It is a perfect storm.
COVID infections are threatening to overwhelm metro-area hospitals and clinics more than two years after the pandemic began. It’s a wave being pushed by hospitalizations of primarily unvaccinated patients, as well as the highly contagious omicron variant.
“It’s all hands on deck,” said Dr. Russell Adams, chief medical officer at UnityPoint Health-Allen Hospital.
“We’re finding that our hospital is suddenly filled, and we’re constantly running out of access to treating patients. A lot is related to COVID in the ICU and on medical floors. In the ICU we have five or six being treated and the vast majority are unvaccinated. On the medical floor, we usually have 20 to 26 COVID patients,” Adams said.
From Dec. 29 to Jan. 7, UnityPoint postponed elective and surgical procedures that required an overnight stay. That has been extended until the end of January.
The two-dose vaccines and booster may reduce the severity of COVID, Adams said. “There are multiple examples through history – smallpox, measles, shingles – where vaccines help. COVID-19 has killed so many people. A vast number of COVID patients in our intensive care unit are unvaccinated, and it’s predominately the unvaxxed who are dying from COVID.”
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In Iowa, there were 161 confirmed deaths from Oct. 13 to Dec. 30, according to state health officials. There have been 24,935 positive tests in the last seven days and 168 COVID patients admitted to hospitals in a 24-hour period as of Friday.
Current Black Hawk County COVID-19 status is ranked as “high.” Data shows 14-day average percent positive rate at 32.9% as of Thursday.
The county is at its highest COVID level since November 2020. On its website, the Black Hawk County Health Department said it continues to work with health care partners to respond to community needs.
“We need everyone to do their part to alleviate the stress on our health systems, to slow the spread of COVID-19 in our community, and to protect the health of yourself and your family.”
At MercyOne Waterloo Medical Center, there has been an increase in COVID hospitalizations in its 12-bed ICU. “Our ICU is full and nine patients are COVID positive,” said hospitalist Dr. Julie Sandell, and 25 COVID patients in total are hospitalized. Eighty-five percent of COVID patients being treated are unvaccinated.
There also has been an increase in patients suffering from flu and other respiratory infections, said Kelly Richards, chief nursing officer at MercyOne. And like other area hospitals, MercyOne is short-staffed.
“Our staffing situation is not unlike anybody else’s situation. We’re doing different things to recruit staff and to be market-competitive. It’s a challenge.”
Although staff is fatigued, Sandell said, “As long as there are people to take care of, we’ll be here every day. I’m very proud of how everyone is pulling together.”
At Waverly Health Center, actual patient numbers are lower than a year ago, but patients being hospitalized have a higher rate of acute illness. “We’re having to keep patients here that we would normally place at larger facilities, but those facilities are at capacity. We don’t have any place to (transfer) them due to a shortage of beds at other facilities. We have the physical space here, and not enough people to care for them,” said Dr. Clay Dahlquist, chief medical officer and hospitalist.
Patients are receiving the best quality care, he said, but resources are being stretched thin by patients who should be transferred to an ICU – “but we can’t find an ICU to take them within a four or five hour drive (many times).”
In addition, Dahlquist said being “short-handed is hard on the staff. Everyone is being asked to do more and more, and what we’re doing is never enough. We’ve chosen this profession because we want to help people, but people are maxxed out after the last 18 months.”
If there is any silver lining from COVID, Waverly Health Center Chief Operating Officer Heidi Solheim said it’s that “it has brought health care communities closer together. We are working with UnityPoint Health, University of Iowa Hospitals and Clinics and others to solve the bed crisis. We talk to Iowa City daily now. I feel positive about the relationships we’ve made. There are fewer barriers and lots of good intentions for creative solutions and a lot of trust in each other,” she explained.
Roughly 400 free COVID test kits are going out the doors at People’s Community Health Clinic, “which is great – that’s what the system was designed for. People can test themselves rather than take up space from someone at a clinic who is at greater risk,” said Dr. Kim Neumann, co-medical director.
Medical experts describe the highly contagious omicron variant as having milder symptoms, similar to a cold. Many people who are infected may be asymptomatic, which increases the spread. Neumann, who is also medical director of PCHC’s pediatric services department, said the variant is “very transmissible.
“Everyone in the household has the same symptoms. I’m a pediatrician, and my exposure is limited to kids, but parents are describing a relatively mild illness – low-grade fever, congestion, cough, headache, but no loss of taste and smell,” she said.
In recent days, “our numbers are triple what we normally see,” in relation to possible COVID cases, said Co-Medical Director Dr. Sharon Duclos. “We have to make adjustments and try to get more staff into urgent care, and sometimes we don’t have the staff and end up capping the number of people we can see. You hate having to turn people away, but you’re trying to preserve your staff and keep them going,” she said.
A percentage of PCHC staff “is out sick with COVID, and like everyone in the health care profession, we have openings that we’re having difficulty filling – aides, nursing staff, counselors – and we’re recruiting, but not getting in applications we used to,” Neumann said.
“For those of us on the front lines, our staff has really stepped up to the plate in an incredible way. They’re taking on new roles and responsibilities within their jobs.”
Kristen Engelbrecht is a registered nurse on 3-Medical at Allen Hospital, one of the primary units treating COVID-19 patients. Two years ago, she was in tears after caring for her first COVID patient. “It was really scary because of the unknown. At the end of that week, I thought if I was in tears just once, then maybe I could make it. Now there’s a lot more we know about COVID, different ways to treat it, an understanding of why we’re doing things,” she said.
For example, COVID patients are asked to lie prone on their stomachs, if possible, which takes pressure off their lungs and improves breathing. “They require less oxygen and have a better outcome. I don’t think people realize that if they are hospitalized for COVID, it’s not just a few days. People are there for weeks and months,” said Engelbrecht, who has been an RN for 5 ½ years.
In spite of the current situation, UnityPoint’s Adams said “we’re in a better place. We have a better sense of what works and what doesn’t work on both the ambulatory and inpatient sides. We are constantly learning and adapting.”
More therapeutics are available, including the vaccines, said MercyOne’s Sandell. “Vaccines will prevent hospitalization and severe disease and death – they do a good job of that. People who are immune-compromised, children with severe immune deficiencies, cancer patients, people with chronic illnesses, their lives truly are in danger. So, it’s not all about you.”
Richards, MercyOne’s chief of nursing, said a vaccinated patient likely will have a shorter hospital stay. “If a patient comes in for treatment who is unvaccinated, we worry, are they going to make it out the door again?”
In the long term, COVID is “something we’re going to have to learn to live with. There will be yearly vaccines, just like with annual flu shots,” Adams said.