Increased hospitalizations this week are the beginning of a surge from the Christmas holidays Ballad Health officials expect to occur over the next few weeks.

Those health officials are also concerned that New Year’s events this week may cause another surge on top of the Christmas increase, furthering straining resources within hospitals and adding more patients for already exhausted nurses and doctors.

“Despite the fact we had a small drop in admissions right before and at Christmas … we are starting to see those numbers climb back up again,” said Eric Deaton, chief operating officer for Ballad Health who is also leading its emergency response to the virus. “We are concerned about the Christmas surge we expect will happen. We could have a surge on top of a surge if we have a lot of gatherings and people not adhering to social distancing over the New Year’s holiday.

“We don’t know the impact of Christmas yet as that story unfolds over the next few weeks, but typically we see a lag of two to three weeks after a holiday to see a surge. What we do know is when we entered the Christmas holidays we had admissions 30% higher than at Thanksgiving. And we are expecting to see another stair step up moving forward after the Christmas holiday.”

One new death and 59 new cases of COVID-19 were reported for Greene County on Wednesday, according to the daily update from the Tennessee Department of Health. Since March, 92 people have died locally from the virus and 5,482 people have contracted the illness.

Currently, 792 people in the county have active cases of the virus and 4,598 have inactive cases as they are beyond the 14-day mark of a positive test or onset of symptoms. The virus also caused another closure of a public office as the Greene County Clerk’s Office closed Thursday due to employee virus cases.

CONTINUED PRECAUTIONS

To help prevent additional holiday surges, Ballad Health officials renewed their call during a weekly COVID-19 briefing Wednesday for individuals to continue measures to prevent the spread such as wearing a facial covering, social distancing from others and avoiding large crowds or events with people from multiple households over the New Year’s holiday.

They also ask that people get a COVID-19 vaccine once it is available to them

“Anyone who is able to the get vaccine, please take it. It is really the thing that will help stop the spread,” Deaton said. Until then, “We ask the community to do the right thing. We have vaccines in place, but it is going to take some time for us to overcome the rising number of cases in our region, and it does affect our team members on a daily basis.”

Ballad Health has not seen many flu cases yet, but typically January and February are the height of the flu season in this region.

“We pray that we do not have an active flu season,” Deaton said. “A tremendous flu outbreak would make it much worse for us, so if you have not had a flu shot, it is not too late. Please get one.”’

Ballad Health has administered the COVID-19 vaccine to more than 10,000 people thus far with few side effects reported among the recipients, he said. The system is beginning to administer the vaccines to first responders in partnership with local health departments and has started to offer vaccines to health care workers in offices and behavioral health agencies outside Ballad Health.

As the number of hospitalizations of COVID-19 have increased, the use of convalescent plasma has continued to be an effective treatment, Ballad Health officials stated, but more donations are needed to meet the demand.

FRONTLINE EXPERIENCE

As the briefing began, Deaton thanked all the Ballad Health employees for their efforts during the pandemic, particularly those who work with COVID-19 patients. The stress of working with these often critically ill patients for a period that has now reached about 300 days is wearying, and its strain is seen among those on the frontlines, he said.

A video dairy was shared from Kayla Flint, a nurse in the COVID-19 intensive care unit at Holston Valley Medical Center. She said the unit has had patients ranging from 20 years of age to 90, and what she sees daily makes her want to try to convince others of the seriousness of the virus.

When she sees the number of people in the community who are not taking precautions and appear to not think the virus is serious, Flint said it makes her “truly scared” for the region.

Asked about what it is like in COVID-19 ICU units, Deaton said that it is a high stress atmosphere. He explained that coronavirus patients are among the sickest that are treated in the ICU and about 30% of COVID-19 patients in the ICU die, which takes an emotional toll on the staff.

Dr. Amit Vashist, chief clinical officer for Ballad Health, who has also served as a physician in the COVID-19 units, said working in either the coronavirus units with the less critically ill patients or in the ICU units is a stressful environment due to the nature of the virus.

“In the words of clinicians, it is a disease like we have never seen before,” he said. “If you have seen one COVID patient, you have only seen one COVID patient. They present with various clinical presentations with different kinds of symptoms in different patients. They require a lot more resources in terms of medications, oxygen supplementation and positive pressure ventilation with ventilators. With all those resources allocated, it puts an additional burden on our frontline caregivers. … It is much more resources than for patients with other illnesses.”

About 300 Ballad Health team members are in quarantine either because they have tested positive or have symptoms and are undergoing testing. The loss of team members due to the virus is also causing strains in staffing, Deaton said, and the system does not have the option to allow more time for health care providers working with virus patients to take days off to get recharged physically and emotionally.

CASE MODELING, PREPARATIONS

The data about new cases from the state has been affected by the lag in testing and reporting by Departments of Health due to the holidays, and Deaton said he does not put a great deal of stock into the 30% positivity rate for the past seven days, a high for the region that has been posted Tuesday and Wednesday.

However, he said the positivity percentage is probably in the mid to upper 20s range for the region, which is still higher than the statewide averages for Tennessee and Virginia.

Although the data and testing has been affected by the holidays, the new cases still point to hospitalizations continuing to increase, according to the predictive models used by the health system, he said.

The Christmas and New Year’s holiday surges could bring hospitalizations reaching the 475-500 range, the models indicate, Deaton said. On Wednesday, there were 330 patients being treated for the virus within Ballad Health facilities with 11 admitted with symptoms awaiting test results. The highest number of COVID-19 patients hospitalized in the health system thus far came on Dec. 20 when 335 were being treated.

The next level of Ballad Health’s surge plan focuses on creating capacity to care for 465-475 COVID-19 patients within the system and that point could be reached in 30 days, Deaton explained.

Currently, there are 74 patients within COVID-19 ICU units, with 48 of those on a ventilator. Deaton said the ICU capacity is a concern as it averages about 90%. On Wednesday, there were 14 ICU beds available throughout the system, a much lower number than is typical, Deaton said.

To create more ICU beds, the health system is looking to convert post-surgical and post-anesthesia areas into ICU areas as well as some space inside emergency rooms since all have the needed equipment and staff experienced in taking care of seriously ill patients, he said.

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