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What does it mean when Texas health officials say only a certain number of ICU beds are open?

Even when hospitals approach intensive care unit capacities, they can take steps to care for more patients.

Update:
This story was revised on Dec. 29 to reflect recent hospital data.

As the highly contagious omicron variant of COVID-19 takes its hold on North Texas, health officials have expressed concern about the likelihood of increasing hospitalizations through the winter months.

Hospitalizations and cases had been low for several weeks following the surge of COVID-19 caused by the delta variant in the summer and early fall. But the omicron variant, which now accounts for the majority of the cases in the U.S., spreads much more quickly, health experts say.

While preliminary data indicates that the omicron variant may cause less-severe disease, health experts say that may not translate to fewer hospitalizations if the overall number of infections is higher than what the region saw with the delta variant.

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As of Monday, there were 1,270 COVID-19 patients in North Texas hospitals — the highest number the region has seen since Oct. 24 — according to state data. In the 19-county area that includes Dallas-Fort Worth, there were 110 adult ICU beds available, and just one available pediatric ICU bed.

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But what does it mean when health officials say only a certain number of ICU beds are open? And how do current ICU capacities compare to nonpandemic years? Here’s what you need to know.

How many ICU beds are there in Texas?

The number of open ICU beds in Texas is dependent on each hospital’s staffing, said Lara Anton, a spokeswoman for the Texas Department of State Health Services. That means the total number of ICU beds in the states fluctuates each day.

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“When there are fewer staff working, there are fewer beds available, and the same goes for when there are more staff working, there are more beds available,” she said. “This applies to all types of beds, including ICU beds.”

Because the numbers change so regularly, the state does not keep track of the total number of beds outside of “disaster situations,” Anton said.

In mid-April 2020, when the pandemic was just beginning and cases were still low, just over 2,500 adult ICU beds were available across Texas, according to state data.

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As of Monday, 584 ICU adult beds were available statewide, according to the data. The state hit an all-time low for open adult ICU beds on Sept. 8, when only 270 beds were available.

In early September 2020, there were 767 pediatric ICU beds open across the state, the most available since May the same year, according to state data.

As of Monday, 129 pediatric ICU beds were available statewide. Since Oct. 1, the number of available pediatric ICU beds has fluctuated between 80 and 150, according to state data.

What about Dallas-Fort Worth?

On any given day outside of a pandemic year (and in the absence of another emergency situation), the trauma service region covering Dallas-Fort Worth has about 1,950 available adult ICU beds and about 275 pediatric ICU beds, said Steve Love, president and CEO of the DFW Hospital Council.

He said the number of adult ICU beds is comparable to the average number of ICU beds per 1,000 residents that is seen in other areas across the nation.

But both numbers are rough estimates, as bed capacity in North Texas ICUs can change “by the hour,” Love said.

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“If you’ve got people in ICU, some are getting better and the doctor sees them and says, ‘Hey, we can move you back to progressive care now. You’re doing so well, you don’t need intensive care,’” Love said. “There could be people that come in and they’re only there for like 24 hours because they went through some surgery and the first 24 hours post-surgery was critical, they’re recovering in ICU and they move out quickly. And unfortunately some people expire and they die, and that frees up space as well.”

But there are several steps hospitals can take when they start approaching capacity in their intensive care units.

“As you move into surges and move into emergency situations — a bus wreck, an earthquake, a hurricane, and yes, a pandemic — what you then do is move into what’s known as surge capacity planning, and that’s where you expand patients,” Love said.

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Surge capacity planning can be implemented in all units of a hospital, not just the ICU. Some surge planning has been implemented during the COVID-19 surge fueled by the delta variant, Love said.

Strategies include putting two patients into a private room or putting patients who are not very sick in nontraditional settings, such as conference rooms or cafeterias. Nonessential surgeries can also be postponed.

“A lot of the equipment in recovery rooms can be used to make makeshift ICU, and you have the same equipment, you have the same monitoring, and you give the same safe patient service,” Love said.

But the most important factor determining how far a hospital can expand its current available beds is staffing, Love said.

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“In this pandemic, from purely hospital operations, not people out in the community point of view, we’ve been more concerned over staffing than we have occupancy,” he said. “We knew we could expand occupancy, but we’ve had a shortage of staff.”

By Monday, Love said Dallas-Fort Worth area hospitals were already seeing health care staff call in sick as they got exposed to people with COVID-19 or started experiencing symptoms.

“This adds to the already strained and fatigued hospital staff,” Love said.

Love said comparing ICU bed availability now to nonpandemic years wouldn’t be an accurate comparison because of the multiple factors during this current surge.

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Love said people shouldn’t panic when health officials warn about low ICU capacities.

“When you say, ‘We’re out of available pediatric beds,’ people go, ‘Oh, my God. If my child’s in a car wreck, they don’t have a place to put them.’” Love said. “That’s not true. We could easily have a place to put them if needed.”

The main message to the public during times of high capacities remains the same as during other times throughout the pandemic: Get vaccinated, boosted and wear a mask.

“If you do that, you’ll keep people out of the hospital and we won’t need these additional ICU beds,” Love said.

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