Region’s hospitals stretched thin in Delta wave

Published 6:11 pm Tuesday, September 21, 2021

On any given day at any of Sentara Healthcare’s seven Hampton Roads hospitals, including at Obici in Suffolk, their capacity to handle more patients has maxed out thanks to more COVID-19 patients during the Delta variant surge.

Though none of its hospitals is turning away patients, people have to wait longer in the emergency department to get care, up to four to five hours, and on occasion, they have to lean on one another to take a patient for whom there’s no room.

Sentara Obici has begun to limit certain kinds of non-emergency surgeries, according to Sentara Healthcare spokesman Dale Gauding, though some such surgeries scheduled for the week of Sept. 20 would still take place due to preparations already made for those patients, such as pre-surgery tests.

However, Gauding said non-emergency surgeries requiring an overnight stay would be postponed from the week of Sept. 27 on. Every week on Tuesdays, the hospital will evaluate what the situation there looks like and then start postponing them two weeks out if needed.

Other Sentara hospitals are also postponing non-emergency surgeries, but it’s a constant evaluation.

“It’s not like a blanket ‘no more electives from here on out,’” Gauding said. “It’s a case-by-case, day-by-day kind of evaluation of their capacity.”

Dr. Michael Genco, chief medical officer at Sentara Obici Hospital, said capacity issues in its ICU forced it recently to transport a patient from Suffolk to Sentara’s Virginia Beach General Hospital, roughly 40 miles east.

“We have been operating at or above capacity for quite some time,” Genco said. “Now we are seeing a significant amount of patients who have COVID that are requiring in-patient hospitalization. But in addition to that, we’re also seeing folks with non-COVID conditions that are requiring hospitalization, higher numbers than probably what we had seen pre-COVID.”

For the week ending Sept. 9, Sentara Obici Hospital had 46 COVID-19 patients and was at 89% capacity, with just two beds available. At Chesapeake General Hospital, it was at 94% capacity with 58 COVID-19 patients and just two available ICU beds. Bon Secours’ Southampton Memorial Hospital was at 75% capacity with seven COVID-19 patients and two available ICU beds.

“We’ve got patients in every little nook and cranny that you can think of trying to do the best that they can to take care of them,” said Claresa Sanchez, patient care supervisor at Sentara Virginia Beach General Hospital.

Across Sentara’s seven Hampton Roads hospitals, it had 315 COVID-19 patients and 122 available ICU beds for the week ending Sept. 9, though Genco stressed that fluctuates daily, and many times hourly, and all of its hospitals have, at times, reached their respective capacities.

“If people are really, really sick, and they require intubation and they need to go to the ICU, we make it happen,” Sanchez said. “Yes, they’re at capacity, they’re very busy, but we will downgrade patients, we’ll assess patients, see who we can move out of the ICU to bring somebody into the ICU. Worst-case scenario, the patient is held in the ICU for a bit until they can get a bed, but we do everything that we can to get the truly sick, sick people up first.”

Statewide, 2,174 people are currently hospitalized with COVID-19 as of Sept. 17, according to the Virginia Hospital and Healthcare Association, with 1,984 of them confirmed positive cases and another 190 whose test results are pending, with 621 people in the ICU and 343 receiving ventilator support.

Genco said those with chronic medical conditions, such as congestive heart failure and COPD, have been facing barriers and having trouble managing them.

“We are really seeing two populations that have both increased at the same time,” Genco said. “We’re seeing greater need from our traditional in-patient population and we’re also seeing a greater need from our COVID population.”

Sentara officials at a recent briefing described extended emergency room wait times and issues at times finding beds for people who need to be admitted to the hospital.

“It takes longer to get them in the right place in the hospital,” Genco said. “So ultimately, in the hospital, you want to get the right patient, to the right place at the right time, and when you’re at capacity, that happens slower.”

Genco said multiple factors determine whether Sentara will admit someone into the hospital — the person’s current symptoms, other medical issues, what kind of support they have at home compared to the support system in the hospital.

The majority of COVID-19 cases coming into Sentara’s hospitals are unvaccinated, between 80% and 90% depending on the location. He said they have had patients “begging to get the vaccine” when they come off ventilators.

“Don’t wait to get (COVID-19) to decide,” Genco said. “You want to get the vaccine. Don’t wait until one of your family members or loved ones has gotten it and seen what they’ve gone through.”

Lucy Vinson, an ICU nurse manager at Sentara Norfolk General Hospital, said many of its COVID-19 patients express regret that they did not get the vaccine.

“We see a lot of very sick patients and they’re very short of breath and they’re very scared,” Vinson said.

About 90% of the patients she sees at Norfolk General are not vaccinated.

“And so, what that tells me is that the vaccine works,” Vinson said. “Our patients, they can come into the ICU on high-flow oxygen, and they’ve progressed as they have come in through the ED and gone to Med/Surg and gone to step-down (intermediate care units), and we’re their last resort.

“We have difficult conversations every day — the team members, the nurses, the physicians —  conversations (about) ‘Do you want us to do chest compressions? Do you want us to put you on the ventilator? Do you want to continue to struggle to breathe or (are) you wanting to give up the fight and be made comfortable?’ These are decisions that they have to make every day and conversations that we have to have every day, and it’s really difficult, and I can’t even explain it.”

Genco said there have been few instances of anyone with a negative reaction to a vaccine needing emergency care.

“We haven’t had to admit anybody for a vaccine reaction that I’m aware of,” Genco said.

Bea Barajas-Williams, manager of respiratory therapy at Sentara Virginia Beach General Hospital, said it has been seeing increasing numbers of “really, really sick” COVID patients who are requiring a high level of care.

She said more people are requiring more oxygen — 60% up to 100% oxygen in some cases.

“They may either get bumped up to intermediate care or go straight to the ICU,” Barajas-Williams said, “depending on capacity.”

She said people can spend between a month to two months in the hospital dealing with COVID-19, and then afterward, depending on what their outcome is, they’ll go to a rehabilitation facility.

The patients coming in with COVID-19 recently are younger, 30 to 40 years old, and have difficulty doing basic tasks.

“They can no longer get up and go use the restroom or brush their teeth,” Barajas-Williams said. “They need to get somebody in there to help them use a bedside commode. That’s something that someone who is 40 years old is just not used to doing.”

Vinson said the nurses and staff check in on each other to monitor their mental health as the influx of COVID-19 strains their hospitals and that of others around the country. Sanchez said they are tired and stressed out, and they give out lots of hugs. They don’t get as much time to spend with each patient since they are so busy.

And staffing shortages are not unique to Sentara, with officials saying there are more than 800 openings systemwide.

“Our staffing struggles really come from patient acuity and how sick our patients are. … We are used to very, very sick patients, but COVID takes it to a whole, entire different level,” Vinson said.

Asked whether they are frustrated with people who come in for care and are unvaccinated and didn’t take precautions, Vinson said they took an oath to care for all patients, no matter their vaccination status. Still, she and other Sentara officials strongly encouraged people to get a COVID-19 vaccine.

“We are exhausted, but we also really love what we do,” Vinson said, “and we want to continue to fight for Hampton Roads and all of your loved ones. But I want to urge you to speak to your doctors and get vaccinated.”