Inside a hospital as the coronavirus surges: Where will all the patients go?

https://www.washingtonpost.com/nation/2020/11/29/inside-hospital-coronavirus-surges-where-will-all-patients-go/?arc404=true

An open bed is “a gift” at a Wisconsin hospital where patients can’t believe other people still don’t take covid-19 seriously.

As the coronavirus pandemic swelled around the 160-bed Mayo Clinic hospital, the day was dawning auspiciously. Two precious beds for new patients had opened overnight. At the morning “bed meeting,” prospects for a third looked promising.

Better yet, by midmorning, there were no patients in the Emergency Department. None. Even in normal times, a medium-size hospital like this can go many months without ever reaching zero.

Everyone knew better than to trust this good fortune. They were right.

From 9 a.m. to 10 a.m., seven patients arrived at the emergency room. Fourteen descended the next hour, then 10 more the hour after that.

About a third had signs of covid-19, the illness caused by the virus, most with trouble breathing. But there was also the man who had smashed his fingers with a hammer. The unresponsive woman who had to be resuscitated. An injured elbow. Neck pain. Acute depression.

By 12:05 p.m., Mayo had put itself on “bypass,” sending all ambulances to the two other hospitals in town, a last-resort move rarely employed. By late afternoon, the emergency room was stashing patients in four beds erected in the ambulance garage — the first time it had adopted that tactic — and holding others for hours as they waited for places in the overflowing hospital.

With more than 91,000 covid-19 patients in their beds, U.S. hospitals are in danger of buckling beneath the weight of the pandemic and the ongoing needs of other sick people. In small- and medium-size facilities like this hit hardest by the outbreak’s third wave, that means finding spots in ones and twos, rather than adding hundreds at a time as New York hospitals did when the coronavirus swept the Northeast in the spring.

“A bed is a gift right now,” said Jason Craig, regional chair for the Mayo Clinic Health System in northwest Wisconsin. “I’ll take all of them.”

In Utah, some doctors acknowledge they are informally rationing care, a euphemism for providing some patients a lower level of service than they should receive. In El Paso, the National Guard has been dispatched to handle the overwhelming number of covid-19 corpses, many held in 10 refrigerated trailers outside the medical examiner’s office.

So far, such extreme measures are not widespread, but only because hospitals have spent months preparing for this catastrophe — one expected to grow worse in the weeks to come as the weather turns cold and Americans move indoors.

More challenging still is locating doctors, nurses, respiratory technicians and other staff needed to provide care as the pandemic places unprecedented demand on the entire nation simultaneously. Even Mayo, one of the most prestigious and well-resourced systems in U.S. medicine, is supplementing its Wisconsin staff with nurses from its hospitals in Arizona, Florida and Minnesota, redeploying nurses from other parts of this hospital and hiring temporary travel nurses who sign on for short assignments.

With nearly 300 staff infected or quarantined in northwest Wisconsin, the system has turned to technological solutions and shuttling patients between hospitals as beds open.

“No one could have forecast what we’re dealing with right now, in regard to what the staff are having to do, what the patients are going through,” said Elysia Goettl, nurse manager of the hospital’s medical-surgical unit.

For two days this month, Nov. 18 and 19, Mayo allowed The Washington Post to watch from inside the largest of its five northwest Wisconsin hospitals as it coped with the virus’s staggering consequences.

On that Wednesday, the health system tallied 341 positive coronavirus tests out of 1,295 given in the main facility and four tiny hospitals in Barron, Bloomer, Menomonie and Osseo — an astonishing positivity rate of 26.3 percent. The state’s seven-day rolling average infection rate that day was even higher, at 32.5 percent. (Six days later, Mayo’s rate would fall to 17.6 percent, and later to 14 percent, though its models forecast a continuing surge of patients.)

In contrast, New York Mayor Bill de Blasio (D) closed the nation’s largest school system the same day, when the city’s seven-day average exceeded just 3 percent. Two days earlier, California Gov. Gavin Newsom (D) imposed tough new restrictions when the state’s 14-day average positivity rate reached 4.7 percent.

In the main 160-bed hospital here, there were 166 patients at 9 a.m. Wednesday, 60 of them with covid-19. At 4 p.m., after a day of transfers and discharges, there were a total of 147. By Thursday morning, as emergency room patients and others found their way into the hospital, there were 167.

“We thought we may get some bed relief, and then, of course, the law of health care kicks in,” Craig said.

Wisconsin largely evaded the first two waves of the U.S. pandemic, which crashed through the New York area in March and April and the Sun Belt this summer. Unlike Seattle and elsewhere, Wisconsin’s younger people were infected first as the state reopened. Now, the virus is reaching into the older, more vulnerable population.

In room 41129, on the hospital’s fourth floor, 63-year-old Mark Ahrens was beginning to recover from covid-19. Ahrens fell ill about two weeks earlier, overcome by paralyzing fatigue. His lungs clogged, leading to pneumonia.

Three floors down, his wife, Kathryn, was undergoing surgery the same day to clear out pockets of thick fluid from severe covid-19 infection in one of her lungs. A double-leg amputee with diabetes and high blood pressure, she contracted the disease at the same time as her husband. The couple were admitted together. Ahrens hadn’t spoken to his wife in a week.

“I feel real lucky that I’m still here,” Ahrens said. “Because I was in really bad shape when we came in.”

A careful mask-wearer outside the home, Ahrens believes he and his wife, who is 57, were infected by Kathryn’s grandchildren, who visited the couple’s home for a week. Kathryn’s daughter, Sandy Kassa, assumes her children picked up the virus during an outbreak at their day-care center, then passed it on to her and the couple.

“I thought I had the flu,” Kassa said. She suffered from fever, chills and difficulty breathing, which has lingered for weeks, though she has recovered. “Somebody was reaching up inside my rib cage and squeezing my lungs.”

