COVID is in retreat, but ‘normal’ is still a long way off for Colorado hospitals

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Colorado hospitals are expected to get a relative break from COVID-19 over the next few months, but a return to any kind of pre-pandemic normal remains elusive as medical staff face burnout and patients are now more and more sick.

The omicron variant of the virus has spread so widely that the state modeling team believe that by the end of this month the vast majority of Coloradans will have some immunity because they have been vaccinated, have survived an infection, or both. It’s unclear what will happen when that immunity wanes or if new variants develop, but that should keep hospitalizations relatively low for a few months.

While a reprieve from COVID-19 is welcome, it doesn’t mean everything is back to how it was before the pandemic, said Dr. Anuj Mehta, a critical care and pulmonary physician at Denver Health.

Hospitals are dealing with a backlog of patients who have not received non-emergency care in previous flare-ups – some of whom may be much sicker than they would have been with timely treatment – ​​and they are trying to deal with it. do with fewer nurses and providers, he said.

“We need to recognize this is a problem and stop the rhetoric that the emergency is over,” he said. “This is a five-year problem, and it needs to be a five- to 10-year solution.”

With previous waves, healthcare workers had a relative lull to recharge, but that wasn’t the case this winter, said Dr. Michelle Barron, senior medical director of infection control and prevention at UCHealth. Hospitalizations had fallen somewhat from the November peak of the wave fueled by the delta variant before the omicron hit, but nearly 1,000 people with COVID-19 were still receiving care when admissions started to rise again .

At the worst of the omicron wave — the sixth wave Colorado has endured — confirmed COVID-19 hospitalizations peaked at 1,676. That’s behind only the third wave, which peaked at 1,847 hospitalizations in December 2020.

While the number of patients hospitalized with COVID-19 has declined steadily since then, hospitals remain nearly full, with around 91% of general beds and 89% of intensive care beds still occupied. The number of available beds has dwindled as hospitals close temporary peak spaces and sometimes struggle with staffing, said Cara Welch, spokeswoman for the Colorado Hospital Association.

Hospitals weren’t built or staffed to operate at around 85% capacity for long periods of time, and patients tend to fare worse when their caregivers are overstretched, Mehta said. At Denver Health, more than 90% of beds have been full since October, stressing direct care staff, he said.

“When you hold that for months straight, it has an impact,” he said.

Sicker patients, fewer caregivers

While the volume of COVID-19 patients is expected to continue to decline, a surge of people struggling with delayed care is replacing it, Mehta said. Patients who haven’t had a colonoscopy in the past two years are coming up with advanced cancers, and a few people have had complications from HIV that Mehta says he hasn’t seen in a decade, likely because their drug regimens have changed. been disturbed.

Dr. Ramnik Dhaliwal, president of the Colorado chapter of the American College of Emergency Physicians, said postponing elective procedures helps control patient volume during spikes and avoids overburdening hospitals. But now the long-term effects are becoming clear as people get sicker, he said.

“It’s a very fine line, in what you can do in the short term that doesn’t affect things in the long term,” he said.

A nurse at a Denver-area hospital, who spoke to the Denver Post on condition of anonymity due to concerns about retaliation, said she is also seeing patients with greater care needs , with fewer people to care for them. While the hospital where she works has done better than many others in financially incentivizing employees to stay, nurses continue to leave bedside positions as they deal with grief and trauma, compounded by the abuse of patients and their families.

“I don’t know how it sets,” she said.

It’s a feeling she understands. The nurse worked in intensive care before the pandemic and for most of the past two years. Before COVID-19, she used to lose one or two patients in a month. But after seeing so many deaths for months, she needed a break and moved to a unit where most patients recover quickly.

“During COVID, I’ve sometimes seen three of my patients die in one day,” she said. “It got to the point where I was just in shock.”

Even as the surge continues to ease in mid-February, two in five Colorado hospitals say they expect to be understaffed in the coming week. It is not clear to what extent the problem is caused by relatively transient factors, such as sick employees, and to what extent is the result of a long-term problem.

