When Goshen Hospital runs out of inpatient beds, Chief Medical Officer Dr. Dan Nafziger said, doctors there have traditionally been able to find a place for their sickest patients locally, across state lines or even in Indianapolis.
But in recent weeks, the infectious disease specialist said, things have changed for the worse.
“On Monday, we sent somebody (more than 200 miles away) to Seymour, Indiana,” Nafziger said. “We called around to neighboring states and couldn’t find a bed.”
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Last week, the Indiana State Department of Health reported 2,865 patients were being hospitalized for COVID-19 — the greatest number since last January — and IU Health, the state’s largest health system, requested support in many of its hospitals from the Indiana National Guard.
Even before the state reached new records last week, health officials in northern Indiana’s District 2 Hospital Preparedness Planning Committee put out a stark warning: “Nearly every hospital in our region has reached capacity or is exceeding capacity. … Our already busy emergency departments are now overwhelmed.”
For smaller hospitals like Goshen, that means more overtime for staff, a delay for elected procedures and longer wait times for those urgently in need of care.
As COVID cases rise across the state, northern Indiana appears to be leading the latest surge, said Micah Pollak, an Indiana University Northwest economist who has tracked coronavirus data throughout the pandemic.
On Wednesday, more than a dozen northern Indiana counties moved into the state’s highest advisory level for community spread and hospitalizations in District 2, which includes St. Joseph and Elkhart counties, jumped to their highest level in more than a year.
On Dec. 4, the State Department of Health reported only 10.3% of intensive care unit beds were open across the region, setting a new record for the pandemic.
“(Your region is) leading the wave for the rest of the state,” Pollak said. “You guys are facing the worst of the wave right now.”
And, it’s not just that hospitalization rates are rising, health experts say. A combination of new variants, continually low vaccination rates and, most critically, staffing shortages, are putting a strain on local hospitals unlike anything seen in prior waves of the pandemic.
“We are busting at the seams,” said Dr. Loren Hamel, president of Spectrum Health Lakeland, just across the Indiana-Michigan border. “Waits in the emergency department have never been longer and there’s no end in sight.”
‘Over 100% for weeks’
Northern Indiana’s hospitalization rates have increased dramatically over a short period of time, jumping from an average of 139 patients hospitalized for COVID-19 throughout the month of October to 339 on Thursday of last week.
“You may have thought things would get back to normal. They haven’t,” a coalition of District 2 health professionals wrote in a letter distributed last week. “You may have thought the worst was over. It isn’t. We implore the community, now is the time to stop the dangerous path we are on.”
Beacon Health System’s own data shows its hospitals have continued to set and surpass records this month for the number of COVID-positive patients it has treated systemwide.
Elkhart General reported a pandemic record of 71 coronavirus hospitalizations twice last week, while Memorial Hospital posted its highest intake of the pandemic on Thursday with 85 patients.
Saint Joseph Health System recorded 88 COVID-19 hospitalizations last week, the system’s highest count in about a year.
“Our Plymouth hospital earlier this week hit a new record high for admitted COVID patients,” Dr. Genevieve Lankowicz, chief medical officer at Saint Joseph Health System, said Friday.
And, Goshen Hospital on Tuesday reported it is currently treating 47 COVID-19 patients, with its admitted number spiking over 50 twice in recent days.
Those figures account only for patients who have been hospitalized because of COVID-19, which has consistently made up about half of the region’s total intensive care unit hospitalizations, according to Indiana State Department of Health data.
“Today, we’re well over capacity, about 115% of our normal capacity,” Dr. Dale Patterson, Memorial Hospital’s vice president of medical affairs, said on Wednesday. “It’s been over 100% for weeks.”
Pollak, the IU Northwest economist, created a map pinpointing ICU and in-patient bed use across the state.
This information can be useful to help contextualize hospital capacities, Pollak said, but the economist also acknowledged the data fails to take into account other challenges facing the health industry.
While hospitals were able to expand capacity early in the pandemic by placing new beds in unused wings, parking lots, ambulance bays and even hallways, that’s become less of an option this winter as hospitals struggle to find staff to care for patients.
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And, diversion to other health systems has become nearly impossible as nearby hospitals also fill up.
“We’re nearing the number of patients that we had back in the November surge and we don’t have the number of people to take care of them,” Patterson said. “This is potentially the worst time for hospitals throughout the pandemic.”
Industrywide, health care systems have grappled with staff shortages as burnt out hospital workers leave the profession.
Competitive wages offered for travel nursing initially challenged local health systems, Patterson said, but now even those positions are in short supply.
Nafziger of Goshen said those left working in hospitals have been subjected to verbal and physical threats, and patients demanding unproven treatments they may have read about online.
“I’ve been in medicine a reasonably long time now,” Nafziger said. “It wasn’t a routine thing before where I had to deal with people breaking down emotionally because of their workload and the pressures they face. It’s awful.”
Michigan leads in hospitalizations
One reason northern Indiana could be emerging as an Indiana hot spot, Pollak said, is its proximity to Michigan.
The Washington Post reported on Wednesday that four states, including Michigan and Indiana, are responsible for nearly half of the country’s total COVID-19 hospitalizations.
In a Spectrum Health Lakeland briefing Wednesday, health officials said Michigan’s hospitals are “as full as we possibly can be.”
