Health care facilities strain under COVID surge

Sep. 16—Health care leaders say the ongoing surge in patients with COVID-19 needing hospital care is stretching resources and staffing.

"We're all stretched, and our staff is stretched," said Dr. Harold Naramore with Blount Memorial Hospital during a Wednesday morning press briefing. "It's not just our nursing staff. It's our respiratory therapists, pharmacy staff, people who prepare meals and people who clean rooms. They're all stretched."

The state's dashboard of hospital resources Tuesday reported about 10% of the hospital beds in the state were available, with only 6% of ICU beds. Hospitalizations in the state have declined slightly from a peak set Sept. 9, with 3,831 patients with a confirmed case of COVID-19. On Tuesday, there were 3,585 patients, with 1,071 patients in intensive care units and 758 patients requiring a ventilator.

Covenant Health on Wednesday reported 339 confirmed patients in its hospitals, with 406 confirmed or suspected cases of COVID-19. Of those, 86% were unvaccinated and 94% of ICU patients were unvaccinated.

At Cumberland Medical Center in Crossville, there were 41 patients with a confirmed diagnosis of COVID-19 and 59 patients either confirmed or suspected of having the virus. Of those patients, 88% were unvaccinated while 100% of patients in the ICU were unvaccinated.

Hospital staff are being asked to work longer hours, care for more patients, and not take time off.

"Almost all these individuals could take jobs at higher rates of pay, particularly nurses, and they've chosen to stay here and help this community in a time of near-crisis," Naramore said.

Naramore spoke of patients on ventilators in their 30s, 40s and 50s.

"It's very sobering. I assure you it's real. I assure you it's happening in your community, and I assure you we need your help," he said.

Dr. James Shamiyeh with the University of Tennessee Medical Center, said hospitals were trying to be creative in staffing and had called in help from the National Guard in some areas, but he said, "There's really not extra staff to bring in from outside the community. There is only so much that we can do. As you start to see more patients in the ICU, sicker patients in the ICU — that's why we need the community's help so much."

The surge doesn't just impact patients with COVID-19, he added, but all patients in need of hospital care.

There have been incidents of patients and families being verbally abusive toward staff, Naramore said.

"Please be kind when you seek our services," Naramore said. "They really don't deserve that."

Dr. Mark Browne, with Covenant Health, said the surge is also impacting emergency departments.

"It's been a bit of a perfect storm," Browne said.

As the hospitals see an increase in in-patients with COVID-19, they have seen dramatic increases in the number of patients coming to emergency departments with COVID-19 symptoms. Hospitals are also serving patients with other illnesses and injuries. At some Covenant Health facilities, emergency departments have reported nearly double the volume of patients. Patients are experiencing longer wait times to be seen and to then be transferred to a room upstairs — because as Browne noted, they have to have a bed available for those patients.

"It is taking much longer for all of our health systems to get patients out of the emergency department that normally we would transfer out in relatively short order," Browne said. "So we're caring for patients longer in our emergency departments, which then backs everything else up."

The Covenant Health daily dashboard reported Cumberland Medical Center has 38 confirmed hospitalizations due to COVID-19, with 52 patients either confirmed or suspected of having the virus. There were 10 patients in the ICU at the hospital, with an average patient age of 54. The hospital reports 84% of all COVID-19 patients are unvaccinated, and 100% of ICU patients are unvaccinated.

Across the Covenant Health system, 84% of all COVID-19 patients were unvaccinated and 91% of ICU patients were unvaccinated.

Browne said the community can assist with the backlog at emergency departments.

If individuals are experiencing mild symptoms, they are asked to seek care through urgent care centers or their primary care physician. Also, the hospitals ask individuals seeking COVID-19 testing to find other providers in the community.

Browne said anyone with severe symptoms — such as chest pain, shortness or breath or symptoms of a stroke — to seek care at the emergency room without delay.

He did note that emergency departments triage patients according to their symptoms, and it is possible that individuals coming in after you may be seen before you.

