Hospitals and health care systems around Michigan are feeling the strain of increased COVID-19 cases and hospitalizations. Over 4,000 patients are currently hospitalized with the disease, and test positivity rates are up in many regions.
One of those regions is the Thumb, where three counties have positivity rates of over 30%: Tuscola at 30.5%, Sanilac at 35.3%, and Huron at 36.9%.
Dr. Mark Hamed is is the medical director for eight counties in the Thumb region: Huron, Lapeer, Sanilac, Tuscola, and District Health Department #2 (Alcona, Iosco, Ogemaw, and Oscoda), as well as the medical director for McKenzie Health System's emergency medicine department in Sandusky.
At McKenzie, there is no ICU or COVID wing, so patients who come in with COVID and need to be hospitalized are stabilized before being transported to another hospital. That's a task that Dr. Hamed says has been difficult lately.
"I can tell you right now, all our regional hospitals: Port Huron, Saginaw, Flint, even many in the metro Detroit area were not accepting because they were kind of at capacity themselves. So we had to call... oh God, I think 14 or 15 hospitals over my last shift to get one to accept, and it was a case by case basis," he says.
Dr. John Brooks is the chief medical officer for McLaren Port Huron Hospital. He says he's cautiously optimistic, though the past few weeks have been rough.
"For our daily [patient] census, 97% has been about the average. We've had a couple days at 100, so we've been very busy," he says. "When you look at the number of people who come in seeking care that we're testing that have a positive test result for COVID, if you go back seven, eight, nine, ten days ago, we were in the 40s to upper 40s, we then got to 57% of our patients walking in the door had a positive result for COVID. Today, for the first day, we fell just below 40%. We don't know if that'll be an ongoing trend, but it's certainly the right direction."
Health care workers around the state have reported growing stress and fatigue in the midst of rapidly climbing cases. Both doctors say that their staff has been feeling the strain.
"The EMS systems are very overworked. They're feeling it, they're voicing it, but they're hanging in there. Our staff at McKenzie and elsewhere in the Thumb, they're very hardworking, very dedicated folks. They're taking care of their own community members, their own family members, and they're motivated. But it's hard, the health care system is definitely under a lot of strain right now," Dr. Hamed says.
Dr. Brooks says McLaren Port Huron has had to make a number of changes, including moving patients around to different floors as beds and space become available. He also says the nursing staff have restructured to ease some of the stress that comes with high bed occupancy. They follow what he calls a team model, where a primary nurse is designated for a shift and other nurses who help get other tasks done to make the overall delivering of care more effective.
"For us, this is our third wave, so we’ve had some experience with this. Because with the treatments, we don’t have the death rate the way it was. That’s less stressful for the staff. It’s just a lot of work," he says.
Despite the recent difficulties, a year of handling the virus has given health care workers a wealth of information to draw from when treating the many patients who come through their doors. Dr. Hamed says the Thumb wasn't hit as hard during the first wave of the virus in 2020, so it gave McKenzie and other health systems time to prepare.
"We're not seeing the need to ventilate as many patients as last year, because we do know now that high-flow oxygen at about 30-40 liters per minute, which is like driving your car with your head out the window, that kind of flow of oxygen going at you, is helping to keep these patients who otherwise would need to be intubated alive and off the vent," he says.
He says the urgency of stabilizing patients has outweighed McKenzie's usual protocol of transporting patients to to other hospitals. "We are actually starting in-patient therapy for these COVID patients in negative pressure rooms. We're actually starting medication like remdesevir that would normally be started in an in-patient setting, but we don't want to wait two days until they get a bed."
"A year ago, we didn't know what to do. That's the bottom line. We just didn't know what to do, and we've had lots of experience since then," Dr. Brooks says. "Before people ever get into the hospital, we have monoclonal antibody therapy. We are a site here, we're given about 400 patients doses of monoclonal antibody, and the goal is to keep them out of the hospital. To get monoclonal antibody, they have to have COVID, they have to have risk factors, and they have to seek care. Of those people, we've had an excellent response, and very very few of them have had to come back for further medical care."
Governor Gretchen Whitmer and the Michigan Department of Health and Human Services announced on Wednesday that they have plans to expand access to monoclonal antibody therapy in an effort to reduce hospitalizations.
With the more contagious B.1.1.7 variant now considered to be widely circulating in Michigan, both Dr. Hamed and Dr. Brooks are encouraging people to make a plan to get vaccinated. Dr. Brooks says they're asking questions about how to reach members of the community who are vaccine hesitant, and how to ensure those people get accurate information about about the safety of the vaccine.
"If I vaccinate today, people are not really going to have any significant immunity for about two weeks. So it's probably not going to stop this wave, but it would actually stop, hopefully, the next wave. If we get enough people vaccinated, we won't have another wave," he says.
Another crucial part of not just the vaccine effort, but getting people to adhere to physical distancing and mask guidelines, will be a not-insignificant amount of community buy-in—something Dr. Hamed says he's seen a lot more of, especially as people watch their loved ones get sick.
"I think the Thumb is getting a bad rap," he says. "I think we're getting unfairly grouped in as a whole because of loud, vocal anti-maskers. But I think that has actually motivated the community to take better precautions."
*Correction: An earlier version of this story said McLaren Port Huron's COVID patient census was close to 97%. That is incorrect. The 97% occupancy refers to McLaren Port Huron's total patient census. The story has been corrected above.
