New Hampshire hospitals are seeing more COVID-19 patients than at any other point in the pandemic. As of Thursday morning, 248 confirmed COVID-19 patients were hospitalized statewide, according to the latest numbers from the New Hampshire Hospital Association. Another 39 patients suspected of having COVID-19, though not yet confirmed, were also admitted on top of that.
(More national context from NPR: New Data Reveal Which Hospitals Are Dangerously Full. Is Yours?)
Newly released data from the U.S. Department of Health and Human Services, and interviews with healthcare officials at individual hospitals across the state, suggests that this latest wave of the pandemic is straining some hospitals more acutely than others. But even those not seeing an influx of COVID-19 patients are feeling the ripple effects.
Here’s a snapshot of where things stand at New Hampshire hospitals in recent weeks.
Officials at several of the state’s largest hospitals said most of the COVID-19 patients they’re seeing lately are being treated without intensive care, putting less strain on ventilator capacity or other resources in their ICU units.
Portsmouth Regional Chief Medical Officer Tom Wold said a few factors could be behind that: In the spring, the medical community knew less about the virus and how to treat it; over time, they’ve learned how to manage it with less intensive therapies. More people are wearing masks, too, which he said could lead to milder cases of the virus.
“This latest spread is really in the community and it's with families and get-togethers,” Wold said. “And that has made it a much slower, more constant rise than an all and out wave of very sick people coming.”
But as COVID-19 patients are occupying a growing share of regular inpatient beds, that’s creating a different kind of pressure at an already busy time of year.
“Because it's December, and traditional health care, episodic, unscheduled illnesses and things that happen in the seasonality of flu season, that's filling a lot of our spaces,” said Elliot Hospital President Dr. Greg Baxter. “So that's become a challenge for us to manage that part.”
Baxter said the Elliot is re-imposing visitor restrictions — a step taken by many other hospitals — and looking at adding bed capacity within their walls to alleviate pressure on their inpatient units. They’re also rescheduling or delaying non-urgent procedures. But Baxter said they're trying to avoid cutting back too much on ambulatory care at this time.
“If we limited access there, we think that would cause a negative impact overall,” Baxter said. “And we would probably very likely find those patients seeking care at hospitals and urgent care, which would further stress capacity limitations in those areas."
Here, it’s important to keep the context in mind: It doesn’t take many patients to strain an ICU unit at New Hampshire’s smallest hospitals. While major hospitals like the Elliot maintain much larger ICU units, according to the latest available data, most of the state’s hospitals were staffing fewer than 10 ICU beds at the start of this month, if even that.
Lakes Region General Hospital, for example, was staffing an average of six adult ICU beds the week between Nov. 27 and Dec. 3, according to federal records. During that same time, they were reportedly caring for five to six COVID-19 ICU patients a day.
“Our ICU is definitely seeing an increase,” said LRGHealthcare Vice President for Administrative and Support Services Cass Walker. “We’ve got the highest level of COVID-positive patients that we’ve had.”
For the most part, Walker said LRGHealthcare — which also runs Franklin Regional Hospital — has been able to weather this influx of COVID-19 patients without making changes to other aspects of its care. They’re still able to keep their operating rooms open for emergency and non-urgent procedures, Walker said and they don’t expect to change that anytime soon.
“We’re making it work,” Walker said. “We’re doing what needs to be done and making it work.”
Ed Laverty, who leads North Country Healthcare’s Incident Command for COVID-19, is knocking on wood. For now, at least, his colleagues at small hospitals in Berlin, Colebrook and Lancaster aren’t seeing too many coronavirus patients — though he expects those numbers will rise a bit at some point in the future. They are, however, still impacted by the surges seen elsewhere.
Critical access hospitals like Upper Connecticut Valley Hospital, where Laverty works, often rely on larger facilities to accept patients who require more complex care. While Laverty said they’ve still been able to ensure transfers for every patient who needs more acute care elsewhere (“people that come in with heart attacks, stroke, complex surgical things, trauma,” for example), they have had some trouble with other transfers.
“Just this past week, we had some mild to moderate difficulty in getting patients transferred out,” Laverty said. “We've gotten more rejections than we normally had in the previous month, so that tells us that the southern hospitals are getting a little bit tight on bed space.”
Hospitals across the state told NHPR they’re feeling some kind of staffing strain, as they have been throughout the pandemic and for years prior, due to persistent healthcare workforce shortages. In some cases, the strain is exacerbated directly by COVID-19 exposure and increasing community spread. In others, it’s due to a lack of childcare options for frontline workers who are parents.
At LRGHealthcare, for example, Walker said they’ve consistently had between 25 and 35 staff out on quarantine in recent weeks — a tough dynamic in a small healthcare system that already operates without a lot of wiggle room. They’ve already brought on additional traveling staff and nurses to fill in the gaps, but they’re also now looking to bring in local emergency medical responders or other “community partners” — particularly to help ramp up testing.
“The issue on getting people in to help us with testing is not only having the staffing, but making sure we have ample supply of the test product, which we do at this moment in time,” Walker said.
At Portsmouth Regional, Chief Medical Officer Tom Wold said they’re looking at whether they can reassign staff from some divisions to work on busier medical units as one solution to their staffing crunch.
“If we have nurses or providers that are less familiar with the inpatient environment or with sick COVID patients, we can team them up with more seasoned nurses or providers and create more efficient teams so we can open up more space, open up more real estate to more effectively care for those patients with the resources that we have,” Wold said.
What counts as a “critical” staffing shortage is a matter of perspective.
“Most of the North Country hospitals run so lean anyway that, you know, we're used to being, kind of, on that critical staffing spectrum all the time,” said Laverty, with North Country Healthcare.
At one point recently, he said, Weeks Medical Center had five of its nursing staff out on quarantine due to COVID-19 exposure. All but one have since returned to work.
“So they made it through without hitting that crisis level,” he said, “if they had one more out they would have hit their crisis staffing.”
There is a glimmer of hope on the horizon for many of the state’s hospitals: The forthcoming COVID-19 vaccine doses that are expected to start going to frontline medical workers in the month ahead.
In the meantime, state health officials say they’re continuing to monitor both the data and the direct feedback they get from hospital leaders as they respond to this wave of the pandemic.
“Data is great, but ideally is enhanced by context,” said Jake Leon, communications director for the New Hampshire Department of Health and Human Services. “The hospitals and their association have been vital partners throughout the pandemic, and frequent communication has helped ensure that data on bed capacity and staffing issues informs individual hospitals’ need for additional internal surge capacity, as well as the State’s preparation for reestablishing the flexible surge sites initially set up to handle a potential surge last spring and summer.”