As COVID-19 hospitalizations remain high across New Hampshire, patients who need intensive care have less staff available to care for them — because many of those health care workers are themselves out with COVID.
And these absences come as New Hampshire’s hospitals are already overloaded with COVID-19 patients and others in need of intensive medical care.
According to data from the New Hampshire Hospital Association, the state’s ICU beds have been at least 90% full since the start of 2022. And per federal data, the state was using an average of about 68% of its ICU beds throughout 2021. Even at the height of the winter surge early last year, statewide ICU fullness remained far below the levels seen today.
How the latest surge caused a spike in health care worker absences
Over 1,000 New Hampshire hospital workers were out because of the virus last week, according to a new survey from the New Hampshire Hospital Association which had participation from 25 of the state’s 30 hospitals.
While that’s only around three percent of their workforce, unexpected absences put a significant strain on hospitals.
At Catholic Medical Center, staff absences due to COVID-19 last week were higher than at any other point in the pandemic, said spokesperson Lauren Collins-Cline.
“It certainly adds a lot of stress to the system,” Collins-Cline said. CMC, she says, already has a 20-25 percent nurse vacancy rate.
Almost 90 percent of New Hampshire hospital staff out due to the virus had it themselves. Only a small percentage were quarantined because of COVID exposure.
Staff who are up-to-date on their COVID-19 vaccines can work after exposure with repeated testing, according to CDC guidance. Hospitals can apply that same protocol to staff who are vaccinated, but not boosted if they feel it’s necessary.
ICUs overflow around the state
Counting all patients receiving ICU-level care, the state’s ICU capacity reached or exceeded 100% several times last week. But because hospitals worked with the state to get permission to set up additional ICU-level beds outside of the ICU, the actual number of patients receiving ICU-level care could be even higher.
“The severity of the situation facing our hospitals is critical,” said Vanessa Stafford, a spokesperson for the state hospital association, adding that staffing shortages and sicker COVID-19 patients who require longer periods of care are further straining bed capacity.
Stafford said hospitals are tapping into contingency plans to open up additional medical, surgical and ICU beds, “but this model isn’t sustainable.”
“We need New Hampshire residents to do their part and help the health care system by getting vaccinated and boosted, wearing a mask when indoors, washing their hands, staying home if not feeling well, and getting a test if experiencing symptoms of COVID-19,” she said.
Stress across the system
Since late October, more than one in five New Hampshire hospitals have reported critical staffing shortages, a number that has risen since the summer.
The increased rates, which are self-assessed by individual hospitals each day, also align with a surge of record COVID-19 related hospitalizations in the state.
The omicron variant is spreading quickly not only among the unvaccinated, but the vaccinated, like hospital staff.
Health experts say cases will generally be mild in vaccinated people, and hospitals NHPR spoke to say that has been true among their staff.
Mild cases mean staff can reduce the time they spend at home, quarantining with the virus, under new guidance from the CDC released for health care facilities last month.
“The good news is with the updated guidance, we'll get them back to work sooner,” said Dr. Michael McLeod, associate chief clinical officer at Concord Hospital. Regardless, he said, any staff absences are “taking away from an already very challenged system.”
The guidance gives hospitals the flexibility to adjust return to work times based on the severity of their needs and resources.
If hospitals are in crisis, the guidance says hospitals can drop return to work restrictions completely for COVID positive staff who are asymptomatic or experiencing mild symptoms.
But hospitals do risk contributing to staff burnout, by bringing people back quickly, even if official guidance allows them to do so. Some COVID cases health experts may consider “mild” can still make people feel exhausted.
The flexibility in the CDC’s guidance means that COVID-19 return to work policies are not uniform across the state’s hospitals.
While several federal medical teams and the New Hampshire National Guard are helping hospitals with staffing, those extra hands are a short-term solution. The acuity of patient volume in hospitals may drop down the road as the pandemic lightens, but staffing shortages won’t disappear any time soon.
