UHC, other hospitals, brace for post-Thanksgiving COVID-19 uptick

Among those patterns is an increase in cases following major holidays. Spikes in cases were observed following Memorial Day, Independence Day, Labor Day and Halloween, according to a joint statement from the American Medical Association, the American Hospital Association and the American Nurses Association.

If this pattern holds, a Thanksgiving-related jump in positive cases could begin in the coming week or two.

By the time Americans celebrated Thanksgiving, COVID-19 rates had already been trending upward, breaking records in states across the country, including West Virginia.

“As people gather over the holiday season, we could see many super-spreader outbreaks resulting from families or friends gathering. The vaccine news is very encouraging, and, yes, the highest risk groups might see a vaccine in the next couple of months. But for most Americans, it will be well into the next year, and all that is just too late to impact the current uncontrolled spread,” said Tony Gregory, vice president of legislative affairs for the West Virginia Hospital Association.

Based on trends in state and county rates compared to United Hospital Center’s patient census, UHC’s COVID-19 Leadership Team is expecting an increase in COVID-19 patients in the seven to 10 days following an uptick in cases.

“Hence, our concerns for the extensive holiday season about to unfold,” said Dr. Mark Povroznik, UHC’s vice president of quality and chairman of infection control.

Of course, the goal of state, local and hospital officials is to prevent the final step in the grim pattern that has emerged — the uptick in deaths that, as Dr. Clay Marsh has pointed out, is typically seen starting about 21 days following an uptick in positive cases.

Despite a record number of hospitalizations for COVID-19 reported in recent days, hospital capacity in West Virginia has not yet reached its limit, according to Gregory.

Hospitals and state officials are in constant communication to ensure sufficient capacity is available for all levels of care throughout West Virginia.

“This helps us make sure we don’t run into some of the same issues that other states are having with the lack of available space or staffing issues. We obviously continue to monitor the issue very closely, but based on what we’re seeing today, we have every confidence that our hospitals are responsibly managing their bed space and staffing,” Gregory said.

At UHC, there are 22 ICU beds, but additional ICU capacity can be created depending on need, according to Povroznik.

A 20-bed observation unit attached to the Emergency Department, typically used to keep ED patient flow moving, could be used for additional capacity to care for patients in the event of a surge.

By shifting resources, another 10-bed area would further expand capacity at the hospital under the surge plan, Povroznik said.

Early in the pandemic, UHC designated a portion of the seventh floor to support COVID-19 operations; that area now has 29 beds. Here, staff and supplies are cohorted, and there are designated areas for provider and essential workflow processes, according to Povroznik.

The number of COVID-19 patients in UHC fluctuates. On Thursday, Povroznik reported the hospital had its highest COVID-19 numbers to date, with 21 patients, including six in intensive care.

By Friday afternoon, that number had increased to 25 COVID-19 patients, including seven in the intensive care unit. One patient was on a ventilator, according to Povroznik.

The hospital’s surge plan also allows for a halt in low-risk elective procedures. Because many of these procedures require short stays in the hospital, halting them can increase bed capacity “essentially overnight,” Povroznik said.

“The leadership team monitors the need to do so daily, and our supportive surgical staff recognizes the importance this action step holds,” he said. “While we recognize delaying surgical procedures can impact patients in many ways, we exercise this step when necessary and are always in a position to implement as the situation demands.”

If the situation were to be designated a crisis by the state Department of Health and Human Resources, a “surge hospital” at Fairmont Medical Center also could receive less serious COVID-19 cases transferred from UHC, Povroznik said.

“Specific criteria exist to assure safe and effective care. Essentially, once a crisis has been determined by the DHHR, a protocol has been formalized that allows for FMC to be used for lower acuity recovering COVID patients awaiting discharge home or to a nursing home to enable regional hospitals that are staffed to care for higher acuity patients to decompress and create additional beds,” he said.

Of course, there is also hospital staffing to consider.

Since October, there have been 44 positive cases of COVID-19 among associates at UHC — more than half of the 79 hospital staff who have tested positive since the beginning of the pandemic as of Thursday, according to Povroznik.

These figures include staff members infected in their communities, not just those who may have come into contact with the virus in the hospital setting, he said.

“Currently, there are no staffing concerns. Through the pandemic, we have kept our staff safe, and our protocols have prevented essential staff from being quarantined,” Povroznik said.

With the current progression of the pandemic and the arrival of “the season of social gathering,” the potential for staff exposures outside of the hospital leading to quarantine is a source of concern and something that is being monitored closely, he said.

“In smaller, more specialized departments, the impact of quarantined staff could be more quickly realized,” Povroznik said.

Gregory said it will be important for West Virginians to do what they can to reduce the risk to health-care workers and prevent a surge in COVID-19 cases in hospitals.

“Our behaviors are driving the spread. We know that pandemic fatigue is real, but we need to remain committed to taking steps we know work to reduce the spread of COVID — wear a mask, wash your hands, socially distance,” Gregory said. “Maybe a step further is wear a mask when you’re with anyone outside your immediate family, not only indoors but outdoors too.”