Hospitals Face Staff Shortages as Covid Surges

By Lauren Weber, Phil Galewitz and Andy Miller, Kaiser Health News

The Cleveland Clinic in Weston, Florida, on Jan. 11 was treating 80 covid-19 patients — a tenfold increase since late December. Nearly half were admitted for other medical reasons.

The surge driven by the extremely infectious omicron variant helped push the South Florida hospital with 206 licensed beds to 250 patients. The rise in cases came as the hospital struggled with severe staff shortages while nurses and other caregivers were out with covid.

The challenge is finding room to safely treat all the covid patients while keeping staffers and the rest of patients safe, said Dr. Scott Ross, chief medical officer.

“It’s not a PPE issue,” he said, referring to personal protective equipment like masks, “nor an oxygen issue, nor a ventilator issue. It’s a volume issue and making sure we have enough beds and caregivers for patients.”

Nationally, covid cases and hospitalizations are at their highest levels since the pandemic began. Yet, unlike previous covid surges, large portions of the patients with covid are coming to the hospital for other reasons. The infections are exacerbating some medical conditions and making it harder to reduce covid’s spread within hospital walls, especially as patients show up at earlier, more infectious stages of the disease.

Although the omicron variant generally produces milder cases, adding the sheer number of these “incidental” hospitalizations to covid-caused hospitalizations could be a tipping point for a health care system that is reeling as the battle against the pandemic continues. Rising rates of covid in the community also translate to rising rates among hospital staffers, causing them to call out sick in record numbers and further stress an overwhelmed system.

Officials and staff at 13 hospital systems around the country said that caring for infected patients who need other medical services is challenging and sometimes requires different protocols.

Dr. Robert Jansen, chief medical officer at Grady Health System in Atlanta, said the infection rate in his community was unprecedented. Grady Memorial Hospital went from 18 covid patients on Dec. 1 to 259 last week.

Roughly 80% to 90% of those patients either have covid as their primary diagnosis or have a health condition — such as sickle cell disease or heart failure — that has been exacerbated by covid, Jansen said.

Although fewer of their patients have developed pneumonia caused by covid than during the major spikes early last year, Grady’s leaders are grappling with high numbers of health care workers out with covid. At one point last week, Jansen said, 100 nurses and as many as 50 other staff members were out.

In one of New Jersey’s largest hospital systems, Atlantic Health System, where about half the covid patients came in for other reasons, not all of those with incidental covid can be shifted into the covid wards, CEO Brian Gragnolati said. They need specialized services for their other conditions, so hospital staffers take special precautions, such as wearing higher-level PPE when treating covid patients in places like a cardiac wing.

At Miami’s Jackson Memorial Hospital, where about half the covid patients are there primarily for other health reasons, all patients admitted for covid — whether they have symptoms or not — are treated in a part of the hospital reserved for covid patients, said Dr. Hany Atallah, chief medical officer.

Regardless of whether patients are admitted for or with covid, the patients still tax the hospital’s ability to operate, said Dr. Alex Garza, incident commander of the St. Louis Metropolitan Pandemic Task Force, a collaboration of the area’s largest health care systems. He estimated that 80% to 90% of patients in the region’s hospitals are there because of covid.

In Weston, Florida, the Cleveland Clinic is also having a hard time discharging covid patients to nursing homes or rehabilitation facilities because many places aren’t able to handle more covid patients, Ross said. The hospital is also having difficulty sending patients home, out of concern they would put those they live with at risk.

Hospital Infections

All this means there’s a reason that hospitals are telling people to stay away from the ER unless it’s truly an emergency, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston.

The sheer number of patients who are showing up and don’t know they have covid during this surge is frightening, Faust said. As more incidental cases pour into hospitals, they pose a greater risk to staffers and other hospital patients because they are typically at a more contagious stage of the disease — before symptoms begin, Faust said. In previous covid waves, people were being hospitalized in the middle and later phases of the illness.

In Faust’s analysis of federal data, Jan. 7 showed the second-highest number of “hospital onset” covid cases since the pandemic began, behind only an October 2020 outlier, he said. But this data accounts for only people who were in the hospital for 14 days before testing positive for covid, Faust said, so it’s likely an undercount.

