The recent sharp spike in the number of people infected by COVID is not just taking a toll on those who are infected. It’s creating major problems for the hospitals and the professionals that treat them.
Dr. Don Williamson, president and CEO of the Alabama Hospital Association, says hospitals sometimes are having a hard time finding room for patients who are suffering from non-COVID afflictions, and their emergency rooms are overflowing.
“Because ER’s are so overwhelmed with COVID, we’ve got a situation where, with many of the hospitals, we’ve converted ER beds into holding beds for patients who can’t find a room upstairs. As a result … it means we have long wait times in the (emergency departments), it means we have challenges in getting people from the ED to a room, in some cases converting ED space into COVID space, and we’ve got individuals on ventilators, and we’re managing patients in the ED because there just isn’t ICU spaces in those cases upstairs.”
Williamson said one issue is people who go to emergency departments when another facility, such as an urgent-care center, would be more appropriate to the task and take less time and resources.
“The state sent out a press release asking people not to come to the ER … just to get tested. One of the challenges is that we’re seeing ER’s where people are showing up not because they’re ill but because they want to be tested because they think they have been exposed to COVID. That’s obviously not a good use of ER time.
“Secondly, don’t come for something that’s not truly an emergency. You’re going to be greatly disappointed because the time is going to be longer, and you’re going make everybody else’s care slower. But in terms of patients showing up, no hospital is turning people away. Our hospitals are in situations where they might not be able to take every referral (from other health care providers) that comes to them, though,” Williamson added.
Hospitals in Mobile and Baldwin counties are taking the brunt of the onslaught for now.
“Mobile County has more COVID patients in hospitals today than they did in January,” Williamson said. “And their numbers are continuing to grow each day. Several hospitals in Mobile County and Baldwin County have eliminated elective procedures, both inpatient and outpatient.”
The Gulf Coast counties are in the heart of a strip of the United States that is seeing the highest rates of COVID infection. The affected area runs from Jacksonville on the Atlantic coast, through the Florida Panhandle, the Mississippi and Louisiana coastal areas and all the way to Houston, Texas. The worst of the outbreak follows the Interstate 10 corridor.
“Some of the hospitals in Mobile are associated with hospitals in Jacksonville, and they think we’re about two weeks behind Jacksonville,” Williamson said. “We think we’re about three weeks behind the Louisiana hospitals. … If we follow that movement, we’re likely to see over the next two weeks some unbelievable surges in our hospitalizations.”
Williamson said he doubts the worst of the outbreak will stay in the I-10 corridor. “That’s evidenced by what you’re already seeing in Birmingham, what you’re already seeing in Tuscaloosa, in Dothan, in Huntsville. We’re seeing it surge pretty much all over the state.”
For instance, hospitals in Madison County had 28 COVID patients hospitalized on July 6. One month later, that figure was up to 132 — roughly quintupled over a month’s time.
Williamson said he also is worried about the positivity rate, which is the percentage of all tests administered that return positive results. “Statewide, our positivity rate is 24%, but within pockets, we’re seeing rates over 30% to 35%,” he said. “I suspect at this point that number is not out of the realm of being real. Testing is down a little bit … and given that positivity went up, I don’t think that indicates a real decline in caseload. I think it reflects that fewer people got tested.”
Williamson saw the report issued by Dr. Suzanne Judd of UAB, who developed a model based on South Alabama data that predicts new cases could skyrocket to 13,000 a day before the end of the month and hospitalizations could surpass 7,000 statewide. “I had some really good Anglo-Saxon words when I saw that,” he joked.
“Right now, we are tracking along that plot. The worst-case scenario — the question that determines how bad it’s going to get — is this: Do we see transmission at the rate through the rest of the state as we’re seeing in South Alabama? If we do, then 7,000 or 8,000 people in the hospital is more than twice the number we saw in January, and that’s a real possibility. But if we run into pockets where we have higher numbers of people who have been vaccinated, who have immunity or aren’t gathering in large groups without wearing masks, we’ll track more along the Indian model,” which is the middle level of three models Judd developed. “We still will exceed the 3,088 people we had in the hospital in January, but it’s a number you can at least plan for. I really think the next two weeks is going to determine what this looks like.”
One other problem for hospitals that has gotten worse since the winter surge is a lack of professional staff, such as nurses.
“Over the last 72 hours, I have talked with all of our member hospitals … and the number (one) issue we face is staffing, Williamson said. “If you go back to January 2020, we were already short-staffed. Then in the pandemic, several things happen: First, some staff simply decide, ‘You know what? Health care is not where I want to be,’ and they went to a different profession. Second, some of the staff, especially nurses, signed on to nurse staffing companies and they took jobs out of state where they could be paid more money. So we have fewer staff now than we did in January. When we start dealing with this surge, we start in a much more tenuous place than we did in January.”
Some nurses also are out because they have contracted COVID. Also, the emotional fatigue of the current surge is different, and it’s taking a toll on staffs, as well.
“They’ve seen this movie before and they know how it turns out, and it’s not a good experience,” Williamson said. “They are emotionally and physically fatigued because, once we got a break from COVID, hospitals filled up with people coming in who had delayed (procedures) during the surge in January, so they’ve been filled with heart attacks, strokes, cancer, the usual stuff. And the last problem is that this is a self-inflicted wound. While some of the (COVID) patients in hospitals are going to be breakthrough cases, the reality is most of the patients … are unvaccinated.”