Ohio Hospitals Sound Alarm on COVID, Staffing Shortages

YOUNGSTOWN, Ohio — During a Friday press conference with health care leaders in the state, Dr. Andrew Thomas, chief clinical officer at The Ohio State University Wexner Medical Center, summed up the overall sentiment of his colleagues – the road out of the pandemic will be difficult if COVID-19 cases and hospitalizations don’t peak soon.

“It feels like where we were in mid-December,” Thomas said.

Thomas was joined by Dr. Bruce Vanderhoff, director of the Ohio Department of Health, Dr. Richard Lofgren, president and CEO of UC Health, and Dr. Robert Wyllie, chief medical operations officer for Cleveland Clinic. The doctors conducted the conference virtually to discuss the state’s increasing rate of patients being hospitalized because of COVID-19.

On Friday, ODH reported 4,855 new cases of COVID-19 since Thursday, when the state saw 5,395 new cases – a reported high since January, Vanderhoff said. That follows several consecutive days of new-case counts in the 3,000 and 4,000 range, he said.

“Those figures are about 10 times the numbers we saw just a month ago,” Vanderhoff said. Cases per 100,000 now average over the past two weeks “well over 300,” up from around 17 in July, he noted.

“We’re seeing new cases at a rate similar to what we saw this past January and February,” he said.

Hospitalizations in the state currently sit at 2,127, with 165 new hospitalizations in the last 24 hours as of Aug. 27, the ODH reports. Of those hospitalized for COVID-19, 628 are in intensive care.

COVID patients account for one in 10 patients in hospitals throughout the state, including one in six in ICU, Vanderhoff reported.

“We’re seeing younger adults right alongside older age groups,” he added. “Unvaccinated Ohioans are by far and away the COVID-19 patients who are filling our hospital beds.

“With delta, we’re seeing people of all ages get sicker quicker and requiring hospital care.”

This “decisive surge” in COVID-19 patients that started in mid-July “parallels what we saw in the fall where we had the largest surge,” said Lofgren. In the greater Cincinnati area, hospitals saw 40 to 50 residents hospitalized with COVID-19 in June and into early July, he said. Today, the area has 363 COVID patients hospitalized, 118 of whom in the ICU.

During the surge in December 2020 to January 2021, Cincinnati’s peaked around 800, Lofgren said.

“That really did stretch our health care delivery system,” he said. “It didn’t quite break, but we definitely saw the push.”

The current upsurge is similar to what the region saw back then, he said. And while hospital systems are more prepared in terms of knowledge of the virus and treating it, and are well supplied with personal protective equipment, hospitals in Cincinnati and across the state “are concerned about having an adequate number of staff to take care of the patients if the surge continues,” he said.

Through the fall of 2020 and into the winter, hospital staff worked overtime and stretched themselves to care for patients, Lofgren said. Since then, systems have lost staff members who opted out of the field or are just unable to stretch as much.

Since mid-spring, Ohio hospitals have heard from staff seeking early retirements or are burned out and can no longer work the overtime hours necessary to care for increased numbers of COVID patients on top of regular patients, Thomas added. Such staff includes nurses, as well as respiratory therapists, radiology technicians and others, he said. “It’s really across the board.

“The toll that this has weighed on people over the last 18 months is kind of incalculable in a way,” he said. “I give the folks at the front line in all of our facilities just immense amount of respect for what they’ve done and persevered through.”

The doctors don’t believe the loss of staff is related to vaccine mandates being implemented by state hospitals. In early August, the Ohio Hospital Association Board recommended that all hospitals in the Buckeye State independently adopt policies requiring COVID-19 vaccinations for employees and staff.

On Thursday, MetroHealth in the Cleveland area announced it will require all employees to be fully vaccinated by Oct. 30. Summa Health and Akron Children’s Hospital have also mandated employee vaccinations.

“I think the staffing issues that we’re seeing started long before anyone announced any vaccine requirements,” Thomas said.

Thomas, who oversees the central part of the state, said hospitals in his zone who have vaccine requirements also have exemptions in place for medical and religious issues, as well as some personally held beliefs.

“I’m not aware of anyone, at least in my organization yet, who has quit their job because of this,” Thomas said. “It’s really more we don’t have the elasticity of extra people and extra hours to expand our beds further as we hear about these numbers of increased hospitalizations.”

Shortages in health care personnel is something that existed prior to the pandemic, Lofgren added, particularly in nursing. Before the pandemic, the greater Cincinnati area had upward of 1,600 nursing positions posted.

