MOUNT VERNON – Last week, Knox County Health Commissioner Julie Miller warned that if COVID-19 numbers continued to rise, the local healthcare system could become overwhelmed.
“I’m gonna say this and it comes from my heart: We are in a bad spot …” Miller said. “We don’t know when the surge is gonna come down, but it doesn’t look like it’s gonna be anytime soon.”
A key part of that local healthcare system is Knox Community Hospital. The hospital has seen an increase in coronavirus-related hospitalizations over the last few weeks, going from four to 11 during the last week of October, and eventually reaching 18 last week (KCH is currently treating 14 COVID-19 patients, as of Tuesday morning).
KCH CEO Bruce White said it’s hard to tell exactly what the hospital’s “maximum capacity” would be for COVID-19 patients. KCH is a 99-bed hospital with a 12-bed Intensive Care Unit and a 19-bed Progressive Care Unit. The number of COVID-19 patients it can handle, White said, depends on the severity of each case.
High-acuity patients require more staffing, equipment and space, while low-acuity patients require less of all those things. Therefore, KCH could theoretically take more high-acuity patients than low-acuity, given the resources at-hand.
“It’s kind of hard to describe. People want that maximum-capacity number, and there really is no firm maximum number that we can share because it depends on the level of care they demand,” White said. “So it’s really hard to describe. They ask, ‘What’s your ceiling?’ And it’s like, that depends on the level of care we’re trying to provide.”
Still, White said last week that he was beginning to grow concerned about the recent trend in hospitalizations. If coronavirus-related hospitalizations continue to rise, KCH will have to reduce or eliminate standard procedures in order to preserve resources.
“Right now, we’re still in what I’d call a ‘normal’ mode, but we’re definitely seeing an increase in ICU and PCU beds,” White said. “But that hasn’t caused us to kick over into an aggressive type of care to preclude other types of services.
“We’re at that point where we’re watching closely – we’re still scheduling those (in-patient surgeries), but we also know that on a daily basis, we’re watching our numbers and trying to project, ‘What’s it gonna be like three days from now? Are we going to have the beds? Are we going to have to start deferring in-patients elsewhere?”
White said KCH is “watching closely” the number of beds being used for COVID-19 patients, particularly those in the ICU and PCU. Staffing has also become a concern, as more employees are testing positive for the virus now, given the increased community spread.
White worries that if enough nurses, doctors and aides become infected, the hospital will not be able to provide adequate care for county residents.
“Staff is the huge issue. Because you might have the beds, you might have the facilities, but if you don’t have the people, that’s really tough,” White said. “And with this third surge, that’s probably one of the bigger concerns that all the hospitals that I’ve talked with in Ohio are facing.”
White said his staff has been diligent about wearing PPE and social distancing throughout the pandemic, which has led to such low numbers so far. He warned, however, that KCH is not immune to the ramifications of heightened community spread. His employees are members of the community, and they stand greater chance of becoming infected when Knox County sees higher virus prevalence.
“The hospital’s being affected. The hospital employees are residents of Knox County, or other counties. They work here, they live here; they have friends here, family here ...” Miller added. “It’s just kind of a microcosm of society, really.”
If Knox County cannot curb the spread of COVID-19, White warns that KCH could become overwhelmed. It could run out of beds, or staff, or a combination of both. If this happens, and KCH is forced to seek outside help, here’s the plan, according to White:
Option 1: Lateral transfers. Knox Community Hospital would check its “lateral transfer” partners, which include Licking Memorial Hospital in Newark and Avita Health System in Mansfield, to see if they have beds available. If not...
Option 2: Columbus partners. KCH would call down to some of the larger Columbus-area hospitals, including Mount Caramel and Ohio State University’s Wexner Medical Center, to see if they have space. If they are also full, then...
Option 3: Greater Columbus Convention Center. KCH would call the “patient transfer center” for Ohio’s second hospital zone, which includes most Central Ohio hospitals. Staff members would try to locate a regional hospital with bed space available. If all regional hospitals were full, the patient would likely be sent to the Greater Columbus Convention Center, which area health officials have designated as a potential “joint surge location” if the need presents itself.
Dr. Andrew Thomas, the Chief Clinical Officer at OSU’s Wexner Medical Center, is leading Ohio’s second hospital zone in planning and surge preparation. He told Knox Pages this week that every day, around 20 hospital executives from Central Ohio (as well as local public health and emergency management professionals) attend a conference call to discuss the current status of each facility.
“At this time, we do not feel that there will be a need to open the Greater Columbus Convention Center Level 3 surge capacity due to the ability of individual hospitals to expand their on-site capacity, but we continue to monitor trends in the data on a daily basis,” Thomas said in an email.
He added, however, that the possibility of reopening the GCCC is currently being discussed, given the recent surge in hospitalizations. The committee of health-system leaders that created the plan in the spring “has met in recent weeks,” White said, “and is prepared to open up the GCCC on an as-needed basis with a 7-14 day window from decision to full operation.”
“They have the supplies ready to go,” White added.
While things remain relatively normal at KCH right now, White called the current surge “really concerning.” Knox County has seen 231 new confirmed COVID-19 cases – roughly 25 percent of its eight-month pandemic caseload – in the last week.
“We don’t have infinite resources – there’s only so many doctors, so many nurses, so many beds, so many facilities – and we can’t have a huge onslaught of population requiring all of those services …” he said. “This third surge, I will say, is really concerning. And we understand some of the reasons for that: everybody’s tired, everybody’s ready to get back to normal, and I think we’re letting our guard down.”
White urged the public to increase its prevention efforts, so that KCH – the county's only hospital, and its second-largest employer – would not become overwhelmed.
He noted that national vaccine trials have been promising so far, and that soon, help would be on the way. If Knox County can buckle down for the next three or four months, White said, it could keep the healthcare system afloat and prevent countless deaths.
“It’s tough choices. It’s giving up things. And we are getting a little tired of it ...” White said. “All the information that we’re being told is that vaccines are two, three, four months away. They’ve gotta get them developed, they’ve gotta get them approved, and then they’ll have to get them distributed and deployed out into the population, and start getting the vaccines administered.
“But if we say that that’s two, three, four months before we’ll be able to do that – in my mind, we’ve done a great job since March, let’s just hang on and keep doing the right things. Because when those vaccines come out, they’re gonna help. We’re still going to be wearing masks, it’s not gonna relieve all those kinds of things. But I think we should be looking at this as, ‘This isn’t forever. Let’s just hang in there.’”