"Be patient and be kind," Browne added. "Our staff are extraordinarily busy. They are extraordinarily tired. They are doing their absolute best every day. They are truly the heroes of this circumstance we're working through. We have folks who have stepped up to work extra and work long."

Narramore said, "None of us have a crystal ball or know how long this is going to last or how bad it's going to get. But we can work together in our community to improve where we're at."

Pediatric Cases

Dr. Joe Childs from East Tennessee Children's Hospital said there have been more pediatric cases in the recent weeks at the pediatric facility, particularly among patients with underlying health conditions. At the time of the press briefing, there were 11 patients in the hospital with four in the ICU.

Childs warned that there is a rare complication young patients who have had COVID-19 may face. Called multi-system inflammatory syndrome in children, or MIS-C, the hospital treated about 35 patients during the winter surge. Symptoms can come on quickly, Childs warned. Patents and caregivers should contact their provider or go to an emergency room if children come down with unexplained symptoms.

ETCH is providing monoclonal antibody infusions for patients who are at risk for complications. However, one of the most important things adults can do to protect young patients from COVID-19, especially those children too young for vaccines themselves, is to get vaccinated.

"The most important thing you can do right now in your household is to vaccinate the adults around them," Childs said.

Vaccines Help

Naramore urged everyone to get vaccinated.

"Please consider the vaccine. Please look at the science," he said. "The truth is, if you take the vaccine and are fully immunized, you very likely won't come into the hospital, and the probability that you're going to die is almost non-existent."

That will help the hospital staff care for patients with severe illness from COVID-19 and other illnesses

Vaccines are safe and effective against COVID-19, the medical providers said, and they help prevent hospitalization and death from the virus.

Dr. Frank Beuerlein with Tennova Healthcare, said more than 1.2 billion doses of COVID-19 vaccines have been administered in the past year worldwide. Peer-reviewed studies show these vaccines to be safe, he said.

"A recent study of 6.2 million vaccinated individuals found there was no significant increase in death or mortality versus the unvaccinated population," he said.

He urged individuals with questions about the vaccines to talk to their doctors.

"The people here today have oversaw 200,000 doses of vaccines in our community without a case of someone having a significant adverse outcome," Beuerlein said. "We believe the vaccine is very safe and very effective. We ask that you please avoid the misinformation on the internet, follow the scientific evidence."

With a two-dose vaccine regimen, people still need about six weeks before they are fully vaccinated. In the interim, Beuerlein urged wearing masks, avoiding large crowds and washing hands frequently.

"Ultimately, it will be the vaccine that prevents unnecessary morbidity and mortality," he added.

While individuals who had COVID-19 in the past do have antibodies, Beuerlein said studies show vaccination can double their level of immunity to future infection.

Early Treatment

Monoclonal antibodies can help patients who test positive for COVID-19 from developing severe disease. However, there are guidelines for this therapy, Beuerlein said.

Monoclonal antibodies consist of an infusion of lab-created antibodies that mirror the antibodies of recovered patients. It can limit the amount of virus in the body, he explained, and reducing symptoms and disease progression.

"It is one of the best things we have available at this time," Beuerlein said.

The therapy is available to individuals who meet specific criteria: a positive COVID-19 test, mild to moderate symptoms, and be at high risk for severe disease. That includes a long list of conditions, he said, such as chronic underlying health conditions, obesity, high blood pressure, or older patients.

Beuerlein said patients interested in monoclonal antibodies should check covid19tn.gov for sites offering the treatment and not go to an emergency room.

"It's better to go to the providers in our communities than to the emergency rooms and go through the wait while you're suffering from COVID," he said.

MEDIC is also accepting patients who have recovered from COVID-19 and wish to donate COVID convalescent plasma used for in-patient treatment.

Heather Mullinix is editor of the Crossville Chronicle. She covers schools and education in Cumberland County. She may be reached at hmullinix@crossville-chronicle.com.