A rising amount of COVID-19 patients in Elkhart County is placing a strain on Elkhart General Hospital.
Dr. Michelle Bache, vice president of medical affairs for Elkhart General Hospital, said, “We are literally at capacity. We do not have any more room to go here.”
Goshen Hospital is not experiencing capacity concerns at this point, but Chief Medical Officer Dr. Daniel Nafziger said that could change quickly if other hospitals have to transfer cases.
Transfers could be a reality for Elkhart.
“We had a big spike in the COVID activity in the area,” Bache said. “Basically, over the past month it’s been creeping up and really over the past week it has increased dramatically. For instance, our census for COVID patients, the number that we have in the hospital today is basically three times higher than it was a month ago. And our deaths have also increased. So, if you look at the total number of deaths we had around Labor Day, we’ve gone up 40% since then.”
Memorial Hospital of South Bend is also feeling strained by the COVID activity, Bache said. That hospital and Elkhart General are members of the Beacon Health System.
“So all through the weekend and then (Monday), we were setting records through the Beacon system for our COVID census.”
On a broader scale — the whole county and what is called District 2 for emergency management purposes — the number of in-patient COVID cases has basically doubled since Labor Day, she said.
Why the numbers are spiking is undetermined.
Some people think it is due to an increase in testing, but that’s not the case.
“What I will tell you is that (testing) does uncover more cases, but an increased number of testing does not affect hospitalizations,” she said. “These are the people who, they got it and they’re sick enough that they need a hospital bed, and then a good number of them are sick enough that they actually died from it.”
Elkhart General outgrew its COVID unit and that section had to be expanded. Bache explained that the staff had to “look for ways to care for patients outside of our COVID unit at the hospital.” They are still using the CDC guidance for negative pressure rooms and for PPE requirements. However, she explained that they’ve exceeded the COVID unit’s capacity.
Elkhart is not having to transfer patients yet.
Bache said she did have a call with the Indiana Department of Health on Tuesday.
“We are looking for other places where we can get some assistance. Also, the other important thing for the public to understand is that it’s really not a bed issue. We certainly can make places to care for these patients. We can do very creative things with our units and construct new areas, but the real critical piece for us is our human resources. And it really does take a specialized nurse to take care of a very sick COVID patient, and we have a limited number of those. You can’t just pull people in off the street to pitch in in these situations. And every hospital in this area is dealing with a similar labor crisis, and the nurses that we do have, we’re asking a lot of them. They’re working longer hours; they’re carrying more patients. So it’s very challenging for them.”
Nurses are spread out between patients and take care of more patients than they ideally would, Bache said.
“There are some COVID patients who are, honestly, so sick that they really need a dedicated nurse,” she explained. “ … Those are for the sickest COVID patients. Others who aren’t as sick might have one nurse caring for three or four.”
Because of capacity, hospital officials are looking at surgical cases, trying to predict who will need an in-patient bed after surgery “and trying to balance that volume,” Bache said. “So we’re having to be very, very cautious with what we’re doing and how we’re proceeding.”
Five patients since March have been transferred to hospitals that offer ECMO, which is basically a heart-lung bypass. These are patients who are the very sickest and have exceeded the hospital’s ability to maintain on a ventilator.
“It’s really amazing that we’ve been able to offer that option here of the ECMO, because without that option these patients would have certainly not survived,” she said.
Outside of those five, Elkhart has not had to transfer patients yet.
In Tuesday’s talks with Indiana State Department of Health officials, Bache said state officials explained that the rest of the state is not necessarily experiencing the surge taking place in northcentral Indiana.
“We don’t know why that is,” Bache said. “But for whatever reason, there are other places in the state that have some capacity. And so, if the situation continues it will be necessary for us to look to other places in the state to send our patients to receive care, and that we should really expect to do that.
“We don’t like to do that because it’s really difficult for families and for patients to be out of their communities and we don’t think that is ideal. But we also have to make sure that we can deliver the quality of care that we’re committed to deliver and we don’t have nursing resources that makes us have to do these difficult decisions.”
One of those transfer places could be Goshen Hospital.
Nafziger said Monday, “While our hospital is not currently experiencing capacity concerns, the situation could change very quickly if other hospitals need to start transferring patients. COVID-19 spreads so easily when precautions are not taken. We know that without interventions, each positive COVID-19 patient will spread the virus to three additional people. This remains a major concern for our community — we all need to do our part to stop the spread.”
So why is northcentral Indiana having a spike?
In speaking with state officials, Bache said it does not appear to be related to the opening up of schools.
“We haven’t really seen big outbreaks, and the schools are doing a reasonably good job with masking and social distancing and contact tracing,” she said. “I don’t know that that can necessarily be blamed. … We are going to have to evaluate some of our activities in light of the amount of community spread we’re currently seeing to decide if we need to be a little more restrictive.”
In Elkhart County, the testing has been relatively stable. In looking at a seven-day average, there are between 600 to 700 tests a day.
“It’s been pretty stable since the end of May,” she said, adding, “We are doing quite a bit of surveillance testing, so there are, for instance, in nursing homes, people who are working in the nursing homes I know are being tested on a pretty regular basis.”
And again, she pointed out, the increased number of cases Elkhart County is seeing is not because of testing more. “The testing is pretty flat,” Bache said.
She urges the community to continue taking precautions. “Even though we moved into stage 5 as a state, that is not a free pass to stop doing everything that we’ve done so far to keep this under control. So masking is still important, social distancing, washing our hands, avoid large gatherings.
“I’m concerned about if the uptick in the hospitalizations continues to occur at the same time that we’re seeing an uptick in our community cases. Usually the hospitalizations are a lagging indicator, meaning you’re not going to see the hospitalizations increase for about a week or two after you start to see the spike in the community. We haven’t yet plateaued or showed a downward trend in our community cases, so I’m concerned that the hospitalization rate will continue to increase. … It’s literally a day-to-day basis.”