Southwest Virginia a ‘cautionary tale’ as COVID-19 hospitalizations rise across the state

Over the past few days, Virginia has reached a grim milestone: more patients hospitalized for COVID-19 than at any other point in the pandemic.

Those numbers are rising across the state with increases reported in each of Virginia’s five health regions, according to data from the state Department of Health. But nowhere is the spike more acute than in the southwest, where the number of beds occupied by COVID-19 patients has soared from an average of 76 a day in late April to 361 as of Wednesday.

The same day, Ballad Health — one of the region’s largest hospital systems with locations in 29 counties across Southwest Virginia, Northeast Tennessee, Northwest North Carolina and Southeast Kentucky — announced it was suspending all elective surgeries for the next month starting Monday. System-wide, Ballad had 45 available beds as of Wednesday, only 13 or 14 of them ICU beds, Chief Operating Officer Eric Deaton said in a news briefing that afternoon.

The system has a refrigerated morgue truck parked outside its Johnson City hospital in neighboring Tennessee, added CEO Alan Levine. A second has been ordered for Kingsport, just a few miles away from the Virginia state line.

“We attempted to take every possible step to avoid postponing nonemergency procedures, but we find ourselves at a point where it’s necessary to preserve workforce and resources in order to meet the surge of COVID patients into our hospitals,” said Dr. Clay Runnels, the system’s chief physician executive.

The metrics in Southwest Virginia are worse than in many other areas of the state, driven at least partially by the lack of comprehensive mask requirements in neighboring Tennessee, Gov. Ralph Northam said in a later news conference on Wednesday. But as the number of patients across Virginia continues to rise — a trend that’s expected to continue in the weeks following Thanksgiving — state officials are worried that more health systems could become overwhelmed.

“No one else is close to where Ballad is right now, in terms of needing to implement the same procedures,” state Health Secretary Dr. Daniel Carey said in an interview after the briefing. “But it’s a cautionary tale to everyone.”

It’s not the first time during the now nine-month-old pandemic that officials have raised concerns over hospital capacity. In early April, Northam announced plans to convert three convention center sites across Virginia into field hospitals to accommodate a feared surge in patients. Those plans were put on hold later that month after statewide health trends indicated that health systems had sufficient bed capacity.

While state leaders are still considering all options for handling a potential spike in cases, Carey said that field hospitals generally don’t address the biggest concerns for health systems. Many of the supplemental facilities constructed in other areas of the country largely went unused, including the U.S.N.S. Comfort, a Naval ship sent from Norfolk to New York City to relieve the city’s beleaguered hospitals. The ship, which had 1,000 beds, departed in late March with the intention of treating non-COVID patients. It left a month later after treating less than 200 — approximately 70 percent of whom had the virus, according to the Navy Times.

“What we got from the health systems and our own realization was that remote sites, several miles away at a convention center, were not going to be supportable,” Carey said. Most hospitals find it easier to create surge capacity within their own facilities, where they can maintain their established systems for maintaining patient records or distributing supplies. Part of the reason why Ballad suspended elective procedures, for example, was to create up to 460 beds dedicated specifically for COVID-19 patients. Without nonemergency surgeries, the system could convert post-anesthesia care units — normally reserved for recovery after surgeries — to caring for patients with the virus, Deaton said at the briefing.

“As one hospital CEO said to me, ‘Dan, it’s not about flat spaces, it’s about the staff,’” Carey added. As of Wednesday, Ballad had filled nearly 94 percent of its medical surge beds and 92 percent of its ICU beds. But 200 of its employees were in isolation or in quarantine after being exposed to the virus — a much larger issue for the health system, according to Levine.

“We have the beds,” he said. “The problem is there’s not enough staff, and the percent capacity is based on what percent of our capacity can we hit given the staffing that we have.”

Carey said the administration began discussing ways to fill Ballad’s current workforce shortages with the health system last week. Workers from Virginia’s Medical Reserve Corps could serve as a stopgap, but it’s more challenging to find volunteers with the credentials to serve in emergency rooms and intensive care units. Carey said a more likely solution would be pulling health workers from other settings, including paramedics and emergency medical technicians, to work in hospital wards under the supervision of registered nurses.

“There’s a lot of flexibility in our Board of Nursing, actually, so the board was connected to the [hospital] leadership and the Department of Health Professions to explore, are there any barriers we could address to allow people to come in from prehospital settings,” he said at the briefing.

Ballad isn’t the only hospital system that’s struggled with staffing. In November, The Daily Progress reported that 170 employees at the University of Virginia Medical Center’s pediatric intensive care unit were exposed to a COVID-positive patient but continued to work to avoid shutting down the ward. Spokeswoman Hannah Curtis with the Carilion Clinic — which covers other areas in Southwest Virginia along with Centra, LewisGale, and Sovah health systems — wrote in a Wednesday email that “like every other health care organization in the country, staffing is at times a challenge.”

“We’re continuing our recruitment efforts, and we’re working with travel nurses to help meet our needs,” she added.

There are a variety of reasons why Southwest Virginia could be struggling with hospitalizations more than other areas of the state, including a more limited health care infrastructure, transmission from neighboring states with fewer restrictions, and — according to Levine — a population with more comorbidities, such as heart disease or diabetes. 

The disease is also spreading faster than in other areas of Virginia, with a percentage of positive COVID-19 tests that’s nearly double the state’s current rate of 8.3 percent. On Wednesday, Deaton called the community spread in the region “enormous,” saying the virus — which has led to 723 deaths within the health system — was a “reality” that the region needed to face.

But both Carey and Northam warned that other hospitals could begin to struggle if Virginia continued to see a rise in cases. While the governor didn’t announce any new policy changes — saying health officials were still analyzing the effects of his most recent cap on gathering sizes — he added that “all options are on the table” if current trends continued.

“What we need from the state is not to deal with the downstream consequences, as serious as they are,” Carey added. “Let’s get to the root here. And the root is that those simple behaviors of wearing a mask, keeping your distance, washing your hands and staying home when you’re sick is the way we’re going to turn this around.”