Fears of surge.

Delaying surgeries and full ICU beds could become a reality again if the delta variant triggers a fall surge

Hospitals start to prepare in case the delta wave gets worse this fall.

Less than two months ago, it seemed unthinkable that Colorado hospitals would again have to decide whether to put off some surgeries, or to consider where they might send patients if their intensive-care beds filled up.

New COVID-19 infections were falling, and it seemed that the worst the future could bring was limited outbreaks in under-vaccinated communities.

And then came delta.

While Colorado hospitals aren’t nearly as full as they were last winter, the trend in new admissions is worrisome. As of Thursday afternoon, more people were hospitalized with confirmed COVID-19 than at any point since late January, and 18% of the hospitals reporting to the state anticipated they could have a staff shortage in the next week, according to the Colorado Department of Public Health and Environment.

The most recent state projections, from late July, showed Colorado could approach winter hospitalization levels if people had more higher-risk interactions and the vaccination rate didn’t increase significantly. At the peak in early December, nearly 2,000 people were hospitalized with COVID-19, and although the state didn’t run out of beds, health care workers reported they were stretched to the breaking point.

The possibility of a reprise is looking more likely, as the trajectory of new hospitalizations is closer to the worst scenario the state’s modeling team laid out than it is to any of the more-optimistic versions.

It’s a situation few expected to have to face again. Doctors and nurses who spoke to The Denver Post likened the first vaccinations over the winter to a light at the end of a tunnel. Now, it’s looking dimmer as the virus’ more-contagious delta variant spreads and their intensive-care wards start to fill again.

Dr. Michelle Barron, senior director of infection prevention and control at Uchealth, said she has “significant concerns” about reaching the levels seen in last winter’s peak again, and it’s likely that seasonal flu will return this year, after it almost disappeared last year because of COVID-19 precautions. As of Aug. 21, the last date with available data, the Cen

ters for Disease Control and Prevention reported “minimal” flu activity in Colorado, but “high” spread in neighboring New Mexico.

“While we have vaccines now … we don’t have any mask mandates, and school is in session,” she said.

As the end of August approached, Uchealth was caring for about three times as many COVID-19 patients as it was in early July, and it had started postponing some procedures that aren’t urgent but could require a hospital stay.

As of Thursday morning, 231 people were receiving care for the virus there — only 32 fewer than at the peak of the spring 2020 wave.

Putting off surgeries, transferring patients

Cara Welch, a spokeswoman for the Colorado Hospital Association, said nearly all hospitals have started taking some combination of steps such as putting off non-emergency procedures, transferring patients to facilities with more room, adding beds or deploying staff members to help in units where they wouldn’t normally work. That also happened during the fourth wave this spring, although to a lesser extent, she said.

On Friday, the hospital association announced it was moving into Tier 1 of its transfer plan, where larger hospitals would take on a greater role in helping coordinate moving patients to facilities with the beds and staffers to care for them.

Far fewer people are hospitalized than were when the plan was in use from November to February, but no one is sure how long the current wave might last, Welch said. She appealed to the public to get vaccinated, wear masks in indoor public places and practice social distancing.

“We’re kind of back to that place where we really need their help,” she said.

While more than two-thirds of eligible Coloradans are fully vaccinated, that means one in three adults and teens are still unprotected, as are nearly all children under 12. In 27 counties, fewer than half of eligible people are vaccinated, giving the virus countless opportunities to spread.

Hospitals have the advantage of extensive practice managing surges and had time to stock up on protective equipment heading into this wave, Barron said, but helping employees manage their stress will be key. While most people are resilient, everyone is tired, she said.

Others don’t expect to face much strain in the coming weeks.

Heather Young, medical director for infection prevention and control at Denver Health, said the hospital has a plan for how to manage a possible surge, including postponing elective surgeries, but she’s hopeful they won’t have to use it. Nearly everyone hospitalized for COVID19 is unvaccinated, so people have a way to prevent the level of illness seen last year, she said.

“Denver Health has had an increase in our volume of inpatients with COVID infection, but we still remain at relatively low levels in comparison to other surges,” she said.

The flu season in Australia also offers some encouragement, because few people are sick there — although it’s worth noting Australia still has a mask mandate and some travel limits, Young said.

Dr. Gary Winfield, chief medical officer for the Healthone hospitals in the region including Colorado, said he doesn’t think hospitalizations will reach their December levels again. He expects they will treat about 160 COVID-19 patients at the peak of this wave, which would be about half of last year’s peak. Fewer patients need ventilators now, and the death rate likely will be lower, because hospitals have experience with treating the virus, he said.

“It’s really, after all this time, become part of our routine” to treat COVID-19 patients, he said.

But some hospitals aren’t seeing a decreased need for ventilators, even as their patient population has shifted. In June, the median age for COVID-19 patients at Uchealth was 62, meaning half were older and half were younger. In July and early August, that dropped to 43, Barron said, and younger patients now need intensive care at the same rate that older patients did a few months ago. The vast majority are unvaccinated, and most of the vaccinated people who are hospitalized have compromised immune systems or are over 65, she said.

Right now, staffing is a bigger concern than bed space or supplies such as ventilators or masks, Welch said. Some health care workers have left the state for higher wages elsewhere, and others retired or found work in a different industry because they were exhausted, she said.

In the first wave, most of pain was localized to the Northeast and a few large cities. In summer 2020, the virus was rampaging through the South. Right now hospitals are filling up around the country. That means it’s unlikely that other states can relieve the pressure on hot spots by sending in nurses or accepting transferred patients.

Over the past few weeks, the pain largely was concentrated in the South, but now hospitals in parts of Kansas and Oregon have begun to run out of beds. Nationwide, more than 100,000 people were hospitalized for COVID-19 as of Thursday.

One model has estimated as many as 98,000 Americans could die of COVID-19 between now and Dec. 1 if the current trends continue, although the toll could be substantially lower if most people wear masks and limit in-person interactions.

“Unfortunately, as the rest of the country battles this surge of the delta variant as well, there are not many national resources that Colorado can rely on for staffing assistance,” Welch said.

Medical workers demoralized

Nurses who traveled from hot spot to hot spot are wearing out. And although the number of people who have left the field is relatively small, every person matters during a surge, said Olivia Thornton, an associate nurse manager for Uchealth University of Colorado Hospital.

It’s “demoralizing” to see another spike, now that vaccines are widely available, she said.

“We’ll somehow figure out how to do it. It’s what nurses do,” she said.

Other states are seeing the effects of staff departures. As of Aug. 18, Mississippi reported almost 1,000 beds were being left empty because no one was available to staff them, while 250 people waited in emergency rooms. In Oklahoma, state officials asked the hospital trade group to reassess capacity, because there might not be enough staff members to care for patients in the available beds.

Some hospitals in Florida and Arkansas have seen staffers quit because of overwork, leaving fewer people to care for the patients and leading to more stress-induced departures, said Dr. Marc Moss, head of pulmonary sciences and critical care medicine at the University of Colorado School of Medicine. Health care workers are exhausted not only by the workload over 18 months, but by the need to defend what they’re experiencing as real, he said.

“All it takes is a few people (quitting), and it just starts to spiral,” he said.

Doctors and nurses are taught not to judge patients’ choices when delivering care, but dealing with another wave that largely could have been prevented if more people had gotten vaccinated is taking a toll, Moss said. And of course, the community solidarity that helped propel them through the first wave is long gone, he said.

“I’m afraid that this wave, because of the reason it’s happening … is going to break the souls of health care workers,” he said. “I’m concerned people are just going to say, ‘I can’t do it anymore.’ ”