Wisconsin is on track to run out of beds in the intensive care unit and, more importantly, the nurses to staff them, in as little as two weeks if the number of people testing positive for COVID-19 does not drop.
On Tuesday, when the state reported a record 5,200 positive cases, only 187 of the state’s 1,469 intensive care unit beds were available. Of the patients in ICUs, 319 were being treated for COVID-19.
Given the trajectory of new cases, the number of COVID-19 patients being treated could double in two to six weeks, said Bill Melms, chief medical officer for Marshfield Clinic Health System.
“There is nothing magical about this math,” Melms said. “Every single positive increases the probability or likelihood of having another patient who is hospitalized.”
Hospitals across the state are already straining to respond to the crisis, with exhausted staffs picking up extra shifts and working long hours. Some hospital systems have begun to line up temporary nurses, including from out of state, to fill shifts in the coming weeks.
Fewer than four out of 100 COVID-19 patients — roughly 3.5% — end up in the hospital. But about one in four of those patients require ICU care.
This means that an estimated 36 of the more than 5,200 people who tested positive for the virus on Tuesday will end up in an ICU — and some of them may be in the units for weeks.
That’s just from one day.
Almost 28,000 people tested positive in a seven-day period. Thus, 200 of them could require ICU care in coming weeks. And there are no signs of the infection rate slowing.
On Wednesday, the state reported 3,800 more new cases and 45 deaths, bringing the death toll to 1,897. The positivity rate for the most recent seven-day period was the highest ever: 27.2%.
There were a record 1,439 people hospitalized with the virus in the state Wednesday, including 339 patients in ICUs — about 20 more than the day before, a single-day increase of 6%.
“It’s the real deal,” said Jeff Pothof, a physician and chief quality officer for UW Health. “We are in pretty hot water right now in Wisconsin.”
UW Health, Marshfield Clinic and other health systems can add ICU beds. The challenge is staffing.
“Creating the space is not as hard,” Pothof said. “At this point, getting the supplies is not that hard. The biggest challenge is the people.”
ICUs are staffed by critical care nurses who have additional training.
“It is much easier to find and staff non-ICU beds,” said Ken Nelson, chief nursing officer for HSHS St. Vincent Hospital and HSHS St. Mary’s Hospital Medical Center in Green Bay.
Those hospitals are near capacity.
“We are in a constant state of planning where our next patient is going to go,” Nelson said.
The trend also is disconcerting.
“We are keenly aware of those numbers released every day,” Nelson said.
Trying to maintain capacity
The field hospital, or alternative care facility, at State Fair Park in West Allis can provide care to COVID-19 patients who require a lower level of care. (It had six patients as of Wednesday.) That can free beds in hospitals.
Hospitals have less flexibility with ICU beds. And most of those beds are needed for other seriously ill patients, such as those who have heart attacks or strokes.
“We have to maintain capacity for those individuals,” Melms said.
Marshfield Clinic has available ICU beds now. The concern is staff.
“That’s our limiting factor,” Melms said. “You give me infinite staff, I would feel a whole lot better about the next four to six to eight weeks.”
Marshfield Clinic has moved nurses who can help critical care nurses in its ICUs. Aurora Health Care has done the same. And health systems have hired temporary staff, or so-called traveling nurses.
Those nurses, though, are in increasingly short supply.
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“Everybody is chasing after them,” Melms said, “and they are just as tired as everyone else.”
ICU nurses typically work three 12-hour shifts a week. Most are picking up extra shifts. But that is taking its toll.
“The staff is absolutely exhausted,” said Pothof, of UW Health. “They have given their all for the last few months and then something like this happens. You can only work so many shifts.”
Nurses who provide care to COVID-19 patients also must wear masks and gowns throughout their shifts.
“They are very tired,” Melms said. “They are emotionally drained. It’s not just physically. It’s emotionally. We are asking them do to a lot.”
Shifting staff, hiring temp nurses
Large health systems, such as Aurora Health Care, have moved staff to different hospitals.
“Right now, we are holding our own,” said Mary Beth Kingston, chief nursing officer for Advocate Aurora Health, the health system that includes Aurora and operates 15 hospitals in the state.
The health system has commitments for 100 temporary, or traveling, nurses in November and December. And it has contingency plans to add ICU beds if needed.
“I am not saying at all that we are not concerned,” Kingston said. “We are very concerned.”
For now, health systems have not stopped doing elective procedures, though they are rescheduling some procedures when they can be done safely for the patient.
In the spring, when health systems halted such procedures, no one knew exactly what was ahead and so-called personal protective equipment —- such as gowns and masks — were in short supply.
Health systems have stressed that many of the patients, such as those scheduled for cancer surgery or a cardiac procedure, need care.
“You can’t put off those other things now,” said Nelson, the chief nursing officer for Hospital Sisters Health System’s hospitals in Green Bay. “There’s some frustration.”
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Few of those patients require ICU care.
Some people have contended that health systems have not wanted to stop doing elective procedures because the procedures typically are among the most profitable services.
Melms of Marshfield challenges that.
“I’ll speak for everyone in health care around the state, what we all are doing is we are putting the needs of the patients first no matter what,” he said. “It’s all about providing the care to the patients who need it. End of story.”
The rise in cases also has been frustrating for physicians, nurses and other staff.
“Our health system cannot be the unlimited backstop for COVID,” said Eric Borgerding, CEO of the Wisconsin Hospital Association. “We have to start taking this more seriously and consistently seriously. This is real.”
The trend has brought another challenge: The high infection rate means that hospital employees are at a greater risk of being exposed to the virus.
Marshfield Clinic has an estimated 10% of its 12,000 employees out because they have COVID-19 or have been exposed to someone who does and need to quarantine, Melms said.
That risk is increasing with each passing day.
“I want to wake up and start to see the number of positive cases in the state starting to go down, because then I know there’s a light at the end of the tunnel,” Melms said. “Then at some point, we will begin to see a decrease in our census rather than an increase in our census.
“Until we see that, then there is no light at the end of the tunnel.”
Contributing: John Fauber and Sophie Carson, Milwaukee Journal Sentinel.