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Damien Scott believed things couldn’t be worse than in August, when a coronavirus outbreak in a nursing home left his rural East Georgia hospital with a mass of critically ill patients.
But Emanuel Medical Center is once again full of a new wave of COVID-19 patients, leaving Swainsboro hospital effectively full since Christmas with new patients immediately replacing those who have been discharged.
Last week, the county’s death toll from COVID-19 reached 57, Scott said.
“If you are in a big city, that number is not high,” he said. “But that’s a high figure for a community of 22,000 inhabitants.”
Scott is far from alone. Hospitals from Georgia to California are filled with waves of coronavirus patients as the spike in post-holiday cases tests the limits of the nation’s healthcare system.
In the past week, a record 22,676 people have died from COVID-19, according to figures from Johns Hopkins University. More Americans die every day than the 2,977 victims of September 11, 2001.
“A very, very dark place”: Hospitals Prepare for Crisis Care Mode with Too Many Patients, Not Enough Staff
Four states with the largest share of hospital beds occupied by COVID-19 patients – California, Arizona, Nevada and Georgia – are struggling to keep pace with the unprecedented surge.
The situation has become so dire in California that the state has required hospitals to develop crisis care plans detailing how they will prioritize care when they do not have enough workers, space. or supplies.
In Los Angeles, public hospitals are preparing to go into crisis mode and the county has ordered ambulances not to send patients to overcrowded hospitals if they cannot be resuscitated in the field.
Per capita COVID-19 cases in Arizona in the week up to Sunday are at the highest level in the country, according to the Centers for Disease Control and Prevention. Atlanta metro hospitals are teeming with people with coronavirus, and more than two dozen hospitals in Georgia do not have beds available in intensive care units, according to the Department of Health and Human Services.
Check your local hospital: Which hospitals in your community are hardest hit by the COVID-19 outbreak?
While public health officials are optimistic widespread immunization will provide a silver lining this spring, there is no respite now for doctors and nurses in overcrowded emergency rooms and care units intensive.
“Absolutely, that’s what we feared,” said Janis Orlowski, health care manager for the Association of American Medical Colleges. The next few days “are going to be revealing of the type of safety practiced by people during the holidays”.
‘No one escapes this’
The challenges are acute in small hospitals which are the only option for the communities they serve. The surge in coronavirus cases is cascading over these small communities, extending beyond the walls of the hospital.
Emanuel CEO Scott believed his hospital reached its limits in August when the coronavirus spread to nursing homes in neighboring counties and patient care “felt like trying to scoop up some water with your hands, ”he said.
The circumstances are even more difficult now. While the summer peak was from nursing homes, the current peak is because the virus is circulating widely. The hospital’s 6 ICUs and 18 general medicine beds are full. And with a surge in cases after the holidays, more people will need care in the coming days as they develop complications.
‘Our neighbors, our family members’: Small Town Hospitals Overwhelmed by COVID-19 Deaths
Health data shows that Emanuel County’s obesity, smoking and physical inactivity rates are all lower than state averages. Life expectancy in Emanuel County ranks 155th out of 159 counties in Georgia, according to the Robert Wood Johnson Foundation County Health Rankings.
Critical care physicians at the University of Augusta trained and coordinated with Emanuel’s physicians to provide remote telemedicine to patients. And the state of Georgia has sent nurses to the hospital to alleviate the staffing shortage.
Emanuel installed a vacuum and installed ionizing units in the ducts to combat the airborne spread of the virus in the hospital and nursing home. He plans to open an outpatient clinic to administer the monoclonal antibody bamlanivimab to as many eligible patients as possible. The goal is to help people recover and save beds for critically ill patients until vaccines are widely administered.
Beyond the inpatient crowd, Emanuel County Coroner Jeffrey Peebles has another concern: a potential shortage of morgue space.
His office has purchased a refrigerated morgue that can accommodate up to 10 bodies that will be placed inside the hospital upon his arrival.
Arrangements were delayed when relatives of those who died from COVID-19 have to self-isolate because they have the virus. Spouses and other family members cannot make arrangements for a loved one until they get rid of the virus.
So far, between county funeral homes, there has been no shortage of capacity. Peebles said he hopes the new morgue unit arrives in time so as not to run out of space.
“It has been stressful for a lot of people,” Peebles said. “We are a united community, so you know everyone when something happens … No one escapes it.”
Jimmy Lewis, founder and CEO of Georgia-based rural hospital group Hometown Health, said rural hospitals were under pressure as they managed this “skyrocket, skyrocket”.
Beyond caring for people in emergency rooms, these small hospitals also need to execute vaccine distribution plans, a process that requires making “general-level hospital administrators,” said Lewis.
“We have to learn to do all of this juggling and logistics on the fly,” Lewis said. “It’s a nightmare because everyone is exhausted.
‘Dark winter days’
When things get cluttered or beyond the expertise of small hospitals, they send patients to larger urban hospitals.
Now it’s the hospitals in big cities like Los Angeles and Atlanta that are seeing more patients than they can handle.
Last week, the Los Angeles County Department of Health Services released advice on how hospitals should allocate limited resources. The document details the decisions hospitals must make when the demand for intensive care services, personnel, space or life-saving equipment exceeds what the hospital is able to provide.
“We are not winning this battle”: Relentless COVID-19 surge fills 1 in 8 hospital intensive care units
Such heartbreaking decisions could include “which patients get which resource, and in some circumstances, may involve decisions to take scarce resources from one patient and give them to another who is more likely to benefit,” the document.
Hospitals are already preparing staff and notifying the community of plans to switch to this crisis mode of care. The Methodist Hospital in Arcadia, Calif., Created a triage team to decide how to allocate limited resources under peak conditions.
When hospitals need to implement such crisis standards, they often rely on hospital committees and policies rather than doctors and nurses to make ethically heavy decisions about the care of their patients, a said Dr. Lewis Kaplan, professor of surgery at the University of Pennsylvania Hospital in Philadelphia.
“It’s a very hard place to look in someone’s eyes, having held their hand and shared what you now know about them, and say, ‘I’m going to decide not to provide this to you.’ , said Kaplan, president of the Society of Critical Care Medicine.
Instead, triage committees collect information about a particular case and assign a score to each patient.
“Hospitals are in very difficult places,” Kaplan said.
Orlowski, of the Association of American Medical Colleges, said hospitals are particularly stressed because the post-vacation surge comes during cold and flu season, the busiest time of year for hospitals.
“We are in the dark days of winter when it comes to this COVID pandemic,” Orlowski said.
Orlowski recalls seeing federal estimates in March predicting 20 to 30 million cases and 400,000 deaths in the United States. During the first days of the pandemic, Orlowski said she thought such estimates were “unfathomable to think there would be 400,000 deaths in the United States – just unbelievable.”
As of Tuesday, 22,663,962 Americans were infected and 377,827 died, according to Johns Hopkins.
She said these March estimates were the worst-case scenario “if we don’t flatten the curve and really deal with it.”
“And indeed,” Orlowski said, “that’s what we’re looking at right now.”
Contributor: Mike Stucka, USA TODAY
Ken Alltucker is on Twitter as @kalltucker or can be emailed to [email protected]
This article originally appeared on USA TODAY: COVID deaths rise as hospitals face unprecedented wave of patients
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