A KHN investigative series revealed multiple gaps in government oversight in holding hospitals accountable for high rates of covid patients who didn’t have the diagnosis when they were admitted, including that federal reporting systems don’t publicly note covid caught in individual hospitals.

“People in the hospital are vulnerable for many reasons,” said Dr. Manoj Jain, an infectious disease specialist in Memphis, Tennessee. “All of their existing underlying illnesses with multiple medical conditions — all of that puts them at much greater risk.”

The ER in particular is a potential danger zone amid the current crush of cases, Garza said. He recommended that patients wear high-quality masks, like a KN95, or an N95 respirator. According to The Washington Post, the Centers for Disease Control and Prevention is weighing whether to recommend that all Americans upgrade their masks during the omicron surge.

“It’s physics and math,” Garza said. “If you’ve got a lot of people concentrated in one area and a high viral load, the probability of you being exposed to something like that if you’re not wearing adequate protection are much higher.”

If patients can’t tolerate an N95 for an entire day, Faust urges them to wear upgraded masks whenever they come into contact with hospital staffers, visitors or other patients.

Dr. Dallas Holladay, an emergency medicine physician for Oregon’s Samaritan Health Services system, said that because of nursing shortages, more patients are being grouped together in hospital rooms. This raises their infection risk.

Dr. Abraar Karan, an infectious diseases fellow at Stanford, believes all health care workers should be mandated to wear N95s for every patient interaction, not just surgical masks, considering the rise in covid-exposure risk.

But in the absence of higher-quality mask mandates for staffers, he recommended that patients ask that their providers wear an N95.

“Why should we be putting the onus on patients to protect themselves from health care workers when health care workers are not even going to be doing that?” he asked. “It’s so backwards.”

Some hospital workers may not know they are getting sick — and infectious. And even if they do know, in some states, including Rhode Island and California, health care workers who are asymptomatic can be called back to work because of staffing shortages.

Faust would like to see an upgrade of testing capacity for health care workers and other staff members.

At Stanford, regular testing is encouraged, Karan said, and tests are readily available for staffers. But that’s an exception to the rule: Jain said some hospitals have resisted routine staff testing — both for the lab resource drain and the possible results.

“Hospitals don’t want to know,” he said. “We just don’t have the staff.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues.

Rare Disease Spotlight: Valley Fever

By Barby Ingle, PNN Columnist 

As the final article in my series on rare diseases, I am going to cover something that has been impacting my life for the past 2 years and 25 days – coccidioidomycosis --- otherwise known as Valley fever. This is a health challenge that has been difficult and longer lasting than typical for a patient like me. I have headaches, chest pain and feel exhausted.

Tests show that I am still positive for Valley fever, both the active fungal infection and the antibodies my body produces to fight it. Over the past few weeks, I feel more pressure in my lungs, as if Valley fever pneumonia is returning. I am more exhausted than ever and have skin blisters again. I liken them to shingles, as I have had them multiple times over the past few years and it usually happens during periods of stress.

I took an antiviral, but maybe it is the Valley fever that is showing itself again as my breathing decreases. I can tell this by feel, as well as testing my blood oxygen levels and heart rate hourly over the past week. My coughing and shortness of breath have also increased.

Is this a new exposure or just the same old, same old? I have a close family member going through Covid currently and have been extremely careful not to get it, but I wonder. I have been tested for Covid 5 times now over the past 2 weeks with 3 home tests, a rapid test and a PCR test. All of these were negative, for which I thank God. But the symptoms of Covid and Valley fever seem to be similar.  

BARBY INGLE

When I first got the Valley fever in 2019, PNN did an article about what I was going through and the growing number of cases in the Southwest. Little did I know I would still be dealing with Valley fever more than 2 years later.

My lung specialist told me it would take about one year to get over it. The variable we did not know at that time was that I was allergic to the one medication that is invented specifically for coccidioidomycosis.

Since my diagnosis, I have been extremely tired -- more than I was with any of the other chronic and rare diseases I live with. I do not know if this is a new infection or if my immune system is compromised by all that I live with. I do know I am tired. All of the time.

