COVID-19 CONUNDRUM
Cases, hospitalizations and deaths rising as heathcare systems run out of workers, beds
As the Christmas week began in the Mid-south, healthcare workers were faced with a startling juxtaposition: the hope provided by the commencement of COVID-19 vaccinations and the grim reality that as cases and hospitalizations continue to rise, healthcare systems are quickly running out of workers to treat all the patients coming in.
The virus is spreading much more rapidly than immunizations, which have only just begun and take about a week after the second dose to become fully effective. Healthcare workers are exhausted, some saying they routinely run on four hours of sleep between shifts. People continue to have other illnesses and medical emergencies. And every day, every week, COVID-19 cases, hospitalizations and deaths continue to rise, unabated.
As of 5 p.m. Thursday, the most recent data available, 7% of the 2,239 acute care beds and 4% of the 423 intensive care unit beds in the region were open. There were 557 COVID-19 patients in Memphis-area hospitals, a 20% increase in the span of one week, and another 80 people awaiting
test results who were hospitalized with COVID-19 symptoms.
Amanda Nelson, a respiratory therapist at Saint Francis Hospital-memphis, received her first vaccine dose Friday. She said the vaccine gave her hope, but in her 25 years as a respiratory therapist, she had never been in a situation where bed space was so limited and masks and gowns were thin on the ground.
“It is so real and it is so frustrating that people don't take it seriously,” Nelson said. “Our ICUS are full. Our floors are full. And you'll have patients sit in the ER for days because you don't have anywhere to put them.”
As of Friday afternoon, all the major hospital systems in the Memphis area had started vaccinating eligible and willing employees. If all goes to plan, thousands of healthcare workers in the metro area will have received their first dose of the two-shot Pfizer vaccine by the end of the year, in time for the hospitals to get their next shipment and start on the second round of shots before opening up vaccinations to more employees.
Statewide, 2,711 people had been vaccinated as of Friday afternoon, according to the state health department.
The University of Tennessee Health Science Center started to vaccinate residents, students on hospital rotations, first responders — including campus police — and faculty providing inpatient services on Saturday.
Wider vaccination of first responders will start before the end of the year.
“Immediately after the Christmas holiday, our first responders will begin to receive vaccines, shots in their arms so that we can begin ensuring that our police officers, firefighters and EMTS are also safe as they interact with the community,” said Doug Mcgowen, chief operating officer for the city of Memphis. “And that's not all. There are many, many more doses to come.”
Vaccination timelines
Shelby County Health Department Director Dr. Alisa Haushalter told members of the Shelby County Commission on Dec. 16 the department expected to receive a shipment of the Moderna vaccine by this week and anticipated starting immunizations for first responders and long-term care facilities on Dec. 28.
“Logistically there's a lot of moving parts, but there's a lot of coordination happening behind the scenes,” Haushalter said.
Many outpatient clinic employees are expected to receive the Moderna vaccine in two to four weeks, according to vaccination guidelines put out by the Memphis Medical Society.
After that, the vaccination timeline gets murkier. For people who are hospitalized or have risk factors such as diabetes or cardiovascular disease, they may be vaccinated earlier in 2021, Haushalter said. It's unlikely the average person without risk factors would be vaccinated until the spring at the earliest.
The Centers for Disease Control and Prevention and the World Health Organization have been warning for months that young, healthy people are one of the major sources of the spread of the virus.
So some of those who are spreading the virus the most are the furthest away from being vaccinated as Shelby County — already feeling the effects of the Thanksgiving holiday on top of a preexisting surge — enters the final two weeks of the year, often one of the busiest times for social and family gatherings.
Dr. Latonya Washington, an internal medicine and pediatrics physician at Saint Francis Hospital-memphis, said the situation inside area hospitals was difficult. Medical workers were tired, some dealing with anxiety and depression, bed space was limited and the ability to get supplies of personal protective equipment and other necessities was strained. She urged people to continue to wear masks and avoid social gatherings at Christmas.
“Our ICU beds are full. Our floor beds are full. We have patients who, every day, probably for the past couple of weeks, have been waiting in the emergency department for a bed to open up upstairs,” she said Friday after getting her first dose of the Pfizer vaccine.
'It was very emotional'
Even amid the increasingly dire conditions healthcare workers are laboring under, the vaccine is undoubtedly good news. Kevin Freeman, chief of pharmacy services at the Memphis Veterans Affairs Medical Center, said staff at the hospital burst into applause after the first vaccine was administered the morning of Dec. 16.
