STUART, Fla. — COVID-19 hospitalizations have reached their highest peak yet this summer, driven by the spread of the highly contagious Delta variant. Inside Cleveland Clinic hospitals on the Treasure Coast, it's a 24-hour fight against the virus. Patients are younger, sicker and unvaccinated. I sat down with four health care leaders at Cleveland Clinic Indian River Hospital to get the big picture of COVID’s toll on the hospital system.
“It’s been most pronounced in the last eight weeks. It's because of the magnitude of the surge,” said Dr. Greg Rosencrance, president of Indian River Hospital. “This surge has been far more extreme than any other surge that we’ve seen. It came on far more rapidly.”
Dr. Richard Rothman, Institute Chair of hospital medicine for the Cleveland Clinic Florida region, agreed.
“The incremental increase in our volumes is up more than 700 percent, from 30 to 35 patients, up to a peak of 395 patients," Rothman said. "Eighty-seven percent of all patients admitted to our hospitals with COVID are unvaccinated, 87 percent.”
The doctors said COVID-19 patients are also younger and sicker.
“One out of every four patients admitted to our hospitals ends up in the ICU,” said Rothman. “One out of every three patients requires some form of respiratory device to help them breathe.”
In addition, those patients take up nearly half of the hospital beds. “No diagnosis should take up 40% of our occupancy in our hospitals,” said Rothman.
Some days there are not enough medical personnel to handle the influx of patients.
"When that happens, we pool our resources. I, myself, have gone home, [and] other leaders, to sleep for a few hours and come in to work the night shift. We make it happen,” said Indian River Hospital ICU and Emergency Department Registered Nurse and Director Holly Mantle.
Dr. Richard Rothman: "In addition to that, we have had to triage care. So, if you're a patient with lung cancer who'd normally see your pulmonologist, you can't see your pulmonologist today, because the pulmonologists are in the ICU's taking care of critically ill patients. It has had a material impact. Not just on those patients with COVID but on all patients we care for. Here on the Treasure Coast there's a number of free-standing emergency departments that transfer patients into Cleveland Clinic facilities and we don't have the beds to accept those patients."
“There’s a number of areas in the hospital where we’re short of critical resources. We’ve relied on travelers,” said Rob Lord, president of Cleveland Clinic Martin Health. “We’ve done everything we can, but it’s an ongoing daily challenge.”
The “travelers” are travel nurses. They’re being used to fill what the Florida Hospital Association calls a “critical” staffing shortage.
“We’ve been fortunate to have a number start recently,” said Rosencrance:
Traveling nurses typically sign three-month contracts, for significantly more pay. Cleveland Clinic is also losing their own nurses, to high-paying travel jobs.
Holly Mantle: "The pandemic has caused a nursing shortage, but most who were ready to retire, retired a little earlier. Some of our younger nurses with young children who might not have been able to have daycare, children being out of school, or being homeschooled, through virtual learning, that has played an impact. So, we've lost a lot of nurses to the profession just by virtue of the pandemic itself and then the surge just this last eight weeks it has really hit hard."
The emotional toll of COVID-19 is measured in long shifts in Cleveland Clinic hospitals.
Holly Mantle: "You come in, and you put on a N-95, you're in that for 13, 14 hours, if you're not begged to stay a little later and help and stay until 11. You're in and out of rooms where you have to gear up in gowns, two pairs of gloves, eye-wear protection on all day long, you may have been accustomed to one or two very sick patients before COVID, you might have three to four, with a helping hand, and these patients are very sick. They're on multiple drug IV medications, their blood pressure and their heart rate are very labile, it's a very labor intensive and very sad patient to take care of. You have family members on the outside who want to come in, or need information, or don't understand and communicating that plan of care is hard. Telling people, we can't let you in, we have to talk about withdrawal, withdrawal of care, which means letting someone go. Emotionally, it's very taxing to our care givers across the house, but very much so in the ER and ICU. It's tough, so as a leader, making sure we're going through and providing that support, lots of pats on the back, you've got this. I appreciate you. what can I do for you. Just making sure emotionally that they're OK, recognizing that burnout, and saying tomorrow you might need to be off."
