Accidental incidents and staff shortages make Covid’s next move difficult for hospitals

The Cleveland Clinic in Weston, Florida, on January 11, was treating 80 covid-19 patients. This is a 10-fold increase from late December. Almost half were hospitalized for other medical reasons.

The surge caused by the highly infectious Omicron variant helped push South Florida hospitals with 206 licensed beds to 250 patients. The increase in the number of cases occurred because the hospital was suffering from a serious staff shortage, while nurses and other caregivers were enthusiastic about going out.

The challenge is to find room to safely treat all patients while keeping staff and the rest of the patients safe, said Dr. Scott Ross, Chief Medical Officer.

“This is not a PPE issue,” he said, referring to personal protective equipment such as masks. “It’s not an oxygen problem, it’s not a ventilator problem. It’s a quantity problem, and make sure you have enough beds and caregivers for your patients.”

Nationally, covid cases and hospitalizations are with them Highest level Since the pandemic started. However, unlike the previous Covid surge, the majority of Covid patients come to the hospital for other reasons. Infections exacerbate some medical conditions, making it difficult to reduce the spread of covids within the walls of hospitals, especially as patients manifest at the earlier, more infectious stages of the disease.

Omicron variants generally produce mild cases, but adding these “accidental” hospitalizations to co-caused hospitalizations is a medical system that is upset as the fight against the pandemic continues. Can be a turning point. The rate of increase in covids in the community also leads to an increase in hospital staff, causing a record number of illnesses and further stressing the overwhelming system.

Staff and staff from 13 hospital systems across the country said it was difficult to care for infected patients who needed other medical services and sometimes required different protocols.

Dr. Robert JanssenThe Chief Medical Officer of the Grady Health System in Atlanta said the infection rate in his community was unprecedented. Grady Memorial Hospital went from 18 patients on December 1st to 259 last week.

According to Janssen, about 80% to 90% of these patients either have covid as their primary diagnosis, or their health status, such as sickle erythema or heart failure, is exacerbated by covid.

Grady’s leaders are using Covid to wrestle with a large number of healthcare professionals, although fewer patients have developed covid-induced pneumonia than during the massive surge of early last year. At some point last week, Janssen said 100 nurses and as many as 50 other staff were out.

The Atlantic Health System, one of New Jersey’s largest hospital systems, has brought in about half of covid patients for other reasons, but not all patients with accidental covids can move to the covid ward. .. Brian Granolati Said. Because they need specialized services for other conditions, hospital staff take special precautions, such as wearing high levels of PPE when treating patients in areas such as the wings of the heart. increase.

At the Jackson Memorial Hospital in Miami, about half of Covid patients are hospitalized, primarily for other health reasons, and all patients admitted to Covid, with or without symptoms, are dedicated to Covid patients. Will be treated with some of the. Atara, Chief Medical Officer.

He said patients are still taxing their ability to operate the hospital, regardless of whether they are hospitalized or covid. Dr. Alex Garza, St. Louis Metropolitan Pandemic Task Force Incident Commander, Collaboration of the region’s largest medical system. He estimated that 80% to 90% of patients in regional hospitals were there for covid.

In Weston, Florida, Cleveland Clinics are also struggling to get patients out of nursing homes and rehab facilities because they can’t handle more patients in many places, Ross said. Hospitals are also struggling to send patients home because of concerns that they may endanger the people they live with.

This all means that there is a reason the hospital is telling people to leave the ER, unless it’s really an emergency. Dr. Jeremy Faust, Emergency physician at Brigham and Women’s Hospital in Boston.

According to Faust, the huge number of patients who appear during this surge and are unaware that they are colluding is horrifying. As more accidental cases flow into the hospital, they usually pose a greater risk to staff and other inpatients because they are in a more contagious stage of the disease before symptoms begin, Faust said. Said. In previous Covid Waves, people were hospitalized in the middle and late stages of their illness.

In Faust’s analysis Federal dataHe said January 7 showed the second most “hospital-onset” Covid case after the October 2020 outliers since the pandemic began. However, the data are likely to be underestimated, as they only target people who have been hospitalized for 14 days before a positive test for covid, Faust said.

A KHN survey series In government oversight in holding hospitals a high rate of responsibility for undiagnosed Covid patients at admission, including the fact that the federal reporting system does not publicly record Covids captured in individual hospitals. Revealed multiple gaps.

“People in hospitals are vulnerable for many reasons,” he said. Dr. Manoji Jain, Infectious disease specialist in Memphis, Tennessee. “All of the existing underlying diseases with multiple medical conditions-all of which put them at much greater risk.”

In particular, ER is a potential danger zone in the current surge in incidents, Garza said. He recommended that patients wear high-quality masks such as the KN95 and N95 respiratory organs.according to Washington postThe US Centers for Disease Control and Prevention is considering whether it is recommended that all Americans upgrade their masks during the Omicron surge.

“It’s physics and mathematics,” Garza said. “If you have a lot of people concentrated in one area and the viral load is high, you are much more likely to be exposed to such things if you don’t wear proper protective equipment.”

If a patient cannot tolerate N95 all day long, Faust encourages the patient to wear an upgraded mask whenever they come into contact with hospital staff, visitors, or other patients.

Dr. Dallas HolidayAn emergency physician at the Samaritan Health Service System in Oregon, said more patients were grouped into hospital rooms due to a shortage of nurses. This increases their risk of infection.

Dr. Abral KaranStanford Infectious Disease Fellows believe that all healthcare professionals should be required to wear the N95 every time they interact with a patient, not just a surgical mask.

However, if the staff were not obliged to use high quality masks, he recommended that patients ask their providers to wear N95.

“Why do we have to take responsibility for patients to protect themselves from health care workers when they don’t intend to do so?” He asked. “It’s very backwards.”

Some hospital staff may be ill and unaware that they are infected. And even if they know, in some states, Rhode Island When CaliforniaAsymptomatic health care workers may be recalled to work due to staff shortages.

Faust wants to improve the testing capabilities of healthcare professionals and other staff.

According to Karan, Stanford University encourages regular inspections, which are readily available to staff. But that is an exception to the rule. Jain said some hospitals are resisting regular staff testing, both for both possible waste of lab resources and possible consequences.

“I don’t want to know the hospital,” he said. “I just don’t have staff.”