Health

‘Incidental’ COVID cases, full ICUs, plus staff shortages stressing NC hospitals

By Rose Hoban

Susan Paulsen started having chest pain on Monday.

The 60-year-old painter who lives in Chapel Hill waited four hours, thinking it was indigestion, hoping it would go away.

Besides, she didn’t want to go near a hospital.

“That seemed like a place I might catch it,” Paulsen said, referring to the Omicron variant of COVID-19 that’s been ripping through North Carolina’s population. 

Omicron has driven up the daily numbers of North Carolinians testing positive for the coronavirus. Since Jan. 1, the state has recorded at least 288,000 cases and had days of record-breaking case counts.

Hospital leaders throughout the state have taken to the airwaves to plead with residents to only come to emergency departments when absolutely necessary. Paulsen had heard those pleas. 

“I didn’t want to be going there for a silly reason and adding to the crowds,” she said. But her husband convinced her to call his dad, a retired cardiologist, who told her in no uncertain terms to get over to UNC Hospital.

Good thing she did. She was having a heart attack.

Paulsen is the type of patient that hospital leaders across the state are worried about getting lost in the shuffle as the state’s health care institutions scramble to cope with a flood of patients infected by Omicron. ICUs are full of people admitted with respiratory failure and regular treatment beds are also crowded with those showing up for other problems who also test positive for the virus, even as staff are calling in sick and unable to come to work because they’re also testing positive.

ICUs full 

“Omicron, no matter what you’re doing right now from following guidelines to testing, it is saturating our community,” said Christopher DeRienzo, chief medical officer at WakeMed Health in Raleigh. 

The WakeMed ICU is full of patients with COVID-19 respiratory disease, he said. 

“The overwhelming majority of ICU patients are unvaccinated,” DeRienzo said, something echoed by health care leaders across the state.

DeRienzo was one of three Triangle-based health care leaders who held a joint call with reporters on Jan. 6 to make a plea to the public in search of COVID-19 testing to look somewhere other than emergency departments. Health care leaders across the state have held similar joint press conferences and on Wednesday, leaders from every North Carolina hospital issued a joint letter asking people to get vaccinated and boosted with another dose when eligible, practice social distancing, wear masks and wash their hands to help relieve the pressure on overwhelmed hospitals. 

This week, the state’s hospitals surpassed the record of COVID-positive patients set 12 months ago, in the midst of last winter’s surge, almost a year to the date.

On Thursday, 4,275 people were hospitalized across North Carolina with illnesses related to COVID, 741 of whom were in ICU beds, according to the NC DHHS dashboard.

“We are seeing as many ICU patients as we saw last winter,” said Shannon Carson, a pulmonologist and head of the intensive care service at UNC Hospitals in Chapel Hill. 

During last winter’s surge, UNC Health had about 500 or so patients across its dozen inpatient facilities. By the beginning of this week, that number had topped 600 patients and kept growing.

Members of the community 

Further complicating the situation is that nearly 1,000 of the 30,000-plus staff are out, according to Alan Wolf, a UNC Health spokesman. 

“These are people who are either testing positive, and not getting too sick, because we have a vaccination requirement, or they’re testing positive from exposure in the community,” Wolf said. Those who test positive have to be out for at least five days, Wolf said. If an employee does not have symptoms after that, they can return to work. If they’re still sick, they need to stay away.

“A thousand people missing is a big crisis for us,” Wolf said.

“Just like other hospitals in the area here, our team is exhausted,” said Andrea Fernandez, regional chief medical officer for the Atrium Health/Wake Forest Baptist system. “We have had to as part of that COVID versus non-COVID-care balance, we’ve had to stop all elective surgeries, and really are having to prioritize and triage our time-sensitive cases.”

On Wednesday, according to Fernandez, there were a total of 236 hospitalized COVID patients, with 53 on ventilators in the system’s hospitals in Winston-Salem, Davie County, North Wilkesboro and High Point. On Thursday, the Triad region of the state — which includes Fernandez’s system — had the most hospitalizations of any region, with close to 1,100 patients.

