Capacity a concern as hospitalizations rise
State number soon could eclipse mark set during spring
Illinois COVID-19 hospitalizations are rising so quickly that, in roughly a week, the number could surpass the highest tally seen in the spring surge, a Tribune analysis has found.
And the skyrocketing admissions are raising new concerns that some hospitals could eventually be packed with patients.
If the virus can’t be slowed, Gov. J.B. Pritzker told reporters Thursday, “we are going to experience a surge in hospitalizations muchhigher than wherewe are now. And in some areas of our state that will mean that you’ll run out of hospital beds, and nurses and doctors who can treat you.”
Hospitalizations are considered a key metric for tracking the spread of the virus. That’s because the better-known daily case counts are strongly influenced by how many people get tested — something that’s changed dramatically between the spring and fall surges. But, in either surge, infected people who were sick enough to need hospital care typically sought it out and could get tested.
The spring surge flooded Illinois hospitals, reaching more than 5,000 COVID-19 patients on one day in April. The daily count is now over 4,000, and over the past two weeks it has risen by an average of nearly 114 cases a day. At that pace, it would break the hospitalization record on Saturday, Nov. 14.
The Tribune analysis of hospitalization data found that the latest surge is different than the one from the spring, which began and was centered in the Chicago area.
Looking at hospitalization rates — hospitalization numbers per 100,000 area residents — shows that the latest surge initially took off more in rural areas of Illinois and in neighboring states. But in the pastweeks, the greater Chicago area has largely caught up to the Downstate regions, while the state as a whole has caught up to its neighbors.
The percentage of the population admitted to Illinois hospitals with COVID-19-like symptoms has tripled in some places in the past month, including the state-designated Region 7, comprising Will and Kankakee Counties.
In the heart of that region is Amita Health Saint Joseph Medical Center Joliet. On Thursday, it had about 70 patients in the hospital with COVID-19 or possible COVID-19 — compared to many days in the 70s and 80s in the spring, said Herbert Buchanan, senior vice president and chief regional officer for Amita Health’s south region.
The Joliet hospital still has space for more patients, but he’s concerned about having enough care providers to treat them, as COVID-19 cases continue to rise. In the past week, the hospital began offering extra pay for nurses to pick up more shifts, he said, and “we have really pushed all the limits on recruiting.”
“We are concerned about the rate of increase, and shouldwe hit another surge, things will get tight,” Buchanan said.
More beds in use
Hospitals report theirbed usage to the state each day, and the growth in the past month has been significant, turning sharper in the past twoweeks.
By 11:59 p.m. Thursday, the tally had climbed to 4,090 either confirmed or suspected COVID-19 patients in hospitals statewide — the first time the number has been above 4,000 since May, and far above the roughly 1,500 seen formuch of the summer.
The number of people hospitalized began a slow rise in mid-September, followed by steeper and steeper hikes, something Pritzker noted in a Thursday news conference.
“We have more than doubled the number of people in our hospital system with this disease in just about five weeks, with no sign of slowing,” he said.
As of Thursday, Illinois overtookWisconsin to have the highest rate of hospitalized residents compared with neighboring states, according to a Tribune analysis of data collected by the COVIDTracking Project.
By Thursday, Illinois’ rate had climbed to 30.7 patients per 100,000 residents. Compare that with a month earlier, when Illinois’ rate hovered around 13 and was in the lower tier of the group of states.
The state does not release bed counts by region. The Tribune filed a public records request Oct. 8 seeking the data. The Pritzker administration had a week under state law to respond but has not done so. A Tribune appeal for the data is pending with the state attorney general’s office.
But the state does release regional numbers on a less precise metric: daily hospital admissions for COVID-19-like symptoms. It’s calibrated to catch symptom codes typed into computers rather than people who tested positive or are suspected by doctors of having the disease.
The state’s admittance figures show all regions of the state seeing increases, some more dramatic than others.
Will and Kankakee’s Region 7 saw its average daily admission rate triple over one month, to 2.84 per 100,000 residents. That is the most in the state. Not far behind are the region for DuPage and Kane counties, and the region for suburban Cook County, which each saw rates roughly triple, to 2.65 and 2.60, respectively.
AtAdvocate ChristMedical Center in Oak Lawn, the hospital reported 104 COVID-19 patients as of Friday, up from48 just three weeks earlier.
The downstate region with the highest rate is Region 6, which includes much of eastern Illinois, including Champaign-Urbana. That high rate is reflected in the experience of Carle Foundation Hospital in Urbana. The hospital had about 50 patients with COVID-19 or possible COVID-19 on Thursday, about the same number it sawin the spring, said Allen Rinehart, executive director of the emergency department, ICU and inpatient services at the hospital.
“Depending on the day of the week, we’re running pretty close to capacity on some days,” Rinehart said.
Thehospital hasn’thadto add more beds yet but could open up another 45 if needed, he said. The hospital has added more traveling nurses recently.
The surges aren’t being felt equally across the state’s hospitals. At Rush University Medical Center in Chicago, considered a bellwether for the spring surge, the latest increases aren’t having as much impact as at its sister hospital in the western suburbs, said Dr. BalaHota, who is vice president and chief analytics officer at Rush.
