Covid and Hospitals: How are things now?

[CrunchRN]

Just curious. Here in DFW I see hospitalizations are rising to 14%. How are things in the hospitals? Are things relatively normal? No more furloughs?

Please share. I am not in acute care, but I am of course very interested in the effects on acute care staff.

[CrunchRN, ADN, RN]

I wonder what the Covid percentage of patients is in the hospitals in Utah? Are they not doing masks etc?

[NRSKarenRN, BSN, RN]

3 hours ago, CrunchRN said:

I wonder what the Covid percentage of patients is in the hospitals in Utah? Are they not doing masks etc?

Utah just implemented statewide mask mandate mid October.  As of 10/26/20, the rolling seven-day average for new cases  is ~1,500 per day with the average positive test rate at 17% - high rate of transmission.   Compared to PA's 10/26  5% positivity rate along with increased cases, masks mandated outside home   and  < 6ft distance between people -- high rate mask wearing seen in my SE PA corner.

Utah Desert News 10/13/2020:

Utah officials set statewide mask mandate for social gatherings,

Quote

After a week of unprecedented new COVID-19 case counts, Utah officials announced Tuesday that masks will now be required across the state “anywhere people congregate together for an event.”...

...The announcement comes after Utah Gov. Gary Herbert has for months hinted at the possibility of a mask mandate but ultimately declined to implement one, saying he prefers local leaders to make that decision themselves....

...New health guidance levels

Under the state’s new plan in the battle against the pandemic, counties will move to the high level of transmission if they have a seven-day positive test rate of 13% or more; a two-week case rate of 325 cases or more per 100,000 people; and if statewide intensive care unit usage is 72% or higher overall and 15% or higher with COVID-19 patients specifically.

The moderate level of transmission index will include counties with a seven-day positive test rate of between 6%-12.9%; a two-week case rate between 101-324 per 100,000 people; and statewide intensive care usage between 69%-71.9% overall and 6%-14.9% for COVID-19 patients.

To move to the low transmission category, counties will require a seven-day positive test rate of 5.9% or lower; a two-week case rate of 100 or fewer per 100,000 people; and a statewide intensive care unit usage of 68% or lower and 5.9% or lower from COVID-19 patients.

While masks are required at all public gatherings, nonpublic, casual gatherings have different restrictions based on transmission level, Saunders said. Church meetings are considered public gatherings under the guidelines. The state is not defining how many people may attend public gatherings.

10/25/20

Utah Hospital Association officials warned Sunday that the state is approaching the need to implement crisis standards of care. That means hospitals with no room would make decisions based on triage criteria, prioritizing treatment based on the severity of patients’ cases and their likelihood of survival with or without treatment.

https://www.deseret.com/utah/2020/10/26/21534502/coronavirus-new-cases-deaths-hospitalizations-crisis-standards-of-care-slight-dip-1201-cases

 

[turtlesRcool]

At my staff meeting today, an administrator stopped in.  One thing she pointed out is that although our community numbers are up, it's not translating to hospitalizations the way it did in the Spring because of the demographics of the patients.  In the Spring when the hospital filled up and so many died, about 50% of our patients were from nursing homes.  The new infections are from socialization out in the community, and the patients largely younger (under 40), so we expect many will not need acute care.  

[CrunchRN, ADN, RN]

Thank you NrsKaren.

That is interesting turtlesRcool - where are you regionally?

Also, I am a huge sea turtle fan.

[turtlesRcool]

25 minutes ago, CrunchRN said:

Thank you NrsKaren.

That is interesting turtlesRcool - where are you regionally?

Also, I am a huge sea turtle fan.

Connecticut

If you look at the states with the highest death rate per capita, they are the places that were hit hard in the first wave (NJ, NY, MA, CT). We have learned so much since those early days when we were guessing at how to treat it, and we didn't even have tests to figure out who was infected.  The shortage of testing and PPE was especially bad news for the nursing homes, and when COVID raced through those facilities, our most vulnerable people had the double whammy of fragile initial health and ineffective treatment (we vented so many people, and 52% of patients we put on vents died). There have been vast improvements in treatments, and outcomes are generally much better.  

