The feared surge in COVID-19 cases has arrived, one to two months early, leading to sharply higher hospital admissions and accelerating the implementation of hospital resurgence plans.
COVID-19 patients at NorthShore University HealthSystem’s Glenbrook and Evanston Hospitals doubled over the past two weeks to 126 on Friday. Patients at AMITA Health Saint Francis Hospital increased four-fold over the past four weeks to 19.
Although current COVID-19 inpatient levels are below the peak reached last spring – 71 patients at Saint Francis and 180 to 200 patients at NorthShore – the timing of the recent increase is worrisome, said Dr. Neil Freedman, head of Pulmonary, Critical Care, Allergy and Immunology at NorthShore and Vice President of Acute and Post-Acute Care Integration. Dr. Freedman is the lead physician in charge of managing Northshore’s COVID-19 patient care and the effort to develop a resurgence plan.
Colder winter weather and the flu season – which generally leads to higher hospital admission – have yet to begin.
In addition, hospitals today are occupied with normal or non-COVID-19 patients, unlike last spring when patients stayed home and elective surgeries were canceled, explained Dr. Freedman. “Last Spring, hospitals were overrun with COVID-19 patients, but the actual number of patients in the hospital was lower and made it easier to re-allocate staff and space,” he said.
Staff, especially nurses, and space, rather than personal protective equipment (PPE), are the main issues this time around. “We have plenty of nurses at baseline, but many nurses have been exposed to the virus through community spread or have children e-learning at home,” said Dr. Freedman, restricting their availability.
To alleviate staff shortages, NorthShore is hiring additional nurses and physicians and bringing out-patient physicians, such as primary care physicians, within the NorthShore system network, into the hospital.
NorthShore has made several recent changes to free up space at Glenbrook Hospital, now entirely devoted to treating COVID cases. These include moving the orthopedic trauma unit and opening a short-stay unit at Skokie Hospital. NorthShore has cut back on some elective procedures and may impose further restrictions if numbers continue to climb.
NorthShore’s predictive analytics team estimates that if current trends persist, NorthShore will have between 206 and 220 COVID-19 patients one week from today and 306 to 343 patients in two weeks. This would exceed the high-end of the patient thresholds envisioned in the resurgence plan developed in September and could require such drastic measures as eliminating all elective surgeries, severely limiting out-patient visits to free up physicians and nurses for hospital care, and in a worse-case scenario, rationing care.
Dr. Freedman attributes the recent sharp increase in COVID-19 patients to the colder weather and people letting their guard down and gathering inside. He said two-thirds of current cases come from small-group exposures with friends and family and cautioned people to assume that everyone can have COVID-19.
Thanksgiving gatherings may need to be virtual this year, suggested Dr. Freedman. “There will be a vaccine in the future, but we need to sacrifice now.”
COVID-19 cases started increasing sharply in mid-October and are currently averaging twice the previous peak in May.
Percent positive test rates are lower than peak levels. Widespread testing, together with climbing positive rates from summer lows, is driving the recent increase.