Indiana hospitals brace for new wave of COVID as cases rise
As the number of COVID-19 in Indiana skyrockets, hospitals across the state are struggling to cope with this latest influx of critically ill patients as they treat more and more patients who come through their doors for non-COVID illnesses.
According to the Indiana Department of Health’s COVID-19 dashboard on Wednesday, more COVID patients were hospitalized statewide this week than at any time during the fall delta surge. There have been 2,755 COVID patients hospitalized, up from a peak of 2,687 in mid-September.
These numbers, in addition to the many patients with non-COVID illnesses filling beds, have hospital officials feared that the coming weeks could be even worse than last winter’s outbreak. Last winter saw a peak of 3,460 hospital patients with COVID.
âIt’s going badly,â said Brian Tabor, president of the Indiana Hospital Association. âThe hospitals are very full. … I don’t think we’ll see the waters recede until well after the holiday season. If you just look at the data from last year, I think it looks strangely like this. “
Some things, however, have changed. The death toll is much lower, as more than 80% of people over 65 have been vaccinated, providing them with protection against the most serious consequence of COVID.
Other changes over the past year, however, are not as promising when it comes to stopping the spread of the virus. The state no longer has a mask mandate in place and there are no restrictions on the size of gatherings.
Although the vaccine has been widely available since the spring, residents of Indiana have been much less likely than those in other states to be vaccinated. Nationally, 70% of people over 12 have been vaccinated, compared to 58.5% of Indiana residents.
In addition, the labor shortage that preceded the pandemic has only intensified, as exhausted healthcare workers leave the profession, hospital officials say. They add that despite a common misconception, vaccination warrants are only responsible for an insignificant percentage of those who have left.
Hospitals in Indiana are mostly filling up with unvaccinated patients, hospital officials here say. The Washington Post on Wednesday reported that four states, including Indiana, are responsible for nearly half of the increase in hospitalizations in the country.
Before this latest wave, hospitals here were already crowded with non-COVID patients with more complicated conditions that require longer stays, Tabor said. Emergency departments are busier than ever during the pandemic, with many patients exhibiting behavioral health issues.
For those who work in health care, it all adds up to a dire situation.
âIt looks a lot like the wave of last winter,â said Dr. Christopher Doehring, vice president of medical affairs at Franciscan Health. âFrom a COVID perspective, it was a lot higher, but when you factor in that we have so many other demands on our services, it’s as bad as ever.â
Locally, hospitals are hijacking more and more, diverting ambulances from emergency rooms. Patients can face long waits in emergency rooms before a hospital bed opens. Many establishments are canceling at least some elective procedures.
Using federal data from the week after Thanksgiving, Micah Pollak of Indiana University Northwest recently produced a graph showing the capacity of intensive care units in state hospitals. About half were above the pandemic average since July of last year. Five were at their pandemic maximum.
“We are maybe four or five weeks away from that wave and it usually takes 10 to 11 weeks to peak,” said Pollak, associate professor of economics. âOur health system is already a little stressed. â¦ Even if today we stopped the spread, we would see hospitalizations increase and I think that’s a big concern.
The omicron variant, which had not been detected in Indiana on Wednesday, is not even in the picture at this point, as the evidence is still unclear on its impact in the United States. The delta variant is still responsible for the vast majority of COVID cases in Indiana.
Hospital officials are also monitoring the numbers with a worried eye towards the future. At the rate that COVID cases are currently increasing, Indiana University Health could affect about 575 hospitalized COVID patients by the New Year, said Michelle Janney, executive vice president and chief operating officer. Prior to that, the healthcare system’s daily COVID census peaked at 517 patients on December 14 of last year.
And, Janney fears the numbers will hit 675 in early January if the situation doesn’t turn around.
