Holy Cross

Holy Cross Hospital in Nogales, the county’s only hospital, has limited capability to treat COVID-19 patients, meaning that many of the local people with the most serious symptoms are transported out of county for care.

As the number of confirmed COVID-19 cases continues to rise rapidly in Santa Cruz County, from 40 to over 500 in the past month, the rates of hospitalization and death among local residents have remained far lower than statewide averages.

According to numbers released Thursday evening by the County Health Services Department, 527 total residents had tested positive for the disease since the start of the pandemic. State data published Friday morning, which counted 503 cases in the county, reported that seven local people had required hospitalization.

The county reported that three area residents had died – a man over the age of 65 with underlying health conditions, whose death was confirmed on Monday, and two other people whose deaths were reported Thursday without further details immediately available.

This meant that Santa Cruz County’s COVID-19 hospitalization rate was approximately 1.3 percent of confirmed cases and the death rate was 0.6 percent – significantly lower than the state hospitalization rate of 13 percent of total confirmed cases and death rate of 4.4 percent, according to Arizona Department of Health Services statistics published Friday.

So why would coronavirus infections in Santa Cruz County be less likely to result in a hospitalization or death than in the state as a whole?

“I have no idea. Maybe we’re just lucky,” Jeff Terrell, the county’s health services director told the NI on Monday. “With this virus, I think it’s an unknown factor why some people get hospitalized, why some people have more severe symptoms compared to other people.”

One potential cause of the lower rates in Santa Cruz County so far, according to public health expert Will Humble, is the lack of nursing facilities in the area.

Humble, executive director of the Arizona Public Health Association and the state’s former chief health official, pointed out that a large number of COVID-19 deaths have involved people living in skilled nursing homes, and a smaller portion in assisted living facilities.

“Perhaps folks in Santa Cruz that are elderly tend to live with family members rather than in a skilled nursing facility,” he said, adding that some elderly residents may end up moving to Tucson when they need the services offered by skilled nursing homes.

At that point, their home address would change to Pima County and they would not be considered a Santa Cruz County resident for public health tracking purposes.

Humble also suggested that local residents in need of additional medical attention for coronavirus infections might end up going to Tucson hospitals rather than Holy Cross Hospital in Nogales, and therefore be counted in Pima County’s statistics.

ADHS spokeswoman Holly Poynter reiterated the fine print included with the agency’s zip code-tracking data, which says that 90 percent of COVID-19 cases have been mapped to the patient’s residential address. If the patient’s address was unknown, only then would state officials map the case to the reporting facility or healthcare provider.

“Individuals who are hospitalized or pass away outside of their county of primary residence will still be counted for the county of primary residence if that information is available to ADHS,” Poynter told the NI in an email.

Still, the case of Santa Cruz County’s first reported COVID-19 death shows that at the least, there can be time lags in the public reporting of those numbers.

The County Health Services Department, which publishes the number of local deaths but leaves the reporting of hospitalizations up to the state, announced on Monday afternoon that it had been notified of the first death of a local resident, and said the man had been hospitalized in Tucson. But as of Friday, the Arizona Department of Health Services was still reporting no COVID-19 deaths in Santa Cruz County.

Transported elsewhere

Data from local fire districts show that a significant number of ambulance transports of potential or confirmed COVID-19 patients have been to out-of-county hospitals.

The Rio Rico Fire District performed nine hospital transports for confirmed COVID-19 patients in April and May, according to data provided by Deputy Chief Richard Johnson. Of those, eight involved taking a patient from Holy Cross to another hospital, while the other was a home-to-Holy Cross transfer.

According to data from the Tubac Fire District, its personnel conducted a total of five patient transports to area hospitals for suspected COVID-19 infections in April. Of those five, one person was taken to Holy Cross and the other four were taken to the Santa Cruz Valley Regional Hospital in Green Valley.

In May, the district conducted a total of six suspected COVID-19 patient transports – two to Holy Cross, three to the SCVRH and one to Tucson Medical Center.

“For the most part, it’s up to the patient to decide” what hospital they want to go to, TFD Chief Cheryl Horvath said, adding that on some occasions, fire personnel make the decision based on protocol. “It has to do with the level of care that the hospitals provide and the level of care that the patient needs.”

Horvath also noted that TFD mainly logs “suspected” COVID-19 infections, since ambulance personnel don’t know in most cases whether the person they are transporting will, in fact, test positive for the disease. In fact, TFD has gone back as far as January, two-and-a-half months before the county’s first confirmed infection, to flag cases in which transported patients had symptoms consistent with 
COVID-19.

The Nogales Fire Department is not licensed to transfer patients out of the county, said Chief Jeff Sargent, who said he was aware of one instance in which NFD had taken a potential COVID-19 patient to Holy Cross.

And while Horvath couldn’t confirm how many of the 11 suspected cases the Tubac Fire District transported in April and May turned out to be confirmed COVID-19 infections and hospitalizations, the eight confirmed patients that RRFD says it brought from Holy Cross to Tucson hospitals during those two months exceeds the seven total hospitalizations the state had mapped to Santa Cruz County as of Thursday.

(Johnson said RRFD had transported an additional 48 suspected COVID-19 patients from March to May, but said he believed those did not turn out to be coronavirus infections. That’s because his department follows up on suspected cases and would categorize them as confirmed if they turned out to be positive.)

The discrepancy between RRFD’s confirmed COVID-19 transportations and the state numbers, though slight, could suggest an undercount in the state’s reporting of local hospitalizations as patients are taken elsewhere for treatment.

Debra Knapheide, CEO at Holy Cross Hospital, referred questions for this story to a corporate spokesman – Holy Cross is part of the Carondelet group of health care facilities in Arizona that is owned by the Dallas-based, for-profit Tenet corporation.

The spokesman, Keith Jones, did not respond specifically to a question about how many beds and/or ventilators the hospital has in place that can be used to treat COVID-19 patients, but noted that the hospital is “licensed for 25 inpatient beds.”

“We provide care for and have adequate supplies for many types of conditions; however, there may be times that a patient may be transferred to one of our Carondelet Health Network hospitals in Tucson for specialized care,” Jones wrote in an email, adding that there is a dedicated unit for COVID-19 patients at St. Joseph’s Hospital in Tucson.

In April, Holy Cross was slated to receive a little more than $1 million in additional payments from the state Medicaid system as part of an allocation meant to help Arizona’s rural hospitals deal with the challenges posed by the coronavirus crisis. Jones sidestepped a question about how Holy Cross was using those funds, and if any of the money would be used to boost the hospital’s capacity for treating COVID-19 patients.

“The payment is intended to help Holy Cross Hospital with operational expenses to maintain essential services in the community and serve our under- and uninsured population. Our top priority is making sure our patients, our staff and our community remain safe,” he wrote.

Terrell, the county health services director, acknowledged that most of the COVID-19 hospitalizations of Santa Cruz County residents involved patients in Tucson hospitals, rather than Holy Cross, and noted the trend’s potential ramifications for the future.

“As far as I know, they don’t really hospitalize them here,” Terrell said. “They (Holy Cross) only have a few ventilators, ICU beds. If we had a major surge, there would be some that would have to be transported to Tucson-area hospitals.”

(Additional reporting by Nick Phillips.)

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