Small family gatherings are thought to be a significant avenue of virus transmission in the current surge. But Kassa didn’t heed the public health warnings until the virus struck three generations of her family.

“I honestly thought before I became sick that people were just being dramatic,” she said. “Now that I’ve experienced it myself, I just know that it’s real.

“I shouldn’t have had my kids over there.”

Ahrens is incredulous at how casually some people are still treating the virus.

“People were … saying it was fake news and stuff. They’ll probably realize in a year from now, when they lose somebody. If they would listen now, they would be here for the next holidays,” he said.

In the room next to Ahrens, 72-year-old Donna Keller said she fought diarrhea, vomiting and dehydration from covid-19 before she was finally hospitalized. “I thought I could whip it,” she said.

Keller said she, too, was careful to safeguard herself against the virus and is unsure how she became infected. But she doesn’t like what she sees on the street.

“The younger kids, I think, feel they can fight this and it doesn’t affect them,” she said. “But they don’t realize that they pass it on to the older people that have a harder time fighting it.”

Ahrens and Keller were discharged Nov. 20, Ahrens to the small Mayo hospital in Bloomer, where he began rehab, and Keller to her home. On Friday, Ahrens’s wife joined him at the hospital in Bloomer.

Until the surge, the floor where they convalesced was reserved for all kinds of medical and surgical patients. On Nov. 18, 38 of its 40 beds were occupied by covid-19 patients, and the hospital was seeking staff so it could fill the last two. More covid-19 patients spill onto the third and fifth floors and into the intensive care unit.

In normal times, Mayo is nearly this full, said Richard A. Helmers, a pulmonologist and vice president for the region’s hospitals. Mayo does brisk business in high-end care, including cardiac surgery and neurosurgery.

But those patients generally follow a predictable course. Doctors and administrators know when they’ll leave, when the next bed will open. Covid-19 patients can linger for weeks, even a month or more, complicating the effort to find space for the current endless surge of sick people.

Despite the overcrowding, officials stress that the hospital is still open to anyone who needs its care.

A glimpse inside the hospital’s sandstone walls reveals little of the stress it is under. The corridors are clean and quiet. Little equipment is visible. Few people scurry through public areas or cluster in conversation. The hospital was designed this way 10 years ago. If necessary, Mayo could close off the covid unit and create one giant negative-pressure system in an attempt to keep the airborne virus contained.

On Ahrens’s floor, nurses attend to covid-19 patients at least once an hour, and each nurse typically is responsible for at least three patients. In an eight-hour shift, nurses must don gowns, gloves, N95 masks and face shields a minimum of 24 times, checking to ensure they are protected against the virus. After each visit, they carefully strip off the protection and dispose of it.

Some nurses are working 12-hour shifts and overtime in a job in which they are holding patients’ hands as they die and helping others grieve over lost loved ones.

Marybeth Pichler was filling in on the floor recently when another nurse asked her to sit with a dying covid-19 patient. He had perhaps an hour to live. He had been given morphine to ease his discomfort.

“I just sat down, and he just talked,” she said. “He talked about how he used to farm and how he had dairy cows and after he sold the dairy cows, he had Black Angus.” After about 25 minutes, the patient took off the mask that provided him high-flow oxygen and soon passed away.

With no visitors allowed, Pichler said she “felt it was an honor to be able to sit with him and hear about his life. Otherwise … he would have been alone when he died.”

“I knew when I volunteered what I was volunteering for,” she added. “When I’m going to work in the morning, I actually pray to be a blessing to someone or to be there for someone.”

For hospital personnel everywhere, the early part of the pandemic meant confronting a new, lethal and unpredictable virus. Now, the dominant theme is burnout from responding all year with no end in sight, coupled with the complications of home life.

“They’re struggling — emotionally, physically. They’re exhausted,” Goettl, the nurse manager of the medical-surgical unit, said. “And they have given 120 percent on their shift, and they walk out exhausted. They go home to a family where they have to give another 120 percent. We do that day in and day out.”

Sara Annis, who supervises the medical-surgical nurses, works long hours at the hospital while her husband puts in 60 to 80 hours a week trying to keep the couple’s brewpub alive. When neither can be home, they leave their children, ages 9 and 12, there alone to attend school online. Neighbors check up on them.

“It’s a huge, huge struggle just to try to balance work and family life right now,” she said.

Mayo is exploring technology to help with the crisis. Before the pandemic, its advanced care at home program was designed as an experiment to determine whether patients who should be hospitalized could be treated in their own homes. They are provided hospital equipment, full-time monitoring from a central control room and visits by paramedics, nurses or nurse practitioners.

But when the virus struck, the program was pressed into service to help ease crowding. Mayo is now caring for five people at home, including covid-19 patient Rita Huebner.

A Mayo paramedic visited Huebner’s small apartment before she arrived, making room for the hospital equipment she would need. Then he and two others delivered her there late that afternoon.

Huebner, 83, said she may have to rehab in a nursing home but for now accepts recuperating at home. “I’m doing pretty good, but not good enough,” she said. “I’m so damn weak.”

Patients trade the security of having trained caregivers at their bedside for the advantages of staying in their own beds, at times with family around them, said Margaret Paulson, chief clinical officer for the at-home program. Remote monitoring can be done at long distances, including from Mayo’s main headquarters in Minnesota.

On Wednesday, the federal Centers for Medicare and Medicaid Services announced new measures to encourage more hospitals to adopt telehealth programs that could ease the strain of the pandemic.

Until the surge eases, there is only one glimmer of light at the end of this crisis. On Nov. 19, Mayo was notified that its first shipment of the coronavirus vaccine would arrive in early January. A team already is devising a distribution plan.

“We need hope right now,” Craig said. “Hope is what’s going to get us through the winter.”

