If a surge in COVID-19 patients brings Spokane’s largest hospitals to their capacity, smaller, specialty hospitals say they are preparing to absorb patients.

MultiCare and Providence Health Care hospitals are not full, even as the number of COVID-19 cases – including those that require hospitalization – continues to grow in Spokane County. But facilities like Shriners Hospital for Children and St. Luke’s Rehabilitation are already planning to be called upon during a patient surge.

With smaller hospitals taking on patients without COVID-19, more beds would be available for patients with the respiratory disease at larger hospitals like Providence Sacred Heart and MultiCare Deaconess.

“It’s something that is actually even written into our emergency operations plan, that we would assume this role,” said Peter Brewer, CEO and administrator of Shriners Hospitals for Children – Spokane. “It’s just kind of pulling this all together because we’ve never done this.”

As of Thursday, 30 of the 161 people who tested positive for COVID-19 in Spokane County have required hospitalization, according to the Spokane Regional Health District.

Currently, hospitals in Spokane County are not experiencing high patient volume or approaching surge capacity.

“I think that I can comfortably say the system is not being taxed by COVID-19 cases,” Spokane County Health Officer Dr. Bob Lutz told reporters Wednesday.

Hospitals are preparing for the possible patient surge, although currently emergency room and urgent care visits are down.

“We’ve been in significant, serious preparation mode,” Lutz said, noting that health care systems in Eastern Washington have had several weeks to prepare as they learned from other hospitals in the Seattle area.

In the Puget Sound area plans are being put into action in preparation for a surge in COVID-19 beyond what local hospitals can handle.

The U.S. Army was called in to help convert the CenturyLink Field Event Center in Seattle into a 250-bed field hospital this week, the Seattle Times reported.

Spokane hospitals prepare

At Shriners, doctors specialize in treating children for conditions like scoliosis or a fractured bone. It doesn’t treat patients for diseases like COVID-19, nor does it have any plans to do so. However, should hospitals like Deaconess and Sacred Heart reach their capacity, Shriners stands ready to accept additional pediatric patients with health care needs unrelated to COVID-19.

“We’re trying to put together a plan that will uphold this all together,” Brewer said.

Preliminary discussions are underway among the broader coalition of health care providers in the Spokane area, but also directly between Shriners and Providence, Brewer said.

“These discussions are being (had) not just regionally, but throughout the state,” Brewer said.

Other children’s hospitals in Washington are also playing a role in the COVID-19 response. Seattle Children’s Hospital announced last month it would temporarily accept patients between the ages of 18 and 21. Mary Bridge Children’s Hospital, a MultiCare facility in Tacoma, is accepting pediatric patients from Good Samaritan in Puyallup, the Tacoma News Tribune reported last month.

In a worst-case scenario, Shriners would accept non-COVID-19 pediatric patients to make way for more COVID-19 treatment at other hospitals, but the logistics are challenging. There are supply issues, equipment issues and personnel issues, Brewer said.

“We don’t have the staff to cover potentially all those kids,” Brewer said.

Shriners is a small hospital designed and built for orthopedics, Brewer stressed, but the children it would accept from Deaconess and Sacred Heart would have a broader range of medical needs.

Shriners has 30 licensed beds. Though it continues to operate on a limited basis and not all of its beds are empty, all of the hospital’s elective surgeries have been canceled or postponed during the pandemic.

St. Luke’s, meanwhile, has 102 beds, making it the largest rehabilitation hospital in the area. It’s also a part of discussions regarding surge capacity and would accept patients requiring rehabilitative care from the region’s acute hospitals.

“St. Luke’s would continue to receive adult and pediatric patients needing rehabilitation as well as patients who are part of a surge event. At this time, admission is for people who are not suspected to have the COVID-19,” hospital spokeswoman Nicole Stewart said.

Even the Mann-Grandstaff VA Medical Center could be tapped to help the civilian health care system in Spokane. The support would be triggered through a request by the state to the U.S. Department of Health and Human Services, as part of the Federal Emergency Management Agency’s response to the crisis, according to Bret Bowers, a VA spokesman.

“Mann-Grandstaff VAMC is in the process of surging medical and ICU bed capacity in anticipation of an increase in COVID-19 incidence,” Bowers said.

Washington State University-Spokane is playing a “supporting role” and looking to the Spokane Regional Health District for guidance and offering assistance where it can, according to college spokeswoman Christina VerHeul.

So far, that assistance has included dispatching health care faculty and students to conduct at-home check-ins on patients who have tested positive for COVID-19. College personnel monitor the patient’s symptoms and, if their condition deteriorates, contact the appropriate healthcare provider.

Last year, the college unveiled a mobile medical unit that would bring health care services to rural communities starting in 2020, but it’s not ready yet and won’t be used in any sort of patient triage capacity for COVID-19. It could, however, be used as a sort of “medical supply closet” in the deployment of health care workers tasked with outreach to various communities, such as those experiencing homelessness.

Keeping beds open

Similar to many hospitals around the country, hospitals in Spokane routinely operate at or near capacity. A survey of Spokane hospitals on Dec. 28, 2017, found their mean operating capacity was 90.5%.

Although hospitals in Spokane have yet to hit their capacity, they’ve already taken steps to minimize the chances of that happening.

Providers are encouraging patients to schedule virtual visits with their doctors and avoid unnecessary visits to the emergency room. MultiCare has designated three of its family medicine Rockwood clinics for patients with respiratory illnesses and canceled routine visits for patients older than 18 months. Providence has designated two of its clinics for adults with respiratory symptoms and one for children.

And on March 19, Gov. Jay Inslee ordered a temporary halt on nonurgent medical and dental procedures statewide in an effort to preserve the limited supply of personal protective equipment for health care workers and allow surgery centers to assist in providing surge capacity.

The health district is also leading an effort to establish an alternative care campus at the Spokane County Fair and Expo Center, adjacent to where it had erected a drive-thru screening tent for patients with COVID-19 symptoms, to minimize the flow of potential COVID-19 patients into health care facilities.

The alternate care facility would alleviate the strain on hospitals by providing shelter to those who have COVID-19 or are symptomatic but can not isolate or quarantine at home, either because they don’t have one, are not safe at home, or don’t want to put family members at risk of contracting the virus.

Patients directed to the site would either be determined to not require treatment at the hospital or have already been treated at the hospital and released.

Health officials and local leaders have said they expect to announce more details about the alternate care site in the coming days.

Reporter Arielle Dreher contributed to this story.