Current Hospital Status as of 11/25/2020, 8 a.m.

• Total Number of COVID-19 Inpatients: 63
• Number of COVID-19 Patients Requiring Critical Care: 14

Data to be updated each morning by 10 a.m., Monday to Friday.

Regional Information

For information on the region’s number of cases and deaths visit Panhandle Health District’s North Idaho Information Page: click here.

Breakdown of Rooms in Kootenai Health

Not all rooms are the same within Kootenai Health. Rooms have different layouts, equipment or are reserved for certain types of patients (cancer, birth center, etc.)

Medical/Surgical Units : 142 beds
1 North/2 East/2 South/3 North/1 West/3 South

Critical Care: 26 beds* 
CC3/CC2

COVID-19 Cohort Unit: 32 beds
3 East (*note, some rooms on 3 East are converted and can be used for critical care as well as changed back for med/surg as need arises)

Behavioral Health: 77 beds
Chemical dependency rehabilitation, adult, youth

Women’s and Children’s: 53 beds
Labor, Postpartum, NICU, Pediatrics

Reference Links

• Think you may have COVID-19? What to do.
• Getting Tested – Hours, Site and Driving Instructions
• Clean and Safe and Ready for You – Don’t put off your health care
• Masking and Visitor Policies – Restrictions in place
• Hope for Heroes

Questions and Answers – November 9, 2020 

Kootenai Health put together an updated document on November 9, 2020 to help address new and frequently asked questions we have heard circulating regarding the COVID-19 pandemic.

Thank you for your continued support of our health care community during these challenging times.

As a regional hospital, it is our job to care for the patients of northern Idaho. We are doing our best to care for every patient, to advocate for the safety of our community and keep our employees safe from harm.

This pandemic is new to all of us and we are learning as we go. We are learning more each day from reliable sources including the CDC, WHO, peer-reviewed scientific papers and studies as well as our own experience in caring for COVID-19 patients at Kootenai Health.

Here is information addressing some of the questions surrounding COVID-19.

Regional Trends

1. How do the Panhandle Health District numbers compare to Spokane Regional Health District numbers?

Spokane Regional Health District – Numbers as of November 6, 2020

• Spokane Regional Health District Population: 532,798
• Total Cases: 10,508
• Currently Hospitalized for COVID-19: 45
• 7 Day Rolling Positivity Rate: 1%
• Current cases per 100,000: 5
• Data from SRHD, State of Washington, COVIDNow

Panhandle Health District – Numbers as of November 6, 2020

• Five Northern Counties Population: 245,406
• Total Cases: 6,152
• Currently Hospitalized for COVID-19: 49
• 7 Day Rolling Positivity Rate for Panhandle Health District: 13.6 %
• 7 Day Rolling Positivity Rate For Kootenai County: 14.3%
• 7 Day Rolling Positivity Rate at Kootenai Health’s testing center: 19%
• Current cases per 100,000:
  • Panhandle Health District Total: 4
  • Benewah 29.2
  • Bonner 17.2
  • Boundary 80.5
  • Kootenai: 3
  • Shoshone: 24.4
• Data from Panhandle Health District, Kootenai Health and COVIDNow

Hospital Capacity

2. How many rooms do you have?

Kootenai Health is currently licensed for 330 beds (up from 254 in 2015)

• 200 of those are for medical/surgical patients including acute care and critical care. Our COVID-19 isolation unit is included in this number.
• 77 are for behavioral health including adult, youth and chemical dependency.
• 52 are for women’s and children’s services including labor and delivery, postpartum, pediatrics and NICU.

When we share capacity numbers, we are providing the capacity of our medical/surgical area as a whole. Not all rooms can serve all patients.

The rooms designated for women and children’s and behavioral health are not set up for medical/surgical patients. They have different equipment for different types of patients and the employees have different skills and training.

For example, on November 6, 2020:

• Medical/surgical area was 92% full
• Family birth center (labor/delivery, postpartum, NICU, pediatrics) was 36% full
• Behavioral health (adult, youth and chemical dependency) was 74% full

On this day we had 45 COVID-19 positive patients, 12 requiring critical level care.

 

3. Why can’t all rooms be used for critical care?

Critical care requires highly specialized equipment, supplies, and most importantly, specially-trained critical care staff to care for patients. We have converted additional rooms to be critical care rooms, but not all rooms can be converted.

