Damien Scott thought things could not get any worse than in August, when an outbreak of coronavirus in a nursing home left his rural hospital in eastern Georgia with a mass of critically ill patients.
But the Emanuel Medical Center is again filled with a new wave of COVID-19 patients, leaving Swainsboro hospital effectively full since Christmas, with new patients immediately replacing those discharged.
Last week, the death toll in COVID-19 County reached 57, Scott said.
“If you are in a big city, that number is not high,” he said. “But it is a high number for a community of 22,000.”
Scott is far from alone. Hospitals from Georgia to California are crowded with waves of coronavirus patients while the peak of post-holiday cases tests the limits of the nation’s healthcare system.
During the past week, a record 22,676 people died from COVID-19, according to data from Johns Hopkins University. That’s more Americans dying every day than the 2,977 victims on September 11, 2001.
‘A very, very dark place’: Hospitals prepare for crisis care mode with many patients, without sufficient staff
Four states with the largest share of hospital beds occupied by patients with COVID-19 – California, Arizona, Nevada and Georgia – are struggling to keep up with the unprecedented increase.
The situation has become so dire in California that the state has required hospitals to complete crisis assistance plans, detailing how they will prioritize care when they do not have enough staff, space or supplies.
In Los Angeles, public hospitals are preparing to switch to crisis mode, and the county has instructed ambulances not to send patients to overburdened hospitals if they cannot be revived in the countryside.
Arizona’s COVID-19 cases per capita during the past week through Sunday are at the highest level in the country, according to the Centers for Disease Control and Prevention. Hospitals in the Atlanta metropolitan area are packed with coronavirus carriers, and more than two dozen Georgia hospitals 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 being hit hardest during the COVID-19 outbreak?
While public health officials are optimistic, widespread vaccination will provide a glimpse of hope this spring, but now there is no respite for doctors and nurses in overburdened emergency rooms and intensive care units.
“It sure is what we feared,” said Janis Orlowski, director of health at the Association of American Medical Colleges. The next few days “will be revealing in relation to the type of security around the holidays that people practiced”.
‘Nobody escapes this’
The challenges are serious in smaller hospitals, which are the only option for the communities they serve. The increase in coronavirus cases creates a cascading effect in these small communities, extending beyond the hospital walls.
Emanuel CEO Scott thought his hospital reached its limit in August, when the coronavirus spread to nursing homes in neighboring counties and caring for patients “was like trying to get water with your hands,” he said.
The circumstances are even more challenging now. Although the peak of summer occurred in nursing homes, the current peak is because the virus is widely circulating. The hospital’s 6 ICUs and 18 general medical beds are full. And with the increase in post-holiday cases, 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 show that Emanuel County’s obesity, smoking and inactivity rates are worse than state averages. Life expectancy in Emanuel County is 155 out of 159 Georgia counties, according to the Robert Wood Johnson Foundation county health classifications.
Augusta University intensive doctors trained and coordinated with Emanuel’s doctors to provide remote telemedicine to patients. And the state of Georgia sent nurses to the hospital to reduce staff shortages.
Emanuel installed negative pressure and ionizing units in the ducts to combat the spread of the virus in the air in the hospital and nursing home. She 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.
In addition to the crowd of patients at the hospital, Emanuel County coroner Jeffrey Peebles has another concern – a potential lack of space in the morgue.
His office bought a refrigerated morgue with space for up to 10 bodies that will be placed inside the hospital when he arrives.
Preparations have been delayed when relatives of people who died of COVID-19 must isolate themselves because they have the virus. Spouses and other family members cannot care for a loved one until they also eliminate the virus.
So far, among the county funeral homes, there has been no shortage of capacity. Peebles said he hopes the new morgue unit will arrive in time so they don’t run out of space.
“It has been stressful for many people,” said Peebles. “We are a very close-knit community, so you know everyone when something happens … Nobody escapes it.”
Jimmy Lewis, founder and CEO of the Georgia-based rural hospital group Hometown Health, said rural hospitals are overburdened as they deal with this “surge, surge.”
In addition to caring for people in emergency rooms, these small hospitals must also execute plans to distribute vaccines, a process that requires hospital administrators to “have a general field note,” said Lewis.
“We have to learn to do all this juggling and logistics right away,” said Lewis. “It is a nightmare because everyone is tired.
‘Dark Winter Days’
When things get crowded or beyond the experience of smaller hospitals, they send patients to larger urban hospitals.
It is these hospitals now in major cities like Los Angeles and Atlanta that are receiving more patients than they can serve.
The Los Angeles County Department of Health Services last week issued guidelines on how hospitals should allocate scarce resources. The document details the decisions that hospitals must make when the demand for critical care services, personnel, space or life-saving equipment exceeds what the hospital is capable of providing.
‘We are not winning this battle’: Relentless outbreak COVID-19 fills 1 in 8 hospital ICU units
These painful decisions may include “which patients obtain which resources and, in some circumstances, may involve decisions to take scarce resources from one patient and give them to another who is most likely to benefit from them,” the document said.
Hospitals are already preparing staff and notifying the community of plans to move to this crisis response mode. Methodist Hospital in Arcadia, California, established a screening team to decide how to allocate limited resources in peak conditions.
When hospitals must implement such crisis patterns, they often rely on hospital committees and policies, rather than doctors and nurses making ethically charged decisions about caring for their patients, said Dr. Lewis Kaplan, professor of surgery at University Hospital of Pennsylvania, in Philadelphia.
“It is a very difficult place to look someone in the eye, having held their hand and shared what you now know about them and saying, ‘I will decide not to provide this to you,'” said Kaplan, president of the Society of Critical Care Medicine .
Instead, triage committees gather information about a specific case and assign a score to individual patients.
“Hospitals are in very difficult places,” said Kaplan.
Orlowski, of the Association of American Medical Colleges, said hospitals are especially stressed because the post-holiday increase occurs during the cold and flu season, the busiest time of the year for hospitals.
“We are in bleak winter days for this COVID pandemic,” said Orlowski.
Orlowski recalls seeing federal estimates in March predicting 20 to 30 million cases and 400,000 deaths in the United States. During the early days of the pandemic, Orlowski said he thought such estimates were “incomprehensible to think that there would be 400,000 deaths in the United States – just unbelievable.”
As of Tuesday, 22,663,962 Americans have been infected and 377,827 have died, according to Johns Hopkins.
She said the March estimates represent the worst case scenario “if we don’t smooth the curve and really take care of it”.
“And indeed,” said Orlowski, “this is what we are seeing now.”
Contributing: Mike Stucka, USA TODAY
Ken Alltucker is on Twitter as @kalltucker or can be emailed to [email protected]
This article was originally published in USA TODAY: The number of deaths from COVID increases as hospitals face an unprecedented wave of patients