Dr. Greg Rosencrance: "I think Holly is spot on with that. I think it's also physically demanding. You've heard about the prone positions for these patients who they require a lot of turning, that requires a number of caregivers to turn these patients-- seven to turn one patient on a regular basis. So, it's not just the emotional toll, it's the physical toll with the masking, the PPE and getting in and out of the situation and then it doesn't go away when they go home. They have a brief respite, but just like the rest of us when we go home, they have to deal with what's in the news, they have to deal with the regular items with life and what comes up."
Rob Lord: “I have referred to this as a pandemic of the unvaccinated at this stage.
Someone said to me the other day that it was a pandemic of distrust. I think there's so much misinformation that has been spread out there on the internet, through other sources. It has caused so many Americans to distrust the vaccine and all of us would say with no ulterior motive to this, is to trust it. But as I've heard the arguments, for not having the vaccine, the thing that just stands out to me is people are relying on misinformation, that is spread through sources that are not to be relied on in my opinion."
Of those who have died from COVID, 95% are not vaccinated.
Holly Mantle: “So, it’s terrible to watch that death when it could’ve been prevented. And that is something that our care givers and myself, that’s one of the hardest things we do every day.”
And there has been an increase in younger patients
Holly Mantle: “This virus, this variant, it doesn’t matter how healthy, how strong, how young one thinks they are. If I could stroll you through the halls of the ICU and show you the folks that are 20, 30, 40 that have lost their lives to this virus, it spares no one. And vaccination, using preventative measures that are out there, that would be what I recommend."
Nurses on the front lines are exhausted.
Rob Lord: “That’s been the biggest toll on me, emotionally, has been watching our caregivers and how they suffer emotional pain from watching young, otherwise healthy people die.”
The recent surge in patients can also put pressure on supplies at any given moment.
Dr. Richard Rothman: “I remember being on the phone a week and a half ago and I got a call and they said state troopers are escorting an oxygen truck to Martin North. What do you mean a state trooper? Well, if we don’t have oxygen in the next 12 hours, we won’t have oxygen.”
Cleveland Clinic, like most hospital systems, is up against staff shortages.
Rob Lord: “As we move forward, this industry is going to need more caregivers without a pandemic.”
According to the U.S. Bureau of Labor Statistics, the U.S. will need 1.1 million new nurses in 2022 amid resignations and early retirements.
Despite the many challenges, these medical professionals couldn't be more proud of their colleagues.
“I’ve never been more inspired by the people that I work with than I am today,” said Lord. “I stand with all of you.”
Dr. Greg Rosencrance: “The same here. I am incredibly proud of all our caregivers, and I’m quite frankly humbled every day by what they do. The resilience they show, not only caring for their patients, but caring for each other.”
Rob Lord: “Early on in this pandemic, the outpouring of support from our community was amazing-- people, parades of cars, people cheering our people on at the change of staff. They never needed that more than they need it today. And I would say to the community, if you know somebody who works in healthcare, that works in a hospital, make sure that you let them know that you appreciate them. Thank them for what they do. They deserve that and so much more. Express that appreciation at your local hospital, wherever you are. Let them know how important they are to you."
These hospital leaders are starting to see a downward trend in hospitalizations, in part, a direct result of more vaccinations. They said that it’s the best way to protect yourself.
Dr. Greg Rosencrance: “We’re not here to convince anyone, but don’t have regrets. We want the same thing as the communities. We want this to be over and we want the pandemic to end. As soon as we can and the easiest and quickest path forward with that are to do the things that we know are effective: get vaccinated, wear a mask, distance, wash your hands, the things that we've been saying for a while. And I think if we do those things, for our community, our country, will be in a better spot."
Dr. Richard Rothman: "We are not here to tell anybody what to do. We don't see ourselves as here to mandate. We see ourselves here to help protect. There are certain times our country where we do all need to come together. And coming together will make a difference. This is that time.”