“About a month ago, we had just seen a plateau of cases … but over the past week, we’ve seen a rise of about 50%,” Berrien County Medical Director Rex Cabaltica said. “Our positivity rate has never been as high as it is now. It’s over 25% … a quarter of the tests that are being done now are positive.”
Hospitalization rates tend to lag behind positivity rates, Pollak said, meaning as the number of confirmed cases rise daily, the demand for hospital beds will follow.
Each wave of the pandemic has lasted about 10 weeks on either end of its peak, Pollak said. He believes Indiana is just over halfway to the peak of its current surge. However, with much still unknown about the new omicron variant, this year’s pattern could stray from last winter.
Early research on omicron shows the variant could be far more contagious, but less dangerous, than previous strains of the virus. With omicron cases expected to peak in January, Pollak said, the wave currently stressing hospitals could continue longer.
Health professionals are also planning for new influenza infections this year that largely weren’t felt last winter because of school closures, mask mandates and stricter capacity limits in local restaurants and businesses.
How hospitals are responding
Fewer open beds and less staff means services in hospitals have once again become pinched.
While some outpatient procedures may continue, those in need of critical emergency room care can expect to see longer wait times and many planned surgeries could be delayed.
“If someone needs to be admitted to the hospital because of their surgery — this impacts people with cancers, that need heart surgeries and things where after your surgery you need an inpatient stay to recover — we haven’t been able to get those people in,” Patterson said.
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The Memorial Hospital vice president said hospitals have pushed some procedures out days or even a week, but his staff’s backlog continues to grow.
“We’ll have to catch up later when this finally does ease up,” Patterson said, adding “How quick will we be able to do that as we’re recovering as a hospital and as a medical community?”
The doctor said teams in the Beacon Health System are working to educate the public on when and where the best place is to seek treatment to help ease the demand on emergency departments.
If patients can seek treatment at an urgent care clinic or a family physician for something like mild cold symptoms or ear pain, they should pursue that route first. Other symptoms like chest pain still merit an immediate trip to the ER.
It’s those gray areas in between that can create confusion for people without medical backgrounds, Patterson said.
“What we would recommend for those people is to get in touch with their provider, if they have a family doctor, if they have someone they see,” Patterson said. “Or, do a telehealth visit.”
Doctors say that as the pandemic progresses, they are gaining a better understanding of the virus, which also can help free up hospital beds.
Hospital workers, compared to a year ago, can now get vaccinated and boosted, drastically reducing their own risk of contracting the virus while working with COVID-positive patients.
And, monoclonal antibody treatments are now available to patients with high-risk factors. Lankowicz said the treatments, best suited for those not yet sick enough to require hospitalization, have an “exceedingly high” rate of success keeping people out of inpatient care.
Saint Joseph Health System has administered up to 36 doses a day of the antibody treatments and is now looking to partner with local homecare agencies to bring injections directly to patients. New oral antiviral treatments, pending FDA approval, could also soon be on the way.
What can you do?
Doctors say the patients they’ve treated for COVID-19 have remained consistent throughout the pandemic. Most are unvaccinated.
Though Memorial Hospital has seen some breakthrough cases, about 80% of those hospitalized for COVID-19 have been unvaccinated.
Of the more than 3.4 million Hoosiers who have been fully vaccinated, 2.4% have developed a breakthrough case of COVID-19, 0.049% have been hospitalized and 0.026% have died, according to ISDH data.
“We are starting to see more infections in people who’ve been immunized a long time ago,” Patterson said. “But, if you get that booster dose, it’s right back to where you were when you got the first two, where you’re decreasing your chances of getting infected and it’s highly unlikely that you’re going to end up in the hospital.”
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Still, vaccination rates across northern Indiana remain low.
St. Joseph and Elkhart counties’ vaccinations rates, as of Friday, sit at 57.5% and 43.9%, respectively, compared to the national average of 60.5% and the state’s total of 53.7%, according the CDC and state health department. LaGrange County, just to the east, shows Indiana’s lowest vaccination rate of 23.2%.
“There are a lot of people that have done the right thing and got vaccinated,” said Nafziger of Goshen Health. “But, it’s hard to be surprised by our increase in cases and hospitalizations and deaths from what I see going on outside of the hospital.”
Unlike last year, there doesn’t appear to be any political will among state or local leaders to reimpose the type of restrictions cities and schools saw during last winter’s surge. So, doctors say they are relying on individuals to take personal responsibility for their own health and that of others around them.
Health experts say you don’t necessarily need to cancel holiday plans this year, but the messaging of practicing frequent hand hygiene, masking indoors and avoiding large gatherings remains the same.
“Everybody has to assess their own risk and their own willingness to potentially be exposed,” Patterson said. “It’s very reasonable for people to get together with their family for the holidays this year with certain expectations.”
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Patterson said families should consider who they plan to spend time with and how large of a gathering they plan to attend. Will everyone be vaccinated? Will anyone with underlying health conditions be attending? Hosts might consider asking guests to be vaccinated, wear a mask or take a test before attending holiday gatherings. And, if you feel sick, Patterson said, stay home. It’s worth noting, though, that COVID is contagious for days before the infected person feels sick.
If you haven’t been vaccinated yet, or received a booster, doctors say now is the time. Health experts recommend anyone who became fully vaccinated six months ago or longer get a booster. Vaccine appointments can be scheduled online at ourshot.in.gov.
“We’re doing all we can here at the hospital to keep up with the demand,” Lankowicz said. “We need people to get boostered.”