Still, COVID remains deadly, and prevention remains the best, most important tool we have.  Masks and social distancing have been legally required in the state since the Spring, and we just recently moved to phase 3 which increased capacity at many venues, though bars and nightclubs remain closed.  Compliance here is generally good, and I think that's partly due to seeing so much devastation last Spring. I do worry about increased transmission as compliance fatigue sets in, and the colder weather moves us indoors, but I'm cautiously optimistic we won't have another wave dominate our health care system the way it did in April and May.

(PS - yes, turtles are amazing, and sea turtles especially so!)

[NRSKarenRN, BSN, RN]

El Passo reported to have 110 persons on ventilators per today's MSNBC news report,

PA and NJ numbers spiked per todays Philadelphia Inquirer

COVID cases in Pa. exceed April numbers; N.J. hospitalizations match July rates: ‘Exponential spread is moving in’
 

Quote

 

We’re seeing evidence that exponential spread is moving in,” said David Rubin, the physician leading the COVID-19 modeling project by PolicyLab at Children’s Hospital of Philadelphia. That would mean it takes less and less time for case numbers to double.

Nationwide, the number of cases also continued climbing. Though the number of daily deaths has remained much lower than during the pandemic’s peak, 983 people in the United States died of the virus or its complications on Tuesday, an increase of 13% from two weeks earlier, according to New York Times data....

..Though Pennsylvania has surpassed the April peak in daily case numbers, its death rate remains much lower than it was in the Spring. Over the last two weeks, the state’s death rate has been at 2.4, well under the national rate of 3.3 deaths per 100,000 people, and ranks 35th among states and the District of Columbia. On Wednesday, North Dakota had the highest rate at 15.6 deaths per 100,000, according to data from the New York Times.

“Today’s case increases will be felt by hospitals in 10 to 14 days,” Rubin said.

In Pennsylvania, 1,187 people were hospitalized on Wednesday. So far, hospitals in most Pennsylvania counties have ample capacity, state monitoring shows.

A total of 1,010 New Jersey residents were hospitalized with COVID-19 as of Wednesday,,,

 

US currently hospitalized: https://covidtracking.com/data/charts/us-currently-hospitalized

 

US interactive map state death stats available :

https://www.inquirer.com/health/coronavirus/coronavirus-covid-19-pandemic-pa-nj-philly-rising-cases-deaths-hospitalizations-rates-20201028.html

 

 

[CrunchRN, ADN, RN]

Thank you for those updates and insights.

El Paso has a very high risk population due to multiple factors. I am not surprised it is getting extremely bad again in that area.

[turtlesRcool]

Due to increased community spread, my hospital revoked visitation yesterday.  With lower numbers back in August, we started allowing patients to have one visitor a day for a two hour period during specified hours.  

Also, we are now required to wear a face shield or goggles/safety glasses during all patient interactions, in addition to our masks.

Still no big bump in hospitalizations. 

[SansNom]

Middle TN here, we had a nice drop in cases for a month or two (like most of the country) and even closed one of our covid ICUs, but have reopened it about a week ago and most of our beds are full again. Since the beginning though we've been expanding and shrinking our covid space based on admissions. Tricky situation.

[Rose_Queen, BSN, MSN, RN]

Had to open 2 units, one of which is asymptomatic and one that is symptomatic PUI/positive. ICU COVID numbers increased tenfold. Some surgeries placed on hold due to lack of beds. Went from single digit numbers of inpatients to triple te number with about 1/3 in ICU.

[Jason6915]

My hospital seems to be slowing down with cases

[CrunchRN, ADN, RN]

It really is all over the board.

Ironically, my MIL had to be admitted to the hospital from her ALF here in Fort Worth Saturday night due to Pneumonia (not Covid related). She was still in the ER waiting for a room to open up as of 6pm last night. The hospital is definitely full, but not sure if that is related to Covid or just flu season being upon us.