Daily Local News (West Chester, PA)
‘ On the verge’
Overwhelming hospitals possible as numbers rise
In the early months of the coronavirus pandemic, Pennsylvania was successful in flattening the curve to prevent hospitals from becoming overwhelmed.
Now residents need to work together to flatten the curve once more as daily new case numbers and hospitalizations continue to rise and have surpassed record numbers set during the peak of the pandemic in the spring.
“What happened to make it come again is not that the virus was magic or anything like that. What happened is it got to be fall,” said Dr. Gerald Maloney, chief medical officer for Geisinger hospitals. “The fact is that everybody moved indoors where the people are closer together and the population density is greater and the ventilation is not as good as being outside.”
Geisinger Health System provides health care in central, southcentral and northeastern Pennsylvania, and southern New Jersey. Headquartered in Danville,
Geisinger services more than 3 million patients in 45 counties, including Schuylkill County. It operates 12 hospitals throughout its service area, including Geisinger St. Luke’s in Orwigsburg, as well as other medical centers and facilities.
aloney said reaching capacity has now become a realistic possibility for hospitals across the state.
“Our capacity is significantly more challenged than it was in the spring,” Maloney said. “The real message here is that the health care resources are in fact exhaustible.”
Those resources include equipment such as beds and ventilators as well as health care workers who are treating an increasing number of patients on a daily basis.
Maloney said every hospital is experiencing similar struggles as numbers continue to rise.
“The heroes ( nurses and doctors) are really getting tired,” Maloney said. “The heroes are stressed. The heroes are burning out. It’s very hard for a nurse to have a really stressful day yesterday and know that she’s got to come back today and it’s not going to be any better, in fact it might be worse.”
‘ On the verge’
If the curve is not flattened, health systems will become overwhelmed. If a hospital reaches capacity, there would be no beds available for any patients — COVID19 or otherwise — or the necessary amount of health care workers to treat the patients.
In a worst case scenario, he said, people would be turned away from hospitals and decisions would need to be made on how best to use limited resources such as ventilators and other equipment for the patients in the hospitals.
“If the trend that we’re on continues,” Maloney said, “we will very shortly be at a situation where you may be sick enough to be in the ICU and I can’t put you there.
“We’re on the verge of having to make tough decisions and say, ‘ You know what, ma’am, thank you for taking your husband to the emergency department. You’re right, he is terribly sick with COVID, but I can’t do anything for him because we don’t have the capacity. We have too many patients already.’
“That’s going to be a very dark day in our history when something like that has to happen.”
The worst case scenario has become a realistic possibility if the health system’s capacity continues to be stretched and strained.
“None of us want to get to that point,” Maloney said. “Something has to be done to get everybody’s attention.”
Beds, not just ICU, are a concern
In the daily report of hospitalizations, the state Department of Health notes how many of the hospitalized individuals with COVID19 are in the ICU and
tracks the availability of ICU beds across the state.
Maloney noted that nonICU beds are also important as the goal is to keep patients from getting sick enough to need to be placed in the ICU.
“The non- ICU beds are possibly even more important,” he said. “One thing we want to do is we want to treat people to keep them from getting ICU- level sick. In order to do that, I have to have a non- ICU hospital bed.
“As people in the ICU get better to the point when they don’t need the ICU anymore, they still need to be in the hospital. If I don’t have a regular bed, I can’t transfer the patient out of the ICU and make the ICU bed available for somebody who is getting sicker.”
Hospitals have the ability to expand bed capacity, including ICU beds, in absolutely necessary situations. Even if a hospital expands bed capacity, there would still need to be enough
health care workers available to treat all the patients within the hospital.
“There’s not enough of them at baseline, and now they’re getting sick, frustrated, burned out and possibly dying,” Maloney said. “The fact that I may have a bed and all the contraptions that you utilize in the ICU, monitors and pumps and all that, I might have that sitting there empty. If I don’t have a nurse to take care of you, then I might as well not even have it.”
Maloney believes people often view the ICU- bed availability data incorrectly by using it as an excuse to continue to ignore safety precautions.
