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Why a North Country hospital is experiencing its worst COVID surge since the pandemic's start

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While national COVID-19 rates appear to be decreasing, New Hampshire's North Country is experiencing a significant surge in COVID-19 infections.

Cases of COVID-19 are rapidly increasing in Coos County, and the spike in community transmission has been overwhelming local health care facilities.

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Androscoggin Valley Hospital President and CEO Michael Peterson joined NHPR Morning Edition host Rick Ganley to discuss the challenges the hospital is facing during the surge in COVID-19.

Takeaways from the interview:

  • AVH currently has nine COVID inpatients with a significant number of them critically ill. 89% of the COVID-19 inpatients are unvaccinated, and all the critically ill patients are unvaccinated. 
  • The hospital’s staffing is stretched thin. A number of hospital staff are out of work due to COVID-19 infections or close contact with someone who is positive.
  • Peterson says low vaccination rates allowed the Delta variant to take hold in Coos County. He’s seen a slight uptick in the rate of people getting their first dose of the COVID-19 vaccine, possibly in reaction to the surge. 
  • Vaccination is the best defense against COVID-19, but Peterson says vaccination will not impact the current surge underway in the county. Limiting community transmission is now the best tool for mitigating the surge, including reduced mobility, social distancing and mask compliance.
  • In addition to a low vaccination rate in Coos County, Peterson says low compliance with masking policies and vaccine misinformation are potentially allowing future surges and keeping vaccination rates down.

Transcript:

Rick Ganley: Can you update us on the numbers that you're seeing right now in your hospital? How does this compare to previous surges that we've seen with COVID?

Michael Peterson: Absolutely, and thank you for giving me the opportunity to share our situation up here. Yeah, this is by far and away the highest level of incidences we've seen up here in the North Country, AVH in particular. This is more than twice the amount of current inpatients that we've ever had here at AVH with COVID positive. So we have to this point luckily avoided a surge to this level, but it's clearly here and upon us at this time. We have nine COVID inpatients, and a significant amount of those are very sick with this current strain. Unfortunately, 89% of those are unvaccinated. All of our critically ill patients are unvaccinated at this time, as well.

Rick Ganley: So what does that mean for your number of beds that are available? What does that mean for your staffing?

Michael Peterson: Yeah. Right now, staffing is very difficult because we also have a number of staff that are out due to COVID, either being positive or close contact with someone who is positive. So staffing is stretched pretty thin. We're also, you know, working multiple shifts. Obviously, we're a 24/7 operation, so that is impacting our total capacity. We have not gone beyond our 25-bed capacity at this point, but literally half of our inpatients right now are COVID positive, and that's pretty significant. So it has led us to implement our surge plan, which is currently one of the things we're doing to respond to this surge.

Rick Ganley: Talk more about that plan. How do you manage the stress that this has put on the hospital?

Michael Peterson: Our surge plan includes things like transferring patients that we can to other area hospitals, mostly non-COVID patients, but also some COVID critical patients to a higher level of care when that's possible. As we know, the southern part of the state has been inundated for a number of weeks now. That makes it difficult for us to find places to offload patients.

Rick Ganley: So what do you do in that case? What do you do when you can't transfer someone?

Michael Peterson: Then we take care of them here. And unfortunately, we're having to take more steps to preserve beds, staff, space and ventilator capacity. Last week, we began delaying elective surgeries that would require a post-op admission to preserve those beds. Just this morning, we initiated the cancelation of outpatient elective surgeries for a period of two weeks, starting on Monday, primarily to redeploy staff at a critical care space capacity and add ventilation and critical respiratory care capacity.

Rick Ganley: Now you mentioned that the majority of the COVID patients you have seen are unvaccinated. When you look around the community that you're in and the vaccination rates that you're seeing, are you worried about this surge continuing?

Michael Peterson: Yeah, unfortunately, I think the current strain has found a target-rich environment. Coos County's fully vaccinated rate is 55.9% as of [October 14th] . The good news is we've actually started to see a slight uptick in the initial dose rate in the past couple of weeks I think as a response to, you know, the severity of the current surge. However, that's, you know, weeks away from having a real impact in terms of mitigation of the current surge.

We continue to pound the message, you know, vaccination is the best tool and defense we have against this virus. But right now, with the current surge, it's really too late to impact what we're going through today, tomorrow, next week with vaccination. What we need to communicate now is limiting transmission among the community. That's reduced mobility, social distancing, mask compliance and so forth. Vaccination rates have made it able for the strain to take hold. And Coos County is below the state average, and I think that's why we're feeling the impact so acutely up here.

Some of the other things that are hurting, beyond the low vaccination rates: we're seeing a very low compliance with CDC guidelines around masking in public, and that's one of the messages I want to get out there is, even [for] the vaccinated people, the guidelines are to mask when you can in indoor settings and, for unvaccinated people, masks in all public settings. That is one of the things that can impact the transmission rates right now.

The other thing that's hurting is the sheer amount of misinformation about how safe and effective the vaccines are. That is preventing us from increasing the vaccination rates and preventing future surges.

Rick Ganley: This surge affects hospital services for non-COVID patients. Obviously, there's ripple effects here, if you've got to take care of critically ill patients and that's taking up most of your beds, you have to delay elective surgeries and such. Can you tell me more about, you know, the ripple effects down the line for the hospitals and what happens, you know, as far as scheduling and economics? How does that all fit into the picture?

Michael Peterson: Well, as you can imagine, folks need us, especially for emergency situations, all the time. We continue to take care of patients who are non-COVID in emergent and urgent situations and certainly don't want to give the impression that we're closed to any of those. It just makes it more difficult to fit them in.

Normally we run at about 70-75% of our bed capacity on any given day. Yesterday, we had no med surge beds, no ICU beds available for anybody of any type. So we're depending heavily and are very grateful for the collaboration of our regional hospitals to help us make sure that we can continue to be the conduit, at least for our community, to the patients who need care of any kind.

Rick Ganley: What are you hearing from the state or from, you know, any other authorities about how they're feeling that this surge is going, when it might plateau?

Michael Peterson: Well, we are actually, you know, in communication with the state and the other hospitals twice weekly at least. And kind of gauging from that, it feels like it's stabilized to a degree in the southern part of the state.

I think what we're feeling is just the ripple effect. It takes a little while longer for things to reach the North Country, and that's honestly one of the difficulties that we're struggling with. The national news is, you know, spreading the word that this seems to be waning. But it's kind of like throwing a rock in a pond. You know, the ripples take a while to get to the outer shores, and that's where we are.

So we're still very much in the early stages of this surge, even though it may be stabilizing in the southern part of the state or even getting better in many other southern states. That's a difficult message to compete with. The national news says things are getting better, but here we are facing, you know, the criticality of the surge as it is today. We're in this for the long haul. We know it will end. We just have to stay solid until that point.

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