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Prevea Health – COVID patients are “labor intensive” and “we need your help”

By LeAnn R. Ralph

COLFAX  — As cases of COVID-19 continue to increase in Wisconsin, some hospitals are turning patients away because there are no beds available.

Across the state, 97 percent of the Intensive Care Unit (ICU) beds are occupied, and 98 percent of the intermediate care beds are occupied, said Karen Timberlake, secretary-designee of the Wisconsin Department of Health Services, during a media briefing held December 2.

On November 30, the state had 688 patients on ventilators, the highest number since the COVID-19 pandemic started, which compares to 638 patients on ventilators November 18, 2020, the second highest number since the pandemic started, she said.

The healthcare system and the healthcare workers are overwhelmed, said Dr. Ashok Rai, president and CEO of Prevea Health.

COVID-19 patients account for 20 percent of those hospitalized, and there is no hospital anywhere that is designed with an extra capacity of 20 percent, he said.

People who have had accidents or have suffered another kind of health emergency, such as heart attacks and strokes, are having difficulty finding care, Dr. Rai said.

In Green Bay, the hospital had to say “no” to 28 patients in one day because there was no room for them due to the number of COVID patients, and three of those patients had suffered strokes, he said.

One patient ended up being transferred to a hospital more than 200 miles away, Dr. Rai said, noting the difficulties for both patients and families with the patients being so far away.

When hospitals talk about available “beds,” there is more to it than just the physical bed. Availability also includes the Certified Nursing Assistants, the nurses, the physicians and other hospital staff needed to take care of a patient occupying a hospital bed, Dr. Rai said.

COVID-19 patients are “labor intensive,” and one COVID patient uses the resources needed for three hospital beds, he said.

“We need your help,” Dr. Rai said.

DHS updated its COVID-19 disease activity data on December 1, and Juneau County had the highest disease activity level of all 72 counties in Wisconsin with 1,453 per 100,000 people.

St. Croix County and Dunn County were the second highest counties in the state, with both of them having disease activity levels of more than 1,400 per 100,000 people.

According to KT Gallagher, director of the Dunn County Health Department, Dunn County had confirmed 124 new cases of COVID-19 on December 1.

Earlier this fall, the daily average of COVID cases in Dunn County was in the teens, and before Thanksgiving, Dunn County was averaging 40-some cases per day.

Delta variant

Virtually all of the cases of COVID-19 in Wisconsin are the Delta variant of the SARS-CoV-2 virus.

COVID-19 is “a different version this year” because the Delta variant “acts different,” Dr. Rai said.

Those who are the most vulnerable to becoming severely ill with COVID-19 have been vaccinated, and the majority of those hospitalized are unvaccinated, he said.

The unvaccinated who end up hospitalized are very sick, Dr. Rai said.

Healthcare workers find it “exhausting” and “frustrating” and want to move past having to take care of so many COVID-19 patients, he said.

It is enormously frustrating when someone suffers a stroke, and hospital staff cannot take care of that patient because there are so many COVID patients, Dr. Rai said.

The majority of those who are intubated and on a ventilator are unvaccinated, and they will be sicker, in spite of the therapeutics available, such as monoclonal antibodies, and they will end up staying in the hospital longer, using more resources, he said.

According to statistics that DHS has gathered, those who are not vaccinated are nine times more likely to be hospitalized if they are infected with the virus, Timberlake said.

And those who are not vaccinated are 11 times more likely to die if they are infected with the virus than those who are vaccinated, she said.

Tools

It is important to keep COVID-19 from spreading so that people can remain working and so that children can stay in school.

Fortunately, there are many tools available to help slow the spread of SARS-CoV-2, Timberlake said.

Getting vaccinated is one tool. Those who are 18 and older, and for whom it has been six months since their second dose of the vaccine, or two months since their dose of the Johnson and Johnson vaccine, should get a booster, she said.

In Wisconsin, 87,000 children aged 5 to 11 have received at least one dose of vaccine, Timberlake noted.

In addition, people should wear masks when they are indoors in a public place, and if people feel sick, they should stay home, she said.

People should also avoid large crowds, use hand sanitizer and get tested if they have been exposed to the virus, Timberlake said.

People should also be vaccinated for influenza as well as for COVID-19, she said.

Being vaccinated will help the healthcare workers, the hospitals, and our families, friends and neighbors, Timberlake said.

Influenza

Last year, influenza was all but non-existent in Wisconsin.

This year, no one knows what to expect for the flu season, said Dr. Ryan Westergaard, chief medical officer, DHS Bureau of Communicable Diseases.

The use of masking and social distancing will cut down on the rate of all respiratory viruses. Because people were taking precautions last year, the flu was not circulating, he said.

