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Pandemic fatigue and the holidays threaten to swamp Pa. hospitals with COVID-19 cases

Hospitals have learned how to prevent COVID-19 transmission within their walls. But community spread is another story.

Beds are pictured inside a makeshift COVID-19 unit in what used to be the lobby of the Temple Heart and Vascular Institute in Temple University Hospital's Boyer Pavilion in North Philadelphia on April 7. Due to the coronavirus pandemic, the hospital converted all of Boyer Pavilion into a treatment space for COVID-19 patients.
Beds are pictured inside a makeshift COVID-19 unit in what used to be the lobby of the Temple Heart and Vascular Institute in Temple University Hospital's Boyer Pavilion in North Philadelphia on April 7. Due to the coronavirus pandemic, the hospital converted all of Boyer Pavilion into a treatment space for COVID-19 patients.Read moreTIM TAI / Staff Photographer

Will Pennsylvania’s hospitals be overwhelmed by the current second wave of the pandemic, or manage the crisis as adeptly as in the spring?

If pandemic fatigue has made you too numb to care about the answer, then that’s part of the problem.

Many restrictions that tamped down hospital COVID-19 caseloads in the first wave are now lifted. People craving normalcy, including holiday gatherings, are risking exposure to the coronavirus. And in surveys, only 63% of residents say they’re complying with the state’s mandate to wear a mask in public.

Meanwhile, hospitals still haven’t recovered from the financial hit of the spring, when the state ordered them to stop doing elective procedures for 40 days. Neither state nor hospital officials want to do that again. But that means hospitals are now fairly full of non-COVID-19 patients, even as coronavirus-related hospitalizations are exploding.

The implications are so worrisome that Pennsylvania Secretary of Health Rachel Levine on Tuesday sent an unusually blunt memo to the executive officers of the state’s 250 hospitals and health systems.

“Current national modeling projections indicate that Pennsylvania is at risk of having our health care system become overwhelmed,” she wrote. “Pennsylvania will run out of ICU beds in December,” according to one forecast.

Time will soon tell. There is no doubt, however, that compared to nine months ago, the dynamics of the current surge are different and, in some ways, more ominous.

Out-of-control spread, again

COVID-19 cases and hospitalizations across Pennsylvania are growing at exponential rates. Hospitalizations leaped from about 500 patients a month ago, to three times that many two weeks later, to 2,900 on Thursday — more than at the peak in late April, according to the state health department.

Pennsylvania hospitals have a total of about 3,800 critical care beds, but two-thirds of those beds are typically occupied. The number of available ICU beds has steadily fallen from 1,200 in mid-June to 780 on Wednesday, state data show.

The good news is that with more diagnostic testing, more therapeutic options, and more younger than older adults catching the virus, not as many cases need hospitalization, and their stays tend to be shorter.

“We’re seeing a shorter length of stay and a lower mortality rate,” said Jack Lynch, president and CEO of Main Line Health. “We don’t know if it will stay that way.”

Even if it does, Levine foresees an unprecedented increase in numbers. “Unfortunately,” she wrote in the memo, “even with a decrease in the percent of patients hospitalized, this second surge is much larger than the initial spring surge.”

At the same time, the societal will to do whatever it takes to avoid overloading hospitals — the now-familiar concept of “flattening the curve” — is less than in the spring.

Levine cited modeling by the University of Washington’s Institute for Health Metrics and Evaluation. While Pennsylvania hospitals are projected to have enough medical-surgical beds statewide, regions with few hospitals may fall short before the demand peaks in January — and ICUs will be full in December. The prediction doesn’t factor in seasonal flu, which could further deplete availability, or a possible vaccine debut.

Levine’s bottom line: If hospitals can’t “effectively manage the situation,” the state will intervene again to require hospitals to cancel or postpone elective procedures.

Of course, models and predictions can be utterly wrong. In the spring, Philadelphia set up Temple University’s Liacouras Center arena as a surge hospital, but barely used it. Penn Medicine, the Philadelphia region’s largest health system, projected its three Philadelphia hospitals would have 3,131 to 12,650 patients with COVID-19 at the peak — a terrifying possibility that prompted extraordinary preparations. In reality, system data show, the combined daily COVID-19 census in those hospitals at the spring peak was well below 500.

The preparations were partly a reaction to news of overwhelmed hospitals in places such as Italy and New York City, where medical workers — facing a deluge of COVID-19 patients and a shortage of resources — were forced to ration life-saving care.

Striking the right tone

Health system executives are in a tough position. They want to sound alarms, but not so much that people are afraid to seek emergency care, as happened in the spring. They want to assure the public that they are prepared to ramp up, without sounding overconfident.

Gerald Maloney, chief medical officer of Geisinger, the leading health system in northeastern Pennsylvania, said its Danville flagship hospital already has 50% more COVID-19 patients now than at the peak in April.

“Could we get overwhelmed? It could come to that,” he said. “The holidays are obviously a big concern. But the analogy is like a dimmer switch on a light. Each hospital in the system has put together a surge plan. We could convert spaces in other hospitals [to ICU beds] if needed.”

Temple University Hospital, which converted three floors of its Boyer Pavilion building into a COVID-19 facility in the spring, scaled back to one floor over the summer. Now, with 120 COVID-19 patients, including 20 needing critical care, all three floors are again in use, said Claire Raab, Temple’s chief clinical officer.

Filling the ICU is “certainly possible,” she said, but then other beds would be converted to fill the need.

A local critical care physician, who spoke anonymously for fear of offending his employer, was less sanguine.

“I think there is a disconnect between leadership and forces on the ground about what capacity means,” he said. “I certainly understand the need to keep the money coming in. But by the time it’s obvious that we can’t do both COVID-19 and non-COVID care, it will be too late. And more and more staff are being quarantined” because of exposure to the virus, typically outside of work.

Indeed, said Lynch at Main Line, “the real challenge for every hospital is staffing.” But that, he added, is why the public should feel personally committed to masking and social distancing precautions.

“Because by people not doing what we all should, my hospital beds are filling up, and my staff is getting burnt out,” he said. “That’s what frustrates me.”