“It was such a relief. It was very emotional, honestly,” he said. “You've prepared for so long and worked with so many different services within the hospital and everybody really pulled together.”
Jarred Bowden, a pharmacist at the VA, got his first dose of the vaccine Thursday.
“I knew that I wanted to be one of the first people to get it,” he said. “We work with this great population and if I can come to work knowing that I've potentially prevented spreading this virus to just one veteran, sign me in.”
Bowden said it was also an emotional experience getting the vaccine, knowing he may soon be able to see his 80-yearold grandmother for the first time in months.
Dr. Steve Threlkeld, co-chair of the infection control program at Baptist Memorial Hospital-memphis, said he and his brother, also a physician at Baptist, have been able to endure the challenges of the pandemic together but have been separated from other family members.
“We have a 90-year-old mom that we've only been able to see a couple times in this whole year. She had her 90th birthday alone. These are things that affect people,” he said.
Threlkeld, who got his first vaccine dose Thursday, said the development of successful, safe vaccines within a year of a new virus being identified was “an amazing accomplishment” under circumstances not seen in a century.
“This disease has killed a million and a half people worldwide, 300,000 people (plus) in the United States. It has kept families apart for a year. It has destroyed and certainly adversely affected so many people's livelihoods. So it's an amazing thing for us to be at this moment,” he said. “But we can't relax. It's going to take a while for this to get to our population and to have its intended effect.”
Logistics and timeline
The logistics behind being able to successfully get the vaccine from a laboratory into the arms of healthcare workers is also no small feat.
Fedex completed its first shipment of the Pfizer vaccine Dec. 14 and has been ferrying the vaccine from Pfizer's manufacturing facility in Michigan to its Express World Hub in Memphis for distribution throughout the country to hospitals and clinics.
The logistics giant is splitting the distribution workload with UPS, shipping the vaccine on regular service Fedex flights with other cargo. The company is using Senseaware ID devices affixed to each shipment to keep an eye on the doses in transit.
When the vaccine arrives at hospitals, pharmacists often take over.
Freeman, the VA chief of pharmacy services, said the hospital started preparing for the arrival of the vaccine weeks ago, including doing mock trial runs.
It has to be kept in extremely cold conditions and before it is administered it needs to thaw for 30 minutes. It then must be reconstituted, a 15- to 20-minute job, and then pulled up into syringes for individual doses, Freeman said.
Once prepared, the vaccine lasts about 6 hours, so Freeman said the VA keeps to a very tight vaccination schedule and has a wait list in case an employee scheduled to receive a shot cannot show up.
“My goal is that we get the vaccine to everyone who is eligible and wants to receive it, but that we waste no doses whatsoever,” he said.
Lots of excitement, some hesitation
Now the vaccine is available, hospital systems are working to provide information to employees who have concerns about it. An internal survey of Methodist employees showed about 45% of respondents said they will get the vaccine, 26% said maybe and 28% said they will not.
Dr. James Hoffman, who is overseeing the vaccination process at St. Jude Children's Research Hospital, said the hospital is having listening sessions to help address questions from those who are hesitant about getting vaccinated.
But the majority of employees at the hospital have been eager to receive the vaccine, he said. And for workers at St. Jude, the vaccine has an added level of significance, since the children they care for are immune-compromised.
“Some people know me as helping to coordinate this and they're asking, ‘Where is it?' and there's a lot of excitement,” Hoffman said. “People have been very excited about it. I guess I really can't think of any other shipment that is watched and of interest to so many people at the hospital.”
Hoffman said St. Jude was continuing to stress to hospital employees and the public both that the vaccine was safe and effective and that it was imperative to continue masking, proper hand hygiene, social distancing practices and other infection control measures.
Nelson, the respiratory therapist at Saint Francis, echoed Hoffman but added the vaccine was welcome news at the end of a horrible year.
“It does give me peace of mind that I'm not going to bring it home to my family. And my family will get the vaccine when it is available to the public,” she said. “It makes me breathe a little easier to think that there's light at the end of this terrible, dark tunnel that we've been in and that it will come, hopefully, to an end soon.”
Commercial Appeal reporters Katherine Burgess, Max Garland and Laura Testino contributed to this report.
Corinne Kennedy covers economic development, soccer and COVID-19’S impact on hospitals for the Commercial Appeal. She can be reached via email at Corinne.kennedy@commercialappeal. com or at 901-297-3245.