ELKHART — Leading doctors in Elkhart County are concerned about the high number of hospitalized COVID-19 patients and what the influx means for the ability to treat other patients whose procedures are being postponed.
“It’s really a nightmare situation for health care workers to not have the resources that we are used to having to take care of the patients in our community that need care,” said Dr. Daniel Nafziger, Goshen Hospital Chief Medical officer and infectious disease expert.
Goshen Hospital has had about 25 COVID-19 inpatients most days in September, which has a normal capacity of about 100 total inpatients. At Elkhart General Hospital, the number of COVID-19 inpatients has doubled this month and is now in the 40s.
That’s despite the current surge and the problems it creates being largely preventable, according to doctors, as the vast majority of patients – 90 percent or more – have not been vaccinated.
The problem has been made worse by the high demand for nurses across the country, which makes it hard for hospitals to find people to hire and has meant that some Elkhart and Goshen hospital employees have left to become travel nurses, which can pay three to four times more than being a nurse at a local hospital, according to Dr. Michelle Bache, vice president of Medical Affairs at Elkhart General.
“Even nurses who are long-time nurses at the health system, have worked in the community for years and years, at some point that dollar amount just becomes too good to resist,” she said.
Additionally, COVID-19 patients tend to be so sick that they demand much more care than others.
Typically, a nurse can work with up to six regular patients, but when it comes to COVID-19, one particularly sick patient can sometimes require two nurses, Bache said.
Surgery backlog grows
Keeping a hospital census manageable requires postponing elective, or non-emergency, procedures, which can have negative long-term consequences for some non-COVID patients, though hospitals try to ensure that those patients are seen sooner than others.
“But I don’t have much question that – whether you look at the additional pain of having to live with a bad hip or knee until you can get it replaced, or if you’re talking about more life-threatening problems like cancer – that we don’t do anybody a service by delaying their surgery,” Nafziger said.
Some of the procedures that are being postponed are serious, Bache said.
“I don’t really want to use the word elective, because a lot of these surgeries are really necessary for people to be able to continue on with their life in a normal way,” she said. “We’ve had to postpone open-heart surgeries, valve-replacement surgeries, major orthopedic procedures like spine surgeries. They’re not minor things.”
Unfortunately, that is a consequence when a now-preventable infectious disease takes up 25 percent of hospital beds.
“There’s not another single diagnosis that overwhelms us like that,” Bache said. “It’s really been crippling.”
And even though Goshen and Elkhart hospitals on one day in March had a combined five COVID-19 inpatients, they were not able to catch up to the backlog of elective surgeries that was built up last year, particularly in November and December when they reached combined peak of 150 COVID-19 inpatients on the same day. With the backlog growing even bigger now, there seems to be no end in sight.
The hospitals were not diverting patients coming to their emergency rooms on Friday afternoon, but they and many other area hospitals often are on diversion, and often at the same time, according to Nafziger.
“It’s a very difficult situation once that happens because if one hospital comes off diversion, they can be quickly overwhelmed with all the patients from our two-county area coming to that hospital,” he said.
Difficult to watch
With 125 new COVID-19 infections per day in Elkhart County, according to the seven-day average on the state’s dashboard, the current wave is second only to that of October, November and December of last year, which peaked at 326 cases per day. Other waves in this pandemic have peaked at less than 100 infections per day.
The positive test rate for all tests is also at its worst point this year, with 13.8 percent of tests returning with a positive result. As recently as June, that figure was under 3 percent.
Deaths remain more rare than before vaccines became widely available, when most months would have about 30 COVID-19 deaths among Elkhart County residents and November reached more than 100. During most of the spring and summer, the county has lost about 10 people or fewer to the disease each month, but trends in deaths tend to be delayed compared to trends in infections, and there have now been 13 deaths in the past 30 days, which is an increase.
For hospital staff, it’s hard to witness.
“The emotional trauma that the caregivers, after all this time, are going through ... a completely preventable illness taking lives of patients in our community, and younger and younger lives ... it’s really difficult to continue to watch,” Bache said.
If more people would get vaccinated, fewer people would get hospitalized or die, she said.
“The simple thing of getting the vaccine would make such a tremendous difference in the burden that this disease is putting on the health system,” Bache said.
There are some pieces of good news, though. Hospitals are better able to care for COVID-19 patients now than they were earlier in the pandemic, thanks to a better understanding of non-pharmaceutical procedures and because, for instance, the anti-inflammatory drug dexamethasone has proven helpful, Nafziger said.
“I feel like we’re making some incremental improvements, but I would say that from a physician’s standpoint, it’s incredibly frustrating not to have more to offer people,” he said. “There are still a lot of people who come in very sick or very late, and there just isn’t much that can be done to turn them around at that point.”
Goshen Hospital has treated some patients who have had bad reactions to ivermectin, an anti-parasitic drug that some have claimed, without evidence, can treat COVID-19. While ivermectin does have proper uses for humans, hospitals across the country have seen patients who have attempted to self-medicate with a version of the drug, often intended for horses and cattle. While clinical trials of ivermectin as a treatment for COVID-19 are ongoing, “Currently available data do not show ivermectin is effective against COVID-19,” according to the Food and Drug Administration.
With COVID-19 vaccines being effective at preventing infection and highly effective at preventing death (0.9 percent of fully vaccinated Hoosiers have had breakthrough cases, and 0.006 percent have died from COVID-19), the doctors are frustrated that the message isn’t getting through to many residents. In Elkhart County, 36.4 percent of residents are fully vaccinated, while neighboring St. Joseph County has surpassed 50 percent.
“In my mind, it’s not even like the phrase ‘An ounce of prevention is worth a pound of cure,’” Nafziger said. “In this case, our once of prevention or vaccination is really worth a ton of cure because it keeps people healthy, it keeps people out of the hospital or with mild illnesses, keeps them off the ventilator.”
Bache said she never expected to be in a situation like the one hospitals find themselves in today.
“Especially when we have a very good, free, widely available FDA-approved vaccine now,” she said.