This year, the state is already experiencing more cases of influenza than there were last year, Dr. Westergaard said.

The good news is — “we have learned we can control (respiratory viruses),” he said.

People are encouraged to also get the flu vaccine because the hospitals in the state do not have the extra capacity to care for influenza patients in addition to COVID patients, Dr. Westergaard said.

Vaccine mandates

One reporter attending the media briefing said she had heard that a local hospital in her area had lost 50 percent of the staff because of the COVID-19 vaccine mandate.

Timberlake said DHS has not heard any reports of hospitals or healthcare systems losing that many staff members.

The policies of hospitals, clinics and healthcare systems to require employees to be vaccinated works to encourage vaccination, Timberlake said.

When people who are immunocompromised come into a hospital or a clinic for treatment, they want their care team to be protected, she said.

Prevea lost a handful of staff members when the vaccine mandate was implemented, but it was not anywhere near 50 percent, Dr. Rai said.

Keeping healthcare workers healthy is a way to keep the healthcare system functioning, he said.

People being hospitalized for COVID-19 and using 20 percent of the resources is creating the issue. The vaccine mandates are not creating the issue, Dr. Rai said.

Children

Children now account for the largest number of new COVID-19 cases.

From the end of August until the end of November this year, children under the age of 18 went from the lowest number of COVID-19 cases to the largest number of cases, Timberlake said.

Children aged 4 to 13 have had the most significant increase in cases, she said.

Older teenagers were able to be vaccinated earlier, and children 5 to 12 were only able to start being vaccinated a few weeks ago, so the significant increase in cases for children who could not yet be vaccinated indicates vaccination is protective, Timberlake said.

With younger children now eligible for vaccination, “we are eager to see it bend the new case curve,” she said.

Children typically do not get as sick with COVID-19, but since the start of the pandemic, 1,800 young people in Wisconsin have been hospitalized, Timberlake said, adding that having your child be hospitalized with COVID-19 would be a frightening situation.

On the other hand, while children do not get as sick, children do live in families, and they can transmit the virus to other family members and can put older, more vulnerable adults at risk, Timberlake said.

Omicron

About a week before the media briefing, the Omicron variant of the SARS-CoV-2 virus was known to be circulating in South Africa.

Since then, Omicron has been discovered to be circulating in at least 24 other countries, and at the time of the media briefing, two cases had been confirmed in the United States in California and in Minnesota.

By later in the day, the Omicron variant had been discovered in several more states.

Early data suggests that the Omicron variant spreads more easily and more rapidly than the Delta variant, Timberlake said.

Delta is still the dominant strain of SARS-CoV-2 in Wisconsin and in the United States and accounts for 99 percent of the samples that are evaluated, she said.

No cases of the Omicron variant had been confirmed in Wisconsin [on the day of the media briefing], but the variant is part of the active sequencing in samples coming into laboratories, Dr. Westergaard said.

Based on the virus’s behavior circulating in South Africa, the Omicron variant spreads rapidly, he said.

What is not known yet is whether it causes more severe disease, Dr. Westergaard said.

According to anecdotal evidence, Omicron causes mild illness, but there have not been enough cases so far to say for sure whether that is true, he said.

Until other evidence has been collected, it should be assumed that the Omicron variant can also cause severe disease, Dr. Westergaard said.

At this point, it is also unknown whether any of the therapeutics, such as the monoclonal antibodies, will work on illness caused by the Omicron variant, he said.

The Delta variant is still the primary concern, Timberlake noted.

Testing

With the rate of COVID-19 increasing in Wisconsin and approaching the highest number of daily cases seen since last year before the vaccines were available, testing for the disease remains important.

One reporter at the media briefing noted that the Biden administration had announced efforts to make at-home tests for COVID-19 free.

Having at-home and rapid testing covered by insurance will make more testing available and at a lower cost, Timberlake said.

At-home testing can be a useful resource, but a variety of testing options are necessary, Dr. Westergaard said.

If people are tested in a healthcare setting or at a public health department, the test results are highly reliable and then are entered into the state system so that the information becomes part of the available data about the disease, he said.

Rapid testing is useful, but it is not a replacement for the PCR testing in a healthcare or public health setting, Dr. Westergaard said.

There are robust testing networks in all counties in the state that include healthcare systems, public health and pharmacies, Timberlake said.

In addition, 75 percent of public school districts are participating in testing programs, and in November, 35,000 children and school staff were tested, Timberlake said.

Many pharmacies also are conducting COVID testing, especially the chain pharmacies, either by appointment or by walk-in, she said.

The advantage of PCR testing done in a healthcare setting is that once the test is determined to be positive, people are in a position to get treatment earlier, when the treatment is the most effective, such as treatment with monoclonal antibodies, Dr. Rai said.

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