Hospitals keep up with COVID cases, but staff feel strain

  • Hospitalizations with coronavirus patients have increased in the last month and while facilities are keeping up with the load, staff are feeling the stress of spending hours cloaked in personal protective equipment and providing additional bedside care for patients who can’t have visitors. (Photo/Mark Thiessen/AP)

Alaska’s health care providers are following the number of new of coronavirus infections with trepidation as it trends upward while they try to manage the cases and urge people to take precautions.

As the summer draws to a close, Alaska is watching its hospitalizations for coronavirus infections steadily tick up. As of Aug. 25, there were 40 coronavirus-positive hospitalizations in the state, with six others under investigation. That’s the most it has been since the pandemic began in March, and since June, hospitalizations have been regularly reaching new highs.

Hospital capacity remains adequate for now, with just more than half of the inpatient beds in the state occupied as of Aug. 25, according to the Alaska Department of Health and Social Services. Since the very beginning, officials have been taking on mitigation measures to try to keep hospitals and health care systems from being overwhelmed by COVID-19-positive patients.

But as time goes on, hospitalizations have increased even as the overall infection curve seems to flatten and the state is heading into flu season and the start of school, when normal hospital occupancy goes up and staff becomes busier.

That’s something health care executives are keeping a very close eye on, said Jared Kosin, the president and CEO of the Alaska State Hospital and Nursing Home Association. As long as Alaska can continue to ride the wave, hospitals should be able to handle it.

“Our single biggest concern is if hospitalizations keep growing and hospitals stay this busy, and we have this influx of COVID patients that we’ve never seen before,” he said.

At the beginning of the pandemic, there was significant concern about hospitals’ capacity for high-acuity patients with COVID-19 who required intense care and ventilators within an intensive care unit. Increasingly, COVID-19-positive patients in Alaska are not having to go to the ICU. Of the 40 who were reported hospitalized with the virus, only 25 percent were in the ICU, Kosin said.

Hospitals decide on staffing partially based on their daily count of patients. They have some flexibility based on the level of care patients need, with some constraints; for example, ICU nurses typically have additional training. Patients hospitalized with COVID-19 who need ICU care may also require the services of a respiratory therapist, which places additional needs on hospital staffing.

Keeping staffing levels up has long been an issue for hospitals, between employees taking leave, schedule coordination, sudden outbreaks of disease, and now the need to quarantine staff who may have been exposed to the coronavirus.

Kosin said hospitals are constantly working on their emergency response plans for massive demands on their services, such as in the case of a plane crash or natural disaster. So far, they’ve been able to absorb the additional needs into their operations without having to activate surge plans.

There are definitely strains on staff, though. Donna Phillips, the labor council chair with the Alaska Nurses Association, said wearing the PPE all day every day is uncomfortable, in part because of temperature. Hospital facilities for staff, like break rooms, may not be set up for social distancing, either, and moving patients around from area to area with all the equipment and protective gear requirements are additional time burdens for nurses who were busy to begin with.

“Those kinds of things I think are super challenging,” she said. “It’s very different, the heat that is generated by wearing a mask all day is kind of difficult. I’m fascinated by how hot you are.”

There’s also been the additional burden of bedside care for patients who can’t have visitors, either. Phillips said that’s something nurses will make time for, as they want to provide good bedside care, but it’s not necessarily something they get extra time for.

“It is more work for the bedside caregiver … to keep everybody around them safe, and without having visitors in the hospital, you’re the only one who can calm that patient down and (still) have one, two, three, four, however many patients you have, so the only person that’s with (the patients) are the people working in the hospital,” she said. “Now that falls to the nurse, the social worker, the case manager, whoever else has time to hold that iPad so they can have a 10-minute conversation with their family once a day.”

So far, there has not been a critical shortage of staff, but there may be some burnout among nurses, she said, especially as hospital census counts have gone back up with other patients beyond coronavirus patients.

If infections and hospitalizations increase again enough to reverse some of the state’s reopening, it could have serious financial consequences for hospitals. This spring, as a preventive measure to conserve beds for the pandemic, hospitals cancelled all elective surgeries and other procedures.

Unlike emergency services and some other acute services, elective surgeries are major moneymakers for hospitals, and cancelling them for several months meant a major financial hit, particularly for smaller and rural hospitals that operate on thinner margins. Health care providers, including hospitals, did receive some pandemic relief money, but Kosin said the uncertainty looming around infections and hospitalizations is concerning.

Kosin said ASHNHA and other health care agencies are encouraging the public to take precautionary measures like washing hands, wearing masks and social distancing expressly with the intent of keeping hospitalizations down to a manageable level, especially as flu season approaches.

“The fate of this is really in every individual’s hands,” he said.

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Elizabeth Earl can be reached at [email protected].

Updated: 
08/26/2020 - 9:25am