Health care workers with the Carilion Clinic in Roanoke wear enhanced personal protective equipment inside the health system’s facilities (Photo courtesy of the Carilion Clinic).
In mid-August, as the delta variant was surging across Virginia, hospitals reached out to Gov. Ralph Northam’s administration for help.
“This rise in infections is once again placing significant stress on general hospitals and nursing facilities within the commonwealth,” wrote Sean Connaughton, president of the Virginia Hospital and Healthcare Association, in a letter to Health Commissioner Dr. Norman Oliver and Health Secretary Dr. Dan Carey. At the time, the seven-day average for new hospitalizations mirrored that of March, when Virginia was still recovering from a massive holiday surge.
Connaughton asked the administration to reinstate emergency waivers that had given hospitals the ability to quickly add bed capacity and hire out-of-state providers, among other regulatory changes that could provide flexibility.
“Staffing levels at these facilities are severely strained by a shortage of health care workers and trained health care professionals, exacerbated by fatigue, personal illness and family needs stemming from this long-term pandemic event,” he wrote. “It is further anticipated that COVID-19 will continue to place increased demands on the commonwealth’s health professional workforce.”
It was far from the only communication between health systems and the Northam administration. Emails from Carey’s office, obtained through a Freedom of Information Act request, show multiple hospitals began raising concerns over increasing caseloads around the same time. An Aug. 13 email from James Moss, the state hospital coordinator with the Virginia Department of Health’s Office of Emergency Preparedness, noted that facilities in Eastern Virginia were already “getting close” to exhausting their bed space.
“Sentara asked VHHA to have the governor reissue [executive order] to allow operating above their licensed capacity,” Moss wrote. “Given what we’re seeing statewide,” he added, “suggest we prioritize and proactively push up asap.”
More than a month later, though, there’s been no action by the administration to relieve hospitals in Eastern Virginia or anywhere in the state — frustrating many health systems and providers as they continue to struggle with a sharp rise in patients. New infections and hospitalizations have declined slightly since their peak in mid-September, the state’s worst surge since last winter. But the current COVID-19 hospitalization rate, at close to 2,000 weekly patients across Virginia, is still dramatically higher than it was this summer, when the weekly average dropped to an all-time low of 220.
Clark Mercer, Northam’s chief of staff, said reimplementing the waivers would require the governor to declare another state of emergency at a time when not all hospitals were experiencing the same needs. He also said the administration had been in close contact with both the hospital association and individual health systems across the state, where hospitalizations correlated strongly with low vaccination rates.
“The numbers have been high, but they haven’t been unmanageable, that we’ve seen,” he said. And it’s true some of the earliest warning signs were among health systems — including Ballad in Southwest Virginia — where less than half of the service population has been fully vaccinated against COVID-19 (so far, the system hasn’t mandated vaccines for its own employees, either).
But the ongoing pandemic isn’t the only challenge that hospitals are confronting. Across the state, emergency rooms have been overwhelmed by an influx of sicker-than-normal patients — driven, doctors say, by delayed care throughout much of the pandemic. And as pediatricians struggle to keep up with exposures at school, many families are flocking to their local hospitals for testing.
The demand for medical care is continuing to reverberate across Virginia, even in areas with higher vaccination rates. Dr. Cameron Olderog, president of the Virginia College of Emergency Physicians, said Inova Fairfax was diverting patients last week as the system struggled to keep up with demand (nearly 74 percent of the county’s adult population is fully vaccinated). The same week, Mary Washington Healthcare in Fredericksburg became the latest system to postpone elective procedures, even with close to 60 percent of adults fully vaccinated in the city and surrounding counties.
“At this point, we’re still awaiting potential action by the administration,” said Julian Walker, vice president of communications for the hospital association. “Many of our members are struggling right now. And whether it’s scaling back visitation or postponing elective procedures, all of these are in response to the pandemic surge and the strain on both hospitals and the team members who work there.”
Hospitals want the reinstatement of waivers that were in place for much of the pandemic under an emergency order. In early 2020, Northam allowed Oliver to authorize new hospital beds without requiring facilities to go through the state’s lengthy licensing process. The order eventually included more than half a dozen additional waivers, including liability protections for medical professionals and allowing out-of-state providers in good standing to practice in Virginia.
