The latest wave of COVID-19 is filling beds at Concord Hospital amid staff shortages and an increase in other serious cases, partly due to care being delayed earlier in the pandemic.
The hospital has not had to turn anyone away, but it is becoming increasingly difficult to provide every patient with the necessary care, officials said.
“We haven’t seen a situation where we have really urgent care – IC, surgery, something like that – that we haven’t been able to do, but it’s choreography. It’s a conversation that happens several times a day to make sure we can handle it,” said Dr. Matt Gibb, Chief Clinical Officer of Concord Hospital. “Waits in the ER are variable and long. … We are running at full capacity all the time.”
The situation is common across New England right now, as cold weather sends people indoors where they can more easily spread disease. Hospitals in the North Country and Seacoast have reported being nearly full to reject patients, while some hospitals in the Boston area have sent patients to Rhode Island and Connecticut due to a lack of beds.
Gibb said Concord Hospital has about 190 beds. The American Hospital Association says it has a maximum capacity of 221 staffed beds, the fourth largest hospital in the state.
“We’ve had challenges… with nursing staff. That’s a very fluid situation,” Gibb said. “In order to have the staff and create flexibility with nursing staff, to staff all the beds, we had to call on a number of staff … like outpatient clinics, outpatient surgery, who had previous experience with inpatient care.”
Gibb said very few employees have left the company’s Concord, Laconia and Franklin hospitals after refusing COVID-19 vaccines. “A negligible number of people were placed on administrative leave out of roughly 5,000 in three hospitals,” he said, referring to a 99.4% vaccination rate, “including a few exceptions.”
Staff shortages are partly caused by people leaving the field due to stress after 18 months of the pandemic and often contentious public arguments – by some estimates 3% to 5% of new health workers in Hampshire have retired or changed jobs since the start of the pandemic – and partly to more competition for expertise.
Gibb pointed to the traveling nurse company, which has seen wages skyrocket this year as hospitals and long-term care facilities try to outbid each other for staff.
Like many hospitals, Concord Hospital has experienced an increasing number of COVID-19 patients.
“I think we’re currently on 43 COVID patients, with I believe 6 in the ICU and 5 on ventilators,” Gibb said. “This morning there were 13, between Laconia and Franklin (hospitals).”
“We’ve added a net of about three to five new (COVID patients) per day at Concord in the past week.”
He said the COVID-19 population is younger than in previous peaks, with many patients between the ages of 30 and 60. Most worrying, he said, is the number of COVID-19 patients who have been vaccinated.
A month ago, he said, at least 90% of COVID-19 patients had not been vaccinated, but now the figure is more than 70%.
“The concern is that we’re seeing a decline in initial vaccination immunity… the people who were vaccinated in March, the early spring,” Gibb said. “It occurs clinically in otherwise generally healthy vaccinated people who land with patient oxygen demand.”
This is all the more reason for people to get vaccinated if they haven’t, or to get a booster vaccination if they have been vaccinated.
Gibb said the hospital is seeing “more than normal numbers of people with non-COVID disease” such as heart disease, stroke and surgical fractures.
“The really acutely ill people — heart attacks, strokes, accidents — those are significant parts of the acute work that isn’t COVID, and we haven’t seen that in the first two experiences” of pandemic spikes, he said. While it’s not entirely clear why this is happening, a likely explanation is that people are delaying preventive care earlier in the pandemic.
“I think people delay care, but it’s hard to quantify,” said Dr. Gibb.
In addition, it has become more difficult to get patients out of the hospital when they improve, as staffing issues and COVID outbreaks mean fewer beds are open at other long-term care facilities to admit them, increasing the pressure.
Gibb noted that ongoing staffing problems have meant that it is not possible to replicate an emergency measure taken early in the pandemic: putting beds in gyms at NHTI and other colleges to treat overcrowded patients, and then staff from use the National Guard to man them.
The problem, Gibb said, is that members of the National Guard trained in health care are already working in health care for their day-to-day jobs. Getting them to do the same job in uniform at a new location would do nothing: “It would rob Peter to pay Paul.”
(David Brooks can be reached at (603) 369-3313 or [email protected] or on Twitter @GraniteGeek.)