Hospitals in crisis

As the number of people flooding hospitals continues to rise, Beebe Healthcare stands as the only area system that has not yet declared a critical situation, known by the industry as crisis standards of care. ChristianaCare, Bayhealth, and TidalHealth Nanticoke have all issued the crisis-level notice as the number of COVID-19 hospitalizations sets new records.

On Jan. 11, Dr. Ken L. Silverstein, ChristianaCare chief physician executive, said ChristianaCare has never before had to issue a crisis notice over an inability to keep up with healthcare services.

“We’re caring for patients in hallways. We are stretched thin,” Silverstein said.

Although Beebe has not yet adopted crisis standards of care, the situation is critical and can change at any moment, said Dr. David Tam, president and chief executive officer of Beebe Healthcare. Beebe recently reported its highest number of COVID-related cases at 76.

"Right now, it's more difficult than ever to deliver healthcare," Tam said. "Our emergency departments and hospital are past capacity. We are making operational adjustments to keep up with the growing demand for healthcare in Sussex County, but this is not sustainable."

Starting Jan. 13, Beebe Healthcare is postponing all nonemergent procedures and taking measures so staff and beds can be reassigned for inpatient care. This is directly related to the continued surge in COVID-19-positive patients who require hospitalization and care, Tam said.

Certain procedures and surgeries will continue, however, including those that screen for progressive diseases such as cancer that could have longer-term consequences if not identified for patients. Examples include colonoscopies, biopsies and endoscopies, as well as access to dialysis. Patients will be contacted by their surgeon's office, and Beebe's multidisciplinary team will continue to evaluate cases daily for the health of all patients, Tam said.

At Christiana, Silverstein said healthcare providers are asking people with minor health needs to avoid the emergency department. “We do not have the capacity to do routine testing or treat mild disease,” he said.

When asked why hospitals have enacted the crisis standards of care with this year’s milder Omicron variant compared to last year’s COVID variants, Silverstein said there is nothing mild about the situation, and the people in the hospitals are critically ill or seriously sick. 

At Bayhealth, Dr. Gary Siegelman, senior vice president and chief medical officer, said they are trying to fast-track patients who come in with mild symptoms. He estimated 10-15 percent of patients coming into the hospital have mild symptoms, and they can be redirected elsewhere for treatment. He said Bayhealth has started a virtual urgent care service – Bayhealth At Home, which is available 24 hours a day. “You can connect, and get a board-certified physician. It’s an urgent care visit, and a way to give patients access if they have mild symptoms,” Siegelman. “We’re trying to use different methods to help get patients through the system.”

Compared to the uncertainty of the virus and the surge of patients in 2020 and 2021, Spiegelman said doctors today know how to treat the virus, but the number of patients is the highest it’s ever been. “That’s really what’s triggering the crisis,” he said.

Staffing shortages have also hit Bayhealth, with some nurses taking early retirement, and others leaving the profession entirely, he said.

The Omicron variant is now the dominant strain in Delaware. Seventy percent of recent cases are Omicron with the rest Delta, officials said. According to state statistics posted Jan. 11, the number of hospitalizations hit a new high of 746, with 77 critical. Officials said 51 people are on ventilators. It is higher than the 2021 peak of 474, even though there are more people today fully vaccinated – about 90 percent of Delawareans over 18.

About 40 percent of hospital capacity is made up of COVID patients, which could be prevented, said Gov. John Carney during his weekly press conference Jan. 11. With about 1,800 total hospital capacity across the state, roughly 800 of the total cases are COVID related, according to state statistics.

It’s the main reason, Carney said, that he reissued the public mask mandate.

“We’re at a critical point. We need people to take special care when they’re indoors,” he said. “We have a record number of people rushing to the emergency room.” 

Carney said he expects some schools will have to close because of high numbers of educators testing positive.

Following an emergency order issued Jan. 3, Carney said, there are more than 300 Delaware National Guard members assisting with the state’s COVID response, including helping in the hospitals.

Dr. Karyl Rattay, Division of Public Health director, said people should get tested if they have symptoms, have been exposed, are not vaccinated, or have underlying health conditions.

Those who are not vaccinated should be tested once a week, she said, but if someone has tested positive in the last three months, they don’t need to get tested unless they have symptoms.

Coming soon are mass testing sites at night and on the weekend. The first is planned in Delaware City, said AJ Schall, Delaware Emergency Management Agency director. He recommended those who need a test should get a Vault test through the state site, de.gov/gettested. 

Last week, Schall said, Vault did 3,000 at-home tests, but they can do more.

“They have a nine-hour turnaround time, so most of their tests … usually by the time you go to bed at night or wake up the next morning, you have the results,” he said.

Wearing a well-fitted mask is important to make sure the virus is not spread, Rattay said, and she advised against cloth masks unless they have multiple layers. “Many people are wearing a surgical mask with the cloth mask over,” she said. She recommended using N95 or KN95 masks as the best-fitting products.

“I don’t want the mask mandate on one day longer than we have to,” Carney said.

Speaking about his latest mask mandate, Carney said he did not include churches because of pending litigation.

“I’ve encouraged my mother, who goes to church every day, to wear a mask, and I would encourage others who are going to church or places of worship to wear a mask as well, but we have those litigation concerns that I mentioned,” Carney said, declining to comment further.

Crisis Standards of Care

While crisis standards of care may sound negative to some, Siegelman said the purpose of the change is to allow more flexibility for patient care.

“It allows the hospital to marshal more resources to take care of patients,” he said.

This is done by postponing elective surgeries, creating new bed capacity by setting beds up in spaces such as a conference room or other areas that don't usually have hospital beds, and redeploying staff to provide help in certain areas. “It helps nurses and other staff who have more patients to take care of,” he said.

So far, he said, about 300 people have shifted from their regular positions for a few hours a day to help out in high-need areas.

“It’s a big help. It’s a moral support, too. The staff see their colleagues stepping up to try and help them, and they feel like people appreciate what they are doing,” he said.

The crisis designation provides documentation that shows the hospital is in a tough situation. “We’ve never had this many patients in the hospital at one time,” Siegelman said. “We want to make clear it’s not business as usual. It gives documentation to the government that it’s an unusually difficult time for the hospital.”