With holiday gatherings on the horizon, both West Virginia and the nation have hit disturbing new milestones as the pandemic enters a new phase of uncontrolled spread.
And the worst appears to be ahead.
As of this week, 612 West Virginians have died of COVID-19. And on Monday, 400 people were hospitalized at once. This hospitalization rate has been rising faster and faster since late October, and leading national experts project the state’s intensive care units will be overwhelmed as soon as early December.
Gov. Jim Justice has been reluctant to re-institute broader measures from earlier this year to control the virus’ spread. State health officials say they have a plan to handle the coming surge in coronavirus patients. But the implications for medical workers and their patients, who may need to travel long distances or wait for care, are still unclear.
“We should be concerned,” said Dr. Ali Mokdad, professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation, a University of Washington research center.
Mokdad, who is part of a team of researchers at IHME that uses modeling to predict when each state will need more intensive care beds than it has, estimates that West Virginia will hit that mark on Dec. 5. The exact date is subject to change, Mokdad said, but the general trend is undeniable: we will reach capacity, and we will reach it soon.
Hospitals have plans to handle the surge. But finding enough beds is only one part of the logistical nightmare facing state health officials, which involves onboarding new staff, shuffling patients and triaging procedures. It remains to be seen whether the state’s preparations are enough to keep an already rising death toll from growing even more grim.
Running full
West Virginia hospitals are already feeling the strain.
“We’re at a record level,” said Tony Gregory, an executive at the West Virginia Hospital Association. But, he noted, this is the health care sector’s busy season.
“This time of year, hospitals tend to run full,” he said.
That’s the case in Marshall County. At WVU Medicine Reynolds Memorial Hospital in Glen Dale, Pattie Kimpel, the hospital’s infection control coordinator, said all 16 of the hospital’s designated COVID-19 beds are currently full and have been for weeks.
“They are absolutely filled right now,” Kimpel said in an interview with WTRF Wheeling News on Tuesday. “We are day-by-day watching this, but… it is here right now.”
At Ruby Memorial Hospital in Morgantown, the ICU was also full last week, but a spokeswoman for the hospital said it wasn’t cause for alarm.
“Anybody who comes into our health center will receive treatment,” Angela Jones-Knopf told WVNews. Patients may be transferred to other hospitals if Ruby runs out of space, she said.
And while there are still ICU beds available in West Virginia, the state’s ICU units are 82% full — far surpassing the national rate of 60%.
The demand for ICU beds is expected to peak in mid-January and need will continue to outstrip availability through March, the IHME predicts. By then, if drastic measures are not taken to quell the virus’ spread, estimates show it will have killed nearly 2,400 people.
“When ICUs are overwhelmed, it’s bad for access to care and care quality,” said Mokdad. “When your ICUs are totally occupied, then your operating rooms, your recovery rooms will be switched to take care of patients, and elective surgeries will be postponed. It impacts everybody, not only people who have COVID.”
But despite the projections, state leaders offered reassurances that the state’s health system was sound.
While other states have reached a “tipping point” and run out of resources to treat all patients, West Virginia still has free beds and plenty of ventilators, said West Virginia coronavirus czar Dr. Clay Marsh.
“Certainly if we didn’t do anything, that could very well be correct — but we will intervene,” said Marsh in an interview on Wednesday morning. He was in his office overlooking Ruby Memorial on the campus of West Virginia University, where he’s a vice president and board member of WVU Medicine, which runs the hospital.
He said that hospitals and state health officials are working together to ensure that new beds are opened and new staff is brought in. If necessary, he said, hospitals will delay elective procedures, a strategy that proved highly effective early on in the pandemic, but had great costs for hospitals that rely on profits from those procedures to survive.
To avoid “bottlenecking,” as Marsh put it, the state’s health system will likely have to shuttle patients between large, central hospitals — which can handle the sickest patients — and small rural hospitals that currently have empty beds.
But, he warned, the worst is yet to come. The next two to four weeks will be a crucial test, as there’s typically a several-week lag between a rise in reported cases and rising hospitalizations.
“We know the wave is coming,” he said.
In response, the governor is now warning West Virginians to take new precautions to limit the spread of the virus, but stopping short of many stricter measures. Regardless, the efforts come too late.
“This thing is running like wildfire,” said Justice in a press conference on Monday.
More than a third of West Virginians do not wear a mask in public consistently — slightly more than the national average — according to self-reported data aggregated by IHME. Health officials, celebrities and political leaders have been pleading for more mask-wearing for months.
Last week, Justice updated the state’s mask mandate to require face coverings indoors at all times, but that order came late and did not include the curfews and further restrictions on businesses that are now commonplace in other states.
“That’s all I got,” Justice said at the time. “I do not have anything in the toolbox, other than the possibility of shutting businesses down.”
He called that, and the prospect of further school shutdowns, “the last thing we need to do.”
‘Don’t you want to make sure we’re safe?’
