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St. Louis Urgent Care Clinics Face an Urgent Problem 

Urgent-care centers are swamped with an influx of COVID-19 patients.


Urgent-care centers are swamped with an influx of COVID-19 patients.

"When it starts to spread across your face and your genitals, that's when you know you need some help."

St. Louisan Amy Whited-Hylton got what she described as a "pretty wicked case of poison ivy" two weeks ago. She'd just bought a house in south city and had been doing some weekend maintenance on her new overgrown yard shortly before she started getting itchy.

By that Tuesday afternoon, the irritation that she'd initially thought was caused by a cluster of mosquito bites had started to rapidly spread and began to take over her most sensitive areas. She knew she had to see a doctor.

Whited-Hylton had been to the Total Access Urgent Care nearby on multiple occasions previously and had always been impressed by the swift, expert care provided, so she stopped in to get what she thought would be a quick exam and a prescription.

"It's not like it's life-threatening. It just got really bad," Whited-Hylton says. "But that's why you have urgent cares — so that even under normal times, you don't crowd the hospitals with poison ivy. That's a waste of their resources. I mean, that's what I thought. But I guess not, because urgent cares are all filled up with other people."

She arrived at a Total Access location at about 3:15 p.m., assuming she'd have no trouble finding a spot before it closed at 8 p.m., but she was told that the clinic was already booked for the rest of the day. She asked if any other locations had openings available. The receptionist checked her computer and said that all Total Access locations were fully booked except one that was a 45-minute drive away in O'Fallon, Missouri — and that location already had 29 people in line.

Knowing that her case was "not an emergency-room thing," Whited-Hylton tried to call her primary-care physician. Her doctor's phones were down because of a recent storm, so she just drove straight there. The office was due to close soon and her primary was her only hope of getting help that day.

She wasn't able to see her doctor, but another physician in the office took pity on her and squeezed her in between patients. One steroid shot to the behind and a prescription for prednisone later, she was on her way to getting all fixed up.

Now that she knows that her go-to spot might not have space for her when she needs help, Whited-Hylton isn't sure where she'll turn for care the next time something comes up.

"I don't really have any serious underlying health issues, but if I did, I'd be terrified to leave the house," she says. "With health care, having good insurance is half the battle, but good luck with being actually able to use it somewhere right now."

Amy Whited-Hylton assumed getting an appointment at her local urgent care would be easy. - THEO WELLING
  • Amy Whited-Hylton assumed getting an appointment at her local urgent care would be easy.

An inability to access immediate help at an urgent-care clinic has become common in St. Louis and beyond as the COVID-19 crisis has worsened. As the delta variant sweeps across the nation this summer, the fragile health-care system has been slammed with another influx of infected patients.

While most of the focus lately has been on overflowing ICUs and emergency rooms, it's often the hardworking urgent-care clinics that keep patients from ever entering a hospital through a combination of early intervention and skilled outpatient treatment on demand.

From stitching up minor wounds to saving patients in the middle of heart attacks, the range of services provided at urgent-care locations frees up both hospital staff and primary-care physicians.

But now that emergency rooms and urgent-care clinics are all filling up, people who need immediate help often don't know where to turn. Essentially, the safety valve that keeps hospitals from overflowing is disappearing. And that's something that nobody knows how to fix through any other method except increased vaccination.

"If we were to see every patient that needed care then I would be asking my people to work 24 hours a day until they collapsed," says Dr. Troy Dinkel, chief medical director of Total Access Urgent Care. "Our queue is full before we open. Literally."

Before the COVID-19 crisis, Dinkel and the other employees of St. Louis' prolific urgent-care chain were accustomed to working hard. But with the pandemic worsening again, no matter how tirelessly they work they can't keep up with the flood of local patients seeking help. It's more than just demand from increased caseloads; Total Access is facing the same staffing shortages now prevalent across the health-care sector.

Technically, there are 27 Total Access locations in the St. Louis area, but only 23 are currently open due to loss of staff. While consolidating employees in fewer locations has kept the quality of care up, the organization still has no choice but to turn away many potential patients each day. The huge amount of people who need medical treatment right now is just too large to keep up with across medical settings, not just in urgent-care centers.

