Secretary of Health Dr. Rachel Levine warned this week Pennsylvania hospitals are facing a dire situation, with the normal supply of intensive care beds expected to be exhausted by late December.
As of Wednesday, 2,904 people were hospitalized with COVID-19 in Pennsylvania, up from a daily average of about 450 in late September and reaching the peak of the pandemic. Among those in hospitals, 628 were in intensive care and 310 were on breathing ventilators.
“Are we at risk of over-running the health care system? Absolutely. Those concerns are real,” said Dr. Peter Dillon, the chief medical officer at Penn State Health.
Levine points to a model from the University of Washington, which predicts hospitalized COVID-19 patients will peak at about 5,000 in late December. That number is well within the supply of available beds. However, about 1,000 will need intensive care — slightly more than the present supply of ICU beds.
Hospitals officials, working with Levine, say they have plans for ensuring everyone who needs an ICU bed or ventilator gets one. This includes tactics such as creating temporary ICU beds, transferring patients to hospitals with more capacity and, as a last resort, putting hospital beds in non-hospital facilities.
Some if not most hospitals are also rushing to schedule and complete elective surgeries, while also warning patients their elective surgery might have to be canceled at the last minute, depending on the volume of COVID-19 patients.
“The ICU beds, and perhaps more importantly, ICU staffing, are of concern,” Dillon said.
Dillon and other hospital officials said they can expand their supplies of ICU beds. It involves taking regular beds and equipping them with monitors and ventilators and shifting staff to care for those sicker patients, Dillon said. He said Penn State Health has extra ventilators and can add still more by taking anesthesia machines from operating rooms and reconfiguring them as ventilators.
York County-based WellSpan Health has the ability to double the number of ICU beds at each of its six regular hospitals, bringing the total to 160, an official said.
Still, a major concern across Pennsylvania involves having enough staff for the extra beds, especially with the threat of health care workers coming down with COVID-19 and being unable to work.
Several hundred nurses at a hospital in Bucks County went on strike earlier this week, saying they were struggling with low staffing issues as coronavirus cases are rising.
During Pennsylvania’s earlier COVID-19 peak in March and April, as many as 2,800 people per day were hospitalized with COVID-19. That happened at a time when less than 2,000 people per day were testing positive for COVID-19 in Pennsylvania. In recent days, the number of daily new infections has regularly topped 5,000, with a high of 6,339 reported Wednesday.
Some of the rise in positive cases results from increased testing, Levine noted. However, she has noted the percentage of positive tests has risen to 9.6%, up from 5% a month ago. More people are being tested, but a greater percentage of people are being infected.
Beds may not be available everywhere
Hospitals are better equipped in treating patients. Improvements in COVID-19 treatment creates the possibility the portion of people who test positive and also need hospitalization won’t be as great as earlier in the year.
Still, Dr. Anthony Aquilina, the chief physician executive at WellSpan Health, recently said that, even with better treatments, the average hospital stay for COVID-19 patients remains 9-10 days, similar to early in the pandemic. It’s because “we are keeping people alive that may have passed away earlier” with earlier treatment methods, he said. As a result, better treatment doesn’t necessarily free up capacity, Aquilina said.
While the University of Washington model predicts Pennsylvania’s demand will stay within the number of available beds, Levine said, “It is not clear they will be available in all regions.”
Moreover, the model focuses only on COVID-19 patients, and doesn’t factor in beds taken up by patients with regular flu, which typically surges in Pennsylvania following the end-of-year holidays, putting major stress on hospitals.
Hospitals are using various models to try to predict what’s coming. All are in the “same ballpark,” Dillon said. However, he said a model devised by health insurer Highmark and used by Penn State Health predicts another surge in January resulting from infections spread during the holidays. WellSpan officials said they too worry about a second surge in January.
UPMC, along with UPMC Susquehanna and Harrisburg-based UPMC Pinnacle, has 34 hospitals in Pennsylvania. The system extends from western Pennsylvania into Lancaster County and also includes much of the northern tier of the state. As of early this week, UPMC was treating 550 patients throughout the system, which also includes a few hospitals in Maryland and New York. That’s up from 90 on Sept. 1.
COVID-19 patients presently account for only about 10% of UPMC patients, said Dr. Donald Yealy, the senior medical director and chair of emergency medicine. While much of the remaining capacity is being used by other patients, Yealy said he doesn’t expect UPMC to run out of room for COVID-19 patients.
“UPMC is very well positioned and I don’t think there will be demand that outstrips supply,” he said.