Both Gregory and Marsh emphasized how important health care workers are to the system — and that they’re exhausted.
“We’ve had a lot of people who worked almost non-stop this whole time,” said Marsh.
Dr. Corey White, an attending physician at Princeton Community Hospital, is one of them.
“Our hospital in Princeton is running at max capacity and has been for the last couple weeks,” he wrote in a nearly 600-word Facebook post exhorting his neighbors to take the disease more seriously.
Princeton Community Hospital has taken on new patients in recent months after its board voted to shutter a neighboring hospital, Bluefield Regional Medical Center, in July. It purchased the 92-bed facility last year. Now, all that remains is its emergency room.
Bluefield Regional Medical Center is one of twelve hospitals nationwide to close during the pandemic, three of which were in West Virginia. The impacts, compounded by the pandemic, have rippled across the system.
“We have some patients that we can’t take care of and we are having to call hospitals in other states to even find room for them to go to because every major facility in WV is on diversion,” White wrote.
“I don’t think that’s true,” Marsh said about the widespread diversions, which force patient transfers because a facility is full. But he acknowledged that the larger hospitals have gotten backed up as more and more people are now seeking medical care, mainly for non-COVID-related procedures.
White did not respond to a request for comment, but nurses across the state echoed his concerns.
Derek Bradley, an ICU nurse and union steward, said that “morale is very, very low” among nurses at Cabell Huntington Hospital.
“The hospital is always full,” he said, but noted that COVID patients require special care and said he didn’t believe the hospital was sufficiently staffed to provide it.
The difference, according to Bradley, is the level of intensive care that COVID patients require.
“[They] deteriorate very quickly. They go downhill very, very fast,” Bradley said.
Nurses at the hospital unionized late last year, joined the Service Employees International Union, and are now deadlocked in contract negotiations with management over their demands for better health care benefits and increased staffing. They rejected a “final offer” from management a few days ago and are threatening to strike.
In Bridgeport, a nurse at United Hospital Center who asked to remain anonymous called the situation “insane,” as the hospital is taking on new patients — some with COVID, many not — “left and right.”
She and her coworkers are taking on extra shifts.
The hospital, like many others, does not test asymptomatic staff for COVID. Instead of offering tests, hospital managers simply send out warnings when a coworker has been potentially exposed.
“I get anxiety so bad. I hate having to go to work,” the nurse said. “We all just want to quit, but we can’t.”
That cry was echoed in Morgantown, where student athletes are regularly tested for COVID-19, but asymptomatic hospital staff, even in the event of exposure, are not. That’s in accordance with current CDC guidelines, but has been challenged over the last several months as hospital workers around the country seek access to regular testing regardless of symptoms. And as cases rise in Morgantown, where 144 WVU hospital staff are currently out with COVID-19, the cry for testing is getting louder.
“We’re health care workers, for Christ’s sake,” said an ICU nurse at Ruby Memorial Hospital. “We’re taking care of your mother, your grandma. Don’t you want to make sure we’re safe?”
The nurse, who didn’t want to be identified for fear of retribution, said that to get a test through employee health, hospital staff have to be symptomatic. But being symptomatic means you can’t be at work.
The nurse, who had recently experienced minor head cold symptoms and worried it was COVID-19, said they had to miss a day of work just to get testing. When the test came back negative, the time away from work was taken out of the employee’s vacation days.
“It’s frustrating,” the employee said.
‘Please…just stay home’
Regardless of all else, the most important thing going forward is our individual behaviors, said Dr. Mark Roberts, chairman of health policy and management at the University of Pittsburgh’s Graduate School of Public Health.
“We have to wear masks. We have to socially distance. We can’t have people over for Thanksgiving,” Roberts said. “We’re not letting our son come home from Montana for Thanksgiving because it’s just not the right thing to do these days.”
According to Roberts, experts fear the current rise in cases will only compound heading into the winter months.
As environmental factors change, temperatures get cooler and more time is spent indoors, there’s going to be a greater likelihood of exposure and transmission if diligent restrictions on social gatherings aren’t put in place and adhered to.
“It’s not just the virus, it’s the virus and our response to it,” Roberts said. “It’s our behaviors that allow the virus to spread.”
The other factor is seasonal variability. According to Roberts, some viruses, like influenza, are far more present in the fall and winter months than at other times of the year. Roberts said we don’t know enough yet about the seasonality of COVID-19 to know what the effect will be on the virus, but in congruence with the other health risks that come with cold temperatures, the burden on hospitals is undoubtedly going to increase.
Still, the most immediate threat, according to Roberts, is the holidays. In Allegheny County, where Roberts is based, data has already shown that a very large number of cases are coming from small group meetings and gatherings at people’s homes.
“Those kinds of connections can spread the disease just as easily as going to a bar or a restaurant,” Roberts said. “We should behave all the time as though we’re infected. It’s not just to protect you, it’s to protect everybody else. Please, this Thanksgiving, this holiday season, just stay home.”