 

4. Do you have enough room to care for patients?

Hospitals accept new patients in a few ways. Some patients are pre-scheduled for a needed surgery. Some come to the emergency department and require hospital-level care. Others come through “direct admissions” meaning they come direct from a doctor’s office or another hospital.

Ideally, we want to keep all patients close to home for their care.

If we cannot accommodate a direct admission patient, we must “decline to admit.” These patients and their doctors are then forced to find another hospital with capacity for admission.

With our current capacity constraints, the number of patients we are forced to decline has increased significantly.

For example:

• In Q4, 2019, we declined to admit 9 patients
• In Q4, 2020, so far – still six weeks left to go, we have already declined to admit 52 patients

Finances

5. Does Kootenai Health get money for identifying a positive COVID-19 case?

No. Kootenai Health does not receive money as the result of positive COVID-19 lab results. Kootenai Health is providing community drive through testing as a public service. The lab testing fees charged for these tests do not cover the cost to run the center.

6. Why do people say Kootenai Health is making extra money due to COVID-19 patients?

As much as we would like it to be otherwise, hospital billing is complex.

Different insurance companies will handle reimbursements differently, however, here is an example and more information about how reimbursement for COVID-19 works with Medicare patients.

Medicare reimburses Kootenai Health by diagnosis related group (DRG). The payment for each diagnosis related group is based on a comparative relative value of the resources it takes to provide service for that particular diagnosis related group compared to other diagnosis related groups. The payment is based on historical information.

Currently, there are no specific COVID-19 related diagnosis related groups, so most COVID-19 patients fall into a pneumonia diagnosis related group and have 20 percent reimbursement added on if it is also a COVID-19 patient. This add on is because COVID-19 patients often have a longer length of stay than a routine pneumonia patient and require more resources.

This information has been used to suggest that physicians and hospitals are gaming the system by falsely identifying COVID-19 patients to get more reimbursement for the hospital. However, there are strict criteria to identify a COVID-19 positive patient and even with the increased level of reimbursement, in most cases the reimbursement does not cover the cost of caring for these patients due to their extended length of stay.

Falsifying data about patient diagnoses would be illegal and unethical. It would also mean our 3,500 employees and physicians have collectively agreed to put their professional reputations on the line by providing false information. This is not happening.

 

Viruses and Masks

7. How can a mask help if viruses are so small?

Viruses are very small. However, viruses don’t move on their own, they must be transmitted in some way. The novel coronavirus (COVID-19) is transmitted in droplets that come through the nose and mouth. Using a mask creates a barrier that greatly decreases the potential to transmit droplets that could be carrying virus. If everyone wears a mask, we can keep everyone’s germs (droplets) to themselves.

Just as we all cover our cough or sneeze with our elbow or a tissue to keep droplets with germs and viruses from spreading to others, masks also help keep the droplets with germs and viruses from spreading. Wearing a mask is about protecting others.

 

8. Can people get sick from increased carbon dioxide intake while wearing a mask?

No. There is enough filtration of air through a mask that wearers do not have increased carbon dioxide intake. Viruses, although very small, are much larger than molecules of oxygen or carbon dioxide which readily pass through masks.

CO2 makes up only about 0.04% of the air we breathe, and is considered life-threatening when its concentration is greater than about 10%.

Surgeons and nurses regularly wear masks for long periods of time as part of their normal work. While it may take time to get used to, and may be uncomfortable, we are all doing our part to keep each other safe. You may want to experiment with different styles and types of masks to see which is best for you.

 

9. I have heard masks don’t work, is that true?

CDC provides information on how masking helps prevent the transmission of respiratory illness. Wearing a mask has long been used to help prevent the spread of respiratory illness such as tuberculosis and the pneumonic plague. Masking helps us keep our germs to ourselves, protecting others.

 

10. Why weren’t masks recommended at the start of the pandemic?

According to the CDC, at the beginning of the pandemic experts didn’t know the extent to which people with COVID-19 could spread the virus before symptoms appeared. Nor was it known that some people have COVID-19 but don’t have any symptoms. Both groups can unknowingly spread the virus to others.

These discoveries led public health groups to reconsider the use of face masks. The World Health Organization and the CDC now include face masks in their recommendations for slowing the spread of the virus. The CDC recommends cloth face masks for the public and not the surgical and N95 masks needed by health care providers.

 

11. Did Kootenai Health mandate masks for the community?

Kootenai Health does not have the authority to mandate masks in public. The only organizations and people capable of mandating masks in public are: the federal government, the state government, the city government or the public health district.

