Ohio Doctors ‘Can’t Sound the Alarm Bell Loud Enough’

CEDARVILLE, Ohio — The leaders of Ohio’s hospital systems have made it clear: the threat of postponing non-COVID care is becoming very real. And in some cases, it has begun.

During a special press conference Monday, Gov. Mike DeWine invited leaders from four major hospital systems in the state to give an update on where they stand during the coronavirus pandemic. The consensus is that unless the trends in cases and hospitalizations reverse, their ability to address other non-COVID issues to the best of their ability – strokes, heart attacks and trauma – is at risk of being reduced.

“Until we see cases peak and start coming down in a sustained way, we’re going to see hospitalizations continue to rise,” said Dr. Andrew Thomas of The Ohio State University Wexner Medical Center. “We can’t sound the alarm bell loud enough to the people in the state of Ohio to change their behavior.”

Thomas was joined by Dr. Robert Wyllie of Cleveland Clinic, Dr. Richard Lofgren, president and CEO of UC Health, and Mercy Health President Ronda Lehman. The press conference was held as the state reported 11,885 new cases of COVID-19 in the past 24 hours.

The hospital zone that includes Columbus has about 960 patients hospitalized as a result of COVID-19, Thomas said. That’s up from some 400 on Nov. 2. As cases have increased over the past four to six weeks, “hospitalizations track right behind it,” he said.

Representatives of the other systems reported similar trends.

The entire state reported 4,358 hospitalizations as of Nov. 23, reported Wyllie. That’s up from about 600 on Sept. 23, he said.

“Regardless of our ability to test, which has gone up substantially – about 70% or 80% since that time – we have significantly outstripped that number in terms of number of people actually being infected,” Willey said. Systems are doing the best they can to balance the load.

Patients are being transferred between different buildings within health systems, while others are being transferred from system to system “because frankly, they just hit their capacity,” said OSU’s Thomas. Currently, COVID patients comprise 40% to 50% of all intensive care patients, as well as half of the patients who are on ventilators, he said.

What’s different about this spread from the spring and summer is that it’s spreading rapidly throughout the state. His zone is composed of 36 counties with more than 40 hospitals and health systems, including those in metropolitan areas and others in rural parts of southern and southeastern Ohio. Those rural areas are “either at or within a couple of patients of their highest census in those regions at any time during the pandemic,” Thomas said.

Comparatively, the spring saw 75% to 80% of all patients in the hospital in the entire zone were just in hospitals in Franklin County, according to Thomas

“For the past month to two months, that’s been running closer to 50% to 60%. So the patients are distributed much more broadly,” he said. “This is not something that’s a Columbus, Cincinnati and Cleveland problem. It’s a problem throughout the state.”

Looking ahead, Thomas said that in the next few weeks, all hospitals are going to “have to start making tough decisions about how it will staff its beds,” which elective, non-urgent procedures it will postpone, “even to the point potentially of postponing ambulatory and outpatient office visits,” he said.

Some hospitals have already gotten to that point. Just after the governor’s conference concluded, Mercy Health – Youngstown announced it is “indefinitely postponing all elective procedures that require an overnight stay,” effective Nov. 26.

The hospital leaders pointed out that the issue isn’t so much space as it is having enough people to staff what they have. Nearly half of the hospitals in Lofgren’s region, which includes Dayton and Cincinnati, are reporting a nursing shortage, the impact of which “can’t be overstated,” he said.

“They’re working extra hours, they’re really stressed to make sure that they continue to provide the highest quality care, for which they’ve been trained to do,” he said. “We’re quickly approaching that point where the influx of COVID patients will in fact displace some of our non-COVID care.”

COVID infections among health care workers is also an issue. As of Nov. 23, the state reports a cumulative 27,685 workers have been infected with COVID-19, or 8% of all infections. Cleveland Clinic’s Wyllie said his system has seen the highest number of caregivers out because of COVID-19.

“We have 970 caregivers out,” he said. “And they’re out because they’re either on quarantine or they have active COVID infection.”

Many of those infections aren’t coming from within the hospitals, he said, rather they’re catching the virus from within the community.

Staffing shortages have required hospital systems to move caregivers from certain in-patient elective surgeries, as well as outpatient clinics, to the hospital floor and in the ICU. The increasing number of cases is also putting a stretch on equipment, such as ventilators, which are being shared between systems as well.

“We are leveraging staff and different roles in different ways,” said Mercy’s Lehman. “But the number of patients that are presenting and need hospitalization, are coming in at a faster rate than we are discharging them.”

While Lehmanallowed that there aren’t as many people dying because of COVID, the ability of discharging people back to their homes safely and ensuring they have the equipment they need, such as oxygen tanks, is being taxed. That is also impacting the available resources for caring for non-COVID patients, such as strokes and heart attacks, she said.

The doctors implored Ohioans to follow standard guidelines for the foreseeable future, including wearing facial coverings, maintaining physical distances and practicing good hygiene. They also cautioned against having Thanksgiving dinners and other family gatherings with individuals from outside of the household.

As for what kind of impact the Thanksgiving holiday may have, the state won’t see those cases of symptomatic people until two weeks after the fact, Wyllie said.

ICU and death numbers, in turn, would start showing about four weeks after the holiday, Lofgren noted. If nothing changes, he said – based on current trends – the state could see as much as a 50% increase in hospitalizations.

Copyright 2021 The Business Journal, Youngstown, Ohio.