For weeks now, Delaware hospitals and state officials have been sounding the alarm: With a COVID surge far outpacing last winter’s, hospitals are being stretched beyond capacity.
“That we are at crisis levels is uncontested,” Dr. Ken Silverstein of ChristianaCare said at the governor’s press conference on Tuesday. He said hospitals can no longer consistently meet normal standards of care, so they are putting in place emergency plans to make sure they can meet the needs of the sickest patients.
“We’re caring for patients in hallways. We’re stretched thin,” he said.
What does that mean for southern Delaware hospitals? I spoke to representatives from Beebe and Bayhealth to find out more about the situation locally.
Dr. William Chasanov of Beebe Healthcare in Lewes said it’s not uncommon for hospitals to be busier during the flu season, but the COVID surge has “definitely exceeded anything that we’ve ever seen before.”
Silverstein said Tuesday the current situation with COVID is “extraordinary and precedent setting.”
The severity of the situation can be seen in the call-up of extra National Guard members to help, both by providing extra hands to do nontechnical work in hospitals and by training to serve as certified nursing assistants.
The surge by the numbers
The infamous omicron variant has spread rapidly around the state. Its arrival has coincided with the winter season, which often sees more illness anyway, and COVID numbers have shot up far beyond their levels last winter. As of Friday morning, the state was reporting 759 COVID hospitalizations with 72 of those critical. However, by Saturday the numbers had dropped a bit, with 716 reported hospitalized and 71 critical. That was still an uptick from the 666 of the week before, which was a big increase over the 485 from the previous week, which at that point was a pandemic record. It may seem like a distant memory now, but by comparison only 14 people were hospitalized with COVID on June 26.
Now 2 out of every 5 people hospitalized in the state have COVID, Division of Public Health Director Dr. Karyl Rattay said, “which is really quite astonishing.”
That has left hospitals slammed. On average, Rattay said, hospitals in Delaware last week were operating at about 117 percent of capacity, with ChristianaCare and Beebe at about 130 percent.
So what does this mean?
There was a lot of talk about “crisis standards of care” at the press conference, which are guidelines hospitals follow when their resources are stretched too thin. It’s a way for them to decide where those resources go.
In Delaware those can vary by hospital. For example, ChristianaCare’s Silverstein said they were taking measures like prioritizing who gets medication on time, not providing hot meals to all patients, and deciding who should receive scarce COVID medications.
Dr. Gary Siegelman, MD, Bayhealth senior vice president and chief medical officer, said Bayhealth is not taking all the same steps. But like other hospitals, they are delaying procedures like some surgeries. That process started about two months ago and has ramped up in the last few weeks as they focus on taking care of urgent or emergency cases.
The two campuses in Dover and Milford are seeing similar situations, he said: They’ve been at higher than 100 percent capacity for the last few months, and it’s gotten worse in the last month. And like other health care providers, Bayhealth has seen staff leave over the past two years.
These factors mean patients who come into the ER and need to be hospitalized may have to wait until beds open up.
“We have more (staff) in the waiting rooms now trying to help patients with just making them comfortable and helping them understand what the process is going to be,” Siegelman said, and these staff are also able to notify a nurse if someone is getting worse.
The state is also allowing Bayhealth to add extra beds because of the emergency, like in a conference center space they have available. And they have reassigned hundreds of staff members to help in areas where they are really short-staffed, Siegelman said, including some who act as runners for the pharmacy to make sure medications get where they need to go. It’s an all-hands-on deck situation – one of Bayhealth's vice presidents is even tapping into past career experience to help out in a lab.
The TidalHealth medical system, which has a hospital in Seaford, has also announced it is adopting crisis standards. "The health system is experiencing occupancy levels never seen before coupled with tremendous lengths of stay, making managing the volumes of patients very challenging," the system said in a statement.
Beebe is avoiding the “crisis standards of care” language, but Chasanov said they have staffing issues like Bayhealth and other health care providers around the country, and are also taking steps like postponing some non-urgent medical procedures and reassigning staff as needed to help. Beebe also recently added more beds.
“We are extremely happy to have National Guards here several days a week,” he said. Volunteers from the Delaware Medical Reserve Corps are also helping out.
Chasanov said they are asking people to help out by not coming to the emergency room for issues that could be taken care of at a walk-in location or with a primary care doctor, and Beebe is making an effort to make more primary care appointments available. Siegelman asked people who are having symptoms and are worried about COVID, but don’t need to be hospitalized, to go somewhere besides the hospital for testing. That could include going to state testing sites or their primary care physician. He also suggested seeing a doctor via remote care, saying Bayhealth is launching a remote 24-hour urgent care service.
Chasanov said Beebe is doing its best to make sure everyone gets the best care, and is able to help people who do need to be hospitalized. Siegelman echoed that, saying people who have serious health issues, COVID or otherwise, can come to the hospital.
The effect on staff
A pandemic that’s still going strong after two years has taken its toll on staff.
“My colleagues are working extremely hard … they’re exhausted, and they’re sacrificing this time from their families in order to take care of everyone,” Chasanov said. He pleaded for people to be understanding.
There’s frustration in the community because of COVID, he said. “People are anxious, people are upset, people want this to be over. And health care workers are taking a little bit of a beating for that.”
“I think we all need to remember that … we’re all human, and that we have to be kind to one another.”
“It’s a tough situation in a lot of parts of society now, right, with COVID over the past couple of years,” Siegelman said, and that includes hospitals. He said the Bayhealth team has been remarkable. “It’s been a really great team effort.”
A note on the severity of omicron
There’s been a lot of talk about omicron being viciously contagious, but with a milder effect than previous versions of the virus.
“As with previous variants, the vast majority of people infected with omicron have a mix of symptoms that resolve relatively quickly and don't require hospital care,” NPR reported, noting studies that find the risk of hospitalization is lower with omicron. But that doesn’t mean people aren’t getting seriously ill.
“I’ve seen the reports that the omicron variants tend to lead people to a more mild illness than potentially with Delta and the other strains that are out there,” Chasanov said. “But that’s not what we’re necessarily seeing. The people who are requiring hospitalization at this point are sick … they are requiring ICU care.”
The fact is, Silverstein said, that many more people are getting infected and people in the hospital are critically ill.
“I respect people’s feelings. I understand people have concerns … with the vaccination, but I’m just telling what we see,” Siegelman said. Bayhealth doctors, he said, are seeing “a lot of COVID patients that again, many of them unfortunately pretty ill and most of them have not been vaccinated.”
A ray of hope
Predicting what COVID will do can be a fool's game, but there are hopeful signs. The New York Times reported Thursday that in a number of places where the omicron variant hit first, cases have begun leveling off.
Local hospital leaders also offered a ray of hope.
“We are hoping though like South Africa and in some other places that the peak comes pretty quickly,” Siegelman said. “... With very infectious organisms like this, you tend to see a quick rise in the number of people that have it because it’s so contagious, but then as it kind of sweeps through like a brush fire, you often see a quick drop as well.”
Chasanov said if the surge follows a similar timeline as last year’s, numbers may start coming down by the end of the month – although he still expects to be busy.
In the meantime, the doctors urged people to take precautions.
"There's heroic work that's going on here," Siegelman said, "and people are going above and beyond to really try to take care of patients."