Cancer patient’s treatment delayed due to Covid

Michael Kagan, a professor at the University of Nevada, Las Vegas, says the cancerous lymph nodes in his neck are like a “ticking time bomb.” But he can do little.

MountainView Hospital, where he was due to undergo his procedure last week, has postponed all surgeries requiring an overnight stay, according to a statement from spokesperson Jennifer McDonnell as the number of Covid-19 cases and hospitalizations rise.

“I don’t get treatment, so on any given day it could spread to another part of my body or it could grow and cause a much bigger problem,” Kagan told CNN’s Brianna Keilar on Tuesday. “I’m just living with a time bomb and I’m just letting it tick off, really.”

With the number of Covid-19 cases rising in the United States and many unvaccinated Americans getting sick, the number of available hospital beds in parts of the country has declined. Some hospitals are now reporting that their intensive care units, usually reserved for the most critically ill patients, are full — a stark reality that forces health care leaders to make tough decisions, whether that be referring new patients to other facilities, cancel surgeries or create makeshift ICU beds in the middle of emergency rooms.

“It’s a nightmare,” says Dr. Teri Dyess, director of hospital medicine at St. Dominic Hospital in Jackson, Mississippi. “We’ve had people drive here (from) three hours before their scheduled surgery, and we don’t have beds to put them in after they’re operated.”

Mississippi broke its Covid-19 hospitalization record on Thursday with more than 1,490 patients statewide, according to state data. Of these, about 388 are on ICs. A day earlier, state epidemiologist Dr. Paul Byers that the minimal available IC capacity meant that dozens of patients were waiting in the emergency room on an ICU bed. Mississippians shouldn’t be surprised if they get sick and end up in a hospital 200 miles away because it’s the only facility available, added health official Dr. Thomas Dobbs.

Hospitals create makeshift intensive care units

At Jackson’s Mississippi Baptist Medical Center, pulmonologist Dr. Maria Rappai said there are about 18 ventilated Covid-19 patients in the hospital’s ICU and “we have several in the emergency room” waiting to go to intensive care. Their ICU usually gets patients from all over the state who may have pneumonia or sepsis or who have had heart attacks and need services such as life support.

They have so many ICU patients that their emergency room now functions as an intensive care unit, Rappai said.

“Maybe we’ll use an ER room as an IC, which then delays the person coming to the emergency room with a broken arm because you have to wait to get into a room to be seen,” Rappai said. “It’s a difficult situation.”

At the nearby hospital where Dyess works — where the intensive care unit usually treats complicated stroke patients from across the state — ICU patients also head over to the emergency room. To keep more ICU beds available, the hospital had to postpone surgeries that require overnight stays, including hip and knee surgeries for patients “severely paralyzed by arthritic conditions,” she said.

“One of our cardiologists couldn’t even get one of his own patients here who had a heart attack. They had to send him to another hospital that could take him,” Dyess said.

This week, the hospital had no room for a cancer patient who needed treatment that required an overnight stay, Dyess said. The patient, desperate to finally get the procedure, told hospital officials he’d be on the floor if he had to, Dyess said.

Hospitals across the country are facing similar problems: In North Carolina, health officials announced Tuesday that the state had seen the largest one-day jump in ICU admissions since the start of the pandemic — and Covid-19 ICU patients made up more than a quarter of Covid-19 patients hospitalized in the state.

“These high levels of COVID-related admissions jeopardize our hospitals’ ability to provide needed care in our communities,” Kody Kinsley, the chief assistant secretary for health at the Department of Health and Human Services, said in a statement. . The vast majority of those patients, Kinsley added, have not been vaccinated.

In Nashville, Tennessee, the adult hospital and emergency department at Vanderbilt University Medical Center were “completely full,” the center said Friday, adding that it was limiting elective cases and declining transfers from many hospitals.

Judge Clay Jenkins in Dallas County, Texas, said Friday there were “zero ICU beds left for children.”

“That means if your child is in a car accident, if your child has a congenital heart defect or something and needs an ICU bed, or more likely if they have Covid and need an ICU bed, we don’t have one. Your child will wait until another child dies,” Jenkins said.

Full ICUs create a dangerous ER backlog

The makeshift ICU beds in EDs contribute to backlog and add hours to patient waiting times.

“The wait times were up to 12 hours for patients to see doctors and receive care in the emergency room,” said Dr. Alan Brown, the chief physician of the Southeast Georgia Health System, in the southern coastal corner of the state. “Our ability to care for patients who are sick with things other than Covid is really hampered by the fact that we are so overwhelmed.”