“One of the things we’ve relied on in the past with these chronic shortages is nurses stepping up and taking extra shifts and working overtime and stretching themselves,” he said. “And I can tell you, that workforce is just tired.”

In Zone 1, which includes Region 5 covering Mahoning, Trumbull and Columbiana counties, one of the efforts made to counter the reduced staff is load balancing patients between hospitals in a respective zone so “no individual hospital gets overwhelmed,” Wyllie said.

“If one hospital is full, we will shift patients to another hospital,” he said. “We’ll transfer people up from Columbiana County up to the Akron area, and from Akron to Cleveland, from Toledo to Cleveland, from Youngstown to Cleveland or Akron.”

Load balancing is also done between zones as needed, he noted.

Thus far, no hospitals in Zone 1 are deferring cases, Wyllie said. And while occupancy in the zone is about 75% to 80%, “it’s climbing every day,” he said. “And that was the capacity before we started losing staff.”

As of Friday morning, Zone 1 had more than 900 patients hospitalized with COVID-19, 300 of whom in the ICU, he reported. During the winter, Ohio hospitals peaked at around 5,100 hospitalizations. “We are hoping this peaks out around 3,000,” he said. “But that’s only a guess.”

Using Florida as a measuring stick, he said that state is a little bit more vaccinated than Ohio. Five hospitals in Florida with 1,000 beds are all “under severe strain right now,” Wyllie said. “So we’re very attuned to what might happen,” he said.

Already some hospitals are being stretched with regard to equipment, Thomas noted. One hospital in his zone ran out of BiPAP machines, which are used to deliver oxygen to patients who are just short of being put on a ventilator, he said.

Another hospital is currently seeing some emergency department patients in its emergency preparedness tent because the ER is full of patients waiting for a bed. And just today, one regional hospital with a 19-bed ER had 11 patients waiting for an inpatient bed, he said.

Some of those patients were able to be parceled out among the 40 hospitals in the region, he said. However, the three largest health systems in Central Ohio – Mount Carmel Health System, Ohio State and OhioHealth – are all facing significant capacity challenges, Thomas said.

“We were busy with noncovid patients prior to this. Partly because people had put off care; partly because, frankly, people were showing up more acute or sicker than they have really ever in the past,” he said. “So the lengths of stay for some of those patients are longer.”

Currently in Thomas’ region, one in six ER patients have COVID-19, up from one in 24, he said. That crowding of ERs with COVID patients is “eventually going to start to impact the ability of our systems to deliver routine care and have routine clinical operations,” he said.

One of the major health systems in his region announced that four of its hospitals will not be able to do elective surgeries, including medically necessary surgeries.

“They can be delayed or postponed for a couple of weeks,” he said. “But if those surgeries require an in-patient bed, they’re postponing them. That’s a pretty major change.

The doctors reiterated that the vast majority of COVID patients in hospitals right now are unvaccinated. They are also seeing younger patients in their 20s and 30s with no pre-existing conditions related to the delta variant.

As of Aug. 27, Ohioans eligible to receive the vaccine aged 12 and up who have started their vaccination process are at 60.35%, compared to 55.74% who have completed the process.

While that’s “an outstanding and important milestone,” Vanderhoff said it’s not enough of an immunity to have the repeated variant waves under control. The 12-and-up rate is important when it comes to keeping kids in school for as long as possible, he said.

“COVID-19 vaccines remain our very best protection and our best way out of this pandemic,” Vanderhoff said.

The doctors have been working to address concerns among their patients. When it comes to younger populations, conversations include patients as well as their parents, he said. “And there’s a lot of concerns out there.”

Doctors work to ensure patients are educated on the vaccines and any risk associated with it, as well as risks of not getting vaccinated and what it means to be sick with COVID-19.

One such risk is a recent report of the possibility of developing myocarditis – or inflammation of the heart muscle – as a result of the MRNA vaccination. Thomas discussed the report with one of his staff members who hadn’t been vaccinated, “and frankly, she was just scared” and wanted to discuss the report with Thomas.

“It’s a risk of one in 50,000 patients,” he said. “It tends to be mild. Tends to go away on its own. Doesn’t cause any severe issues.”

And while one in 50,000 may appear to be a high risk, “if you realize the virus itself, the risk is closer to one in 50 or higher,” he said. “It’s a thousand-fold more risky to let yourself get the virus than it is to get the vaccine.”

Copyright 2022 The Business Journal, Youngstown, Ohio.