WILMINGTON –– Intensive care capacity at New Hanover Regional Medical Center is strained once again amid a Covid-19 surge that may be worse than the last one.
NHRMC is close to maxing out its ICU capacity but has declined to share specific numbers. ICUs across Novant Health’s entire system are at 97% capacity, a Novant spokesperson shared Tuesday. State data shows 72% of ICU beds in southeastern N.C. are occupied as of Tuesday; regular inpatient bed capacity is at 75%.
Conditions are rapidly evolving
The hospital has cut back on non-emergent procedures and is encouraging individuals who aren’t acutely ill to seek out urgent cares instead. Freed up space in operating recovery rooms is being used to accommodate intensive care patients –– a temporary move as the hospital waits for volume to decrease elsewhere.
Predictive analytics cited by hospital executives (provided by the system’s new owners in Novant Health) show the surge continuing for the next two to three weeks before plateauing.
Visitor restrictions will soon tighten up as exhausted staff feel firsthand the gravity of the delta variant’s strength, more contagious and intense than its original strain.
“It’s been absolutely devastating,” Sarah Silvers, an NHRMC ICU nurse said in a Monday recorded message the hospital shared with members of the press. “We’re all tired. We’re physically, mentally, and emotionally worn out.”
Patients are younger, healthier, and getting sicker
Taking up about half of the hospital’s ICU resources, Covid-19 patients in this surge are younger and getting sicker sooner. The average Covid patient is in their 40s.
“We have sick patients within our ICUs and within our floors that have no comorbidities –– including our younger patients,” Dr. West Paul, senior vice president and chief clinical officer for the Novant Health coastal market, said in a joint media call Wednesday morning. “This is far over [the] peak that we saw in December, January. So this is almost a new animal.”
At least this time around, there’s enough personal protective equipment. “Two weeks ago, we were at 47 [Covid] patients and now we are over 100,” he said. In the southeast region, 144 people were hospitalized for Covid as of Tuesday, up from 93 earlier this month and 36 in mid-July. Those hospitalized within a 24-hour period jumped from five in mid-July to 29 Tuesday.
Just last week, the county’s health and human services director reported no cases among children. In a media update two days later, Paul acknowledged the hospital did have pediatric Covid patients. Wednesday, Paul specified NHRMC has “under 10 and over four” pediatric cases, but couldn’t go into specifics.
“We didn’t see that earlier on,” he said. “But we’re seeing that now, for whatever reason. We are beginning to see that part of the population be much more affected.”
Anticipating the first day of school, hospital administrators are ensuring it has enough pediatric ventilators and other equipment in the event cases among children continue to rise as they have elsewhere; in Louisiana, children had a 24% positivity rate earlier this month. “[W]e know this can still be transmitted quite easily throughout the school system,” he said.
One commonality among almost every Covid ICU patient as of late: they’re unvaccinated.
“I think the hardest thing is that many of the ICU admissions, the patients that we’re seeing, it could have been prevented,” Silvers said.
Standing next to Silvers in the video recording made available to the press, another NHRMC ICU nurse, Ashley Gillespie, shared a dire warning: “We are not the faces that you want to see. Once you see us, you are truly going to be fighting for your life.”
By the time someone requires intubation, they’ve usually spent the past several days gasping for breath, Gillespie explained. “Once it gets to that point, the simplest way to put it is a tube goes down your throat and you’re then put on life support,” she said. “If I could say anything else, please get your vaccine. Once you get down to us in the ICU, it’s not likely that you’re going to get out and be OK. You will be probably dependent on oxygen possibly the rest of your life.”
Dr. Kevin O’Neil, medical director of the NHRMC ICU, reported the ICU had been essentially shut down from a Covid standpoint before the latest surge.
“The hospital is filling up pretty rapidly,” O’Neil said in a Tuesday recording. “It’s going to start impacting hospital care –– we’re not going to be able to provide elective surgeries and other things if we can’t get this to slow down or stop.”
Non-emergent procedures are being delayed
Though the hospital is still performing surgeries, it has drastically cut back on “non-time” surgeries, meaning non-time-sensitive procedures, West explained. Surgeons have been reviewing their schedules, concluding, “this one can wait for two to three weeks, this one can wait for a month,” West said, delaying planned procedures based on their clinical criteria and relationship with their patients.
Emergency and time-urgent procedures are still underway.
“If you have an emergency, you’re acutely ill, come to our facility. We’ve got the resources to take care of you,” West said. At the same time, if a patient isn’t acutely ill, “we plead on going elsewhere if you don’t feel this is emergent care. There are other facilities available,” he said.
Hospital staff can function in “intensive care mode” anywhere, West explained, with space presenting an obstacle as capacity pushes the current ceiling. Should volumes climb higher, intensive care units could completely occupy operating recovery space and even expand to the orthopedic hospital on Wrightsville Avenue (where the main campus already recently borrowed staff from), Pender Memorial, or Novant Health Brunswick Medical Center.
Physically moving patients and resources is time-intensive –– a lesson West said administration learned during the last peak. “We were a bit naive last time thinking we could trigger these things fast. So we have planning in place already looking at those risk assessments,” he said.
There aren’t enough nurses to deal with the surge
Like other healthcare systems nationwide, NHRMC is experiencing a nursing staffing shortage, adding to capacity constraints. EMS vehicles and paramedics have been stalled at drop-off at NHRMC for various conditions, not just Covid-19.
The bulk of nurses nationwide are nearing retirement age and nursing school enrollment is lagging. A cyclical phenomenon, depleted staffing increases stress for nurses on hand, which further exacerbates the problem.
As of Wednesday, NHRMC has nearly 200 open nursing positions and more than 100 nursing support roles listed on its career page.
When an ambulance arrives, there must be a transition off between paramedics and hospital staff, preferably a “warm handoff,” where the two groups can discuss the details of a patient’s condition and what should be done to treat them.
“If we don’t have the nurses, if they’re attending to someone else at the time, the EMS members actually stay with that patient until we can have a handoff appropriately to our triage nurses to get them in,” West said.
In addition to Covid, emergency department arrivals are on the rise due to people who put off their chronic conditions and have become acutely ill, West explained.
“We do not see these numbers typically in our hospital or in our emergency department,” he said.
New Hanover County has free vaccine availability with no appointment required every weekday.
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