Dr. Darlene Tad-y, vice president of clinical affairs at the Colorado Hospital Association, estimated that hospitals in Colorado and nationwide have lost about 20% to 30% of their frontline staff since the pandemic began, either because they went to work for employment agencies or left the industry. A small number left vaccination warrants, but state data shows about 98.9% of Colorado hospital workers have been vaccinated or given an exemption.

It will take “months to years” to replace these people with new graduates, so retaining workers that hospitals already have will be doubly important in the near future, she said.

“The problem is that the pipeline is pretty sparse,” she said.

Mehta expressed concern for the coming months as his colleagues begin to process the trauma they have suffered over the past two years. Some people who stayed because they didn’t want to leave their co-workers during a crisis may decide it’s time to move on, especially if they aren’t getting the support they need to cope. exhaustion and guilt during times when they couldn’t. it helps, he says.

“I think people reached the point of exhaustion months ago and kept doing their jobs,” he said.

Preparing for future scale-ups

Now that it looks like hospitals will get a reprieve from the virus for at least a few months, it’s time to start talking about what they’ve learned over the past two waves, UCHealth’s Barron said. One of the biggest questions will be how to recruit staff for future surges, because unlike masks and gloves, trained people cannot be stored until needed.

Hospitals use modeling to help predict the severity of an influenza season, so they can plan accordingly. In the future, they’ll probably have something like this for COVID-19, Barron said. They will have to prepare for more severe, more contagious variants and the possibility of a variant that vaccines and previous infections cannot stop, she said.

“We will continue to evolve,” she said.

Going forward, Colorado will need an “agile” response to increase resources during surges and reduce them when the situation improves, said Scott Bookman, the state’s COVID-19 incident commander. The Colorado Department of Public Health and Environment, health systems and others are still figuring out exactly how this will work, but it’s likely the state will back off as providers will be able to support the tests and vaccinations, he said.

“I’m confident we’ll be ready,” he said.

The level of difficulty maintaining hospital staff was higher in this wave, although other sectors had the same problem because so many people were infected, Bookman said. But the state-run health care staffing center and hospital transfer coordination center have helped, as have state efforts to make testing widely available, he said. .

“We went into winter prepared for this,” he said.

While the omicron variant was different from previous versions of the virus — hospitalizations rose faster, but also fell faster — facilities essentially used the same manual to open surge beds and recruit staff, said Tad-y. It is likely they will be able to do the same with future waves, although the number of beds and workers needed will depend on the situation, she said.

While there’s “no doubt” healthcare workers will step in if there’s another flare-up, they need support to keep going, Tad-y said. Two years of the pandemic have left many people feeling “beaten”, and when the public vents their frustration on their nurses, it makes the situation worse, she said.

“I’m very worried about this,” she said.

“Never go back to before”

Even if COVID-19 does not produce strong surges in the future, the problems facing the healthcare system do not disappear overnight.

Dhaliwal, chairman of the group of emergency physicians, said one of the first steps to solving the problem is to determine exactly the gap between manpower needs and the number of people trained and available. Once the state has a response, it can work with universities, hospitals and others to create incentives for Coloradans to enter the health care field and stay in the state, he said. he declares.

“None of this is a short-term fix,” he said.

The public can help by trying to avoid contracting the virus, as a relatively small increase in the number of patients can tip hospitals from busy to overwhelmed, said Mehta, the Denver Health physician. They can also help by reconnecting with their primary care providers to catch up on routine care; use emergency rooms if they think their condition is life-threatening, but not for less urgent problems; and supporting healthcare workers in their lives, he said.

“Everyone is going back to their normal life and we are still fighting a war,” he said.

Barron also used the metaphor of surviving a war to describe the effect on frontline caregivers. While some people will be inspired to enter the field of infectious diseases – as she was when HIV burst onto the world stage – others will struggle to cope with their inability to save their patients. They will need support from their hospitals and the public, and recognition that “normal” is a thing of the past, she said.

“We will never go back to before,” she said. “We are changed.”

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