Fears of coronavirus jump intensify in Thanksgiving’s aftermath

At a rural health system in Wisconsin, officials and medical experts began drawing up protocols for the once unthinkable practice of deciding which patients should get care. The chief quality officer of a major New York hospital network double- and triple-checked his system’s stockpile of emergency equipment, grimly recalling the last time he had to count how many ventilators he had left. In Arizona, a battle-weary doctor watched in horror as people flooded airports and flocked to stores for Black Friday sales, knowing it was only a matter of time before some of them wound up in his emergency room.

Days after millions of Americans ignored health guidance to avoid travel and large Thanksgiving gatherings, it’s still too soon to tell how many people became infected with the coronavirus over the course of the holiday weekend. But as travelers head home to communities already hit hard by the disease, hospitals and health officials across the country are bracing for what scientist Dave O’Connor called “a surge on top of a surge.”

“It is painful to watch,” said O’Connor, a virologist at the University of Wisconsin at Madison. “Like seeing two trains in the distance and knowing they’re about to crash, but you can’t do anything to stop it.”

“Because of the decisions and rationalizations people made to celebrate,” the scientist added, “we’re in for a very dark December.”

The holiday, which is typically one of the busiest travel periods of the year, fell at a particularly dire time in the pandemic. Some 4 million Americans have been diagnosed with the coronavirus in November — twice the previous record, which was set last month. More than 2,000 people are dying every day. Despite that, over a million people passed through U.S. airports the day before Thanksgiving — the highest number of travelers seen since the start of the outbreak.

Many states did not report new case counts over the holiday, and it typically takes about a week for official records to catch up after reporting delays, said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.

But in two to three weeks, she said, “I fully expect on a national level we will see those trends continue of new highs in case counts and hospitalizations and deaths.”

The nation has already notched several bleak milestones over the holiday weekend. On Thanksgiving Day, hospitalizations in the United States exceeded 90,000 people for the first time. The following day, the country hit 13 million cases. At least nine states have seen 1 in every 1,000 residents die of the coronavirus.

Mark Jarret, the chief quality officer for New York’s Northwell Health system, said he understood that many people are tiring of constant vigilance after nine months of isolation and Zoom gatherings and waving at people from six feet away.

“But we’re so close to getting some control,” he said, noting that federal officials are on the verge of authorizing one or more vaccines against the virus next month. “This is not the time to let up. This is the time to put on the best defense we can to prevent further spread, further death.”

Officials urged people who traveled or spent time with people outside their household to stay at home for 14 days to avoid further spread of the virus. Some jurisdictions are moving toward lockdown measures not seen since the spring. Los Angeles County on Friday issued a three-week “safer at home” order, limiting business capacity and prohibiting gatherings other than religious services and protests.

Meanwhile, the December holidays are looming.

“Hopefully people will try to minimize their risks around Christmas, especially if there’s data that show Thanksgiving was really harmful,” O’Connor said.

To Cleavon Gilman, a Navy veteran and emergency room doctor in Yuma, Ariz., the wave of holiday travel was “a slap in the face.”

“It’s as if there’s not a pandemic happening,” he said. “We’re in a war right now, and half the country isn’t on board.”

On Friday, members of the University of Arizona coronavirus modeling team issued an urgent warning to state health officials, projecting that the state will exceed ICU capacity by the beginning of December.

“If action is not immediately taken, then it risks a catastrophe on a scale of the worst natural disaster the state has ever experienced,” the team wrote in a letter to Steven Bailey, chief of the Bureau of Public Health Statistics. “It would be akin to facing a major forest fire without evacuation orders.”

Arizona has no statewide mask mandate, and businesses in many parts of the state, including indoor dining at restaurants, remain open.

Gilman said the intensive care unit at his hospital is full and there’s nowhere to transfer new patients. When he’s home, his mind echoes with the sound of people gasping for breath. He and his colleagues are exhausted, and with cases spiking across the country, he worries there is no way they can handle the surge that will probably follow Thanksgiving celebrations.

In La Crosse, Wis., Gundersen Health System chief executive Scott Rathgaber echoed that fear. “We’ve had to tell our hard-working staff, ‘There’s no one out there to come rescue us,’” he said.

Like many in his college town, Rathgaber is anxious about what will happen when students who spent the holiday with their families return to campus. Though the University of Wisconsin and other schools shifted classes online for the remainder of the semester, he anticipates students who have jobs and apartments in La Crosse will return to town.

“We had trouble the first time the students came back,” Rathgaber said, noting that the start of college classes in September preceded outbreaks in nursing homes and a spike in deaths in La Crosse County. “I will continue to implore, to beg people to take this seriously.”

Gundersen has already more than tripled the size of the covid-19 ward at its main hospital, and even before this week it was almost entirely full. Physicians from the system’s rural clinics have been reassigned to La Crosse to help in the ICU. Staff who may have been exposed to the virus are being called back before completing their 14-day quarantine. And Rathgaber now attends regular meetings with ethicists and end-of-life caregivers to figure out Gundersen’s triage protocol if the hospital becomes overwhelmed.

“We’re not at a breaking point, but we are getting there,” Rathgaber said. “I’m concerned about what the next two weeks will bring.”

66 hospitals postponing elective procedures amid the COVID-19 resurgence

Hospitals still scheduling elective surgery during coronavirus crisis

Hospitals across the U.S. are beginning to suspend elective procedures to respond to an uptick in hospitalized COVID-19 patients. 

Below is a breakdown of 66 hospitals postponing or canceling the procedures to free up space, ensure proper staffing or enough protective gear to care for COVID-19 patients:

1. Mercy Health Youngstown (Ohio) will indefinitely suspend elective procedures that require an inpatient admission starting Nov. 26, according to the Tribune Chronicle. 

2. Prescot, Ariz.-based Yavapai Regional Medical Center, which recently joined Dignity Health, will limit elective procedures effective Nov. 26 to Dec. 4, according to The Daily Courier. 

3. South Bend, Ind.-based Beacon Health System is suspending nonemergency surgeries to free up bed space and staff to care for a surge in COVID-19 cases, according to WSBT. The surgeries affected include those that require an inpatient stay. 