“It definitely does feel like the incidents of hospitalization are higher west of the city than it is in the city,” he said.
Amita Health Resurrection Medical Center Chicago had about 80 to 100 COVID-19 patients a day at the height of the pandemic earlier this year. As of Thursday, it had fewer than 40, according to its chief medical officer, Dr. David Bordo.
Running out of space?
A major fear of public health officials has always been that hospitals become overcrowded — such as in Italy and New York City earlier in the year. Illinois reports that, as of Wednesday, it still had more than 11,000 hospital beds open statewide.
It’s difficult to predict howmuch, andhowquickly, a surge could affect Illinois’ hospital capacity. That’s because hospitals haveways to increase bed space. In early March, they collectively cut non- COVID-19 patient counts by a fourth over two weeks after canceling or postponing most elective surgeries, the Tribune analysis found.
State health department Director Dr. Ngozi Ezike told reporters Wednesday that some hospitals are slowing elective surgeries again to make more room for COVID-19 patients, and some hospitals told the Tribune it’s a move they are considering, as coronavirus hospitalizations continue to grow.
Hospitals are uneasy about taking that step because, among other reasons, elective surgeries can in
clude important treatments such as heart valve replacements, repairs of herniated discs and certain cancer therapies.
Another option is adding beds. During the first surge, hospitals across the state were able to open up about 8,000 additional beds, beyond those freed up by keeping non-COVID-19 patients away.
Silver Cross Hospital in New Lenox has already opened an additional negative-pressure unit because of the increase in COVID-19 patientsandtokeeppatients and staff safe, hospital spokeswoman Debra Robbins said in an email. As of Thursday morning, the hospital had 76 patients with COVID-19 and another eight awaiting test results.
Advocate Christ could add more beds and slow elective surgeries if the increases continue, said Dr. Robert Citronberg, executive medical director for infectious disease and prevention for Advocate AuroraHealth.
“If everyone is full, we definitely have the ability to dial back electiveprocedures until the situation gets better, and that may happen,” Citronberg said. “I think we’ll know in the next three to four weeks where this particular surge is going.”
Illinois’ first surge was concentrated in the Chicago area, and COVID-19 hospitalizations slid significantly after the region flattened the curve, from a peak of about 5,000 daily patients to roughly 1,500.
That left Illinois in a relatively comfortable spot thissummer— with at times thousands more open beds than before the pandemic and the ability to do elective surgeries again. But that comfort level has slowly decreased with the fall surge. In hospitals’ intensive care units, about two of every three beds are now occupied with patients, including those with COVID-19.
Ezike warned reporters Thursday that bed space was becoming a concern.
“We are really at the point where we are concerned that, whether you have the flu, whether you have COVID, whether you have chest pains, whether you have strokelike symptoms, we are worried there won’t be a bed enough for everyone,” she told reporters.
For now, state data suggests that although capacity has shrunk somewhat in each region, the drop has not been nearly as dramatic as the rise in hospitalizations. For now, downstate facilities generally have more space available than hospitals in the greater Chicago area.
Better treatments
One bright spot in the latest surge is that hospitals say COVID-19 patients are entering a health care system that’s gotten much better at treating the sickest of the sick.
Back in the spring, doctors say, little was known about how to treat the
illness. They’ve learned that, for some patients, ventilators can sometimes do more harm than good. So they’ve used other ways to get oxygen to patients, including positioning them on their stomachs.
That not only helps keeps some patients from getting sicker, it allows community hospitals to keep more patients instead of transferring them to larger hospitals that specialize in more critical care.
At the same time, doctors have identified the more common side effects of COVID-19, such as blood clots, so they can better watch for those conditions and treat them sooner, said Dr. Emily Landon, head of infection prevention and control at the University of ChicagoMedicine.
“We know how to prevent people from having those clotting complications that were really pretty deadly very early on,” Landon said.
Also helpful are new medications, such as the antiviral drug remdesivir to slow the virus and the steroid dexamethasone to suppress an overactive immune system. Antibody treatments are emerging, too, although nothing is evenclose to being considered a cure.
“There’s certainly not a silver bullet when it comes to the medications that we use,” said Dr. Paul Casey, Rush’s chief medical officer.
Casey and others say they’re also seeing younger, less sick patients in the hospital, helping improve their odds of survival.
For all those reasons, the number of COVID-19 patients in intensive care has not risen as dramatically in this surge. By late Thursday, the number in Illinois was 786, which was more than double from a month ago but significantly fewer than the record 1,290 COVID-19 patients hospitalized in ICUs onApril 28.
But hospital officials also are facing aworsening surge that could stress the system; doctors and nurses can be less effective if they’re exhausted and running from patient to patient. And one thing not captured in the state data is whether hospitals have enough staff with the right skills to handle a steep increase in patients.
“What I don’t know, and none of us know right now, is what’s going to happen in the next four weeks,” Hota said. “We definitely know that, before this spike in cases, we’vehadthese better outcomes. … But is that going to hold up? Or are we going to see a rise in some of these adverse outcomes?”
Another unknown, doctors said: Will thecommunity do what it takes to bend one more curve?
“We have cheap, inexpensive, easy prevention measures: Wear a mask. Wash your hands. Keep social distance,” he said. “It’s still not too late to bend the curve back downagain.”