19 are intubated or in the intensive care unit, which requires a higher level of care — and the staffing associated with that.

“They want to be able to squeeze the hand of a young mom when she delivers a baby, they don’t want to squeeze the hand for the last time of a 45-year-old male who died because they were unvaccinated,” Rasmussen said. “They see patients they know should be able to walk out of the hospital and they’re not and that’s what’s really hard for them.”

The delta variant, which overtook the state as the dominant variant in July, has led to a spike in cases and hospitalizations among both the vaccinated and unvaccinated, according to state data. By July, the delta variant made up more than half of the samples sequenced in the state, and that rose to nearly all samples by August.

Montana has lagged the rest of the nation when it comes to vaccine uptake. About 54% of the eligible population of those ages 12 and up are vaccinated in the state. That equates to about 49% of the state's total population vaccinated, compared to the U.S. rate of about 57%.

“For those that are unvaccinated, mortality is higher, hospital rates are higher, long-haul issues are also at play here that we didn’t have in the first round,” Rasmussen said. “ … For anyone who works in health care, it is deeply troubling to them that they have so many patients that otherwise should be able to go home and can’t or patients who are willing to take the risk of other extreme measures when they don’t have to.”

The state health department recently said the amount of monoclonal antibodies it receives to treat sick patients is being rationed by the federal government. And while Rasmussen said so far the state has had enough to meet demands, hospitals are concerned about that going forward.

“The challenge for patients is for them to understand that you could choose to take a pass on the vaccine and hope that there is monoclonal antibodies for you but even the monoclonal antibodies are in short supply,” Rasmussen said, adding that while the Pfizer-BioNTech vaccine has been approved for use by the FDA, monoclonal antibodies are still under emergency-use authorization.

What hospitals need the most right now, Rasmussen said, is for community members to be vaccinated.

“That is the best way to be able to avoid bad outcomes, to avoid (overwhelming) the system, avoid really stressing caregivers, is for community members who have not been vaccinated to consult their physician about the safety and efficacy of the vaccine,” Rasmussen said.

Rasmussen said that as hospitals are doing everything they can to care for patients, they’re also dealing with hostile situations.

“All we ask for is a little bit of patience and a little bit of grace as we deal with what is a very difficult time for families, for patients and the people delivering the health care. It is difficult for them too,” Rasmussen said.

Republican Gov. Greg Gianforte has said that he will not mandate vaccines but has encouraged people to consider them. After the legislative session earlier this year, local health departments were stripped of some of their power to issue things like mask requirements to slow the spread of the virus, and the ability to enforce any mandate was largely eliminated. Hospitals are expecting a more intense season for other respiratory illnesses without those measures in place and as colder weather drives people indoors.

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