Tuesday, January 18, 2022

Incidental cases, staff shortages make COVID tougher for hospitals

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The Cleveland Clinic in Weston, Florida, treated 80 COVID-19 patients on Jan. 11, a tenfold increase since the end of December. Almost half were hospitalized for other medical reasons.

The rise, due to the highly contagious variant of Omicron, helped lift South Florida Hospital to 250 patients with 206 licensed beds. The increase in cases occurred when nurses and other caregivers were struggling with COVID while the hospital was struggling with a serious shortage of staff.

According to Dr. Scott Ross, Chief Medical Officer, the challenge is to find a place to safely treat all patients with COVID and to ensure the safety of staff and remaining patients.

“It’s not a problem of personal protective equipment,” he told personal protective equipment such as masks, “neither an oxygen problem nor a fan problem. It’s a huge problem and making sure we have enough beds and caregivers for patients.”

Omicron wave:As COVID-19 is on the rise, there are no hospital beds for those in need of care

Nationwide, COVID incidence and hospitalization are at their highest level since the pandemic began. However, unlike previous COVID elevations, the vast majority of patients with COVID are coming to the hospital for other reasons. Infections exacerbate some medical conditions and make it difficult to reduce the spread of COVID within hospital walls, especially when patients appear in the early, infectious stages of the disease.

While the omicron variant typically results in milder cases, adding a large number of these “accidental” hospitalizations to COVID patients could be a turning point for the health care system as the fight against the pandemic continues. An increase in COVID in the community will also lead to an increase in rates among hospital staff, which will make them call in record numbers of patients and further strengthen the overcrowded system.

Officials and staff at 13 hospital systems across the country say caring for infected patients who need other medical services is difficult and sometimes requires different protocols.

Dr. Robert Jansen, chief physician at Grady Health System in Atlanta, said the level of infection in his team was unprecedented. Grady Memorial Hospital contracted 18 people with COVID on December 1, up from 259 last week.

About 80 to 90 percent of these patients have COVID or health as their primary diagnosis, such as sickle cell disease or heart failure – which is exacerbated by COVID, Jansen said.

Although fewer of their patients are diagnosed with COVID-induced pneumonia than at large rates at the beginning of last year, Grady executives are battling COVID with a large number of medical staff. At one point last week, Jansen said, 100 nurses and about 50 other staff were outside.

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In the Atlantic Health System, one of the largest hospital systems in New Jersey, half of all COVID patients come for other reasons, not all of those with accidental COVID can be transferred to COVID wards, said CEO Brian Gragnolati. . They need special services for their other conditions, so hospital staff take special precautions such as wearing high-level personal protective equipment when treating patients with COVID in areas such as the heart.

At Jackson Memorial Hospital in Miami, half of all COVID patients are primarily patients who have been admitted for COVID for other health reasons – whether they have symptoms or not – in a section of the hospital reserved for COVID patients. will be treated, said Dr. Xeni. Atallah, chief physician.

Whether patients with COVID or hospitalized, patients are still taxed on the hospital’s ability to function, said Dr. Alex Garza, of the St. Louis Metropolitan Pandemic Working Group, which works with the region’s largest health systems. event commander. He said 80 to 90 percent of patients in hospitals in the region are there because of COVID.

The Cleveland Clinic in Weston, Florida, is also having a hard time sending patients with COVID to nursing homes or rehabilitation facilities because many places are unable to treat more COVID patients, Ross said. The hospital is also having a hard time sending patients home because it could put residents at risk.

All of this means that hospitals are urging people to stay away from emergency care, said Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston.

According to Faust, the majority of patients who are unaware of the presence of COVID during this ascent are frightened. According to Faust, when hospitals come across more accidental cases, they pose a greater risk to staff and other hospital patients because they are usually in the infectious phase of the disease – before symptoms begin. In previous COVID waves, people were hospitalized in the middle and later stages of the disease.

In an analysis of Faust’s federal data, it showed the second highest number of “hospital-initiated” COVID cases since the January 7 pandemic began, which lags behind October 2020. According to Faust, these data only apply to people who have been in the hospital for 14 days before being tested positive for COVID, so this is considered low.

The KHN research series identified many gaps in government oversight in prosecuting high rates of undiagnosed COVID patients at the time of hospitalization, including the fact that federal reporting systems do not publicly record COVID in individual hospitals.

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“People in the hospital are vulnerable for many reasons,” said Dr. Manoj Jane, an infectious disease specialist in Memphis, Tennessee. “All of their existing underlying diseases have many medical conditions – all of which put them at greater risk.”

According to Garza, emergency medical care in particular is a potentially dangerous zone in many cases. He advised patients to wear a high-quality mask such as a KN95 or N95 respirator. According to The Washington Post, the Centers for Disease Control and Prevention is considering whether to recommend all Americans update their masks during the omicron rise.

“It’s physics and math,” Garza said. “If you have a lot of people gathered in an area and have a high viral load, you’re much more likely to get something like this if you don’t use proper protection.”

If patients do not tolerate N95 for a day, Faust urges them to wear an updated mask when communicating with hospital staff, visitors, or other patients.

Dr. Dallas Holladei, an emergency physician at the Samaria Health Services System in Oregon, said more patients are being combined in hospital rooms due to a shortage of nurses. This increases their risk of infection.

Dr. Abraar Karan, an infectious disease specialist at Stanford, believes that given the increased risk of exposure to COVID, all healthcare professionals should have an obligation to wear N95 to communicate with every patient, not just surgical masks. .

But because there are no high-quality mask mandates for staff, he advised patients to ask their providers to wear N95.

“Why do we have to oblige patients to protect themselves from medical staff, but medical staff don’t even want to do that?” He asked. “It’s too far behind.”

Some hospital staff are unaware that they will become ill and suffer from infectious diseases. And even if they knew, in some states, including Rhode Island and California, asymptomatic health workers could be reinstated due to staff shortages.

Faust wants to increase testing skills for medical staff and other staff.

Regular testing at Stanford will be encouraged, Karan said, and the tests are ready for staff. But there is an exception to this rule: Jane points out that some hospitals have resisted routine testing of staff – both for laboratory resources and for possible results.

“Hospitals don’t want to know,” he said. “We just don’t have staff.”

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