4. Citing a spike in COVID-19 cases, Goshen (Ind.) Health is suspending nonurgent surgeries, according to WSBT.

5. Stormont Vail Health in Topeka, Kan., is rescheduling some elective surgeries that require overnight stays to free up bed space, according to local news station WIBW. 

6. UW Medicine in Seattle will suspend nonemergency surgeries that require an inpatient hospital stay, effective Nov. 23 through Feb. 1.

7. Mercy Hospital South in St. Louis plans to delay some nonurgent procedures that require longer hospital stays amid a spike in COVID-19 hospitalizations, according to the St. Louis Post-Dispatch.  

8. Metro Health-University of Michigan Health in Wyoming, Mich., has delayed some surgeries that require an inpatient stay, according to MiBiz.

9. Albuquerque, N.M.-based Presbyterian Healthcare Services is canceling nonurgent surgeries that require hospitalization, according to local news station KBOB. The health system said it will postpone those surgeries that can be delayed for six weeks or longer safely.  

10. HSHS Sacred Heart Hospital in Eau Claire, Wis., is postponing electives on a case-by-case basis amid a surge in COVID-19 cases, according to The Leader-Telegram.

11. IU Health Methodist Hospital in Indianapolis has started to reduce the amount of elective procedures it will perform, while still trying to catch up on those that were postponed during the initial surge, according to MedPageToday.

12. Carson Tahoe Hospital in Carson City, Nev., has delayed non-time sensitive surgeries for a few weeks to free up space and staff to care for a surge in COVID-19 hospitalizations, according to local station News 4

13. The 267-bed Mercy Health Muskegon (Mich.) has begun to delay elective surgeries as needed amid an influx of COVID-19 cases, according to MiBiz.

14. Buffalo, N.Y.-based Catholic Health will halt all inpatient elective surgeries that require an overnight stay for two weeks amid a COVID-19 hospitalization surge, according to Buffalo News. The healthcare system will start rescheduling procedures Nov. 21, and reevaluate if an extension is needed Dec. 5. 

15. Chicago-based Northwestern Medicine will reduce the number of nonemergency surgeries it performs to help preserve bed capacity and staff to help care for a surge in COVID-19 cases, according to the Northwest Herald

16. Morris (Ill.) Hospital and Healthcare Centers postponed some inpatient surgeries requiring overnight stays the week of Nov. 16 due to a bed shortage exacerbated by the rise in COVID-19 cases, according to NBC Chicago. 

17. Memorial Community Hospital and Health System in Blair, Neb., is limiting elective surgeries requiring an overnight hospital stay for several weeks to preserve bed capacity and ensure proper staffing levels to care for the influx of COVID-19 cases, according to the Pilot-Tribune & Enterprise

18. Spectrum Health in Grand Rapids, Mich., is deferring elective surgeries requiring an overnight hospital stay, according to Michigan Radio. The deferral rate is about 10 percent, according to the report. 

19. Avera St. Mary’s Hospital in Pierre, S.D., is postponing nonemergency procedures so staff can care for the influx of COVID-19 cases and respond to emergent needs, according to DRGNews.

20. Salt Lake City-based Intermountain Healthcare will postpone some surgeries that require an inpatient admission to free up beds, preserve supplies and free up providers amid a surge in COVID-19 hospitalizations. The hospital system will only delay those that can be safely postponed. 

21. Froedtert Health in Wauwatosa, Wis., will delay non-urgent surgeries that require an inpatient admission post-surgery in an effort to free up staff and beds amid the coronavirus case surge in Wisconsin, according to local news station TMJ4. The hospitals are located in Wauwatosa, Menomonee Falls and West Bend. 

22. Memorial Hospital in Aurora, Neb., has suspended elective surgeries that take place at its Wortman Surgery Center to dedicate staff to inpatient and emergency care.

23. Minneapolis-based Allina Health is delaying some non-urgent procedures at three of its hospitals until at least Nov. 27, according to The Star Tribune. The delays will affect non-urgent procedures that require an overnight hospital stay. 

24. Bloomington, Minn.-based HealthPartners has started postponing some total joint surgeries, including hip or knee replacements, at three Minnesota hospitals, according to The Twin Cities Business Journal. The affected hospitals are Methodist Hospital in St. Louis Park, Regions Hospital in St. Paul and Lakeview Hospital in Stillwater. 

25. Southern Illinois Healthcare, a two-hospital system based in Carbondale, will reduce its elective surgery volume by about 50 percent as more people seek inpatient care for COVID-19, according to The Southern Illinoisan. The surgeries affected by the delay include those that require an overnight hospital stay.

26. University of Cincinnati Health activated surge operations Nov. 16, requiring a 50 percent reduction in elective inpatient surgeries and procedures across the health system, according to local news station WLWT.

27. Rochester, Minn.-based Mayo Clinic has started scaling back elective care to ensure it can care for patients with emergent needs and a high influx of COVID-19 patients, according to The Post Bulletin. 

28. Citing a 1,500 percent increase in COVID-19 hospitalizations between Nov. 1 and Nov. 17, Lake Health in Concord Township, Ohio, is pausing elective surgeries that require an overnight stay, according to The News-Herald. The pause will continue through Nov. 20, but the system will reevaluate if the pause needs to be extended on a weekly basis. 

29. Cook County Health, the public hospital system based in Chicago, is suspending elective surgeries requiring inpatient stays, according to WBEZ. The decision was made to ensure adequate staffing to care for an influx in COVID-19 cases.  

30. Urbana, Ill.-based Carle Foundation Hospital has canceled some elective procedures that require an overnight hospital stay in an effort to free up beds and staff to care for COVID-19 patients, according to The News Gazette.

31. Elkhart (Ind.) General Hospital stopped all elective surgeries Nov. 17 after more than 200 patients were admitted to its 144-bed hospital, according to The New York Times. Of those patients 90 were being treated with COVID-19. The hospital also diverted ambulances during this time.