Still, UPMC has plans for meeting whatever surge might arise, he said. These include converting space within UPMC to accommodate hospitalized patients and, as a last resort, setting up hospital beds in non-hospital facilities.
“We’ve had those plans in place for months,” Yealy said. “We’re nowhere near doing any of those advanced interventions. But we’re prepared if things require it.”
Yealy acknowledged concerns about staffing all the occupied beds. But he expressed confidence UPMC will be able to head off staffing shortages by taking extra care to prevent staff from coming down with COVID-19, taking advantage of relaxed state regulations that make it easier for health care workers to re-enter the work force, and moving staff around. Keeping staff healthy requires sufficient supplies of protective equipment, he noted, although he expressed confidence UPMC won’t run short.
Yealy also said UPMC can turn to staffing agencies if necessary, although he acknowledged other hospitals would be relying on agencies.
As of early Wednesday, York County-based WellSpan Health was caring for 230 COVID-19 patients, which is 50 more than a week ago, and up from an average of 50-60 during the summer. The latest numbers include 91 at WellSpan’s York Hospital, 54 at Chambersburg Hospital and 32 at Good Samaritan Hospital in Lebanon County.
John Porter, the chief operating officer, said WellSpan is moving staff and equipment among hospitals to deal with COVID-19 surges. It has opened incident command centers at five hospitals and has an operation center to track overall capacity and decide the best location for each patient, with some patients getting transferred to a different hospital. WellSpan is putting some non-COVID-19 patients at its WellSpan Surgery and Rehabilitation Hospital to free up space for COVID-19 patients at York Hospital, Porter said.
As of Wednesday, Penn State Health was caring for 86 COVID-19 patients at its three hospitals, up from 55 on Nov. 1. Twenty-two were in intensive care and 7 were using breathing ventilators.
“Our starting point is much higher. The prevalence and level of infections is just so much higher. This does feel different going forward,” Dillon said.
State will intervene if needed
Levine said she and Gov. Tom Wolf are asking hospitals to work together to make sure no hospital or region is overwhelmed, meaning they should coordinate among themselves on things including sharing supplies and transferring patients from overstressed locations to facilities with more available capacity.
In March, Levine ordered hospitals to cease elective surgeries to free up supplies of protective equipment and bed space for COVID-19 patients. The ban, which lasted 40 days, triggered complaints from hospitals, which said the number of COVID-19 patients never stretched their capacity. They said empty beds and loss of revenues from lucrative elective surgeries caused serious financial harm. They further said patients suffered from putting off surgeries, such as hernia repair, which aren’t considered emergency, but can be important to someone’s ability to function and enjoy life.
In a letter to hospital executives this week, Levine said she has no plans to impose a new ban on elective surgeries. Rather, she said she is trusting hospitals to manage them based on local conditions.
However, she urged them to complete elective surgeries as quickly as possible, so they don’t have to be canceled at the last minute because of a surge in COVID-19 patients, and to warn patients of potential delays or rescheduling in the event of a surge. She further said she expects hospitals to delay elective surgeries if it threatens to interfere with their ability to care for COVID-19 patients, and she expects them to make “make patient – not profit – driven decisions about what can be postponed” should staffing become tight.
She also held open the possibility the state might step in if Pennsylvania finds itself in the same situation as Texas, Wisconsin or Arizona, which have recently dealt with serious capacity issues.
“If the [health department] determines that the hospital community cannot effectively manage the situation to provide care to patients who need it the most, we will intervene to ensure Pennsylvanians with acute needs are receiving adequate care,” she told hospital executives.
UPMC’s Yealy said it should be left to hospitals and health care systems, rather than the state, to manage elective surgeries, based on local conditions. He said the goal is “not to choose winners and losers” among COVID-19 patients and patients with serious but non-emergency needs, but rather to serve as many patients as possible.
Penn State Health’s Dillon noted that following the spring ban on elective surgeries, doctors saw patients with cancers that were more advanced than they might have been, and heart patients who would have benefitted from getting surgery sooner.
As of this week, Dillon says he’s constantly looking at the patient load across Penn State Health, trying to predict what it will look like in seven days, and making decisions based on that projection.
He said he hopes Pennsylvanians will recognize the stress on hospitals, and help prevent COVID-19 cases through preventive steps such as mask-wearing and avoiding travel and indoor gatherings over the holidays.
He said each COVID-19 patient has the potential to impact the care received by non-COVID-19 patients, such as heart attack victims.
“It isn’t just COVID patients. It’s everyone’s health,” he said.
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