Acadiana’s fall healthcare crisis has arrived on schedule, about three weeks after noticeable increases in new coronavirus infections.
Emergency rooms are filled with patients needing regular hospital beds. Parked ambulances have become extensions of emergency rooms, with EMTs tending to patients for hours before beds free up. Soon they will be ferrying patients to hospitals in other parts of the state, wherever there is room.
The logjam works in the other direction, too. On Tuesday there were only a dozen available intensive care beds in the seven-parish region, which is home to more than 600,000 people. Yet some patients remained in intensive care because they had nowhere else to go. Ochsner Lafayette General staff on Tuesday needed to find regular beds for 11 formerly critical patients who had recovered enough for non-intensive care, according to spokesperson Patricia Thompson.
Hospitals are scrambling to expand intensive care units, facing challenges unlike those in previous COVID-19 case spikes. For one thing, intensive care capacity is a measure of staffing as well as bed counts, and more nurses are needed to expand. But temporary help is harder to find now when almost every state is experiencing a severe surge at the same time.
“We had nurses that came to us from throughout the country to help support us,” said Thompson, referring to southwest Louisiana’s devastating summer surge. “This time no one is sending the cavalry.”
For another thing, demand for intensive care is higher in fall and winter than in warmer times, meaning hospitals advance through their phased surge plans at a quicker pace. Our Lady of Lourdes Regional Medical Center has just begun the third stage of its surge plan, which will roughly double its intensive-care beds, from 24 to about 48.
This is the first time in the pandemic that Lourdes has gone to its third stage, even though COVID-19 patients are now taking up fewer beds than in the summer — about 30 percent now, compared with 50 percent during the summer peak, according to Chief Medical Officer Henry Kaufman.
Kaufman said Lourdes will staff the expansion by reassigning nurses who normally work elective procedures — which will be stalled — to intensive care. Lourdes has a fourth surge stage as a well, but staffing for that “will be a challenge,” Kaufman said.
COVID-19 hospitalizations over a rolling two-week period had more than doubled for 12 straight days in the Acadiana region as of Nov. 30, when there were 220 inpatients. That was a 129% increase over the two-week period that ended on Nov. 16. That rate of increase is comparable to the one in the first half of July, which culminated in a peak of 304 COVID-19 hospitalizations across the region.
About half of the region’s COVID-19 patients were at Lafayette General, which saw its caseload jump from 13 to 107 in November. The Lourdes COVID-19 caseload quadrupled in two weeks. Both systems are holding new patients in emergency rooms while searching for beds.
As many as 20 patients are waiting in ERs at any time, forcing ambulances to wait for space to free up before heading out on another call, said Charles Burnell, medical director for Acadian Ambulance.
“It’s almost like a little mini-hospital bed for awhile,” Burnell said. “We function as a healthcare provider in that environment, just basically waiting and making sure nothing bad happens until they can get into a regular hospital bed.”
Elsewhere in Louisiana, Acadian is being forced to transport patients to facilities that are hours away from their homes, Burnell said. That has not happened yet in Acadiana, Burnell said, but he expects that it will soon.
“Right now we are not having those issues in those other states, but Louisiana is unique,” Burnell said, noting that Acadian also operates in Texas, Mississippi and Tennessee.
Whether Acadiana’s fall COVID-19 hospitalization spike exceeds the summer one will likely depend on whether Thanksgiving gatherings yield another bump in case counts. The November case surge occurred in sync with the aftermath of Halloween, but recent daily case counts are showing signs of leveling off. At the same time, daily case and test reporting has been erratic since Thanksgiving, making it difficult to identify a trend line.
Weekly “date of test” reports are more reliable for tracking the virus’s spread, but those reports are released on a seven-day lag. The next one is due on Wednesday, which will cover the period leading to the day before Thanksgiving. In other words, the effects of Thanksgiving will not be fully realized until well into this month, as healthcare providers brace for the impacts of the Christmas and New Year’s holidays.
“We don’t think it’s going to get better any time soon,” Kaufman said at a panel discussion in Carencro on Tuesday. “I am extremely concerned about where this pandemic is going to leave us once we reach the peak point.”