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Triangle hospitals brace for holiday COVID-19 surge before the vaccines arrive

The (Raleigh) News & Observer logo The (Raleigh) News & Observer 12/2/2020 Richard Stradling, The News & Observer (Raleigh, N.C.)

RALEIGH

As the number of people sickened by coronavirus across North Carolina continues to rise, hospitals in the Triangle are treating as many COVID-19 patients now as they did during last summer’s peak.

And they expect those numbers will continue to grow as people infected while traveling and gathering over Thanksgiving become ill. It can take one to two weeks before someone’s COVID-19 symptoms become serious enough to require hospitalization, said Dr. Cameron Wolfe, an infectious disease specialist at Duke University School of Medicine.

“We would expect next week to start seeing the hospitalization impact as a result of Thanksgiving, and even the week after that,” Wolfe said. “I think there’s some rough times ahead, to be honest.”

The number of people hospitalized with COVID-19 was already climbing before the Thanksgiving holiday. Even allowing for a 10% bump in early November, after the U.S. Centers for Disease Control and Prevention changed the criteria for counting COVID-19 hospitalizations, the daily number of people hospitalized has doubled in North Carolina since early October, to 2,039 on Wednesday.

“Our trends are worrisome,” Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services, said during a press conference Tuesday. “Too many people are becoming seriously ill with COVID.”

Cohen said the state expects to receive the first shipments of a vaccine against COVID-19 developed by Pfizer by the middle of the month. She said hospital workers who treat COVID-19 patients and those who clean areas where those patients are treated will be given top priority.

But supplies are likely to remain limited, Cohen said, and it will take several months before North Carolina has enough vaccine to make it widely available. That will be too late to head off spikes in cases caused by the holidays and winter weather that keeps people indoors where the virus spreads more easily.

Dr. Chris DeRienzo, the chief medical officer at WakeMed, said he is encouraged that vaccines are on the way, but says people need to remain vigilant against spreading the virus in the weeks and months ahead. WakeMed hospitals are treating 10% to 15% fewer COVID-19 patients now than they were at the peak in July, DeRienzo said, but they expect those numbers to go up.

“We certainly are bracing for an impact of Thanksgiving,” DeRienzo said. “We are hoping for the best, and we are preparing for a very challenging winter.”

Supply of hospital beds not the first worry

The state Department of Health and Human Services tracks the availability of hospital beds across North Carolina as a benchmark of the state’s ability to respond to the pandemic.

But hospital leaders in the Triangle say a bigger challenge is having enough doctors, nurses and other health care workers on hand to treat patients. The region’s big three hospital systems — Duke, UNC and WakeMed — all have workers out because they’ve contracted the virus or been exposed to it.

“We are seeing our employees get sick,” said Wolfe at Duke. “It’s not typically that they’re getting sick from work. It’s mainly because they do what the rest of us do. They go to the supermarket, and they have to be out.”

More than 50 health care workers at UNC Rex are out because they’ve tested positive for coronavirus, said Dr. Linda Butler, the chief medical officer. To help fill the gaps, Rex has taken the unusual step of hiring 25 traveling nurses, Butler said.

“This is the first time in many years we actually have traveling nurses in the hospital,” she said. “We are in an area that is usually very resource rich in the way of manpower.”

Doctors are harder to replace on short notice, Butler said, and usually have to pick up shifts for colleagues who are out sick or on quarantine. She said UNC has already hired doctors for a new hospital in Holly Springs that isn’t scheduled to open until next fall so they could help at Rex and other hospitals during the pandemic.

The 11 hospitals in the UNC Health system have more than 250 COVID-19 patients, including more than 50 at Rex, Butler said. Rex had 18 ICU beds set aside for COVID-19 patients and another 28 beds for less seriously ill ones. As the numbers grow, the hospital has begun cordoning off beds on another floor for people with COVID-19, she said.

“If we continue to have spread over Thanksgiving and over Christmas, then we may become bed challenged,” Butler said. “Right now it’s more the workforce that will be limiting than beds.”

No procedures postponed yet

Last spring, hospital leaders in North Carolina looked to New York and Italy and saw how their counterparts were overwhelmed with COVID-19 patients. Triangle hospitals and clinics postponed hundreds of non-emergency surgeries and other procedures to conserve staff, beds and supplies for the surge they feared was coming.

They hope to avoid that this winter but can’t rule it out yet. Duke Health has about 100 COVID-19 patients across its three Triangle hospitals, Wolfe said, and the beds and resources used to treat them are not available for other kinds of patients.

“We’re not canceling surgeries yet, but that’s always in the backs of people’s mind, that if we get any more full what has to give,” he said.

One challenge, Butler said, is that COVID-19 patients tend to stay longer and require more resources than most. The average patient at Rex stays for four days, she said; but the average COVID-19 stay is a little more than eight days, and 15 COVID-19 patients have remained at Rex more than 40 days.

“That ties up a bed,” she said.

But hospital leaders say they’re much better equipped to handle COVID-19 patients now than they were last spring. They have better treatments that keep patients from needing to be placed on mechanical respirators, and they know how to manage patients and staff to minimize the risk of the infection spreading.

“We’ve been practicing now for nine months,” Wolfe said. “So handling 10 patients now is easier than handling 10 patients was then.”

And Triangle hospitals say they have enough supplies, including the personal protective equipment that was in such short supply last spring. The demand hasn’t fallen off, so keeping everything stocked is hard work, they say. And expensive.

WakeMed’s DeRienzo said the prices for items such as masks, gowns and gloves are as much as 10 times higher than they were before the pandemic.

“That’s an unfortunate realty of the supply chain right now,” he said.

Coronavirus hospitalizations are rising at a time of year when hospitals in the Triangle normally begin to see a sharp increase in the number of flu patients.

But doctors say the steps people are taking to prevent the spread of coronavirus — washing hands frequently, wearing masks and keeping apart from each other — should help reduce the spread of flu.

That’s what appears to have happened in the Southern Hemisphere this summer, where June through August is typically the height of flu season. This year, very few people got sick with the flu, according to the Centers for Disease Control and Prevention. Of 60,031 specimens tested in Australia, for example, only 33 were positive for influenza, according to World Health Organization data cited by the CDC.

Triangle doctors hope that while we wait for a vaccine, the precautions people take to ward off COVID-19 will keep hospitals from seeing many flu patients.

“Obviously we haven’t yet done a perfect job on COVID,” Wolfe said, “so it remains to be seen how we do on the flu.”

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©2020 The News & Observer (Raleigh, N.C.)

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