Kootenai Health does require all people who enter our buildings (employees, patients, visitors) to wear a mask at all times.

The hospital has the obligation and legal right to implement rules and restrictions to keep patients and staff safe.

We support the decision to mandate masking to help keep our community safe

 

Testing

12. If you test the same person twice, and both tests are positive, are they counted as two cases?

No. The tracking numbers for the county represent the number of COVID-19 positive individuals, not the number of positive test results.

13. Is the COVID-19 nasal swab test accurate?

Our medical professionals believe the nasal swab test that checks for the virus is accurate and the results can be trusted. It is much more likely to have a false negative (testing too early or insufficient sample) than a false positive.

If tested too early, or submitting an insufficient sample, a test could result negative.  This same individual may test positive at a later date in time. It is extremely rare that a false positive result is seen.

Recently we have seen a number of home tests and antibody (serology) tests on the market. If a test sample is not collected by a trained professional and/or the test is not processed in a lab that follows appropriate clinical protocols, its accuracy can be negatively impacted.

 

14. Can the numbers be trusted?

As with all infectious disease cases, Kootenai Health, other health care organizations, and laboratories provide the number of COVID-19 positive tests to Panhandle Health District each day. The Panhandle Health District reports this information in their dashboard online and sends the information to the State Department of Health and Welfare, who then passes it onto the CDC. This information is then used by the state and federal government.

 

Diagnosis

15. Are people who are admitted for COVID-19 admitted for other reasons and just happen to have COVID-19?

Most people who are admitted with COVID-19 are admitted because they have oxygen levels so low they are in respiratory distress and need hospital-level care.

While it is possible that someone comes in for something other than COVID-19 and happens to be COVID-19 positive, this is less common.

 

16. How do you know if patients have COVID-19 or the flu?

Kootenai Health uses highly accurate Polymerase Chain Reaction (PCR) tests to determine if a patient has SARS-CoV2 virus (which causes COVID-19).

Doctors use symptoms and tests to diagnosis patients. Patients are often tested with a “full panel” of viral tests which checks for a range of viruses including respiratory syncytial virus (RSV), influenza, and SARS-CoV2. The results of these tests help a doctor determine a patient’s diagnosis.

Any patient listed as positive for COVID-19 at Kootenai Health has the SARS-CoV2 virus.”

17. Is COVID-19 real?

Yes. As of October 27, more than 235,000 Americans have died with COVID-19.

Across the globe, there have been more than 48 million cases and 1.24 million deaths.

In the Panhandle Health District we have had 79 people die.

Any implication that this virus is somehow unreal, a hoax or insignificant is false.

 

18. What is a coronavirus?

Coronaviruses are a type of virus and should not be confused with influenza, the flu virus.

Human coronaviruses were first identified in the mid-1960s. Four of the common coronaviruses cause the common cold. Three other coronaviruses have been identified that originated in animals and evolved to infect humans:

• MERS-CoV (causes Middle East Respiratory Syndrome, or MERS)
• SARS-CoV (causes severe acute respiratory syndrome, or SARS)
• SARS-CoV-2 (the novel coronavirus that causes COVID-19)

The new, novel coronavirus SARS-CoV-2 is causing a global pandemic of respiratory illness.

 

Surge Planning

19. Why aren’t you stopping all surgeries to accommodate more patients?

Many people in our community require procedures, treatments and care unrelated to COVID-19.

This includes care needed to treat cancer, heart problems and neurosurgery. Delaying this care can be life threatening.

At this time we are attempting to provide care for both COVID-19 positive patients and non COVID-19 patients for as long as possible to prevent any possible harm that could result from delaying medical care.

 

20. Isn’t the hospital normally full at this time of year?

Kootenai Health does sometimes become full, however this last month we have set several records for the highest census days we have ever recorded. Up until this year, our highest census days have occurred in the middle of January and February in the thick of flu season.

Flu season is in its earliest stages and is not yet widely spread in our region. We are anticipating an increase in flu cases in the coming weeks and months which is why we are sharing our capacity concerns.

We are hopeful that working together we can prevent the spread of all viral illness which may overwhelm the health care system this fall and winter.