Many of the Atrium Health/Wake Forest Baptist staff are out sick, too. 

“That’s really where the challenge is for us is that as we have more and more staff out, we don’t have the ability to keep hospital beds open,” Fernandez said. 

A bright spot for Fernandez has been that because of the vaccine mandate for staff, many of those who tested positive for the disease are returning to work pretty quickly. 

That’s not the case for all, though. 

“This is not a cold,” Fernandez said. “They can have fever, they can have a bad cough, they can have significant fatigue, that doesn’t allow them to care for their families and care for their patients. And so that’s why we need to keep them out until they’re well.” 

Another light amid the darkness, Fernandez said, is that the community is starting to heed the hospitals’ callsl to take precautions. Several large events planned in Forsyth County over the past week were canceled or postponed, Fernandez said, showing a commitment to try not to add to the virus spread. 

“People are starting to get the fact that this is worse than the flu, this is worse than a cold and can actually have significant implications on chronic conditions, and can worsen chronic conditions and can have effects that last well beyond those five days,” she said. 

Because of COVID and with COVID

David Wohl from UNC Health said that COVID is so widespread in the community right now that it’s not uncommon to be treating someone who had a traumatic injury and after swabbing their nose, learn the patient is also COVID-positive. 

“There are people who come in for COVID-19, who get progressively more ill from mildly symptomatic to actually having symptoms while in the hospital,” Wohl said. What adds to the workload, Wohl said, is that often they need to treat the COVID, along with the thing that brought them to the hospital in the first place.

A large majority of patients in UNC’s intensive care unit who are COVID positive are there because the virus has sickened them, not because they tested positive incidentally while seeking other care, hospital administrators say.

At WakeMed, DeRienzo said it was likely some “incidental” COVID patients are arriving with issues that were exacerbated by their COVID diagnosis. 

For example, someone may have COVID and their risk of heart attack goes up three times during the first week of illness, DeRienzo said, citing a Swedish study.

“After that diagnosis, it gradually falls but it stays up for stroke and for COPD exacerbations, for asthma, you name it, there’s a whole range of other things,” DeRienzo said.

That makes it a “folly” to try to distinguish whether people are in the hospital “with COVID” or “because of COVID,” DeRienzo added.

“If someone has diabetes, and they go into diabetic ketoacidosis, you know, a very serious sequelae of diabetes, we know that viruses can trigger that,” DeRienzo said. “Is that COVID-related? Who makes that call?” 

Even for those patients who arrive with other problems, and are then diagnosed with COVID, the intensity of care increases. 

“We wouldn’t want to mix those populations if at all possible,” Fernandez said. “We bring them to one of our COVID units, we manage the disease process. 

“Our nurses do have to spend a lot more time gowning up, putting on their goggles, putting on their N95s to go in those rooms. The care that’s delivered is just more arduous.” 

Expecting even more

All of the hospital leaders estimated that fewer than 20 percent of patients are “incidental” COVID cases. Even at that percentage, with soaring hospitalizations, the number of people in beds because of a COVID is likely to go up more before trending downward, they added. 

“Test positivity is the first thing to crest, and then several days a week later, maybe seven to 10 days, hospitalizations begin to crest and then ICU comes after that, and then, unfortunately, deaths follows that,” DeRienzo said. “If past is prologue, then I would certainly hope we begin seeing a crest in the case wave over the course of this week. And I’m sort of looking towards the end of next week, as a point where I’m hoping to begin seeing a stabilization in hospitalization numbers.”

In the meantime, DeRienzo said that he hopes people experiencing chest pain such as Paulsen did continue to make their way to area hospitals to get the emergency care they need. He was disturbed to hear about her hesitation. Fortunately, she was treated with medicines and released after one day.

“I’m sure there are folks out there right now who need care for something and are scared and are going to delay,” DeRienzo said. “We are all working tremendously hard to maintain access to the full spectrum of care.”

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