"ICUs are full. Hospitals are full. Emergency departments have people lined up in the hallway getting their lacerations sewn up right in front of everyone else because the health-care system is overwhelmed," Dinkel says. "So this is not a circumstance that is unique to urgent care — it just has to do with capacity and the realities of the delta variant running rampant right now. The urgency of getting vaccinated is extreme. I don't know how it could be more extreme."

Dinkel is ex-military, and he speaks about challenges for his staff in a direct, no-nonsense way. He describes the COVID-19 health-care force as heroic and says he's glad to be on the same team, but it's clear that it pains him that his team — his fellow soldiers in this war — are up against an enemy with an unfair advantage.

"There's a lot of information, there's a lot of emotions surrounding the vaccines. I've always been a humongous advocate of vaccination," he says. "I was fortunate in the military; I got vaccinated against everything. I had an anthrax vaccine five times, small pox three times. If I were to give any advice, it would be please, please, please get vaccinated and have thoughtful conversations with other people — nonjudgmental conversations. Not political discussions, but just thoughtful, statistical discussion where you say, 'I care about ya. I love ya. I want ya to be protected. Let's just make sure that you are protected.'"

Dave Dillon, vice president of public and media relations for the Missouri Hospital Association, mirrors Dinkel in his concern over skyrocketing COVID-19 cases, access to prompt health care and the need for increased vaccination.

The issue isn't just that the emergency rooms and urgent-care clinics are overflowing, Dillon explains. "The real issue becomes how full is the critical-care space in Missouri," he says, describing the scarce capacity of hospital ICUs and other places where patients battle life-threatening injuries and illnesses. After a decline in COVID-19 cases this spring, a surge in delta cases turned the state into one of the country's hottest hot spots. Cases exploded, going from 249 average positive PCR tests per week to an average of 2,137 per week in a two-month period. The southwest corner of the state emerged as the epicenter, and cities such as Springfield were quickly overwhelmed by the rush.

Dillon uses the spike in Springfield as an example for what could happen next.

"In southwest Missouri, hospitals are definitely still up against the wall. They're at or even exceeding their licensed bed capacity, and their ICU capacity is very low. And those hospitals have been working for a month or more and when necessary transferring patients elsewhere," he says. "Why that matters and why hospitals throughout the state are concerned about it is that even in St. Louis and Kansas City — and some of the other sizable but not metro-type areas, meaning St. Joseph, Columbia and Hannibal — when those hospitals begin to get close to their capacity, then you run out of the ability to transfer [patients]."

A new wave of COVID-19 patients hit by the delta variant have stressed the health-care system. - THEO WELLING
  • A new wave of COVID-19 patients hit by the delta variant have stressed the health-care system.

While many St. Louisans might not have been too concerned about a surge in cases on the other side of the state, these sudden increases can still have an impact on local access to critical care. Many COVID-19 patients spend weeks in the intensive care unit. If patients from far-flung areas are sent to St. Louis hospitals and then St. Louis has its own surge, ICU beds here could already be full when locals need them.

Still, having actual beds to put patients in or having enough ventilators to breathe for them isn't even the biggest problem the health-care system is facing. Right now, the problem is that there aren't nearly enough nurses to take care of everybody.

"Our biggest challenge isn't beds. It's a workforce that has been up against the wall for eighteen months. It's inadequate to expand the beds with the existing workforce that we have," Dillon says. "So you have to bring in additional workers to staff beds."

Traveling nurses are being hired by local hospitals at rates of hundreds of dollars per hour to cover the worker shortage, but Dillon says that soon it's likely that finding money to hire expensive part-time nurses won't be the biggest problem for hospitals — it will be finding traveling nurses to hire at all. Dillon says that as COVID-19 case counts grow in Texas, it has already become harder to find nurses to work in St. Louis. And there are only so many nurses to go around.

This issue takes on even more gravity when it comes to taking care of sick kids. Extra pediatric and neonatal nurses are even more difficult to come by in the current health-care ecosystem, which could spell disaster in the coming months.

"In this wave, the concern is of course that delta seems to have the ability to — unlike the earlier virus — affect kids more. And if you're eleven or younger, you can't get vaccinated yet. So that's the challenge as we're sending kids back to school right now," Dillon says.