It has also put my thinking and ability to handle pain into a new view. I am now very mindful of my breathing, getting oxygen appropriately, and any tingling sensations. That is the feeling I get when my oxygen levels are low. I used to worry more about the burning fire pain from RSD. That is still there and is constant, too. However, if I can’t breathe, the pain doesn’t matter as I won’t be able to live. 

How does one get coccidioidomycosis? The coccidioides fungus that causes it is found in soil of the desert Southwest and causes infection when inhaled. You can get it simply by breathing in microscopic fungus spores. Even our pets, especially dogs, can get Valley fever. It is not passed from human to human, although if you breathe the same air, you may see a cluster of people with it.

My husband Ken was tested for Valley fever after I developed it. His lungs show that he did have it, though he has a great immune system and showed no signs or symptoms. His body just beat it.

For people like me with suppressed immune systems, the risk is high for complications and severe symptoms if we become infected. I was actually misdiagnosed at first because Valley fever does resemble a flu with fever, cough, chills and chest pain. Once it turned into pneumonia and I was treated for a bacterial infection, it was figured out.

Ironically, my lung specialist thought that Ken and I probably got it from driving with the car windows down for fresh air. Valley fever cases spike when summer monsoons hit and cause dirt devils, and after earthquakes when fungal spores are kicked up into the atmosphere.

Worldwide and nationally, Valley fever is considered a rare condition. But in the U.S. Southwest and northern Mexico it is more common. If you are visiting the Southwest or live here, it is a condition you should know about and understand. The sooner you can take action against it or not be exposed to it, the better. Arizona, where I live, accounts for about two-thirds of the cases each year.   

Most infections last for a few weeks or months, but some patients like me can have symptoms that last longer. Because I experienced such a severe case at the start, I have long-term damage in my lungs and will likely continue to have challenges with my breathing and energy.  

I hope that you have enjoyed my series on rare diseases and have found the information educational, useful and motivating. I would love if more people understood the 7,000 plus rare diseases just a little better. I still have a long way to go to understand and learn about them. I have only scratched the surface. It has given me a better understanding of the diversity in conditions, the similarities that patients with rare diseases experience, and an empathy for those fellow patients who I advocate for as often as I can.

Barby Ingle lives with reflex sympathetic dystrophy (RSD), migralepsy and endometriosis. Barby is a chronic pain educator, patient advocate, and president of the International Pain Foundation. She is also a motivational speaker and best-selling author on pain topics. More information about Barby can be found at her website.

Positivity Is My Survival Technique

By Mia Maysack, Guest Columnist

As a young girl, swimming and diving were my main passions in life. I spent every day at our neighborhood pool, from the moment they opened it until the second they closed -- even on rainy days.  I figured I was already wet and there was a great group of lifeguards. I didn't have a care in the world.

All of that changed at the age of 10 when I developed “swimmer’s ear” -- an infection of the ear canal that is often brought on by water that remains in the ear after swimming.  The water creates a moist environment that aids bacterial growth.  

After a routine visit for ear drops at a local clinic, I returned home to rest. Within a couple hours, I awoke from a nap feeling stiff from my neck on down. It was as if I were suddenly paralyzed. I was terrified. The next few moments felt like an eternity. If my mother had not come in to check on me, I could have died right there in my childhood bed.  

My mom knew something was wrong with her young and healthy daughter, and it wasn't much longer before we were on our way to the hospital. During the ride, I remember feeling the head pain for the very first time.

I also recall feeling upset with my father, because on the way he had all the windows down and I felt so cold.  He also had his rock music blasting, which angered me considering how much head pain I was feeling. I did not realize it then, but he was only doing his best to keep me awake - as I was slipping into a coma. 

After arriving at the hospital in a wheelchair, I threw up all over my poor dad. After profusely apologizing, I fell into a deep sleep. Days passed without anyone having any idea what was going on. When my desperate mother inquired, she was told, "Every moment Mia survives is a miracle."

Eventually it was discovered my body was fighting a grave infection and emergency surgery was required. The bacteria was harbored within the mastoid bone of my left ear. It should have been a relatively quick fix, but during the procedure the surgeons found the bone so infected that it crumbled into tiny pieces. It required hours of focused and careful work. 

