Hospitals south of region nearing COVID tipping point
Valley health care providers are worn out, physically and mentally.
More troubling: As they approach a third year of dealing with COVID-19, there is a growing sense that the worst might be yet to come.
Coronavirus cases have continued to explode here and nationwide, with the highly contagious omicron variant leading to an unprecedented spike in cases.
That has Valley providers concerned that overwhelmed hospitals might be a week or so away from a possible breaking point.
Pennsylvania has registered more than 20,000 COVID-19 cases a day in the first part of 2022. The state is on pace to shatter the record number of cases in a single month, while the number of patients hospitalized nears levels not seen at any point during the pandemic.
It’s putting more pressure on medical staffs everywhere, including Evangelical Community Hospital and across Geisinger’s health system.
The issue right now, hospital officials say, is numbers — both cases and staffing. Vaccinated staffers are getting infected because of the contagiousness of the omicron variant.
Evangelical President and CEO Kendra Aucker said the hospital had 40 staffers out with COVID on Thursday. Two weeks earlier there had been just three people off.
Geisinger’s Dr. Gerald Maloney, chief medical officer for hospital services, said across the health system — which has 21,000 employees — hundreds are out sick.
“What we figured out during all this is that we’ve had three problems: Stuff, staff and space,” Maloney said. “We have the space figured out. This time we have the stuff. Now it’s the staff. That’s the problem. We know what’s coming, but it’s hard to prepare if we don’t know how many people we’re going to have.
“We can put beds where they’ve never been before, but if I don’t have the staff, we can’t use them,” he said.
Because case counts are erupting at record numbers — there were more than 1,000 cases in the Valley in the first six days of 2022 — health care leaders know it will translate into a rise in patients, just like it has with each surge.
Aucker said on Thursday, Evangelical had 102 patients and 54 of them were COVID patients. The majority of those were not fully vaccinated. So half of Evangelical’s beds had COVID patients.
“How do you take care of the heart attacks, the GI bleeds, appendix?” she said.
“Everyone says hospitals are full, but what does that mean?” Dr. B. James Connolly, medical director for the Department of Emergency Medicine at Evangelical, asked. “From an Emergency Department standpoint, we don’t have the resources to do the things we need to do the way we need to do them. That’s terrifying. Every night we are faced with the potential of being overrun. We all wonder, ‘Is tonight going to be the night? Are we finally going to be pushed over the cliff?’ That is the heaviness we are dealing with.”
“What’s worrisome,” Connolly said, is that providers have “played every hand we have. If it gets much worse, then what? What else can we do?”
Frontline medical providers have been fighting COVID in the Valley for nearly two full years. The first confirmed case in the Valley was in Montour County on March 21, 2020. On Friday, the Valley passed 37,000 cases. More than 800 Valley residents have died from COVID since the start of the pandemic.
And that data just counts Valley residents, not patients from outside the four-county region being treated locally.
The up-and-down nature of the pandemic has led to tired staffers. A year ago, when COVID-19 vaccines became available, it was thought to be the beginning of the end. Instead, doctors, nurses and staffers are now treating volumes of patients as high as at any point in the pandemic.
Over a 10-day stretch bridging June and July 2021, Evangelical had no COVID patients. On Friday it had 57, including 10 in intensive care units and four on ventilators. All 10 patients in the ICU are unvaccinated, hospital officials said, along with all four on ventilators. On Aug. 2, 2021, Geisinger was treating six COVID patients at its Danville campus. That number is now more than 120.
“We are at the two-year mark of this hard to deal with this situation and we don’t know when it’s going to end,” Aucker said. “We are weary and tired. Our providers function in a constant state of stress. We’re doing what we need to do, but it’s definitely taking an emotional, mental and physical toll. It’s hard when people die. It’s not a normal thing to see several people a week in their 40s die from something preventable.”
Last week, the Pennsylvania National Guard joined federal COVID-19 response team members in Lackawanna and York counties to help ease hospital overcrowding.
