Hospital personnel in the USA (nurses, residents, attendings): How busy are your hospitals?

My friend's hospital is packed with people with the flu but no Covid 19 within hundreds of miles.

EMS calls are way down but hospital numbers are up because everyone thinks they have the virus. I'm worried about the actual sick patients that aren't calling 911 or going to the hospital because they are afraid.

aquestionforhealthcare wrote:

Is it slow?

Saturday night means drunks, drug addicts, car accidents and the usual flu patients and the new twist, people wanting to be tested for COVID but no patients.

The oddballs are our in force tonight.

https://www.axios.com/russia-coronavirus-misinformation-bb3ce9ad-6596-43cf-82a4-90436efbc8bd.html

I'm a resident at a major academic hospital in a major city impacted by the coronavirus. We have 15-20 patients admitted for it with almost 100 more who tested positive and are now home. We receive multiple emails a day with updates to patient numbers, changes in protocols, etc. Those numbers increase every day as more people get tested.

An entire floor of the hospital is now converted to negative pressure rooms specifically for coronavirus patients. (Negative pressure rooms keep air from flowing out into the open; it is instead removed by a special vent with a filter.) We have not run out of PPE yet, but I could see that happening.

Our surgeons can only perform non-elective surgeries (i.e. surgeries that cannot be delayed for more than 30 days without a significant change in outcome). These include both things like appendectomies and repairs of hip fractures but also major cancer operations, heart surgeries, etc. We're not doing cases like joint replacements or plastic surgery. As surgical volume decreases, we expect surgical and anesthesia residents to be floated to other departments (e.g. ED, ICUs, medicine wards) to help triage and care for the increasing volume of patients in those places.

We have health care professionals beginning to test positive for coronavirus and expect that number to increase in the coming days. Right now, we can only get tested if we show symptoms. We are not screening health care professionals.

Hello trolls, busy hospitals don’t have time to answer your obvious disinformation.

This is accurate.

I work in the ER in a city that has not had many cases. I am receiving the same daily emails (or more) with updates. They are shutting down elective surgeries and planning for how resources will be used in a way that exposes the fewest people possible.

For the adult center, it has been eerily quiet. You still get some of the usual garbage in the ED, but overall volumes are weirdly low. A lot of the people who don't need really need the ED aren't coming. It seems like a lull before the storm.

For the pediatric center, volumes are way down. And it seems like it will continue this way for the coming weeks. They are cutting back staffing in the ED and urgent cares because there aren't any patients to take care of.

Thanks for health care professionals chiming in on this thread. I am not one, but those I know say the hospital expects the peak to be more than a month away. While they have some cases, this is still the calm before the storm for them.

Interesting that even nurses are seeing their hours cut in parts of the US other than the coasts. Everyone else is out of a job on the coasts due to Government mandate.

Yep. Agreed with both of these. I’m at a major academic medical center in the SouthEast. We’re somewhere in between. We have shut down elective cases and have contingency plans in place for everything. It does feel like a wartime scenario and we are asking medical students and retired physicians to be available if needed. Pregnant staff are also being asked to work. We have a lot of patients admitted and awaiting rule outs (tests are still slow to return). Surprisingly a reasonable volume of younger people. We have a few critical care admissions but we’re not overwhelmed by any stretch yet. Expecting a surge in the next 2-4 weeks.

My wife is a pediatric intensivist at a major teaching hospital in the midwest. The pediatric units are on the slow side now because social distancing has slowed down some of the other causes that land people in the PICU: accidents, flu complications (kids home from school, daycare), etc. They have had a small number of pediatric COVID patients but not many, yet. Even in Italy, I believe the pediatric wards have been pretty slow because of COVID not really affecting young people as much.

The adult side is more busy but there not over capacity yet.

People don't fully appreciate, however, the stresses this is putting on hospitals, particularly because of scarcity of personal protective equipment. Using PPE makes managing cases more difficult for pratcical reasons (full dress up, down going into rooms). Likewise, decisions on how to ration PPE can't be made independently of testing: if you test a patient, it's full PPE for all future interactions, which uses scarce resources. This lasts until tests come back, which earlier in the week was 2-3 days.

Things have improved on that front. Testing is in-house now and can be done much faster (hours, not days). So there's not as much of a long-term stress on PPE. And the can test many more people, so expect to see the reported case numbers go up.

People also don't fully understand the stress on personnel. Older intensivists (most places are saying 70+) are being held off work. If someone is exposed, they get benched. So as caseloads increase as the virus spreads, a lot of places are working with short rosters.

As someone else noted, the slow units now mean nothing. We've been locked down most places for about 9 days, and there's a 2-14 day incubation period. It's going to get very stressful.

My wife moved from the Philippines about a decade ago, and so has been in touch with her old medical school and residency friends. It's extremely trying there. There are a ton of cases. There's fewer resources there to start with, but they're being stressed beyond what they can carry. They have patients in hospitals being found dead because they can't monitor everyone all the time and don't have the technology to do so. There are respirator shortages. They also have PPE shortages, causing more doctors to get sick and the virus to spread more frequently in hospitals. To make matters worse, personnel is limited, and some (cowardly) doctors that do everyday care are "social distancing" and this is causing untreated stuff to get worse and end up in the hospitals.

She's had one old med school teachers die, and knows many other former teachers/attendings she's work with -- mostly in their 60s -- who are intubated, which has about a 50/50 prognosis.

The US has better resources, but situations like this are similar to what we can expect if hospitals get overwhelmed. It's not hysteria.

The good news is that Cepheid has received FDA clearance for a covid-19 RT-PCR assay for the GeneXpert. Most hospitals already use this platform for flu testing among other things. Results will be available in 45 minutes from the time the cartridge is loaded. The bad news is that the collection swabs are in short supply across the country.

jesseriley wrote:

Hello trolls, busy hospitals don’t have time to answer your obvious disinformation.

From the #1 Russian troll on this site.

erik wrote:

This lasts until tests come back, which earlier in the week was 2-3 days.

Things have improved on that front. Testing is in-house now and can be done much faster (hours, not days).

Thanks, Eric. Faster test results are great news, but it's not everywhere yet. My training partner was tested Friday morning at one of Vanderbilt's walk-in clinics and was told results will be back in 2-3 days.

I completely support Pence taking charge after Trump resigns.

Clever...

I work in surgery. As others have noted, we are no longer performing elective surgeries. Overall census is fairly low for this time of year. No Covid19 cases as of yet. I am certain that we'll see some, but hopefully not too many. PPE supplies are low, but we are told it's on the way. Will see tomorrow. I pray that this nightmare ends soon.

In Orange County, CA: we have 4 cases at our hospital and are doing our best to prepare for a possible surge. Feels like we're waiting for the war to begin. We definitely don't have enough N95 masks, but neither does anybody at this point. My dad sent me a pack of 10 he had purchased to work in his woodshop.

Ultimately, it's estimated Southern CA is about 17-20 days behind Italy so it makes sense we are still in the waiting phase.