Omicron stretches hospital staff thinner, as even mild breakthrough infections require quarantines and isolations
January 21, 2022
Nurses, doctors and other hospital staffers out quarantining, isolating or caring for sick family members are placing even more stress on New Hampshire’s hospital system, even though COVID-19 hospitalizations may be beginning to plateau.
Hospitals have been full since early December. Staff members have been stressed, dealing with a pandemic for nearly two years. Some have been leaving the field. And with the highly transmissible omicron variant spreading, even vaccinated people are testing positive — triggering a five-day isolation period.
They are all trying to answer the same question.
“How do you make plans around surges and also deal with staff becoming sick all at the same time?” asked Matt Dunn, chief medical officer of Memorial Hospital in North Conway.
“We have a significant number of staff out with symptoms, who either tested COVID-positive themselves or who are caring for children or family members,” said Jenn Torosian, chief nursing officer of Catholic Medical Center in Manchester. “That’s posing an extreme staffing challenge on top of already-high rates of vacancies.”
Hospital employees are out sick far less than they were during the worst of the pandemic, before they were vaccinated against COVID-19. But staff shortages are still a big problem because of the higher number of patients, and more patients who are sicker and need longer stays and more care, according to Torosian and Tim Scherer, chief medical officer at Southern New Hampshire Medical Center in Nashua.
“There are fewer clinicians and staff to be able to manage those patients than what we’re typically used to,” Scherer said.
Elective surgeries on hold
As in the early days of the pandemic, so-called “elective procedures” remain on hold at many hospitals — this time because of staff shortages rather than concerns over infections.
“We’ve made that concession, to make sure we’re accommodating acute-care demand,” said Kevin Desrosiers, chief medical officer of the Elliot Hospital in Manchester.
“They need to be done,” Desrosiers said of the elective surgeries, a category that includes procedures like knee replacements and hernia repairs. “It’s just an issue of how we can triage the severity of the need.”
The Elliot is seeing significant numbers of staffers out isolating with a positive COVID test, quarantining after a household contact or caring for a sick family member, Desrosiers said. At the same time, the hospital is at anywhere from 90% to 95% full on a given day. And the intensive care unit is well over capacity, Desrosiers said: between 120% and 150% full this week.
The patient volume includes a mix of COVID cases, people recovering from COVID and other common winter illnesses, and people waiting for a bed at a nursing home to become available, Desrosiers said.
Statewide, more than 16% of all hospital patients have COVID-19, and almost one in three patients in intensive care has COVID.
At Catholic Medical Center, Torosian said short staffing is the hospital’s most pressing problem. Although the hospital has a vaccine requirement and boasts a vaccine rate over 90%, breakthrough infections and infections among family members can pull staff out of the hospital for at least five days.
In Nashua, Scherer said COVID cases have spiked this week at Southern New Hampshire, but he’s seeing the same staff shortage as his colleagues across the state.
“Things are heavier than we’ve seen throughout the pandemic so far,” Scherer said. “There are fewer clinicians and staff to be able to manage those patients than what we’re typically used to.”
“At every hospital in the state and every hospital in the nation, people are fatigued and challenged on a day-to-day basis,” said Memorial Hospital’s Dunn.
Staff are stressed, he said, but not despairing.
“We’re on a pretty massive uptick. Our team is under no illusions that the next few weeks or month is going to be probably harder than it’s ever been,” Dunn said.
But waves have to ebb.
“I think we have a good understanding of what’s likely coming our way,” he said, “and when we may see a little bit of a reprieve.”
Moving between units
To keep up with demand in the busiest wings of hospitals, nurses and other staff are getting pulled from less-busy units like labor and delivery.
A nurse who does not normally work in an intensive care unit might be paired with an intensive care nurse at the Elliot Hospital, Desrosiers said, to help lighten the load.
Dunn said he wonders if this kind of staffing, with more staffers floating between units instead of specializing, might represent a path forward for hospitals, particularly small community hospitals like Memorial.
“Health care, as we know, is not the most nimble business,” he said. “We’ve learned a lot about what it means to be nimble.”