Story Produced by New Hampshire Bulletin
Catholic Medical Center in Manchester aims to discharge its long-term care patients to a nursing home within five days. Today, it can take more than 14 weeks because an unprecedented surge in COVID-19 patients and too few health care workers have left the state with dangerously few treatment beds.
Tying up a single in-patient bed for weeks triggers a domino effect of crises that puts all patients, not just those with the coronavirus, at risk, hospital leaders warned.
The emergency room backs up, forcing people to wait hours for an admission. That wait is exacerbated by COVID-19 patients, who often need a two-bed room to themselves, meaning one fewer bed for someone else.
When there are no beds left, hospitals are transferring patients who need acute care, including stroke and heart attack victims, to other hospitals – in and out of state. And some hospitals are limiting or postponing elective but still-serious procedures that require an in-patient stay, such as hip and knee replacements.
Meanwhile, health care staff are dealing with two additional challenges.
Non-COVID-19 patients who put off care for illnesses during the pandemic are showing up at hospitals in large numbers and much sicker than they would be had they gotten care.
And triaging an overrun emergency room is one more challenge for an already-strapped health care team trying to monitor the 20 to 30 mental health patients waiting days or weeks for their own treatment bed.
“Our strategy is that we try not to look at the bigger picture, and we literally take things day by day,” said Jennifer Torosian, associate chief nursing officer at Catholic Medical Center, where there was a single ICU bed open Dec. 3 and 31 COVID-19 patients. (Many days there are no free ICU beds, she said.) “Our goal from a nursing leadership perspective and an in-patient care perspective is to get us through the holidays safely.”
Hospital and state health leaders have been sounding the alarm about diminishing bed capacity for weeks and begging people to get vaccinated, receive a booster, and continue masking and social distancing.
“The picture is getting pretty dark, and it’s getting more challenging,” said Steve Ahnen, president and CEO of the New Hampshire Hospital Association, which holds daily calls with hospital leaders to triage capacity shortages. “We want people to understand that the moment we are in is one not like anything we’ve seen before.”
State officials are seeking permission to use nearly $90 million of federal aid to free up hospital space. Initiatives include recruiting staff and offering financial incentives to open more beds in long-term care facilities and rehabilitation centers, allowing hospitals to transfer non-acute patients. Health and Human Services Commissioner Lori Shibinette’s request was approved Thursday by the Joint Legislative Fiscal Committee and goes before the Executive Council Wednesday.
Ahnen said those state and federal initiatives will help but are not enough.
“We need (the community’s) help,” he said. “Get vaccinated. Get tested. Mask. Distance. Those things are absolutely essential if we are going to turn this around.”
Elliot Hospital spokeswoman Kelly Scargill said Friday they have responded to increased demand on hospital services by activating their surge plan to create additional bed space in nontraditional areas to care for ICU and non-critical patients. Its 54 COVID-19 patients represented 20 percent of its admissions, she said.
Southern New Hampshire Medical Center had 22 COVID-19 patients on Dec. 3, she said, and was dealing with an “extreme demand” on clinical staff. The 186-bed Concord Hospital counted 52 COVID-19 patients Friday, and spokesman Matthew Johnson said they were near “critical capacity.”
The situation is bleak across the state.
Earlier this week, Shibinette said just 9 percent of the state’s hospital beds were available but cautioned the true availability is less because that count includes beds restricted to maternity and pediatric patients.
There are even fewer ICU beds available, according to the state’s COVID-19 dashboard, which put that capacity at 3.7 percent Friday. It’s a record low since the start of the pandemic. COVID-19 hospitalizations have also reached record levels, with over 400 hospitalized earlier this week, and 395 Friday. An additional 18 patients were suspected to have the coronavirus.
The prior record came in January, just as the vaccine became available, when COVID-19 hospitalizations hit 334.
Local and state health care leaders have said 60 percent to 70 percent of those patients are unvaccinated, but that the unvaccinated account for nearly all COVID-19 ICU patients.
“Capacity is tight and it’s getting tighter,” Ahnen said. “And the reality is it’s going to be more challenging over the next four weeks. They are going to be the most challenging of the pandemic.”
The strain on capacity is even more dire in some parts of the state. Health and Human Services does not report bed availability by hospital on its dashboard, but it does show regional rates.
Among the six hospitals in the Upper Valley and southwest part of the state, just 1.4 percent of ICU beds and 4.4 percent of regular beds were open Friday. Sixty-seven of their patients were hospitalized for COVID-19, according to state data.
Exeter Hospital, where all regular, ICU, and emergency room beds were taken Friday, has begun limiting and postponing elective procedures to preserve bed space. Seventeen of the hospital’s 100 beds were occupied by COVID-19 patients, said spokeswoman Debra Vasapolli.
“We are at a critical stage for our hospital. Right now, we do not see an end in sight,” she said. “We are doing the best we can, but our staff, they are tired. They’ve been working long shifts, caring for our community. What I really want to stress is that we need people to get the vaccine and, if they are eligible, to get the booster. This is very real.”
The arrival of boosters has made tracking the state’s vaccination progress, which began lagging this summer, difficult. Because not all pharmacies are reporting their immunization data to the state, some booster doses are being counted in the rate of first and second vaccine doses. Health and Human Services spokesman Jake Leon said the department saw vaccinations begin to pick up in the fall.
If interest in the state’s Dec. 11 Booster Blitz this week is any indication, those booster numbers could be high. In one day, 10,000 booster appointments had been claimed. Just three sites still have appointments – Berlin, North Conway, and Haverhill – available at vaccines.nh.gov. Boosters and vaccine appointments at pharmacies and other sites can also be made at that website.
The state’s mobile vaccine van, which offers vaccines for all age groups and boosters without an appointment, has also seen significantly more interest in recent days. Health and Human Services announced Friday that a Nashua stop would not be taking walk-ins because all appointment slots had been taken.
Story republished with permission under New Hampshire Bulletin’s Creative Commons licensing.