32. Advocate Aurora Health, with dual headquarters in Milwaukee and Downers Grove, Ill., has started reducing elective procedures by 50 percent at some of its facilities, according to a Nov. 16 media briefing. The health system said that more hospitals will look into the option to postpone elective procedures later the week of Nov. 16. 

33. The University of Kansas Health System in Kansas City started postponing some elective surgeries to free up inpatient beds Nov. 12.

34. St. Luke’s Health System in Boise, Idaho, will stop scheduling certain elective surgeries and procedures through Dec. 25, according to a company news release. The temporary delay starts Nov. 16. St. Luke’s medical centers in Boise, Meridian, Magic Valley and Nampa will also cancel elective cases requiring an overnight stay scheduled for the week of Nov. 16, according to the news release. 

35. Citing an increased demand for inpatient beds, Ascension Genesys Hospital in Grand Blanc, Mich., will not schedule any new inpatient elective surgeries until at least Nov. 30. The hospital said it has asked surgeons to “thoughtfully examine” already scheduled cases requiring extended recovery through Nov. 30.

36. SSM Health St. Mary’s Hospital in Madison began rescheduling nonemergent surgeries to free up intensive care unit bed space, according to local news station NBC 15.

37. Cedar Rapids, Iowa-based Mercy Medical Center will reduce elective surgery cases through Nov. 20. It also temporarily stopped scheduling new elective procedures.

38. Columbia Memorial Hospital in Astoria, Ore., will reduce some elective procedures due to an increase in COVID-19 cases, according to the Cannon Beach Gazette.

39. St. Louis-based BJC HealthCare will postpone some elective surgery cases at all 15 of its hospitals and ambulatory care settings starting Nov. 16. The surgery postponement will last eight weeks. The announcement comes just one week after the health system started rescheduling nonemergency surgeries at four of its hospitals.

40. Citing a significant increase in COVID-19 hospitalizations, Cleveland Clinic said it will postpone some nonemergency surgeries. Cleveland Clinic said it will reschedule nonessential surgical cases that require an inpatient stay at its hospitals in Ohio through Nov. 20.  It will reassess its scheduled surgical cases daily to determine if more cases need to be delayed.

41. Baxter County Regional Medical Center in Mountain Home, Ark., said Nov. 11 it will begin postponing nonemergency surgeries. The hospital will only defer procedures requiring an overnight hospital stay in order to free up beds for COVID-19 patients. 

42. Portland, Ore.-based Legacy Health will reduce the number of elective procedures requiring an overnight hospital stay by 25 percent.

“We will monitor the situation and adjust as needed,” Trent Green, Legacy Health COO, wrote in an email to staff. “If the number of hospitalized patients continues to grow, we may cancel more surgeries. As hospital volumes lower, we will add back elective surgeries.”

43. Kaiser Permanente Northwest, which has hospitals in Oregon and southwest Washington state, is implementing a “scheduling pause” at some of its Oregon medical centers through Dec. 31.

44. Portland-based Oregon Health & Sciences University is implementing voluntary elective surgery deferrals. The hospital system will evaluate surgical cases daily to ensure it has the appropriate capacity to care for all patients.

45. Aurora, Colo.-based UCHealth began postponing some nonemergency surgeries due to a surge in COVID-19 hospitalizations. The health system will defer nonemergent surgeries that require inpatient admission. The health system began postponing some of those surgeries the week of Nov. 2.

46. As of Nov. 11, Grand Rapids, Mich.-based Spectrum Health has 14 hospitals nearing capacity amid a surge of COVID-19 cases. As a result it is starting to delay inpatient surgeries that require overnight stays.

47. Community Memorial Hospital in Cloquet, Minn., has halted some elective surgeries to free up beds amid a surge in hospitalizations.

48. Sarah Bush Lincoln, a 145-bed hospital in Mattoon, Ill., is postponing most inpatient elective surgeries due to bed capacity constraints. The hospital said it will make the decision on whether to postpone a surgery on a case-by-case basis. 

49. Memorial Health System in Springfield, Ill., will begin delaying some nonurgent surgeries Nov. 16.

50. Evanston, Ill.-based NorthShore University HealthSystemhas started evaluating elective surgeries on a case-by-case basis and delaying those that can be postponed safely.

51. UnityPoint Health Meriter in Madison, Wis., is rescheduling nonemergent surgeries that require overnight stays to save beds for COVID-19 patients. The hospital has seen a “significant” uptick in COVID-19-related hospitalizations, with about one-third of UnityPoint Meriter’s beds occupied by patients with the virus.

52. St. Luke’s, a two-hospital system in Duluth, Minn., is postponing nonemergency surgeries amid a surge in COVID-19 patients. The health system said it will only delay surgeries that require an overnight stay and can be rescheduled safely.

53. Omaha, Neb.-based Methodist Health System began postponing elective surgeries at its flagship hospital Oct. 29, president and CEO Steve Goeser told Becker’s. It is reviewing the surgery schedule to determine which ones can be postponed safely.

54. Omaha-based Nebraska Medicine is limiting nonurgent procedures due to a rise in COVID-19 hospitalizations. The health system said that it has enough beds, but high-level intensive care unit providers “aren’t an infinite resource.”

55. CHI Health in Omaha, Neb., said that some nonurgent procedures will be postponed amid the COVID-19 resurgence. By postponing some surgeries, CHI Health said it aims to free up beds and capacity for patients.

56. Sanford Health, a 46-hospital system based in Sioux Falls, S.D., will begin rescheduling some nonemergency inpatient surgeries that require an overnight hospital stay due to an influx of COVID-19 patients. 

57. Bryan Health, based in Lincoln, Neb., will begin scaling back elective surgeries requiring an overnight hospitalization due to a rise in COVID-19 cases. The system said it will decrease elective surgeries requiring overnight stay by 10 percent for the week of Nov. 2 to ensure it is able to care for COVID-19 patients and perform essential surgeries.