 
21. How old are the patients hospitalized? Is it just the old and frail who are impacted?

No. For example here is an example of the patient age ranges on our isolation unit (not inclusive of all patients):

• COVID-19 totals:
  • Teens: 1, 20s: 0, 30s: 1, 40s: 2, 50s: 6, 60s: 5, 70s: 11, 80s: 9, 90s: 1
• COVID-19 patients requiring critical care:
  • 40s: 2, 50s: 4, 60s: 1, 70s: 2, 80s: 4

 

22. Are all the patients from nursing homes?

No. Very few of our COVID-19 inpatients are from nursing homes. The majority of our patients were living in the community prior to hospitalization. We would remind our community that this disease is not just affecting the old and frail. We have seen many otherwise healthy individuals require hospitalization. Some of those have required critical care and died.

 

23. Can you add more beds?

It is important to note that not only do patients require physical beds, equipment and space, but they also require qualified staff and the personal protective equipment to keep them safe.

Kootenai Health is currently transitioning a number of our current rooms into double occupancy rooms to accommodate more patients and has a surge plan to accommodate an influx of patients which would require more isolation units and shutting down other parts of the hospital to care for COVID-19 patients.

No resource is infinite.

 

24. Will you close the emergency department?

No. Our emergency department is open and will always remain open to care for patients, however, there may be increased wait times or instances when patients must remain in the emergency department for care.

 

25. Why can’t you hire more staff?

Kootenai Health is actively hiring nurses, medical staff and physicians.

However, there is a national nursing shortage and hospitals around the country are experiencing the same capacity and staffing concerns as the need outpaces the available resources.

Kootenai Health has hired a number of “traveler” nurses to help care for the increase in patient hospitalizations, however, this resource is also stretched thin as nurses are needed throughout the country.

To meet the need for staffing, Kootenai Health is trying to hire 111 traveler nurses. We have only been able to fill 71 of those positions so far. These travelers are in high demand due to the pandemic.

 

26. What does “requiring critical level care” mean?

Patients requiring critical level care need close attention from physicians and nursing staff.

At Kootenai Health a patient requires critical level care when their illness is severe enough to require the oversight of an intensivist (a specially trained critical care physician.) Patients requiring critical care may have respiratory failure, septic shock, multiple organ dysfunction and require oxygen assistance.

Community and Hospital Growth

27. Is the hospital full because the community’s growth has outpaced the growth of the hospital?

It is true that we live in one of the most rapidly growing regions in the nation. Idaho was the fastest growing state in 2019 and Kootenai County is predicted to grow at two times the national average in the coming years.

While our region is expanding exponentially, Kootenai Health has anticipated this growth and completed more than $130 million dollars in expansion over the past five years.

While no resource is infinite, we have steadily increased our services and accessibility for our community over the past five years (see next).

In communities around the nation, hospitals are experiencing new pressure and fear of being overwhelmed by the growing COVID-19 pandemic and upcoming flu season.

It is important to note, these capacity issues are not unique to Kootenai Health. We are one of many now struggling to keep up with the mounting demand.

 

28. How has Kootenai Health expanded to meet the growing needs of our community?

In 2015, Kootenai Health had 254 beds (please note, many of these are designated for behavioral health and women’s and children’s and were double occupancy).

In 2016 we began our expansion project. It included:

• East wing first floor, Family Birth Center which includes:
  • 10 labor and delivery rooms
  • 18 postpartum rooms
  • 12 private neonatal intensive care rooms (two that can accommodate twins)
  • 2 cesarean operating rooms
• East wing second floor unit with 32 rooms for neurosurgery and orthopedics
• East wing third floor unit with 32 rooms. This unit was initially closed for future growth. It was opened in November 2019 and transitioned into the COVID-19 isolation unit in July 2020.

With the expansion, Kootenai Health is now a 330 bed hospital (third largest hospital in Idaho).

Other expansions:

• In 2017 we completed a $10.5 million, two story, 22,000 square foot expansion on our campus in Post Falls which provides access to specialty practices such as cardiology, OB/GYN.
• In 2018, we expanded our surgical services from eight to 11 operating rooms and built a new recovery and waiting area including a hybrid operating room, which can be used for both cardiac and general surgery.
• In 2018, our emergency department expanded from 23 to 36 rooms with new efficient work flows so patients can be seen more efficiently.
• Our number of employees has grown from 1,800 in 2012 to more than 3,500 in 2020.
• Our number of employed physicians has grown from 75 to more than 200.
• Overall we have added more than 200,000 square feet (100,000 in East Expansion; 20,000 in ED; 10,000 in Surgery; 30,000 in Post Falls; 45,000 at 1919 Lincoln Way). 
• We have hired OB, pediatric, neuro and acute medical hospitalists to provide the highest level of coverage for our hospitalized patients at all times.