ELKHART — Half of the patients at Elkhart General Hospital are COVID-19 patients, and the hospital Tuesday had to divert ambulance traffic.
Dr. Michelle Bache, vice president of Medical Affairs at the hospital, said she has been at Elkhart General for 22 years and this is only the second time they have had to divert ambulance traffic.
“We don’t have any other place to put our patients,” she said. “Our hospital today, we have 92 COVID-positive patients in our hospital. Half of our patients here are COVID.”
All of those patients are on various levels of oxygen support, starting with nasal cannulas, then high-flow nasal cannulas, bilevel positive airway pressure (BiPAP) and finally ventilators.
“We are in short supply of all of those,” Bache said, adding there was a bit more of a cushion with the ventilators. Currently, EGH has 13 ventilators in use.
“We’re really trying to keep the patients on other types of oxygen as long as possible to avoid the ventilator,” she said.
In the event they run short suddenly, Bache said the anesthesia machine can be used as a ventilator, but then they would not be able to do any surgeries.
Back in July, EGH received ventilators from FEMA, and the hospital may be able to get more of those.
However, those ventilators are not the more deluxe ventilators used for COVID patients. COVID patients, she explained, are hard to ventilate so the “fancy” ventilator is used to meet their demands.
EGH did put in an order for more ventilators from a company that has the ones they need, but it could take up to eight weeks to receive them.
Bache anticipates still being in this sort of crisis in eight weeks, and until the positivity rate goes down.
“We fully expect this to be going on for another eight weeks,” she said. “Until we see some signs of things improving in the community and the number of cases going down and our positivity gong down, we fully expect the situation in the hospital to get worse on a daily basis. We’re already at crisis status. We do not have any open beds today.”
She said that they are reopening a unit in the old section of the hospital that was closed about a year ago, just to get some beds open. She had hopes it would be open Tuesday night.
On Tuesday, there were 16 patients in the emergency room who were waiting for a bed. That’s 50% of the ER that is not useable, she said.
“Before we can take more patients in, we need to be able to decompress our emergency department, find a place for those patients by opening up new units. So we’re hoping we might have more beds that we can open up later this afternoon or evening. That’s what we’re hopeful for, but we did not have a lot of patients discharged today. Patients are sicker; they’re staying longer. … We’ve been trying to deal with it for as long as we can, and honestly, it’s been a really, really tough go since Friday. We’re just seeing high volumes of patients in our emergency department — almost all of them have COVID symptoms. Almost all of our admissions today are COVID-related. We have patients right now that are in the ER that have been waiting for over 24 hours for a bed in the hospital,” she said.
The patients who have been diverted have gone to Goshen and to St. Joseph. Those hospitals are at critical levels themselves.
Goshen Hospital’s Chief Medical Officer and Infectious Disease Specialist Dr. Daniel Nafziger stated Monday, “There are 44 patients on the COVID-19 unit at Goshen Health, 41 who have tested positive and three who are awaiting test results.
“Today is the most dangerous day of the epidemic so far for catching the coronavirus in Elkhart County. Over half the patients in our hospital are in isolation and the total number of patients in the hospital is at record levels. Some patients who need important surgeries are having their procedures delayed because COVID-19 patients are filling our intensive care unit beds. We’ve had to transfer some patients because we didn’t have enough beds. People who are sick still need to be able to come to our hospital if they need care.”
Bache said that at Elkhart, “We had a surge plan, and we’ve gone up to 100% of our surge plan. So we’ve exceeded what we projected our surge capacity to be. So now we’re trying to surge above our surge. And in order to surge above our surge, we need not just beds. We need — and you’re hearing this from everybody — we need staff; we need people to work. And that’s becoming more and more challenging.”
The state of Indiana provided a list of retired and unemployed medical professionals who might be willing to come in and help, she said.
“When we put calls out to those people, we did not get anybody who wanted to work,” Bache said.
What EGH really needs are staff, such as an intensivist (a critical care physician), she said, “who has trained for eight or nine years to be a physician and specialize in intensive care medicine and in pulmonary critical care.
“I mean, you just don’t go out to your local temp agency and find these sorts of skilled people,” she said. “And an ICU nurse — these patients are so sick. So, you really can’t take a nurse who maybe works in an office in the community and have them be primary caregiver for an intubated COVID patient.”
Elkhart General is scaling back some procedural areas, closing down some operating rooms, pulling staff from that area to help in the inpatient area. They are also looking at ways they can scale back in offices and in community practices to see if they can get staff from there.
“It is literally all hands on deck right now,” Bache said. “And everyone’s focus right now is just COVID care because that’s all that we have and it’s consuming all of our resources.”
“Everybody in the community should be concerned about this,” she said. “And everybody in the community should do what they can do to try to turn the situation around because we don’t have any place else to go. We don’t have any more room to surge. And what that means is that other care has already and will continue to be affected by this pandemic. ... If you need to have a procedure done, or surgery done for a problem, you may not be able to have it done. What it means is if you have a heart condition and you get hospitalized, the nurses taking care of you are going to be stretched and are going to be taking care of many more patients than we would typically expect. And all of those things affect outcomes and they affect the health of the community as a whole. Everybody should care about this.”
The ER is not turning away patients who arrive for treatment, unless they arrive by ambulance, the doctor stressed.
“We’re definitely still open,” Bache said. “We need some time to regroup and some time to get these other areas open so we can take care of the demand.”
Beyond the quick 10 beds they can open with the new unit, she said, hospital officials are talking about alternative care sites, setting up beds in the hospital auditorium, or even setting up a tent outside the hospital as an alternative care site.
Bache expects the high numbers of COVID patients to continue, especially through this week. On Monday, there was a quarter of a mile long COVID testing line at their site, so they had to divert traffic to a staging area at McNaughton Park.
“There just seems to be a real disconnect with the community and the hospital,” she said. “The people really don’t understand the severity of this pandemic and how serious this is. It’s not going to be too long before every single person in this community is going to have a story about losing a loved one to COVID or having some sort of negative health impact from this pandemic because they couldn’t get the care they needed because our resources were completely exhausted because of the pandemic.”
She asks that the public help turn the tide by taking it seriously and do their part by: wearing a mask, staying distant, washing hands, staying out of large or medium groups — or no groups outside of immediate family members and staying home from work when sick.
“It’s really putting the health of the entire community at risk,” she said of people not abiding by health guidelines. “We all need to be good neighbors. We need to be concerned humans and do our part. The time is now.”