Augusta hospitals full of COVID-19 patients but preparing for more as cases surge
Jim Davis saw University Hospital fill up with COVID-19 cases that broke its own record for infected patients in-house last week, climbing well beyond where it was at its previous peak in late July, past 105 to 110 and then 118.
But the number that scares the University CEO is 442: the number of people who tested positive for the disease in University's labs the previous week, higher than anything the hospital has seen so far and a harbinger of even more patients that could come flooding in.
But University is prepared for them, making plans to go as high as 135 inpatients at a time or beyond, even as it taxes the hospital and its caregivers.
It is a spike Davis warned his board two months ago was coming, but he does not consider himself prophetic.
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"I'm not psychic," said Davis, an engineer by training. "I watch data."
University is not alone – AU Medical Center and Doctors Hospital of Augusta were also nearing previous highs as the total number of very sick COVID-19 patients across the city broke records late last week, a scene repeated across Georgia.
"My fear is this is going to keep going up," Davis said.
What has kept the situation from being even worse in Augusta is the former St. Joseph Hospital, which University acquired and renamed University Hospital Summerville. University spent about $10 million renovating the hospital and retrofitting it to handle COVID-19 patients in three 24-bed units and a 16-bed intensive care unit, Davis said.
"Our problem now is those are full," he said.
University had started taking down some of its dedicated COVID-19 "cohort" units when it was down to between 20-30 patients in September, but now those are going back up, Five South is still a COVID-19 unit, and now Five North is being prepared to again be a negative-pressure unit for COVID-19, Davis said. The west wing is projected to do the same, he said.
"And then we will go back to Summerville" and look at opening a fifth unit there, said Reyne Gallup, University's executive vice president and chief operating officer for acute care services.
At AU Medical Center, the COVID-19 census reached 68 patients last week among three ICUs and two COVID-19 wards, said Chief Medical Officer Phillip Coule. But those numbers can be deceiving because once a patient is no longer infectious they are taken out of the COVID-19 total, he said.
Both University and AUMC have been more aggressive in preventing hospitalizations, in part by giving monoclonal antibodies similar to what President Donald Trump received.
"We’re treating people more aggressively as outpatients," Coule said, particularly those who are over age 65. "We’ve giving them to patients at risk because it is known to reduce hospitalization."
That treatment is "amazing for people that are not admitted that are pretty sick," Davis said. "They see results turning around in 24 hours, which is key to actually keeping some of those people out of the hospital or we could be having a bigger problem."
The record number of hospitalized patients also comes as University is discharging droves of its COVID-19 patients each day who have recovered, Davis and Gallup said. University discharged more than 60 patients last week even as its numbers continued to climb, spokeswoman Rebecca Sylvester said. The average time a COVID-19 patient spends in the hospital has dropped from 10 days to six, Davis said.
"We do a much better job of caring for these folks than we used to," he said. "(Caregivers) have better tools and they have a lot of experience doing this."
That experience is key, Gallup said.
"Our staff know the subtle signs to look for, for patients to get interventions done sooner," she said. "I think they are more apt to know the disease process, what is happening, with our physicians and providers stepping in as quickly as possible."
For instance, putting a patient on heated high-flow oxygen to help prevent them from being put on a ventilator, Gallup said, or turning conscious and alert patients having trouble breathing onto their stomachs, known as proning, seems to help.
The caregivers are the key to that, she said.
"Respiratory therapy has been incredible through this," Gallup said, along with the doctors and nurses.
But there is just not enough of them, Davis said.
"It’s very difficult to get nurses," he said. "Respiratory therapists are very difficult. We’re asking people to work extra overtime, extra shifts. We’re using agency (nurses). We’re very fortunate the state provided us with about 30 nurses. It’s been very helpful. Thank you, Gov. (Brian) Kemp."
The state will have spent $250 million on that staffing support by the end of the year, and there should be more help with an additional $70 million for that effort, Kemp announced last week.
But there is also a larger problem the hospitals face – all of the other patients that need care. University topped 500 total patients last week, a level it has rarely exceeded before, Davis said.
"It’s not just COVID patients," he said. "We’ve got other patients we are dealing with, too."
University has been doing 90-110 surgeries a day, Davis said. Even as it opens additional COVID-19 units, "when we fill up the fifth floor, we may have to look at restricting surgeries at that point just because we are going to be out of beds," he said.
AUMC is already at that point, with 415 patients in the hospital while 16 more were waiting in the emergency department, CEO Katrina Keefer said.
"We are backed up," Coule said. "We are holding patients in the emergency room. We’ve had to delay and postpone some elective surgeries. We’re definitely feeling the strain."
One area they have been "very fortunate" in is having adequate personnel, he said.
"Luckily for us, we haven’t had great deal of issue regarding that right now," Coule said, and staff have been relatively healthy. "Certainly, vaccination will help with that."
AUMC began vaccinating with the Pfizer vaccine last week. But the highly anticipated vaccines could provide their own problem, Davis said.
"Everyone is talking about vaccinations, and I am thrilled we’re getting them," he said. "But my fear is, knowing the way people think these days, (they will think) that the war is over. ... My real fear is we are taking our eye off of the ball."