58. Mayo Clinic Health System began deferring elective procedures at its hospitals in Northwest Wisconsin Oct. 31 amid an escalation of COVID-19 cases. The health system did not say when elective procedures will restart. The Mayo Clinic Health System has clinics, hospitals and other facilities across Iowa, Minnesota and Wisconsin.

59. Madison, Wis.-based UW Health is postponing a small number of elective procedures to free up bed capacity to care for COVID-19 patients, according to WKOW. Jeff Pothof, MD, UW Health’s chief quality officer, said that patients may be asked to push back a non-emergency procedure by about a week. 

60. Saint Vincent Hospital in Erie, Pa., will postpone a small number of elective procedures after some patients and caregivers tested positive for COVID-19. The hospital did not specify the number of patients and staff who tested positive. 

61. Johnson City, Tenn.-based Ballad Health will begin deferring elective procedures at three of its Tennessee hospitals due to a spike in COVID-19 hospitalizations. On Oct. 26, Ballad began rescheduling up to 25 percent of elective services at Holston Valley Medical Center in Kingsport, Tenn. Procedures are also expected to begin being deferred at Bristol Regional Medical Center and Johnson City Medical Center. 

62. Maury Regional Medical Center in Columbia, Tenn., will suspend elective procedures requiring an overnight stay for two weeks. Hospital leadership will re-evaluate the feasibility of elective surgeries by Nov. 9.

63. Cookeville (Tenn.) Regional Medical Center said Oct. 26 it suspended elective procedures requiring an overnight stay after it was caring for a record high of 71 COVID-19 patients, according to WKRN.

64. Salt Lake City-based University of Utah Hospital canceled elective procedures after its intensive care unit hit capacity on Oct. 16. The hospital said it needed to postpone the elective care to allocate staff to care for critically ill patients. 

65. Sanford Health in Sioux Falls, S.D., will stop scheduling new elective surgery cases requiring an overnight stay, according to system CMO Mike Wilde, MD. New elective cases requiring an overnight stay were not scheduled for Oct. 19-23, but previously scheduled elective surgeries were performed.

66. Billings (Mont.) Clinic began evaluating each surgical case for urgency in late September. It is postponing those it says can wait, according to The Wall Street Journal.

Striving to maintain normal operations in the third wave

https://mailchi.mp/4422fbf9de8c/the-weekly-gist-november-20-2020?e=d1e747d2d8

What Does 'Batten Down the Hatches' Mean?

In talking to our health system members from across the country in the past few weeks, we’ve heard that the COVID surge is happening everywhere. Nearly everyone we’ve talked to has told us that their inpatient census of COVID patients is as high or higher now than during the initial wave of the pandemic in March and April. And nearly everyone is expecting it to get much worse over the next few weeks, as hospitalizations increase in the wake of the explosion of cases we’re seeing now.

But there is something striking in our conversations in comparison to eight months ago: no one seems to be panicking. Crisis management processes that were developed and honed early in the pandemic are proving very helpful now. Normal patient care services are continuing despite the uptick in COVID volume, and protections are in place to keep the care environment segregated and COVID-free as possible.
 
While dozens of health systems, many in the hardest hit states in the Midwest and Great Plains, have announced plans to curtail elective care during this third wave, the decisions are based on individual hospital capacity and staffing, instead of being mandated by states. Having largely worked through the “COVID backlog” across the summer and early fall, system leaders want to avoid canceling surgeries again, and few are expecting state governments to force them to. 

Many of our members have drawn up plans for selective cancellations depending on capacity, but we’re not likely to see sweeping shutdowns again—unless the workforce becomes so overstretched that it impacts operations.

That’s good news, and will likely lead to less interrupted patient care. And it’s good news for hospitals’ and doctors’ economic survival, as many would not be able to absorb the body blow of another widespread shutdown. Fingers crossed.

Missouri’s COVID-19 data reports send ‘dangerous message to the community,’ say health systems

Marion County reports six additional COVID-19 cases | KHQA

A group of health system leaders in Missouri challenged state-reported hospital bed data, saying it could lead to a misunderstanding about hospital capacity, according to a Nov. 19 report in the St. Louis Business Journal.

A consortium of health systems, including St. Louis-based BJC HealthCare, Mercy, SSM Health and St. Luke’s Hospital, released urgent reports warning that hospital and ICU beds are nearing capacity while state data reports show a much different story.

The state reports, based on data from TeleTracking and the CDC-managed National Healthcare Safety Network, show inpatient hospital bed capacity at 35 percent and remaining ICU bed capacity at 29 percent on Nov. 19. However, the consortium reported hospitals are fuller, at 84 percent capacity as of Nov. 18, and ICUs at 90 percent capacity based on staffed bed availability. The consortium says it is using staffed bed data while the state’s numbers are based on licensed bed counts; the state contends it does take staffing into account, according to the report.

Stephanie Zoller Mueller, a spokesperson for the consortium, said the discrepancy between the state’s data and consortium’s data could create a “gross misunderstanding on the part of some and can be a dangerous message to the community.”

Florida Coronavirus Deaths Spike To Record High After Days Of Declines

https://www.forbes.com/sites/nicholasreimann/2020/07/28/florida-coronavirus-deaths-spike-to-record-high-after-days-of-declines/?utm_source=newsletter&utm_medium=email&utm_campaign=dailydozen&cdlcid=5d2c97df953109375e4d8b68#2d45f7d31d35

Florida Coronavirus Deaths Spike To Record High After Days Of Declines

TOPLINE

The coronavirus death toll Florida reported Tuesday set a new daily record high for the state, while new cases, hospitalizations and the number of ICUs at capacity once again rose, reversing what had been days of the state’s coronavirus crisis appearing to show signs of improvement.

