Random cases and staff shortages make next COVID act difficult for hospitals

The Cleveland Clinic in Weston, Florida, was treating 80 COVID-19 patients on Jan. 11, ten times more than at the end of December. Nearly half were hospitalized for other medical reasons.

A surge caused by a highly contagious omicron variant has helped boost patient numbers at a South Florida hospital from 206 licensed beds to 250 patients. The surge in cases came as the hospital struggled with severe staffing shortages while nurses and other caregivers were out with COVID.

According to Dr. Scott Ross, Chief Medical Officer, the challenge is to find a place to safely treat all COVID patients while keeping staff and other patients safe.

“This is not a PPE issue,” he said, referring to personal protective equipment such as masks, “not an oxygen issue, nor a ventilator issue. It’s a volume issue and providing enough beds and carers for patients.”

The number of COVID cases and hospitalizations is at its peak in the country the highest levels since the start of the pandemic. However, unlike previous outbreaks of COVID, a large proportion of COVID patients are admitted to the hospital for other reasons. Infections exacerbate some medical conditions and make it difficult to reduce the spread of COVID within hospital walls, especially as patients present at earlier, more contagious stages of the disease.

While the omicron variant usually results in milder cases, adding a huge number of these “accidental” hospitalizations to those caused by COVID could be a game-changer for a health care system that has faltered as the fight against the pandemic continues. The rise in COVID cases in the community is also driving the rise in cases among hospital staff, causing them to cause a record number of cases and further strain an overburdened system.

Officials and staff at 13 hospital systems across the country said caring for infected patients who require other medical services is challenging and sometimes requires different protocols.

Dr. Robert Jansen, chief medical officer at Grady Health System in Atlanta, said the infection rate in his community was unprecedented. Grady Memorial Hospital has increased from 18 COVID patients on Dec. 1 to 259 last week.

Roughly 80% to 90% of these patients either have COVID as their primary diagnosis or have a health condition such as sickle cell anemia or heart failure that is exacerbated by COVID, according to Jansen.

While fewer of their patients have developed COVID-induced pneumonia than during the major spikes early last year, Grady leaders are battling more healthcare workers with COVID. At one point last week, according to Jansen, 100 nurses and 50 other employees were absent.

At one of New Jersey’s largest hospital systems, the Atlantic Health System, where about half of COVID patients were admitted for other reasons, not all patients with accidental COVID can be transferred to COVID units, CEO Brian Gragnolati said. They need specialized services to treat other conditions, so hospital staff are taking special precautions, such as wearing higher-level personal protective equipment when treating COVID patients in places like the heart wing.

At Jackson Memorial Hospital in Miami, where about half of COVID patients are for mostly other health reasons, all patients hospitalized with COVID, whether they have symptoms or not, are treated in the part of the hospital designated for patients with COVID, said Dr. Honey. Atalla, chief physician.

Whether patients are hospitalized with COVID-19 or with COVID-19, patients still burden the hospital’s ability to operate, he said. Dr. Alex Garza, head of the St. Louis pandemic task force, bringing together the region’s largest healthcare systems. He estimates that 80% to 90% of patients in the region’s hospitals are there because of COVID.

In Weston, Fla., the Cleveland Clinic also finds it difficult to discharge COVID patients to nursing homes or rehab centers, Ross said, because many places cannot accept more COVID patients. The hospital is also having difficulty sending patients home for fear they will put those they live with at risk.

All of this means there’s a reason hospitals are advising people to stay away from ERs unless it’s truly an emergency. Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston.

The sheer number of patients who show up and don’t know they have COVID during this surge is frightening, Faust said. As more accidental cases are admitted to hospitals, they pose a greater risk to hospital staff and other patients, Faust said, because they tend to be at a more contagious stage of the disease — before symptoms appear. In previous waves of COVID, people were hospitalized in the middle and advanced stages of the disease.

In Faust’s analysis federal dataJan. 7 was the second-highest number of “hospital-onset” COVID cases since the start of the pandemic, second only to the October 2020 outlier, he said. But that data only counts people who were in the hospital in the 14 days prior to testing positive for COVID, Faust said, so it’s likely an understatement.

A KHN Investigative Series revealed numerous gaps in government oversight of holding hospitals accountable for the high percentage of COVID patients who were not diagnosed on admission, including that federal reporting systems do not publicly flag COVID found in individual hospitals.

“People in the hospital are vulnerable for many reasons,” said Dr. Manoj Jain, an infectious disease specialist in Memphis, Tennessee. “All of their existing underlying diseases with multiple diseases – all of which puts them at much greater risk.”

The ER, in particular, is a potential danger zone amid the current caseload, Garza said. He recommended that patients wear high quality masks such as the KN95 or N95 respirator. In accordance with Washington PostThe Centers for Disease Control and Prevention is weighing up whether to recommend that all Americans renew their masks during the micro-micron surge.

“It’s physics and mathematics,” Garza said. “If you have a lot of people concentrated in one area and a high viral load, you’re much more likely to be exposed to something like this if you’re not wearing adequate protection.”

If patients cannot tolerate N95 all day long, Faust encourages them to wear improved masks whenever they come into contact with hospital staff, visitors or other patients.

Dr. Dallas Holladay, an emergency physician for Samaritan Health Services in Oregon, said the shortage of nurses is causing more patients to gather together in hospital rooms. This increases the risk of infection.

Dr. Abraar Karan, an infectious disease fellow at Stanford University, believes that all health care workers should wear N95 at every patient contact, not just surgical masks, given the rising risk of contracting COVID.

But in the absence of higher quality mask requirements for employees, he recommended that patients ask their suppliers to wear N95.

“Why should we give patients the responsibility to protect themselves from healthcare professionals when healthcare professionals aren’t even going to do it?” he asked. “It’s so backward.”

Some hospital workers may not know they are sick – and contagious. And even if they know, in some states, including Rhode Island and CaliforniaAsymptomatic healthcare workers may be recalled to work due to staffing shortages.

Faust would like to see increased testing capacity for medical professionals and other employees.

Regular testing is encouraged at Stanford, Karan said, and tests are readily available to employees. But this is the exception to the rule: Jane said some hospitals are resisting routine testing of staff, both because of the leakage of lab resources and the possible outcomes.

“Hospitals don’t want to know,” he said. We just don’t have staff.

Source link

Leave a Reply

Your email address will not be published.

Back to top button