Monthly case increase was 60% at height of winter spike, death increase 20%
JOHNSON CITY, Tenn. (WJHL) – Northeast Tennessee’s health care systems, schools and others impacted by COVID-19 surges have had to contend with a far more rapid rise in cases during the current delta variant spike than they did during the winter surge.
The rate of case, hospitalization and death growth trends far exceed the celebrated increase in people getting vaccinated — a number that more than doubled from July to August, from 9,906 to 21,733.
The trend concerns Ballad Health CEO Alan Levine, who said staffing is the hospital system’s primary limitation as numbers continue increasing. Levine said the system needs more registered nurses, licensed practical nurses and nursing assistants right now, but the work environment makes that very difficult.
“We already have a crisis in terms of a nursing shortage,” Levine told News Channel 11 Monday. “It was there before COVID but with each of these surges what you see is a “burnout rate” and PTSD with nursing.”
Despite well over a third of residents within the seven-county region being vaccinated, the more contagious variant propelled cases from 1,677 in July to 12,112 in August.
That 622% increase in August cases over July followed a 263% spike in July over June’s 462 cases, meaning cases rose 2,522% in just two months.
The winter surge, which seemed rapid at the time, developed much more slowly than the current one.
Cases rose 60 percent from November’s 9,088 to December’s 14,531. They had increased by 59% in November compared to October’s 5,717, so those totals started from a much higher baseline.
January saw cases decrease by 46% to 7,919, and the number dropped all the way to 2,676 in February.
The follow-on effect: Deaths and hospitalizations
The quick delta increase hadn’t shown signs of leveling off much as August came to a close. The first six days of September had the region on pace for more than 17,000 cases in September, though that could come in significantly lower if the surge turns around soon.
But the rapid spike so far has been reflected in the rise in COVID deaths as well as the pace of people hospitalized for COVID in Ballad Health hospitals.
Deaths are a lagging indicator, continuing to rise or at least stay high for a period after case rates peak and begin declining. Even so, COVID deaths increased 746% from July to August, increasing from 13 to 110. In June, 12 COVID deaths were reported.
That again compares to a less rapid increase during the winter surge. A total of 74 deaths were reported in October, 181 in November and 218 in December. That’s a 20 percent increase from November to December and a 195% increase from October to December.
The region should brace for a continued high death toll for several weeks after the current case surge abates, whenever that is.
While cases in January were just over half of December’s totals, there were actually more deaths in January — 231 compared to December’s 218.
Speed of Ballad surge dwarfs that of fall-winter
Hospitalizations, people in ICU and those on ventilators in Ballad Health hospitals all increased by more than 500% late July to August 31 — and by more than 1,000% from the end of June to the end of August.
Levine declined to speculate much on surge plans, but he referenced changes at Mississippi hospital systems in which leaders converted a parking garage to a “ward-type” setting under a tent.
“There are things that hospitals can do to try to give your staff more flexibility and those options are available to us if we need to use them,” Levine said.
On July 28, there were just 46 patients hospitalized with COVID in Ballad facilities. That total jumped to 125 in just 7 days.
In that type of approach, he said, “you can stretch your staff out more instead of having them each going in and out of private rooms.
From Aug. 4 it took 14 days to crest 200, reaching 201 on Aug. 18, while the runup to 300 patients took 13 days with the number hitting 313 on the last day of August.
Tuesday, the total reached 402, meaning it took just 34 days for the system to go from reaching 100 COVID inpatients to reaching 400.
Those increases contrast with how the fall and winter surge impacted the hospital system. Hospitalizations increased roughly in line with case trends. The system first reached 100 hospitalized COVID patients Oct. 8, with 103 people.
It took 25 days for the number to reach 200, with the total hitting 212 on Nov. 2. It took another 37 days for the total to exceed 300, when it reached 306 on Dec. 9.
In early January hospitalized patients reached a then-high of 361.
The ICU and ventilator trends are similar. By Nov. 1, 45 patients were in ICU with COVID and that number never even doubled over the next two months, reaching a high of 77 Dec. 29 for a 71% increase.
Ventilated patients totaled 17 Oct. 30 and hit 48 Dec. 30 — a 182% rise.
The increases have been much steeper, over a shorter time period, for the delta surge. There were 13 patients in ICU and eight on ventilators July 22. Just 35 days later on Aug. 25, those figures had increased by 446% and 513% respectively, to 71 and 49.
Tuesday, those totals stood at all-time highs of 92 and 66.
Levine said Ballad purchased several dozen new ventilators last year. In the midst of the current surge, the system opted to buy another 30 or so recently, along with some pre-ventilator equipment.
Even patients who survive after time spent on ventilators have endured a great deal, Levine said.
“Death is certainly the worst of this but there are a lot of people that we are able to save… but let me tell you, the suffering- it’s horrible,” he said.
“Imagine … completely losing your capacity to breathe on your own. This is real, people really are suffering. And it’s not just the elderly, it’s your uncles, it’s your aunts, it’s your sisters, your brothers and your children that are suffering with this.”
With the seven-day “community spread” rate of new COVID cases per 100,000 reaching a delta surge high of 858 Tuesday, record-high hospitalization numbers and elevated death numbers are likely to persist for at least several weeks, if not longer — unless previous trends don’t hold.