Just a few hundred feet from St. Claire Regional Medical Center in Morehead, Kentucky, it’s business as usual at Mcdonald’s.
Morning commuters crush together to get coffee, hash browns, and egg McMuffins. There are a few masks, but mostly the scene inside almost looks like any busy Mcdonald’s before the pandemic.
But inside St. Claire, things are very different. There, the reality of the Delta variant surge of Covid-19 is on full display.
“This fourth surge here in this region has been the worst of all the surges since the beginning of the pandemic,” said Don Lloyd, St. Claire Regional’s CEO. “It’s not only for St. Claire but for all the institutions throughout Kentucky, whether you’re in Western or Eastern or Central, it doesn’t make a difference; it’s just horrendous.”
For weeks, he said, the hospital has struggled to keep up with the flow of incoming patients by expanding its clinical capabilities multiple times. Now the hospital has four temporary intensive care units (ICUs). About half of the patients coming into the hospital have been Covid positive, he said.
“The difference between this surge and the others is the proportion of those patients who are critically ill,” he said.
Of those admitted with Covid, about half will end up on some kind of breathing apparatus, he said. About half of those patients will be put on a ventilator. Lloyd said about 25% of the Covid positive patients that are admitted will die. Of those that are put on a ventilator, about 75% will die.
At the height of the pandemic in 2020, St. Claire had a maximum of 25 patients. During that time, the hospital saw around two Covid-related deaths a week, Lloyd said.
As of September 17, St. Claire had more than 160 Covid positive patients, and was experiencing two or three deaths per day, he said.
Without adequate numbers of beds, the hospital has had to come up with creative ways to handle them – including erecting a fully operational field hospital in its parking lot. For patients who need to be admitted, he said, the hospital has to find a bed. The hospital is limited in transferring patients because other hospitals don’t have beds either.
“We are operating right now at about 135% of capacity,” he said. “We had one ICU, but right now, we have critical patients in five locations. We converted the post-anesthesia care units to a secondary ICU which is full. Our regular ICU is full. We opened up a third ICU in an infusion oncology area and now because we don’t have beds available in that area, we are seeing critically ill patients and holding them and treating them on Covid units where we’ve allocated a certain number of beds for the critically ill.”
Patients are getting care, he said. But providing care in those conditions is not optimal – for the patients or the medical staff.
Regardless of the number of beds the hospital adds, he said, the real issue is the number of nurses to care for those patients.
Patients with Covid are often treated through what is called “proning,” he said. In this treatment, patients lay on their stomachs for a period of time before being turned over. But turning a patient isn’t as simple as flipping them onto their back.
“It requires six people to turn those patients because they’re still hooked to a ventilator, and they have all sorts of lines and drains in them,” he said. “You need to be very judicious and careful. At the very best, that is a 15 to 20-minute process… When you have 22 people on ventilators, that’s a massive undertaking and utilization of clinical resources.”
To augment the clinical staff, the hospital has trained non-clinical staff to help with turning patients. Additionally, 30 nursing students are volunteering their time to help. But still, he said, there’s not enough nurses to care for the volume of patients the hospital is seeing. The hospital has also closed clinics and transferred nurses from those clinics to the Covid care teams.
The hospital has also had help from disaster teams from the Federal Emergency Management Agency (FEMA) and non-clinical help from National Guard members, he said.
“I’ve been doing this for 40 years,” he said. “I’ve been through, maybe 15 or so hurricanes up to a category 5 on a couple of occasions. I’ve been through man-made disasters, and terrible, terrible multi-vehicle accidents, but the death and carnage that I have witnessed and my teams have witnessed for almost two months now… I have never seen anything like it.”
This surge of the pandemic is taking its toll on nurses, physicians, and other clinical staff, he said.
“I’ve had nurses that have just fallen apart after holding up an iPad so a family could say goodbye or holding the hand of somebody in ICU as they pass,” he said. “You know, it’s worth it. When you sign up for this business, you know, you have to do those things occasionally, but you don’t expect to do it five times in one shift.”
The hospital offers psychological counseling to all of its staff members to help them cope with the onslaught of patients, he said. But they will have to continue to work mandatory overtime until the surge comes to an end.
The hospital’s analytics says the peak of the surge could come at the end of this month. But, he said, there won’t be time to rest. Delayed trips to the hospital last year are leading to escalations of serious conditions in patients this year. And while there was virtually no flu season last year, already the hospital is seeing respiratory syndromes.