âWe are seeing the numbers for COVID escalate,â she said. âWe expect it to pass (last winter’s total). I hope I am wrong. “
Janney said the UI healthcare system currently has over 2,000 inpatients, more than he’s seen in many years. Equally concerning, all hospitals in the system are full, so hospitals cannot simply switch between them. Right now, IU Health Methodist only takes the most critical patients, she said.
The hospital system strives to convert non-ICU beds to ICU beds as needed. He expanded the capacity of emergency services using non-traditional spaces. In addition, it has hired more transport vehicles to help those who are ready to go either to return home with the home hospital program or to a long-term care facility. Only one hospital in the IU health system, IU Health Tipton has a comprehensive elective surgery program; the others all prioritize elective acuity-based procedures, Janney said.
And everyone is getting ready for the next step.
âWe expect next month or weeks to come to be the most difficult time since the start of the pandemic,â Janney said.
After the fall outbreak, the Community Health Network saw a dramatic decrease in the number of COVID patients, said Chief Medical Officer Dr Robin Ledyard. Now, however, the numbers have skyrocketed again. In just three days, the healthcare system went from 130 COVID hospital patients to 165.
Thanksgiving gatherings likely helped, she said, adding that similar Christmas gatherings could spark even more cases. To avoid this, she recommends that those who can be vaccinated and that everyone be tested for COVID before the meeting to make sure no one is infected.
âI know it’s hard for people to believe that we are still in the middle of a pandemic, so people have to consider the best course of action, which is the vaccine,â she said. “There are some great ways to be safe right now and we just have to try to do them as a communityâ¦ I want the public to understand how full and busy hospitals are.”
Around this time last year, elective surgeries were suspended, a victim of the COVID outbreak. Governor Eric Holcomb has not taken this step again, but many hospitals are choosing to cut back on elective surgeries themselves, Franciscan’s Doehring said.
Yet, he said, it can come at a cost to patients.
“These are not easy decisions,” he said. âMy God, do I really need colon cancer surgery this week? “Some surgeries are more elective than others.”
Used to dealing with it
But not all health officials have expressed concern over the situation. Every year around this time, hospitals fill up with patients with respiratory illnesses as well as other illnesses, said Dr Stephen Swinney, clinical director of Ascension Indiana. As COVID increases the numbers, the hospital adapts to handle the influx.
âIt’s not particularly unusual for us to have full hospitals at this time of year. â¦ We’re comfortable and used to handling this, âSwinney said. âEven before COVID we were used to having to flex up and downâ¦ I think we’re in a much more comfortable place than before in terms of what to expect.â
Others in the health field say this year is different from the past.
December is always a busy time of year, but this year, hospital staff just completed nearly two years of responding to a pandemic, said Dr Jennifer Hartwell, chief of the Physician Welfare Office of the Indiana University. They hear every day how full hospitals are and how they should prioritize discharging patients to make room for others.
While people with COVID are only part of the patient mix, these people need much more intensive care than others, which further saps resources – and the future looks bleak.
âWe’re starting at a different baseline,â Hartwell said.
Hospitals at IU Health have taken steps to manage the influx, shifting to team-based care so the same number of providers can handle more patients, said Hartwell, a trauma and intensive care surgeon. They also redeploy staff when needed to help cover the intensive care unit or emergency department.
While hospitals are managing and will continue to manage the situation, Hartwell said she was concerned about the pandemic’s toll on healthcare workers who want to provide the best possible care but are now hampered to do so. Many healthcare workers have been exhausted by the pandemic – the ups and downs of COVID and the feeling that a broader vaccination could have prevented the last two outbreaks, Hartwell said.
“What breaks my heart is just that I’m not sure the general public really understands how injured healthcare workers are emotionally and psychologically because of all this turmoil.” , she said.
And at the end of the day, it might not just be the vendors affected by the situation, Pollak said. He noted that his card was already out of date, as the data was a week behind schedule.
What will next week’s data show if COVID cases continue to rise?
“That’s the concern – will there be room for COVID patients? He said, “but now we’re at the point where there’s going to be room for more patients.” It is a real concern.