Some 110 state guard medical providers, medics and support personnel were being dispatched to WellSpan York Hospital and the Commonwealth Health Regional Hospital of Scranton, where 30 beds were to be added between the hospitals to ease overcrowding due to COVID-19.
Brig. Gen. James McCormack of the Pennsylvania National Guard is overseeing active duty Air Force medical response teams in the two cities. Gov. Tom Wolf sought the help from the Federal Emergency Management Agency.
The Pennsylvania National Guard has conducted about 140 staffing support missions and provided some form of assistance to more than 130 long-term care facilities since April 2020, including several in the Valley.
Connolly said he sees a clear difference from staffers from the start of the pandemic. They are just worn down.
“We have a really collegial department. We’ve always covered for each other, without hesitation, if someone got sick or had family issues,” he said. “What says we are tired right now is we can’t get anyone to cover a shift. If we have 3-4 providers out, I am terrified to find coverage if that happens. We’ve done OK so far, but that’s what keeps me up at night.”
“The staff is tired and frustrated,” Maloney said. “People are doing more work and taking care of more patients than at any point. It’s also incredibly fatiguing to take care of COVID patients. It’s a lot more physically tasking, putting on and taking off the protective equipment. It’s a lot to deal with.
“They are ready for this to be over.”
Aucker said some staffers, because they are on the front line and dealing with sick patients and frustrated families, are dealing with more than they should.
“People are not nice and I have zero tolerance for that,” she said. “We provide the same level of service, but they are annoyed they have to mask or with visitation rules. It’s brutal for staff to work at this pace. We are all over this. Everyone is over this. We are tired.”
Aucker, Connolly and Maloney all said they expect the worst is yet to come. Omicron, the highly contagious variant behind the latest surge, is just starting to hit the Valley, Connolly said.
“Around Christmas, we had 60 positive cases in the system, now we have 100 positive cases,” Connolly said. “It’s just now starting to take off. We won’t see really sick people for 10 days. We just don’t know how bad it’s going to get.”
Maloney looks back at recent history in an attempt to gauge the potential surge in hospitalizations coming.
On Thanksgiving Day, there were 3,456 COVID patients being treated in Pennsylvania hospitals, including 161 in the three Valley facilities.
Two weeks later, there were 4,404 hospitalized statewide and 183 in Valley hospitals. Since then, hospitalizations have surged to more than 7,000 statewide and are back above 200 locally.
“If you look at Thanksgiving, we conclude a lot a people caught COVID around then, becoming exposed and infected at gatherings,” Maloney said. “So we’re only days away from New Year’s Eve. I think we’re another 5-10 days before we really see people from the holiday. It’s going to get worse before it gets better.”
Many experts have said and some studies have shown many who get the latest variant get milder symptoms. Maloney isn’t quite sure yet, he said, that is the case.
“It’s a little bit difficult to tell,” he said. “Is it because the number of people are vaccinated and boosted, or is it because it’s not as serious? We just don’t know yet.”
There is some good news for Valley hospitals fighting another surge of COVID-19.
Because hospitals are dealing with a third surge since the pandemic began nearly two years ago, officials have learned a lot. They’ve learned what treatments work and how to manage staff and what supplies to have on hand.
“The first surge was not as bad as this,” Connolly said. “If it was this bad, it would have been a lot worse.”
“We’ve learned how to care for COVID patients in the hospital,” Maloney said. “We can take much better care for patients. People are surviving now that wouldn’t have survived a year ago.”
Maloney said patients that are hospitalized with COVID tend to stay for long periods of time in the hospital. Many of those patients, who are adding to near-record hospitalizations across the nation, state and in the Valley, would have died early in treatment a year ago, Maloney said.
“We are seeing more patients now than last year, but we are treating them longer too.”
“We learned a lot quickly,” Aucker said. “We are now able to execute a lot of things that have become routine.”
Tribune News Service
contributed to this story.