Hospitals ‘very close to a tipping point’ to be able to save all severely ill patients

Published: Nov. 11, 2020 at 9:39 PM CST
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(WSAW) - Wisconsin’s COVID-19 levels in new daily cases, daily deaths, weekly averages, and hospitalizations are consistently breaking record highs and are reaching points where resources are straining even more than compared to a month ago or at the beginning of the pandemic.

On Sept. 11, there were 1,369 newly confirmed positive cases of COVID-19 on that single day in Wisconsin. On Oct. 11, there were 2,676 newly confirmed cases on that day, more than double the number a month before. On Nov. 11, there were 7,048 newly confirmed cases. That is more than five times the amount in September and more than double the number of new cases in a month’s time. All counties in Wisconsin have high COVID-19 activity level.

Dr. Ryan Westergaard, the Wisconsin Department of Health Services' chief medical officer for communicable diseases said in a Wisconsin Health News webinar Wednesday that crisis levels New York saw at the beginning of the pandemic is similar to what Wisconsin is seeing now.

“We look to New York City in April where they were hit hard and heavy with a high degree of community spread, which translated relatively quickly to hospitals being overwhelmed and a large number of preventable deaths not just from severe COVID-19 disease, but also from an insufficiently equipped health care system for all of the people who were getting sick,” he said.

“So, at the peak of that crisis in April, they were seeing 5,000-6,000 cases per day confirmed positive and they have a population of just over eight million. Here in Wisconsin, we have a population of just under six million and we’re seeing 6,000-7,000 cases a day,” he stated.

He continued Wisconsin is not seeing additional deaths in the state due to hospitals not being able to take care of patients who do not have COVID-19, but he said he is concerned. He said that is DHS’s highest priority.

“We’re very close to a tipping point,” he warned. “And I think right now, all of the hospitals are strained and it’s causing a lot of stress on health care workers and leaders, but the case fatality rate has remained kind of low relative to what he’s seen elsewhere.”

He said the reason the fatality rate has remained low is because Wisconsin has been able to learn from other states over the last six months about how to best care and treat patients with severe COVID-19, but that requires intensive care units and hospitals. If hospitals are overrun with patients, resources and staffing to provide proper care for patients, including patients without COVID-19 will limit the ability of health care providers.

“That tipping point is when we stop being able to save everyone who gets severely ill,” he urged, adding everyone is at risk if hospitals are no longer able to help critical patients of any kind.

Hospital groups in north-central Wisconsin already are more strained than even a month ago when the state decided it was necessary to open the State Fairgrounds' alternate care facility, which typically has four to seven patients there regularly. While Ascension, Marshfield Clinic, and Aspirus all have surge plans to accommodate patients, that means they are having to move staff around, condense patients, and reduce non-emergency procedures.

Marshfield Clinic’s media relations specialist, Jeff Starck said their “Marshfield hospital was able to continue performing the majority of procedures but that number is now being reduced as we see an increase in the number of COVID patients. Many of the nurses and other staff members who would have assisted with those procedures are now being used to help care for COVID patients or replace employees who are sick or have to quarantine due to an ill family member.”

In the north-central hospital region, on Sept. 11, the number of patients in the hospital with COVID-19 was 28, now it is 228.

Health care workers are also being impacted by the virus directly. As they interact with the community outside of the medical facilities, many have had to quarantine or isolate after coming in contact with people who have tested positive for COVID-19. That means they cannot go to work, creating even more staffing shortages and causing their remaining staff to work longer hours.

“That is one of the one, two, three punches of COVID right now, if you will, on the health care systems.” Wisconsin Hospital Association CEO, Eric Borgerding said in Wisconsin Health News webinar. “Not only are we seeing demand, COVID related demand for care, just, almost go at a vertical pace, truly (referring to the trend in cases and hospitalizations), but it’s coming at a time when our capacity to treat that demand is becoming more and more diminished.”

He went on to say that if capacity in terms of the number of beds or physical limitations was the only issue, that could be easily solved, but it is the staffing of those beds that he hears about daily from hospitals all over the state.

In a separate briefing with the Wisconsin Manufacturers and Commerce members, Mark Kaufman, WHA’s chief medical officer showed the latest graphs of the various COVID-19 data.

“In the spring we talked about flattening the curve, well this is the curve that we were referring to and clearly, we have not flattened the curve,” he said.

He continued, “There’s some chatter occasionally that are we just seeing more cases because we’re doing more testing and the answer is that’s really not the root cause.”

He stated Wisconsin is at 36% for its seven-day average of the percentage of positive cases by person, explaining that states that have gone through COVID-19 waves have talked about keeping that average below 5%. He called Wisconsin’s percentage “dismal.”

This surge is also impacting health departments' ability to manage this infectious disease. Judy Burrows with the Marathon County Health Department said last week the average number of daily new cases of COVID-19 was 170. The county has about 30 contact tracers. If each person who was diagnosed with COVID-19 only came in contact with five other people, that would be 850 those contact tracers would need to call. Burrows stated at this point, they are not truly contact tracing; they are just trying to make contact with people to help inform them of what to do next, if they can even get in contact with them.

