At CMC, unvaccinated hospital patients grinding system to a halt, president says

January 3, 2022

New Hampshire Union Leader | By Mark Hayward

One out of five nursing slots is unfilled.

Blood supplies are tight.

And COVID-19 patients languish in hospital beds, unable to be transferred because nursing homes can’t take them.

Such is the state of one of the largest hospitals in New Hampshire, Catholic Medical Center in Manchester, as it braces for another post-holiday surge of COVID patients, most of them unvaccinated.

“The folks that we see in our ICU on ventilators for weeks at a time are grinding the health care system in this state to a halt,” hospital President Alex Walker told reporters outside the hospital emergency department after hosting an unprecedented tour of his hospital.

Hospital officials say that unvaccinated COVID-19 patients outnumber vaccinated patients by a ratio of 7 to 1.

They walk into the hospital under their own power but eventually end up in the ICU on ventilators. These latest patients aren’t like the elderly or infirm who crowded the hospital during the initial winter 2021 COVID-19 surge.

They are young and middle-aged adults.

They say their last words to spouses before a doctor intubates them. They have photos of young children on their walls, children that Dr. Richard Read expects will have to grow up in single-parent homes.

“It doesn’t seem to have an end in sight. It’s constant and relentless,” said Read, the medical director of hospital care services.

In the glass-walled rooms of the ICU, COVID-19 patients are bedded down in rooms marked by an X of red masking tape. A sign warns that the door must be closed at all times. Nurses don a fresh set of blue gowns, masks and gloves every time they enter the room.

That’s where a 44-year-old who entered the hospital before Thanksgiving died, said Patty Labrie, a nurse who runs floor D-100, a 47-bed unit that at times is half filled with COVID-19 patients.

The patient thought COVID-19 was a conspiracy, Labrie said.

“He was very scared and afraid to die,” Labrie said. He was transferred to the ICU, where he succumbed.

Walker said he expects a surge from the Christmas-New Year’s holiday gathering and travel. “It’s going to be a rough ride,” he said.

It will be different from last winter, when capacity problems focused on space and equipment. The National Guard fitted up surge centers; hospitals closed their doors to elective procedures and scrambled to find ventilators and PPE.

This time, the issue is nursing and hospital staff. The vacancy rate on the nursing staff is 20 to 25 percent, said Jennifer Cassin, vice president of nursing and the chief nursing officer.

Some are leaving for the better pay that traveling nurses make. They leave behind demoralized co-workers, Cassin said.

At the emergency department, nurses face confrontations: They turn away visitors because of a new policy; they enforce a mask mandate that some want to debate. They hear the shouts and anger from belligerent drug users. In the meantime, they dodge cots set out in hallways, and they care for patients who should already be admitted to hospital wards.

“The ED is being pushed further and further to take care of ICU patients,” said Sarah Jones, an emergency department nurse. One hour on a ventilator may be OK, but not the five or more hours they end up at times, she said.

“There’s no let up,” said Sen. Maggie Hassan, D-N.H., who also toured the hospital and made a point to encourage nurses at their work stations.

“The emotional trauma is significant,” Hassan said.

Hassan said government can help by sending teams of medical workers, which it has. She also said American Rescue Plan money is being used to boost nurse pay.

Meanwhile, bipartisan efforts are underway in Washington to have panels of outside experts review the FDA’s emergency authorization of vaccines, Hassan said. The hope is to convince holdout health care workers to get vaccinated.

She was less committal about a suggestion by Dr. Alan Flanigan, medical director of the Emergency Department. He wants the state to sanction doctors who give patients the anti-parasitic drug ivermectin.

The question is how long CMC can keep going.

Every day, the hospital checks blood supply and staff to handle all of the surgeries scheduled for the day.

During the post-Thanksgiving surge, CMC postponed some elective procedures, Walker said. The hospital president acknowledged that “elective” is a somewhat misleading word; some open heart surgeries are elective.

He said the hospital hasn’t reached a point of all-out triage.

“We’re proud of the fact that we find a way to care for everybody,” he said.