JOHNSON CITY, Tenn. (WJHL) – Record COVID-19 hospitalizations and staffing shortages have hit Ballad Health — and patients — hard just two weeks before 1,000-plus unvaccinated employees who haven’t applied for exemptions are supposed to have gotten their first dose.
CEO Alan Levine and other Ballad leaders described the mounting crisis in stark terms at a news conference Thursday, with some of the pandemic’s worst metrics ever being delivered to the media.
Behind the backdrop of the data, Levine and others spoke of an exhausted staff with some nurses and other clinical team members working four or five straight days of 12 to 14-hour shifts. They spoke of overcrowded emergency rooms where patients who need to be admitted can wait more than 24 hours to get a room.
“It’s frustrating and heartbreaking to see patients who go to the ER and wait hours upon hours before they can be treated,” Levine said.
“It’s not that that’s something we want to see happen, it’s our nurses and doctors are prioritizing the best they can to take care of the people who are most acute and most at risk.”
Short staffing on patient care floors and demand for new inpatients creates inflection points when those bottlenecks occur, Levine said.
“Nursing leadership will determine it’s no longer safe to bring more patients onto this floor because we want to make sure we’re taking good care of our patients, and we don’t want to stretch our nursing manpower so thin that they end up making mistakes.”
And they spoke of continued low vaccination rates and ongoing severe disease and death even from the overall milder Omicron variant, due to the sheer numbers of infected people. Chief Operating Officer Eric Deaton said 73 people had died from COVID at Ballad hospitals over the past seven days.
“The Omicron variant has had a huge impact on our region,” Deaton said.
A few numbers
Deaton said more than 15,000 COVID tests were positive within Ballad’s footprint last week, double the number at the height of last fall’s Delta variant surge and triple the numbers from last winter’s surge. The two-state area had a test positivity rate of 44.7%, far above previous records and higher than Tennessee’s statewide rate of slightly over 41% and Virginia’s statewide rate of 27%.
86% of the 436 COVID inpatients were not vaccinated, and their average age was 63. The 14% of vaccinated COVID patients had an average age of 73. Of the 78 COVID patients in intensive care units, 92% were unvaccinated, while 96% of the 55 patients needing ventilators were also unvaccinated.
A full 297 COVID patients who were sick enough to potentially be hospitalized were being monitored closely through Ballad’s “Safe at Home” program. Were they hospitalized, Levine said that would require an additional 42 nurses.
But nurses and other staff are in very short supply, with 834 employees, 7% of Ballad’s total workforce, out quarantining or isolating due to COVID positive tests Thursday. That shortage has prompted Ballad to declare “crisis staffing” and the system will begin bringing back COVID-positive staff who are asymptomatic or recovering enough not to have had a fever for 24 hours.
“There are simply not enough bedside caregivers,” Chief Nursing Officer Lisa Smithgall said, citing higher-than-normal patient-to-staff ratios. Smithgall asked for “grace and patience” for Ballad clinical and other staff and pleaded with people to abide by the system’s masking guidelines.
As to the 73 recorded deaths in the past week, Deaton said despite solid evidence the Omicron variant causes fewer severe illnesses as a percentage of overall cases, “when you have this many positive cases, that’s going to cause more and more admissions across the region.”
Deaton said 30% of Ballad’s current inpatients are COVID patients, compared to about a 25% average nationally — and about a third of all deaths in Ballad hospitals last week were from COVID.
Monoclonal antibodies having limited effect due to tight supply, ineffectiveness of two varieties
One tool that helped prevent hospitalizations during the Delta variant has become less impactful during Omicron — the use of monoclonal antibodies.
Ballad’s VP of medical staff services, Dr. Mark Wilkinson, said the federal Food and Drug Administration withdrew emergency use authorization for two of the three main monoclonal antibody treatments because they’ve proven ineffective against Omicron.
“Those two types of antibody cocktails were effective against the Delta variant and … utilization for those antibodies spiked in August-September and also through the holidays,” Wilkinson said.
Only sotrovimab has retained its EUA.
“Unfortunately sotrovimab is in short supply, so our supply is extremely limited and so you see a dropoff to about 50 doses a week the past two weeks.”
Those tight supplies have left Ballad needing to use the National Institutes of Health’s “tiered standards” and only administer the antibodies to people at the highest risk for hospitalization and death.
Impact of staffing woes ‘cascades through the system’
Deaton said Ballad has already hit the high side of its peak COVID hospitalization as predicted a week ago. But he said the system’s modeling has tended to be pretty good and that Ballad is forecasting a decline in COVID inpatients over the coming week. Levine, however, said he didn’t expect that decline to begin for at least a few days.
Coming on top of a nursing shortage that already existed prior to the pandemic, the current crunch is creating problems that become clear to many families seeking care at Ballad, Levine said.
When skilled nursing facilities, mental health facilities and other “post-acute” locations are short-staffed and can’t take patients Ballad is ready to discharge, an additional bottleneck is created.
“And who gets to feel the brunt of that? It’s the emergency department patient that’s sick and wants to be seen and treated, and they’re waiting,” Levine said.
Not only is it heartbreaking for staff, he said, but “there’s a point beyond which it becomes so dangerous that we have to do something different.”
Though numerous hospital systems have put so-called elective surgeries on pause as the Omicron variant has stressed capacity, Levine said Ballad did not want to do that for a third time.
“That seems to imply to some people that these are surgeries that aren’t really necessary, but that’s not true,” he said. “These are patients some of whom have cancer, some of whom have serious orthopedic injuries. These are patients who need these procedures, that need this care.”