“We prioritize who we’re going to contact first based on their age and if they’re part of a congregate living or school system because that’s where we feel we can have the biggest impact,” she explained.

That means they are not tracing people’s steps, asking if they went to the polls, to a Halloween party, to a wedding, etc. She urged people to pick up the phone if they call because it could be the only opportunity contact tracers have to help individuals properly navigate isolation and quarantine in their homes properly. For Marathon County residents, she said if the phone number begins with 715-261-xxxx, pick it up.

Marathon County is among the top four counties in the state in terms of the number of facility-wide investigations being done. Currently, the county is investigating 182 facilities, which Burrows said runs the spectrum including at schools, office buildings, factories, etc.

How did we get here?

Compared to other states, Wisconsin was managing the pandemic fairly well at the start. The state has been able to learn about the virus as other countries and states saw surges and figure out best practices, but the surge still made its way to Wisconsin.

“I believe that inconsistent messaging from leaders across the spectrum has really been a major root cause for why we are doing poorly,” Dr. Kaufman said. He also cited the politicization of COVID-19 safety measures like masking, misinformation on social media, students (particularly college students) returning to school, cold weather and people moving indoors due to that, and people not consistently following COVID-19 safety precautions.

Dr. Westergaard said based on the data, the COVID-19 started to get away from manageable control in mid-to-late summer. He believes that is due in part because there were a lot of people who were likely asymptomatic, did not limit their interactions with others or follow COVID-19 safety guidelines, and spread it to others, particularly on college campuses.

“I think we have a fair amount of people who are doing their best," Burrows said. “I think we have some people that (sic) are skeptical of the recommendation we’re making and I think all of us are tired. All of us want to do the things that we used to do the way we used to do them and the reality is we can’t do that right now.”

All three said studies show wearing masks helps to mitigate the spread of the virus, but that is just one of several measures that people need to take.

“People need to remember that wearing masks and keeping your social distance are a ‘yes and.’ You should do both. Wear the mask and keep a social distance of six feet or more in order to protect yourself and I think sometimes people think that if they’re doing one they don’t have to do the other,” Burrows said.

Some hope

The U.S. Food and Drug Administration granted emergency use authorization Monday for Eli Lilly’s monoclonal antibody, bamlanivimab to treat COVID-19. It is for newly infected patients who are at high risk for a severe reaction to the disease, but who are not in the hospital. Dr. Kaufman said early data shows those when it is used, it decreases emergency room visits and hospitalizations. So far, it appears Wisconsin will receive 4,260 treatment courses through DHS from the U.S. Department of Health and Human Services initially.

“The company says it will manufacture enough drug to treat a million patients by year-end, which sounds really terrific and it is good news, but just consider the fact that the virus is now infecting an average of over 111,000 in the United States every day,” Dr. Kaufman cautioned.

There are 38 COVID-19 vaccines being tested, which are at a variety of trial phases. So far none are fully approved, six are approved for early or limited use, but are in other countries. Pfizer will likely be the first vaccine in the United States to be approved for emergency use authorization, they expect that by the end of November. While they would expect to have enough supply to immunize 15-20 million people. It does require two doses.

However, there are no long-term safety studies because it has not been around long enough. The Pfizer vaccine has about two months of encouraging safety data, but Dr. Kaufman said two years is a good point for that kind of data. The vaccine uses messenger RNA, which Dr. Kaufman said has never been used in humans.

He added a vaccine also will not help to stop the spread over the next three to five months. To have herd immunity in the population, he explained about 80% of the population would have to have COVID-19 antibodies. To determine how many people would need to get the vaccine to get herd immunity, you multiply the percentage of effectiveness, which the Pfizer vaccine is currently showing more than 90%, by the percentage of the population vaccinated to give you the percentage of herd immunity in a population. So, if 80% of the population got the Pfizer vaccine, there would be 72% herd immunity.

“Now, I’ve heard people say, ‘well maybe one of the -- the pandemic is so widespread that maybe we’re approaching herd immunity.’ Well, unfortunately, no," Dr. Kaufman said. "There was a recent study from the Red Cross from their blood donors and that indicates that only 7% of the population in the country have COVID-19 antibodies.”

In another public meeting with the DHS discussing the planning for vaccine implementation, Wisconsin is expected to be allocated 975 doses of the Pfizer vaccine if it is given emergency use authorization. They are still working to specify the priority levels of who would get the vaccine, but in general, frontline health care workers would be prioritized to get the vaccine first. With the steps needed to get the vaccine to states, the earliest the first set of health care workers could get it would be in January. The second dose would be needed to be taken about 21 days later.

Dr. Kaufman again said the way to mitigate the spread of the virus in the meantime is through wearing masks, social distancing, limiting interactions with people outside of your home, sanitizing surfaces, and washing hands. Burrows added, as holidays approach, people also need to celebrate differently, understanding that that is not an easy decision, but a necessary one.

“Our hospitals are very full,” Burrows stated. “Our critical care units are very full. We need to pay attention to those signs that we’re headed into a very, very dangerous winter if we don’t really hunker down and start following the recommendations we’ve been giving people.”

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