“Just by looking and saying, ‘ We’re OK to continue the behavior that we know makes it easier to spread the disease because 10% of the ICU beds in the state are open,’ that’s silly to me,” he said.
M aloney compared that line of thinking to a plane
taking off with a flat tire. While the pilots and crew know the landing will result in some people being injured, it’s seen as acceptable because the local trauma center has enough beds available for the injured.
Prevention is key
Flattening the curve means everyone doing all that they can to not get sick or get others sick in the first place.
By now, the general public knows the virus is spread through droplets and that the two best ways to lower the risk of spreading the virus are to wear a mask and practice social distancing, he said. Following these two simple measures protects not only the individual but all those around them.
“If you have COVID- 19 and I can’t breathe in what you put out, you can’t give it to me,” Maloney said. “We cover our mouth so stuff doesn’t come out and
the other is we stand far enough apart. That’s basically the way that we prevent the spread and we flatten the curve.”
Maloney said it is frustrating to continue to see people fight against these precautions. He said it is still important for people to take COVID- 19 seriously even if some people won’t contract the virus or recover from a severe case.
He added that it is counterproductive when prominent figures who have recovered from COVID- 19 tell others the disease was nothing to worry about. He said that encourages people to ignore mitigation efforts.
Maloney likened that to someone who was unharmed in a car accident telling others that they were fine so no one should be concerned about stopping at a stop sign.
The mitigation efforts in the spring were successful.
“The way we know that they worked was because of the fact that we did actually see the curve flatten,” Maloney said. “We ( Geisinger) ultimately did get down by midsummer to double digits across the entire system and some of the hospitals actually got down to zero patients in the hospital with COVID- 19.”
During that time the health system saw a percent positivity rate, the percentage of positive tests among the tests done, of about 5% to 6%. This meant that at most, six out of every 100 people tested for COVID- 19 were positive for the virus. Geisinger has seen the number of hospitalized COVID- 19 patients double since spring and the percent positivity rate increase to more than 25% in the health system’s service area. This means one in four people is testing positive for COVID- 19.
Percent positivity rate and the number of hospitalizations show if mitigation efforts work. If efforts are working, the percent positivity rate will decrease. Maloney said percent positivity rate is typically the first indicator and a decrease in the rate is usually followed by fewer people being admitted to the hospitals about five or six days later.
Throughout the pandemic, people have been encouraged to avoid gathering with people with whom they do not share a home.
In an effort to encourage more people to follow this recommendation, Gov. Tom Wolf and Secretary of Health Dr. Rachel Levine put Pennsylvania “on pause” with additional limited- time mitigation efforts including banning indoor dining in restaurants or bars and prohibiting indoor gatherings of more than 10 people who do not share a home. These efforts were put in place until Jan. 4 in hopes of slowing the spread during the holiday season.
Health care workers and officials have been concerned about the holiday season, Maloney said, and the results following Thanksgiving show why the concern has been warranted.
“In our hospitals, we had the greatest increase from Thanksgiving Day to the following Thursday than we had in any other week throughout the entire pandemic,” Maloney said. “It’s fairly obvious if you plot it along the calendar that Thanksgiving and the family gatherings that ensued probably were responsible for that.”
The upcoming holidays are even more of a concern than Thanksgiving as they are often a more important gathering time for families and friends.
Not only are people unable to properly social distance indoors, but they often feel they do not need to wear a mask with people they are close to even when they do not share a home.
Maloney said that even if the person is a relative, if they do not share a home with you, then they are a “microbiological stranger.” He said not wearing a mask around them would be the same as inviting a stranger into your home without a mask. The risk is the same as the virus spreads more easily in enclosed spaces.
“Somehow we feel safe around our relatives and we’re not,” he said. “That’s where Christmas is going to come and pose a problem. That’s why I really think that keeping people forcibly apart as much as we can now definitely can’t hurt.”
Maloney said the best way for people to thank health care workers is to do their part by following the safety precautions and mitigation efforts to slow the spread of the virus that will help flatten the curve and prevent hospitals from becoming overwhelmed.
“The main thing is this is real, even if you haven’t been personally touched by it,” he said. “If you want to thank them ( health care workers), do whatever you can to get your friends and family to wear a mask.”