‘THE VOLUME IS OBSCENE’
How Connecticut’s hospitals are dealing with COVID surge
Dr. Robert Fogerty said he expects the number of COVID patients in Connecticut hospitals to exceed 2020’s peak “probably within the next two weeks.”
“If you want a date, I’d say 2,000 inpatients on Jan. 12,” he said. “Boy, I hope I’m wrong.”
Fogerty is director of bed resources at Yale New Haven Hospital and, if he’s right, that would be more than the pandemic-high 1,972 COVID hospitalizations there were on April 21, 2020.
Hospitals in Connecticut are seeing a fast increase in the number of new patients. The state announced Wednesday a net increase of 114 COVID patients in Connecticut hospitals, for a total of 1,676, but that’s only a piece of the picture.
“We have seen a tremendous amount of patients coming through the emergency room, generally for mild disease, or sometimes for testing only,” said Dr. Ajay Kumar, executive vice president and chief clinical officer for Hartford HealthCare. “That does actually increase our impact on emergency rooms.”
Dr. Brooks Walsh, an emergency room physician at Bridgeport Hospital, took a break Wednesday after treating a stroke victim. That, he said, is the big difference between the current surge and April 2020: “All that stuff has come roaring back,” he said.
“In a lot of ways, it’s worse than it was in 2020,” Walsh said. “It’s so much better in other regards, but we have our own set of problems. A lot of non-COVID stuff stayed away in early 2020. That’s not true this time.”
The sharp rise in hospitalized
cases comes amid a surge in new infections. On Wednesday, the state reported 10,344 COVID cases were found in 45,760 new tests for a positivity rate of 22.6 percent, one of the highest since widespread testing started weeks into the pandemic.
There was a shortage of nurses before the latest surge and medical professionals were leaving the job after nearly two years of a pandemic, some in the industry have said.
“The burnout is real,” Fogerty said. “People are leaving, and nobody blames them. And that says a lot in health care.”
The surge has only exacerbated that situation, according to Gregory Shangold, an emergency room physician and former president of the Connecticut State Medical Society.
“Many of the staff, despite being vaccinated, are coming down with COVID,” he said. “You have a workforce shortage just because so many people are getting COVID.”
“You need more staff as the volume has gone up, and we were starting at a short baseline,” he said.
Though Fogerty and other hospital administrators have said they are able to handle the influx of patients, resources are getting stretched.
“If you define capacity as the physical space as well as the staff, we’re definitely above capacity. Rooms are filled, patients are staying in emergency rooms,” Shangold said, which has led to some difficult questions. “Do you do surgeries and things like that or are we so overwhelmed that we can’t pay as much attention to the details that we normally do?”
Walsh agreed that there are staffing issues — “A lot of people, nurses in particular, have left, picked different opportunities,” he said.
But those who have stayed are dedicated.
“The people who have stayed, they’re just really such good people. We have a good core staff here who wants to be here,” he said. “Even though we have some shortages, the people who are here are good folks.”
Kumar said “one of the most important impacts” of the latest surge has been on the hospital emergency rooms.
Dr. Ken Robinson, Hartford HealthCare’s chief of emergency medicine, said staff has been able to handle the increased volume.
“We are managing it at this time,” he said.
“I don't want people to be worried about coming to the hospital and thereby delay coming to the hospital, if they have a serious worry, chest pain, shortness of breath, if they think they might be having a stroke,” he said.
So far, Connecticut hospitals have not paused elective surgeries, but medical personnel have been forced to make increasingly difficult decisions.
“The folks that clearly need the hospital, we will always find a way to care for them. That's what we do,” Fogerty said. “The folks that clearly don't need the hospital go home. That middle slider bar are the hardest and most emotional triage decisions to make.”
Though the numbers are the same, a lot has changed since 2020.
“Back then, we didn’t have masks,” Fogerty said. “I think the problems are just different. We had plenty of staff back then. Now there's no staff anywhere.”
In 2020, the coronavirus had never been seen before. Doctors didn’t know how to treat it or how it spread.
“We know more about it now than we did back then,” Fogerty said. “I remember having a discussion, can we use tape? Can we use ibuprofen? Can we use steroids? We now know all that. Now we know how to treat this more effectively. So the unknowns are less, but the volume is obscene.”
“Over the last couple of weeks, we've seen a 25 to 30 percent increase in our daily patient volume,” Kumar said Tuesday, but the percentage of patients in intensive care units is far lower than it was in 2020.
Hartford HealthCare said Wednesday there were 425 COVID patients in its hospital system, though only a small fraction were in the ICU.
“We had about 61 patients that were in our ICUs getting treated,” said Keith Grant, HHC’s senior system director for infection prevention. “And of those 61 patients, we had seven patients that were vented.”
“With the same number of patients in the hospital, we have really half of those numbers, the number of people in critical care,” HHC CEO Jeff Flaks said. “So although we may have the same number of people we're caring for, the level of acuity, level of intensity that we're experiencing for those people is different.”
And hospitals have learned how to “maximize the use of all of our resources, including our beds and our staff,” Fogerty said.
“Now we realize that with things like private rooms, and HEPA filters and cohorting strategies, we can make use of more rooms without having to block off entire wings,” he said. “We we can do that, not for every patient, there are some patients that are extremely vulnerable, and we still cordon them off as best we can. But, to some extent, the mainstreaming of the disease process has been pretty critical.”