KEY FACTS

Florida reported 186 new coronavirus deaths Tuesday, topping a record that had stood since July 22 and ending a streak of what had been a declining daily death toll every day since then.

Hospitals reporting 0% available ICU beds are also again on the rise, with 55 facilities reporting they were at capacity Tuesday, up from the 49 that reported 0% availability Monday.

Other major metrics that show worsening coronavirus spread, like hospitalizations and the rate of tests coming back positive, are also on the rise after declines during the past week.

Florida is the nation’s coronavirus epicenter, and has been for weeks—posting daily case increases that have been unmatched by any other state during the pandemic thus far.

Florida reported 9,243 new cases Tuesday, a rise from the 8,892 reported on Monday, which was the lowest increase the state had posted in three weeks, yet still more cases than most countries have reported throughout the entire pandemic so far.

The death toll in Florida is still far below what New York had during the worst of the pandemic there in March and April, when on its worst days the state would report around 1,000 deaths on its own.

KEY BACKGROUND

Florida was one of the fastest states to lift restrictions on its economy, and was eager to do so since the state largely avoided the dire impact the spring coronavirus surge brought to areas like New York. But a spike would come. Around Memorial Day, when large crowds packed popular vacation spots, the state was only reporting about 500 new cases a day. By mid-July, the state was regularly reporting over 10,000 new cases a day. A rise in hospitalizations would follow, and, more recently, a spike in deaths.

TANGENT

The southern part of the state has been the hardest-hit, including the city of Miami. Even its baseball team, the Miami Marlins, have not escaped the rampant coronavirus spread in Florida. At least 17 members of the organization, mostly players, have tested positive for coronavirus—thrusting plans for a 2020 Major League Baseball season into doubt.

 

 

 

 

Houston, Miami, other cities face mounting health care worker shortages as infections climb

https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR14P9OGxTOPU8pMgjsVof7YlOAPv-vfxq2MBm9RlpYFVVa3qvpmvyIjFyA

Shortages of health care workers are worsening in Houston, Miami, Baton Rouge and other cities battling sustained covid-19 outbreaks, exhausting staffers and straining hospitals’ ability to cope with spiking cases.

That need is especially dire for front-line nurses, respiratory therapists and others who play hands-on, bedside roles where one nurse is often required for each critically ill patient.

While many hospitals have devised ways to stretch material resources — converting surgery wards into specialized covid units and recycling masks and gowns — it is far more difficult to stretch the human workers needed to make the system function.

“At the end of the day, the capacity for critical care is a balance between the space, staff and stuff. And if you have a bottleneck in one, you can’t take additional patients,” said Mahshid Abir, a senior physician policy researcher at the RAND Corporation and director of the Acute Care Research Unit (ACRU) at the University of Michigan. “You have to have all three … You can’t have a ventilator, but not a respiratory therapist.”

“What this is going to do is it’s going to cost lives, not just for covid patients, but for everyone else in the hospital,” she warned.

The increasingly fraught situation reflects packed hospitals across large swaths of the country: More than 8,800 covid patients are hospitalized in Texas; Florida has more than 9,400; and at least 13 other states also have thousands of hospitalizations, according to data compiled by The Washington Post.

Facilities in several states, including Texas, South Carolina and Indiana, have in recent weeks reported shortages of such workers, according to federal planning documents viewed by The Post, pitting states and hospitals against one another to recruit staff.

On Thursday, Louisiana Gov. John Bel Edwards (D) said he asked the federal government to send in 700 health-care workers to assist besieged hospitals.

“Even if for some strange reason … you don’t care about covid-19, you should care about that hospital capacity when you have an automobile accident or when you have your heart attack or your stroke, or your mother or grandmother has that stroke,” Edwards said at a news conference.

In Florida, 39 hospitals have requested help from the state for respiratory therapists, nurses and nursing assistants. In South Carolina, the National Guard is sending 40 medical professionals to five hospitals in response to rising cases.

Many medical facilities anticipate their staffing problems will deteriorate, according to the planning documents: Texas is hardest hit, with South Carolina close behind. Needs range from pharmacists to physicians.

Hot spots stretch across the country, from Miami and Atlanta to Southern California and the Rio Grande Valley, and the demands for help are as diffuse as the suffering.

“What we have right now are essentially three New Yorks with these three major states,” White House coronavirus task force coordinator Deborah Birx said Friday during an appearance on NBC’s “Today” show.

But today’s diffuse transmission requires innovative thinking and a different response from months ago in New York, say experts. While some doctors have been able to share expertise online and nurses have teamed up to relieve pressures, the overall strains are growing.

“We missed the boat,” said Serena Bumpus, a leader of multiple Texas nursing organizations and regional director of nursing for the Austin Round Rock Region of Baylor Scott and White Health.

Bumpus blames a lack of coordination at national and state officials. “It feels like this free-for-all,” she said, “and each organization is just kind of left up to their own devices to try to figure this out.”

In a disaster, a hospital or local health system typically brings in help from neighboring communities. But that standard emergency protocol, which comes into play following a hurricane or tornado, “is predicated on the notion that you’ll have a concentrated area of impact,” said Christopher Nelson, a senior political scientist at the RAND Corporation and a professor at the Pardee RAND Graduate School.

That is how Texas has functioned in the past, said Jennifer Banda, vice president of advocacy and public policy at the Texas Hospital Association, recalling the influx of temporary help after Hurricane Harvey deluged Houston three years ago.

It is how the response took shape early in the outbreak, when health-care workers headed to hard-hit New York.

But the sustained and far-flung nature of the pandemic has made that approach unworkable. “The challenge right now,” Banda said, “is we are taxing the system all across the country.”

Theresa Q. Tran, an emergency medicine physician and assistant professor of emergency medicine at Houston’s Baylor College of Medicine, began to feel the crunch in June. Only a few weeks before, she had texted a friend to say how disheartening it was to see crowds of people reveling outdoors without masks on Memorial Day weekend.

