Surge in COVID-19 patients fills Concord Hospital as it deals with staffing issues

  • ICU nurse Michelle Rheaume puts on COVID protective gear in the unit at Concord Hospital in June 2021. Hospital officials say they haven’t turned anyone away, but that space is quickly filling up. Monitor file

  • ICU nurse Meghan Flint puts on the full COVID pandemic medical gear that the staff wears dealing with patients at Concord Hospital on Thursday, June 3, 2021. The pandemic has brought about new procedures and protocols that will the hospital will bring into the future. GEOFF FORESTER

Monitor staff
Published: 11/18/2021 3:06:52 PM

The latest COVID-19 surge is filling beds at Concord Hospital amid staff shortages and an increase in other serious cases partly caused by care having been postponed earlier in the pandemic.

The hospital hasn’t had to turn anyone away, but getting each patient the necessary care is growing increasingly difficult, officials said.

“We have not seen a situation where we have truly urgent care – ICU, surgery, something like that – that we have not been able to do, but it is a choreography. It’s a multiple-times-a-day conversation to make sure we can handle it,” said Dr. Matt Gibb, chief clinical officer of Concord Hospital. “Waits in the E.R. are variable and long. ... We are running at capacity all the time.”

The situation is common throughout New England at the moment as cold weather sends people indoors where they more easily spread disease. Hospitals in the North Country and Seacoast have reported being full almost to the point of having to turn away patients, while some Boston-area hospitals have been sending patients to Rhode Island and Connecticut because of a lack of beds.

On Thursday, the Department of Health and Human Services said 327 people were in a hospital with COVID-19, an increase of more than 50% in two weeks, and just short of the peak hospitalization figure in January at the height of the winter surge.

Gibb said Concord Hospital was staffing 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 staffing. That is a very fluid situation,” Gibb said. “To have the staff and create flexibility with nursing staff, to staff all the beds, we’ve had to draw on some staff … like ambulatory clinics, ambulatory surgery, who had previous experience with in-patient service.”

Gibb said very few staff 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 5,000 roughly in three hospitals,” he said, citing a 99.4% vaccination rate, “including a few exemptions.”

Staffing shortages are caused in part by people leaving the field due to stress after 18 months of the pandemic and often contentious public argument – by some estimates, 3% to 5% of new Hampshire health care workers have retired or changed fields since the pandemic began – and in part to increased competition for expertise.

Gibb pointed to the traveling nurse business, which has seen wages skyrocket this year as hospitals and long-term health care facilities try to outbid each other for the staff.

Like many hospitals, Concord Hospital has experienced an increasing number of COVID-19 patients.

“I think we are currently at 43 COVID in-patients, with I believe 6 in ICU, and 5 on ventilators,” Gibb said. “This morning there were 13, between Laconia and Franklin (hospitals).”

“We’ve been adding at Concord a net of about three to five new (COVID patients) a day over the past week.”

He said the COVID-19 population is skewing younger than in earlier surges, with many patients between 30 and 60. Most worryingly, he said, are the number of COVID-19 patients who have been vaccinated.

A month ago, he said, at least 90% of COVID-19 patients were unvaccinated, but now the figure is more like 70%.

“The concern is that we’re seeing some waning of initial vaccination immunity … the people who were vaccinated in March, early spring,” Gibb said. “It is showing up clinically with otherwise generally healthy vaccinated people landing with in-patient needs for oxygen.”

This is all the more reason for people to get a vaccine if they haven’t done so, or to get a booster shot if they have been vaccinated.

Gibb said the hospital is seeing “more than normal number of people with non-COVID illness” such as heart disease, stroke, and surgical fractures.

“The truly acutely ill people – heart attacks, strokes, accidents – those are sizeable portions of the acute work that is not COVID, and we did not see that in the first two experiences” of pandemic surges, he said. While it’s not entirely clear why this is happening, a likely explanation is that people put off preventive care earlier in the pandemic.

“I do think people deferred care, but it’s hard to quantify,” Gibb said.

In addition, it has become more difficult to move patients out of the hospital when they improve because staffing issues and COVID outbreaks mean fewer beds are open at other long-term care facilities to take them, which adds to the pressure.

Gibb noted the continuing staffing issues has meant that it’s not possible to repeat an emergency measure taken early in the pandemic: putting beds into gyms at NHTI and other colleges to handle overflow patients, then using National Guard personnel to staff them.

The trouble, Gibb said, is that members of the National Guard who are trained in health care are already working in health care for their day jobs. Making them do the same work in uniform in a new location wouldn’t accomplish anything: “It would be robbing Peter to pay Paul.”

David Brooks bio photo

David Brooks is a reporter and the writer of the sci/tech column Granite Geek and blog, as well as moderator of the monthly Science Cafe Concord events. After obtaining a bachelor’s degree in mathematics he became a newspaperman, working in Virginia and Tennessee before spending 28 years at the Nashua Telegraph . He joined the Monitor in 2015.

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