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Northern and Southern Indiana hospitals are struggling to handle a surge of patients amid all-time highs in COVID cases while their Central Indiana counterparts are not seeing as much of a rush as they did in the spring.
Since mid-September, when Gov. Eric Holcomb announced the state would enter the final phase of its reopening plan, the number of patients hospitalized for COVID-19 across Indiana has risen dramatically.
About a month ago, about 850 people were hospitalized. Wednesday the total reached 1,484. The last time that metric broke 1,400 was in early May, on the decline from an all-time high of just under 1,800 the previous month.
Administrators at larger health care systems, however, are not now feeling the crunch. Statewide, more than a third of intensive care unit beds are available, and under 20% are being occupied by COVID patients.
But the situation looks very different to the north and the south. Less than a quarter of the ICU beds are available in the Vanderburgh area, and more than 20% are occupied by COVID patients, who tend to be sicker and require more care. In the health district that includes St. Joseph County, almost half of the intensive care unit beds are occupied by COVID patients.
“We have more COVID positive patients than we have had here at any time,” said Dr. Dale Patterson, vice president of medical affairs at Memorial Hospital in South Bend, part of the Beacon Health System. “We’re feeling very stretched right now with our ability to do more. If the number of patients goes up, it’s going to be very difficult to find enough room for everybody.”
Dr. Dale Patterson of Memorial Hospital in South Bend. (Photo: Santiago Flores/South Bend Tribune)
To ensure that the hospital has sufficient beds, staff have had to reschedule some procedures that would require the patient to stay overnight, Patterson said. One day last week, the hospital, which is a trauma center, had to go on diversion, turning ambulances away because there were not enough beds or nurses to take additional patients.
Now the hospital is weighing how to cancel additional surgeries, with an eye to keep on doing as many procedures as possible, Patterson said.
On the other side of the state, Deaconness Hospital in Evansville also is seeing an increase in COVID cases, said Dr. Gina Huhnke, medical director for the emergency departments and director of medical affairs.
Typically the hospital runs at 80% to 85% capacity. Recently, however, it has had some occasional “red” days when capacity hits the 90s. One day last week the hospital had to borrow some ventilators from another hospital in town, she said.
And all of this has come before the typical peak in winter’s flu season, she said.
“Our volumes are even very high for what we would consider peak,” Huhnke said.
Precautions put in place as risks rise
Although flu has not started circulating in high numbers, the coronavirus has. Vanderburgh County has seen its average number of daily cases rise to more than 200 in the past week.
Earlier this week the Evansville mayor issued an executive order limiting social gatherings to 125 people. Hosts of larger gatherings must file an application with the Vanderburgh County Health Department.
In addition, the health department is limiting attendees at indoor sporting events and increasing messaging around wearing masks and social distancing, said Joe Gries, administrator of the Vanderburgh County Health Department.
“We’re trying to get the message out to protect our hospital capacity,” he said. “Right now, I think they’re able to handle where we are now, but moving forward, where things are going to possibly ramp up, we hope that that some of the things we’re doing here locally could relieve a lot of pressure on the hospitals.”
Some of the pressure comes from hospital staffers contracting the virus in the community, Huhnke said.
Deaconness also has had some staffing issues when people need to stay home either because of their own exposure or to care for a quarantined child, she said. Complicating matters further, other viruses that look like coronavirus are circulating, taking staffers off the job while they await a test result.
Every day the hospital’s surgery department staff checks to make sure they haven’t scheduled too many procedures requiring inpatient beds.
Not only do so-called elective procedures often contribute to hospitals’ bottom lines, they may be necessary for a patient’s care, as in the case of procedures such as biopsies or follow-up procedures for serious health issues, hospital administrators say.
‘A lot more prepared’
The situation has not reached this point in other parts of the state, however. Both IU Health and St. Vincent hospitals officials say that when it comes to COVID, they feel well-positioned to handle what the coming weeks could bring.
Unlike in the spring, when many states including Indiana halted elective surgeries temporarily, hospitals say they are hoping they can keep their doors open while handling any COVID surge.
Several factors play into their confidence. Many of those falling sick now are younger and less likely to be severely ill. Over time, doctors have learned more about the disease and better ways to treat it, making them less reliant on ventilators. Personal protective equipment is not in such short supply as it was last spring.
All that March planning helps now for the IU Health hospitals across the state, said Dr. Chris Weaver, IU Health senior vice president of clinical effectiveness.
“The beauty for us is we are a lot more prepared,” he said. “We know a lot more about the virus and know how to treat it, and we’re in a good spot in terms of our surge planning. … This allowed us to feel good about where we are, so we haven’t had to shut down elective surgeries.”
While all IU Health hospitals are busy, its regional hospitals can so far handle what they are seeing, Weaver said. Although if necessary they could transfer overflow patients to IU Health Methodist, so far they have not had to do that unless the patient requires therapy not available at the initial hospital.
St. Vincent Ascension is also busy, from its primary care offices to emergency rooms to hospitals, said Dr. Stephen Swinney, chief clinical officer for the health system.
For now, he said, it’s not as bad as what doctors see during a typical flu season. While there are some respiratory illnesses circulating right now, influenza numbers have remained low. Still, the COVID-19 cases have stressed some hospitals.
“The fall every year is a busy time for hospitals, so the COVID increases we are seeing are significant,” he said. “Some of our hospitals are near capacity, but we can flex capacity. We have the ability to expand up and down based on need.”
Because the system has many employees across multiple states, they can send staff from one area to another if one place is particularly hard-hit. The health care system also typically maintains a pool of nurses poised to go where needed.
So far, however, St Vincent has not recently had to move staff from one place to another, though earlier in the pandemic, a group of Indiana nurses went to help in Chicago.
Earlier preparations pay off
At this point, Swinney said, he thinks that the St. Vincent hospitals will be able to handle the increase in COVID patients that could come this winter.
“The beautiful thing about having the crisis that we did early in this pandemic was we were preparing for worst-case scenarios. We modeled out the worst-case scenarios, and we prepared,” he said. “No, I don’t think we’re going to get the worst-case scenario.”
Not that anyone is getting complacent.
Wednesday Gov. Eric Holcomb said at his daily press briefing that the state was taking steps to reduce cases in nursing homes with an eye to lowering the number of Indiana residents requiring hospital care.
Since the start of the pandemic, 3,116 people aged 70-79 have been hospitalized, more than any other age group, according to the Regenstrief Institute’s online coronavirus dashboard. People aged 60 to 69 account for 3,080 cases, and those over 80 account for 2,732 cases.
“If we can prevent infections in our nursing homes, we will protect our hospital capacity,” Holcomb said.
IU Health officials are closely monitoring volumes, with an eye to whether they might have to make some changes either in certain hardest hit areas or the system overall, Weaver said.
While the state tracks the percentage of available intensive care unit beds on its online coronavirus dashboard, Weaver said he is more concerned about having sufficient staff to care for patients in those beds.
And just in case additional space is needed, IU Health Methodist has kept up the tents it erected in the spring to expand capacity to handle a COVID surge.
Contact IndyStar reporter Shari Rudavsky at [email protected] Follow her on Facebook and on Twitter: @srudavsky.
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