Those provisions expired on July 1, when Northam’s emergency order came to an end. But Connaughton pointed out in his letter that, at the time, both cases and hospitalizations were as high as they were in March, when the waivers were still in place. Even with the recent drop, metrics remain far higher than they were at the start of the pandemic, when Northam himself ordered a statewide pause on elective procedures and mobilized the National Guard to respond to an anticipated surge.
“It is further anticipated that COVID-19 will continue to place increased demands on the commonwealth’s health professional workforce that will require additional personnel, including for the ongoing administration of COVID-19 vaccines,” Connaughton wrote. Staffing is currently a huge problem facing hospitals in Virginia and across the country, heightening the competition for nurses, respiratory therapists and other much-needed medical providers.
Olderog said any flexibility that would allow more practitioners to enter the field — from waiving state licensing requirements for out-of-state providers to re-expanding telehealth or easing practice regulations for nurses — could be helpful. COVID-19 hospitalizations and high ER demand are putting an additional strain on staff, as is the drive for new treatments such as monoclonal antibody therapy.
“At any point we that we can allow somebody to practice at the full extent of their abilities, it frees up other providers,” she said. “Right now, the biggest resource we’re running out of is people.”
According to Mercer, though, those staffing needs likely wouldn’t be met by reinstating emergency waivers. “Some of the requests they’ve put in aren’t going to address the fact that there just aren’t enough nurses right now,” he said. The administration has suggested state legislators could be taking a more active role to assist hospitals, from promoting vaccines in their home districts to taking up legislation that could allow the state health commissioner to independently waive regulations during a public health emergency.
“That would probably be a good thing for the General Assembly to look at,” Mercer said. Northam, for his part, has also continued to emphasize vaccinations as the single biggest solution to relieving hospitals and ending the ongoing pandemic.
“We’re fighting a virus and we’ve all got to step up to the plate and be part of the solution,” Northam said at a news conference last week. “We’ll do everything we can to keep the staffing, keep the beds open, but it’s getting to the point where we don’t have as many answers as we’d like.”
At least internally, though, there’s been acknowledgement that state leaders may have to consider other solutions to significantly reduce COVID-19 hospitalizations. In a Sept. 1 email, one VDH staffer raised the possibility of establishing clinics for monoclonal antibodies — a laboratory-designed drug that can temporarily help the immune system ward off severe symptoms of COVID-19 — at both local health departments and at more hospitals across the state.
“With about 45 percent of Virginians not fully vaccinated and the delta variant showing no current signs of slowing down, I believe we need to work with our private sector partners to discuss planning,” wrote Dr. Brooke Rossheim, a public health physician specialist for the department. Some individual hospitals have submitted their own requests for assistance, including hard-hit Augusta Health, which requested National Guard support from both the state and federal government.
“So many other hospitals find themselves in similar situations to ours, and resources are strained everywhere (compounded by recent developments calling for those same limited resources to help with Haitian refugees in Texas and Afghani refugees in Northern Virginia),” Augusta Health spokeswoman Lisa Schwenk wrote in a Monday email. “We appreciate there is a lot of competition for these same resources.”
It’s not clear how the current strain will evolve in the coming months. Modeling from the University of Virginia, widely relied on by state officials, suggests the state could see another peak through the week of Oct. 17. More pessimistic projections suggest cases could rise steadily through the holiday season even as vaccination rates continue to increase — something Connaughton said many hospitals are expecting.
Even without a continued spike in patients, higher-than-normal numbers of COVID-19 hospitalizations could complicate efforts for facilities, especially amid the current staffing shortage. Mercer suggested that not all hospitals are collaborating to transfer patients when there’s a shortage of space. But Olderog said a lack of fully staffed beds has been the real problem. Transferring patients can be complicated, and often can’t occur if an open facility can’t meet the person’s medical needs.
“If a patient is vomiting blood and needs a gastroenterologist, they probably also need an ICU bed,” she said. “And finding both those things — a GI doctor and a place with an available bed — can be really difficult.
“There’s a fair amount of head-in-the-sand right now,” she added. “I understand people want to keep things open as much as possible, but there’s a lot of stress on the medical system.”
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