The hospital reported more than 130 Covid-19 patients on Wednesday, according to Brown — much higher than the previous record of 98 patients at the previous peak. He said hospital officials don’t think they’re nearing their peak anytime soon.

The hospital’s ICU would normally treat patients with sepsis, heart failure or heart attacks or surgical patients, Brown said. But Covid-19 patients — more than 90% of whom are unvaccinated, he said — now outnumber all other cases, he added. Elective surgeries and endoscopies have been cancelled, he added, to make room and draw more staff to patients with the virus.

“We desperately needed the nursing support because our ICUs are so overrun with critically ill Covid patients,” Brown said.

“It’s really bursting at the seams,” he said.

Announcing a mask mandate that took effect Friday, Oregon Governor Kate Brown said earlier in the week that Covid-19 hospitalizations were at an “record high” and statewide ICU beds were 90% full. goods.

“Some of our hospital regions have fewer than five ICU beds available to start the day,” she said. “Without safety measures, by September we could be short of as many as 500 manned hospital beds of what we need to treat patients, which are patients who come to the hospital for any reason: Covid, a heart attack or a car accident.”

On Friday, Brown announced that the state will deploy up to 1,500 members of the Oregon National Guard next week to support hospitals dealing with a surge in Covid-19 patients.

Ambulances waiting outside hospitals

In some parts of the United States, the backlog of ICs is so great that ambulances are queuing outside facilities.

“You have an ambulance bringing in a Covid patient, or any other medical emergency, and if they don’t have an ICU room, then they have to wait,” Arkansas Governor Asa Hutchinson said at a news conference Tuesday. Just a day earlier, the state reported that only eight IC beds were available. “And that’s the problem, because if an ambulance waits four or five hours for a space to become available, they can’t respond to other emergencies. So you can only wait for a bed to become available.”

While medical staff will care for patients, Hutchinson said, the level of care wouldn’t be the same as in an ICU, which usually has more specialized equipment and nurses tend to patients more often.

In Houston, Fire Chief Samuel Peña said the bottleneck created by filling hospitals is exacerbating the problem of ambulance availability, which in turn “creates risks of delays in responding to the next call in our community.”

“In some cases, if our ambulance crews wait more than an hour to hand their patients over to (ER) personnel, the availability of units in the system decreases,” Peña told CNN in an email. “In an EMS system as busy as Houston’s, keeping EMS personnel in hospitals will result in longer system-wide response times.”

The chief told CNN affiliate KTRK that a patient had been waiting on a hospital bed for more than five hours on a stretcher in an ambulance. He told CNN that the patient was a man in his 60s in stable condition.

According to state data, there were about 321 available IC beds in the state of Texas on Thursday — with a population of nearly 29 million. The Trauma Service Area, which encompasses the Houston metropolitan area along with Austin, Colorado, Fort Bend, Matagorda, Montgomery, Walker, Waller and Wharton counties, had 50 available ICU beds as of Thursday to serve a population of more than 6 million people to serve , state data show .

Employees are stretched thin?

For many hospitals, the main concern was that there was not enough staff to care for the patients in the ICU.

“The real challenge is NOT the physical beds,” Mississippi Gov wrote. Tate Reeves in a Facebook post on Wednesday. “The challenge is that our hospitals may not have enough health care professionals (teachers, nurses, respiratory therapists, etc.) to staff those beds.”

The state has lost nearly 2,000 nurses in the past year, the governor added.

Some patients in the ICU often need the constant attention of a nurse, said Dyess at St. Dominic Hospital. But the facility is struggling with a shortage – many nurses are burnt out, have retired or have not been vaccinated in the past year, and may be sick with Covid-19 themselves. The hospital is thus forced to increase the nurse-patient ratio, often to three ICU patients per nurse instead of one to two patients, which is the standard. For other hospital beds, a nurse may care for as many as eight or 10 patients on some nights, she added.

“Each Covid patient has about 15 IV poles around them. They use drugs to raise their blood pressure, electrolytes, antivirals, antibacterials, diet, you name it,” Dyess said. “So you think of a nurse with three patients with 15 IVs going — it’s almost unbearable.”

Southeast Georgia’s health system staff must also care for more patients.

“People don’t seem to appreciate… how demanding this Covid wave has been,” said Michael D. Scherneck, president and CEO of the system. “People still have the mentality of, ‘Well, I want to be seen right away.’ We want to see you right away, but unfortunately just the pure facts and the pure numbers there are just so many people you can take care of at any given time.”

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