Her fears were borne out when she found herself making call after call after call from her ER, unable to admit a critically ill patient because her hospital had run out of ICU space, but unable to find a hospital able to take them.

Under normal circumstances, the transfer of such patients — “where you’re afraid to look away, or to blink, because they may just crash on you,” as Tran describes them — happens quickly to ensure the close monitoring the ICU affords.

Those critical patients begin to stall in the ER, stretching the abilities of the nurses and doctors attending to them. “A lot of people, they come in, and they need attention immediately,” Tran said, noting that emergency physicians are constantly racing against time. “Time is brain, or time is heart.”

By mid-July, an influx of “surge” staff brought relief, Tran said. But that was short-lived as the crisis jumped from one locality to the next, with the emergency procedures to bring in more staff never quite keeping up with the rising infections.

An ER physician in the Rio Grande Valley said all three of the major trauma hospitals in the area have long since run out of the ability to absorb new ICU patients.

“We’ve been full for weeks,” said the physician, who spoke on the condition of anonymity because he feared retaliation for speaking out about the conditions.

“The truth is, the majority of our work now in the emergency department is ICU work,” he said. “Some of our patients down here, we’re now holding them for days.” And each one of those critically ill patients needs a nurse to stay with them.

When ICU space has opened up — maybe two, three, four beds — it never feels like relief, he said, because in the time it takes to move those patients out, 20 new ones arrive.

Even with help his hospital has received — masks and gowns were procured, and the staff more than doubled in the past few weeks with relief nurses and other health-care workers from outside — it still is not enough.

The local nurses are exhausted. Some quit. Even the relief nurses who helped out in New York in the spring seem horrified by the scale of the disaster in South Texas, he said.

“If no one comes and helps us out and gives us the ammo we need to fight this thing, we are not going to win,” the doctor said.

One of the root causes of the problem in the United States is that emergency departments and ICUs are often operating at or near capacity, Abir and Nelson said, putting them dangerously close to shortages before a crisis even hits.

Texas, along with 32 other states, has joined a licensure compact, allowing nurses to practice across state borders, but it is becoming increasingly difficult to recruit from other parts of the country.

Texas medical facilities can apply to the Department of State Health Services for staffers to fill a critical shortage, typically for a two-week period. But two weeks, which would allow time to respond to most disasters, hardly registers in a pandemic, so facilities have to ask for extensions or make new applications.

South Carolina last week issued an order that allows nursing graduates who have not yet completed their licensing exams to begin working under supervision. Prisma Health, the state’s biggest hospital system, said this week that the number of patients admitted to its hospitals has more than tripled in the past three weeks and is approaching 300 new patients a day.

“As the capacity increases, so does the need for additional staff,” Scott Sasser, the incident commander for Prisma Health’s covid-19 response said in a statement. Prisma has so far shifted nurses from one area to another, brought back furloughed nurses, hired more physicians and brought in temporary nurse hires, among other measures, Sasser said.

Bumpus has fielded calls from nurses all over the country — some as far afield as the United Kingdom — wanting to know how they can help. But Bumpus says she does not have an easy answer.

“I’ve had to kind of just do my own digging and use my connections,” she said. At first, she said, interested nurses were asked to register through the Texas Disaster Volunteer Registry; but then the system never seemed to be put to use.

Later she learned — “by happenstance … literally by social media” — that the state had contracted with private agencies to find nurses. So now she directs callers to those agencies.

Even rural parts of Texas that were spared initially are being ravaged by the virus, according to John Henderson, CEO of the Texas Organization of Rural and Community Hospitals.

“Unless things start getting better in short order, we don’t have enough staff,” he acknowledged. As for filling critical staffing gaps by moving people around, “even the state admits that they can’t continue to do that,” Henderson said.

The situation has become so dire in some rural parts of the state that Judge Eloy Vera implored people to stay home on the Starr County Facebook page, warning, “Unfortunately, Starr County Memorial Hospital has limited resources and our doctors are going to have to decide who receives treatment, and who is sent home to die.”

Steven Gularte, CEO of Chambers Health in Anahuac, Tex., 45 miles from Houston, said he had to bring in 10 nurses to help staff his 14-bed hospital after Houston facilities started appealing for help to care for patients who no longer needed intensive care but were not ready to go home.

“Normally, we are referring to them,” Gularte said. “Now, they are referring to us.”

Donald M. Yealy, chair of emergency medicine at the University of Pittsburgh Medical Center, said rather than sending staff to other states, his hospital has helped others virtually, particularly to support pulmonary and intensive care physicians.

“Covid has been catalytic in how we think about health care,” Yealy said, providing lessons that will outlast the pandemic.

But telehealth can do little to relieve the fatigue and fear that goes with front-line work in a prolonged pandemic. Donning and doffing masks, gowns and gloves is time consuming. Nurses worry about taking the virus home to their families.

“It is high energy work with a constant grind that is hard on people,” said Michael Sweat, director of the Center for Global Health at the Medical University of South Carolina.

Coronavirus has turned the regular staffing challenge at Harris Health in Houston into a daily life-or-death juggle for Pamela Russell, associate administrator of nursing operations, who helps provide supplemental workers for the system’s two public hospitals and 46 outpatient clinics.

Now, 162 staff members — including more than 50 nurses — are quarantined, either because they tested positive or are awaiting results. Many others need flexible schedules to accommodate child care, she said. Some cannot work in coronavirus units because of their own medical conditions. A few contract nurses left abruptly after learning their units would soon be taking covid-positive patients.

Russell has turned to the state and the international nonprofit Project Hope for resources, even as she acts as a morale booster, encouraging restaurants to send meals and supporting the hospital CEO in his cheerleading rounds.

“It’s hard to say how long we can do this. I just don’t know” said Russell, who praised the commitment of the nurses. “Like I said, it’s a calling. But I don’t see it being sustainable.”