After sewing my head shut, I was left to rest in the intensive care unit. It was then that left side of my face began oddly twitching. My family had been through the ringer at this point, but my mother did not leave my side. She noticed this change and called for immediate attention, fearing I was having a stroke or seizure.

MIA MAYSACK

It turned out there had been bacteria left behind and it was now attacking my facial nerves, which demanded a second emergency surgery. 

This rare experience left me with deafness in my left ear, partial facial paralysis that has turned into permanent facial synkinesis, as well as chronic migraines and daily cluster headaches. Considering the odds I was up against, I often refer to myself as walking miracle. Bacterial meningitis is swift, sometimes deadly and often results in limb removal. So although my entire life had been turned upside down, I knew I was lucky to be alive. 

Although I go through life with a positive and gratitude attitude, my head has been hurting every single day since this happened. We had no way of knowing back then that I would live with the consequences of that experience forever. I am thankful to have learned the concept of mortality at a very young age, as that helped to cultivate core values, morals and choices for myself  -- which kept me out of a lot of unnecessary trouble other kids my age were getting into. 

Upon returning to school, none of my friends wanted anything to do with me. Instead of checking in and asking what happened to me, untrue stories circulated and the teasing began. Children can be downright cruel in middle school and high school, and because I now looked different than everyone else, I was an easy target. I would spend my recess inside the nurse’s office, working with her on facial retraining exercises. I used to glue or tape my eye closed at night, otherwise it would have essentially dried out and I may have suffered vision loss or lost the eye altogether. 

Accepting My Differences

I have come a long way since then with overall acceptance and I embrace my differences because they represent my fight for life, health and well-being. 

Over all these years, I have tried just about every treatment for my pain that anyone could think of. Medications further complicated things, while neglecting to help with the underlying issues.  Diet changes made no difference.  Nor did biofeedback, acupuncture, Botox, dry needling, trigger point injections, herbal remedies, massage, and chiropractic. The list goes on and on. 

I feel a deeply rooted disappointment with our current healthcare system. We have made many powerful discoveries and improvements in medicine, and the breakthroughs are tremendous for many.  I have come across some great personnel within the medical community, however they are few and far between. 

Due to my illness being invisible, I am often either treated as though I am overreacting, flat out lying, drug seeking or being dramatic. At one point I was banned from a pain clinic for missing a few appointments  because I did not feel safe enough to drive myself.

There is a common attitude toward chronically ill patients, that we are not fully taking responsibility for ourselves or our ailments, and a general opinion within society that we should pop an aspirin and shut up already. If only it were that easy or simple. I wouldn't be here writing this if it was. 

Living each day with head pain, among other discomforts, gets in the way of me being able to think straight and living the life I used to envision for myself.  Often overlooked or flat out disregarded is the constant losses the chronically ill are forced to navigate through.

For example, I worked very hard to earn a job at the very same hospital that saved my life, but ultimately had to step down because they were unwilling to accommodate my need to work fewer hours. I've also had to drop out of college multiple times because they are not set up to cater to the needs of those who suffer from debilitating pain. 

Within the past year and a half, my daily pain scale number of 5/6 has escalated to a 7/8, which has been devastating. Due to high demand, getting in to be seen at a pain clinic (if you are fortunate enough to have one in your area) can take months. When you've been stuck in a cluster headache for 90+ days, it's only natural to feel isolated and alone. There are times I have asked myself how or if I am able to go on like this. 

Our health is one of the most important things in life. That truth is what led me to pursue patient advocacy so passionately. I began witnessing other people getting treated the same way that I was, and it sparked a fire to advocate for the sake of them as well. 

I am living proof that we are far more than any diagnosis. Positivity has become a survival technique as well as a coping mechanism for me. It has led me down a path of holistic wellness through mindfulness and the humble reminder that -- although things could definitely be better -- they could have been much worse.  

Mia Maysack lives in Wisconsin. Mia is a proud supporter of the Alliance for Headache Disorders Advocacy and was recently honored by the U.S. Pain Foundation as its “Pain Warrior of the Month.”

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.