Health systems grapple with COVID-19 and ripple effect

Treatment for patients with the virus is putting other procedures on hold.
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West Michigan health systems are feeling the pressure of rising COVID-19 rates in the region.

Spectrum Health, University of Michigan Health-West and Mercy Health Saint Mary’s earlier this month provided an overview of the region’s response.

Dr. Darryl Elmouchi. Courtesy Spectrum Health

Representatives from the health systems included Dr. Darryl Elmouchi, president of Spectrum Health West Michigan; Dr. Peter Hahn, president and CEO of University of Michigan Health-West; and Dr. Matt Biersack, president and chief medical officer of Mercy Health Saint Mary’s.

Elmouchi said Spectrum was reaching record numbers of COVID-19 patients on Dec. 3, with inpatient and intensive care unit numbers beyond capacity limits. The number at that time was 455 patients. As of Dec. 16, the number had risen to 479 patients COVID cases, including 129 adult and six child ICU patients. On that same date, Spectrum Health’s COVID-19 dashboard showed a 19.8% lab testing positivity rate for the virus.

“This is unprecedented here in West Michigan with this high volume of testing, and this is really driving future infections, future hospitalizations and unfortunately, future deaths,” Elmouchi said.

Dr. Matt Biersack. Courtesy Mercy Health Saint Mary’s

Biersack echoed similar sentiments in regard to hospital occupancy causing major strains on Saint Mary’s staff. As of Dec. 3, the hospital was at 98% total capacity and 100% ICU capacity, with internal case positivity rates continuing to climb.

“We’re also seeing that the health care workforce as a whole is contracted. There’s national data that suggests that maybe up to 100,000 have left the workforce and among them are some of our more experienced clinicians. … And acuity is so much higher, we actually had to have an additional fleet of ventilators arriving (Dec. 3) to support the demands in our ICU,” he said.

Biersack said the onslaught of COVID cases has a ripple effect: Previously scheduled surgeries are delayed and visitation rules for the entire hospital have changed.

“And I think the worst impact that we’ve seen from this pandemic has just been on our health care workers. Our staff are tired. I know they are at all of our health systems. They’re desperate for a reprieve from the pandemic,” he said.

Dr. Peter Hahn. Courtesy University of Michigan Health-West

Hahn said UM Health-West has been operating at capacity for three months, and is, on average, at 90% of its staffed bed capacity and carrying its highest COVID inpatient census numbers to date.

“So, this is absolutely, I think, a time of reckoning for health care, especially on the hospital side,” he said. “This prolonged delta surge combined with, you know, staffing shortages, exhaustion, it’s a very difficult time. And yet I think we all hold the line for the community.”

According to Hahn, the bulk of COVID patients in critical care and on ventilators are unvaccinated and have a very long length of stay, often over two weeks, causing difficulty in terms of flow within the hospital. In the last two weeks of November, for example, UM Health-West delayed or canceled 70 “very important” procedures and put more emphasis on outpatient care due to lack of beds and staffing, according to Hahn.

“… And obviously the vast majority of admitted COVID patients are unvaccinated. Over 90% of our patients who are on ventilators are unvaccinated, and if they’re vaccinated, what we’re seeing is these are elderly folks with multiple, multiple comorbidities,” he said. “…This is also affecting our emergency room where, on average, there can be a three-hour wait (and) sometimes up to a six-hour wait. And then on the other side of that, we’re having difficulty getting patients to short-term nursing facilities because of their own staffing issues, transportation issues, etc.”

All West Michigan health system representatives offered similar pleas to the community to do their part to ease the burden on health systems, and to remain vigilant on safety guidance and get vaccinated.

“Maybe before I start talking specifically about vaccines, I might put a little ‘why’ out there, so why is this all so important?” Elmouchi said. “And obviously for most people, I think it’s pretty recognizable, but we really, over the last few months, put so much stress on the health care infrastructure of West Michigan and our state that it is getting to a point that we all should be concerned.”

According to Elmouchi, Spectrum Health received 700 calls over a six-week stretch in late fall to accept patients from outlying hospitals in Michigan that needed a larger hospital with a higher level of care. Spectrum has had to deny all of those calls when historically, it accepts all of those patients. The organization also has had to defer more than 1,100 surgeries since the current surge began, which causes patient suffering and psychological trauma, he said.

“That’s happening not just here, that’s happening across the state. So, you could be in the U.P., you could be somewhere up north, anywhere else, get in a car accident, have a heart attack, and even if it’s not COVID related, because the strain COVID is putting on a health care system, you could potentially not get the care you otherwise would,” Elmouchi said. “… So, one of the reasons that people should care about this, even if they’re not terribly personally concerned about COVID, is it could impact any other part of your health. And then when you look at the caregivers, all of us and all the folks that work with us, people are really struggling. This is needless death day after day.”

Biersack said Mercy Health also has canceled a number of surgical procedures and implemented other measures including opening an additional nursing unit to support patient care and converting COVID rooms into semi-private to accommodate the high level of needed care. He also highlighted the importance of vaccines by presenting Trinity Michigan data, showing statistical volume of vaccinated versus unvaccinated patients in the hospital.

“The predominant number of patients in our ICUs and who are dependent are unvaccinated, and if we look at our Mercy Health St. Mary’s data, 86% of those in the ICU this week are unvaccinated, 88% of those that were on ventilators were unvaccinated. So, I think this demonstrates a dramatic effectiveness to vaccines,” he said.

Spectrum Health showed similar figures comparing patients who have received the COVID-19 vaccine versus those who have not.

“And I always tell folks that are hesitant about the vaccine, if I could just tour you in ICU for five minutes, introduce you to pregnant women that are on the ventilator, introduce you to young people with kids there that are on the ventilator potentially dying, vaccines work. They’re incredibly safe, incredibly effective, and the only way we’re ultimately gonna protect our community and our health care resources,” Elmouchi said.

As for the omicron variant, all representatives agreed the community should not panic as researchers don’t yet know if the variant will cause more severe disease.

“… A lot of the (omicron) cases that were reported as of this first month were mild in nature. And again, it’s still unclear, a lot of these questions around transmissibility and severe disease, and so I think one of the take-home messages is that we still have to be highly concerned about what we’re seeing right now with delta before we become fixed on the impact of omicron,” Biersack said. “Delta is definitely the variant of the day and nearly the exclusive cause of COVID infections within our community and state. So, we still have much to do in terms of curbing the impact from delta while we await more information about omicron,” he said.

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