"So you not only have the illness in kids, but you have the illness in kids and when they leave school they will go home [and infect others] and so you get the collateral impact."

Because of the high vaccination rate of seniors, Dillon says the average age of people currently hospitalized with COVID in Missouri is no longer people in their 60s and 70s, but people in their 40s and 50s. So it's not grandmas and grandpas who are more likely to be taken down by COVID now — it's moms and dads.

A recent article in Forbes said that the ICU situation in Dallas is so dire that the North Texas Mass Critical Care Guideline Task Force held a meeting to discuss using a patient's coronavirus vaccination status to factor in which patients get access to priority care — based on the assumption that the vaccinated have a much better chance of surviving.

When asked if Missouri has any plans to implement similar protocols should things get as bad here in the Midwest, Dillon says, "We have, since the beginning, been concerned about having to move to a crisis standard of care. And that would be, in essence, the clinicians would make those kinds of judgments."

Skipping the vaccine is like playing the biggest game of chicken," says Jill, a charge nurse who works at an ICU in rural Illinois.

At her unit, just a short drive from downtown St. Louis, nurses are overwhelmed, overworked and "don't have any fucks left to give about people's opinion" of the vaccine, she says.

When we talked recently, Jill's ICU had nine patients, which meant they should have had five nurses looking after them, but there were only two nurses available per shift. (We're only using Jill's first name, because she isn't authorized to speak to media.) Sometimes the ICU will borrow a nurse from another floor of the hospital to help out.

The nurses don't dare take a day off, though. Or quit. Jill says they're already "running their asses off" to take care of the patients, and that losing another nurse would further endanger their efforts. She doesn't have required overtime at her hospital but says since nursing is a "team sport" that everybody does their best not to leave their coworkers in the lurch. She describes each shift as a "thirteen-hour nightmare, over and over and over."

Staff at Total Access Urgent Care centers in the St. Louis metro have had to scramble to take care of the rush of patients. - THEO WELLING
  • Staff at Total Access Urgent Care centers in the St. Louis metro have had to scramble to take care of the rush of patients.

"Most of the people I know who have gone through all of this pandemic, we all have such PTSD from these surges that half of our unit is on some anti-anxiety meds. Like, I don't sleep anymore," she says. "It's just ruining people's lives."

"I just feel haunted by all of the people that I have watched suffocate to death. Alone. In an ICU. I know they're not really alone because we're there, but I don't want to die with a bunch of strangers who were just wiping my ass. I just feel like we just carry them with us everywhere all the time. I remember every one of them."

Traumatized and pushed to her limit, when Jill speaks about her job, her emotions are right at the surface. For her and for many other health-care workers in her position, sadness, anger and panic over COVID-19 are all intertwined.

"When you think about these young people in their 40s who have a tracheotomy who are now going into long-term care, all because you wouldn't get a vaccine because you saw it on Facebook," she says, "it's a confusing set of emotions. Because it's like, 'You fucking deserve it,' and then on the other side you're like, 'That is so fucking terrible.'

"For me it's so aggravating when you need to transfer patients who are non-COVID and you can't find a bed because they're all full of COVID idiots. Can you imagine losing a close friend or family member because they couldn't get to the care they needed because the hospital was full? People are still having heart attacks. People are still overdosing. People are still having things that they need an ICU bed for even though COVID is going on."

They don't distribute vaccines at Jill's hospital, so she can't try to convince patients to get one during their stay, but she does have conversations about the vaccine with the few COVID-19 patients who are able to talk to her because they're not on a ventilator.

Even though some of them have barely lived through the worst of the virus, many still won't even consider getting the vaccine. But they'll all take experimental treatments once they're in the hospital.

"I could tell someone we tried this treatment on two monkeys and they both died. But they are so frantic to not feel like they're drowning that they would take it," Jill says. "But they won't take a vaccine. It doesn't even make any sense. Because literally they want it all. They want the remdesivir, they want the dexamethasone, they want the convalescent plasma, they want the antibodies from people who have had COVID — they want it all. They have to sign all of these waivers, but they will sign them all. So will their family. And they will still not do the one thing that will make it so they don't get this sick.

"The people who are unvaccinated are like sitting ducks."

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