'It has hit hard and fast' Suburban hospitals adjust to soaring COVID-19 patients, worry about what's to come

"What is interesting about the second surge is how fast it hit and how quickly it happened," said Khatua, Edward-Elmhurst Health's chief physician executive and COVID-19 Incident commander. "The first surge was a quick uptick. You would have thought over time we wouldn't have seen the sharp incline, but it has happened really quickly. That is the piece that has been troubling. It has hit fast and hard."

The soaring hospitalizations statewide over the last month has local hospital systems treating more patients than at any other time during the pandemic. It has raised concerns over hospital capacity, but even more so, staffing levels.

And what is most alarming is the uncertainty ahead, as doctors and nurses brace for the potential of even higher numbers of infected patients with the Thanksgiving and Christmas holidays around the corner and winter looming.

Edward and Elmhurst hospitals are treating a combined 172 inpatients with confirmed cases of COVID-19 as of Thursday. At the springtime peak, Khatua said that number was closer to 140.

The hospital system has seen a dramatic increase since the beginning of October. Edward, in Naperville, was averaging 2 to 3 admissions per day with COVID-19 the first week of October. By the end of October that number was 6 to 7 per day and now it is at 13.

At the same time, the number of positive tests on the outpatient side has gone up tenfold during the last month, an indication of the level of community spread. Patients testing positive for COVID-19 who were at the hospital for elective surgeries has gone from 0.5% to 3.0% in the last month, hospital officials said.

"The stress level for hospitals is pretty immense," said Dr. Jonathan Pinsky, Edward's medical director for Infection control and prevention. "We don't know where this is going. When you see this rapid increase there is an uncertainty of when we will reach this peak. There has not been a change in how the community is practicing masking and social distancing.

"I can't see what is going to change this curve, that is the concern I have. This is likely to continue to perpetuate until something really dramatic happens that would slow down the chain of transmission."

Hospitalizations statewide have gone up for 24 consecutive days, with the 5,953 COVID-19 patients statewide reported Wednesday, the most of any time during the pandemic.

Advocate Aurora Health, with 27 hospitals across Illinois and Wisconsin including Good Samaritan in Downers Grove, is at about 1,100 COVID-19 patients. In the spring it saw about 800 across the system. Good Samaritan has about 40 inpatients currently with COVID-19. The Daily Herald reported this week that Advocate is deferring half of its elective procedures as admissions surge to new highs.

"Although we are not surprised by this surge, I'll be honest, we are facing challenges related to staffing with this surge," said Susan Okuno-Jones, chief nursing officer at Good Samaritan. "One thing we are noticing different this time is that in the spring overall hospital volume was lower. There were so many unknowns that folks were delaying coming in. We are not seeing that now."

AMITA Health Adventist Medical Center in Hinsdale is caring for 28 COVID-19 inpatients and 23 others awaiting results, while AMITA's hospital in La Grange has 32 COVID-19 patients and 26 waiting results, higher than the spring peak for both facilities and four times that of a month ago.

Northwestern Medicine Central DuPage Hospital in Winfield has seen an 86% increase in hospitalized COVID-19 patients since September, and is now admitting 20 to 30 patients with infections a day. Although, in a positive trend, the percentage of patients in intensive care and on ventilators has been lower during the second surge.

"It has been a crash course in a disease entity that we really knew nothing about," said Dr. Jeff Huml, medical director of critical care at CDH, who connects the spiking hospitalization numbers to the skyrocketing positivity rates in the community. "The sheer volume continues to be a challenge for us, the volume of critically ill patients. The health care team, the ICU team are tired, but we are tired and motivated to care for anyone's loved one."

Okuno-Jones said that Advocate is both looking internally to see where it can deploy nurses and clinicians, with clinicians practicing in other areas being called back to provide in-patient care and support. Advocate has calls daily within both the region and state and organized processes to make staffing requests.

Connie Nolan, a nurse manager in the critical care unit at Good Samaritan, said that being part of a larger system, Advocate has the flexibility to reallocate resources throughout the system and redeploy staff members throughout the hospital, while also doing some reductions of elective and in-patient surgeries.

"While is is stressful and disheartening, the CCU team at Good Samaritan is an amazing team," Nolan said. "We face different challenges every day and work together as a team to try to rise to the occasion. Every day brings something new."

At CDH, Huml said that they have added extra nurses to staffing, recruiting additional employees through external agencies, but in terms of critical care physicians "we're maxed out."

"On a good day without a pandemic, we have enough," Huml said. "If one becomes ill, and is not able to work for two weeks, that is going to be a tough hole to fill."

Khatua said that his biggest concern right now is staffing, something that Edward-Elmhurst Health continues to monitor closely. While Illinois was one of the biggest hot spots in the pandemic's first surge, and the concern at that point was getting enough PPE, this time the infection numbers are spiking everywhere at the same time, which makes Khatua most focused on the "human capital and people."

Edward-Elmhurst is taking an "all hands on deck" approach in trying to manage staffing on a day-to-day basis, looking at the ability to redeploy staff with skill sets and also considering agency staff.

"We are going to run out of people before we run out of beds and supplies," Khatua said. (During) the first wave we were concerned about staff getting sick because of COVID, but we are seeing that even more now."

While the U.S. Surgeon General this week attributed "pandemic fatigue" for the rising case numbers, Khatua worries about a different kind of COVID fatigue setting in among staff.

"If you think of our healthcare workers, not only do they come in and see the worst that this virus can do to people, but they go home and deal with frustrations at home and in their community," Khatua said. "It's really frustrating and a struggle for all of these individuals.

"Imagine being in that situation where you cannot control anything beyond the four walls of your health care system, and still having a debate over people wearing masks."

Northwestern Medicine hospitals announced Wednesday that they are reducing non emergency surgeries and procedures requiring in-patient stays to preserve bed capacity, similar to Advocate.

Pinsky said that at Edward-Elmhurst there has not been any move toward curtailing existing services due to bed availability, but he has asked his physicians to discuss with their patients the higher risk of getting infected with the amount of virus spread in the community.

He also said that the hospital system has created more bed space and allocated more beds for COVID-19 patients, with additional ICU beds made available, although it's a bit tighter because elective surgeries have not been stopped.

Pinsky emphasized that for those tired of staying home, that don't know when the pandemic is going to end, there is a "light at end of the tunnel" with preliminary reports of vaccine studies and possible distribution in the coming months.

"What we need to do is hold the course and know that there is that light at the end of the tunnel," Pinsky said.

Huml concurred, encouraging the community to take the virus seriously as the Thanksgiving holiday approaches.

"If you want to be thankful for your family member for a number of years in the future maybe this is one year to celebrate outside," Huml said. "We have no choice but to persevere. We have to listen to what the scientists and clinicians tell us, to wash hands, social distance and wear a mask and try not to interact significantly inside, and outside of your sphere and home environment. We need to take this seriously and follow the guidelines."