Doctors and nurses caring for an overwhelming number of unvaccinated COVID-19 patients during a pandemic describe two kinds of emotional distress. The pain of watching someone die who — had they been vaccinated — would have lived. And turning away other patients suffering their own serious illnesses because COVID-19 patients are filling their hospitals.
They want the latter to be better understood and appreciated.
Delayed care, they say, leads to worse outcomes. Untreated chest pain becomes a heart attack. Untreated diabetes leads to vascular disease, even amputation. Delaying a colonoscopy to investigate blood in a patient’s stool risks delaying a cancer diagnosis and treatment.
“I went into medicine to help people. I’m doing this job because I want to make people better,” said Dr. Elisabeth Souther, who works in the ICU at the Dartmouth-Hitchcock Medical Center in Lebanon. “And when I know that there are patients that live and work in New England, especially in New Hampshire and Vermont, that we should take care of here and could get the care they need here that we cannot provide, that is so sad. It is — really the word is heartbreaking.”
Health providers across the state, especially those working in hospitals, are experiencing the same. And they expect that to continue, maybe even worsen, following Christmas and New Year’s gatherings and the spread of the exceedingly more contagious omicron variant.
“I just want to emphasize how this affects everyone,” said Dr. Thomas J. Lydon of Wentworth-Douglass Hospital in Dover during a press conference Tuesday. He treated a patient who didn’t seek medical care until he began struggling to breathe and came to the hospital assuming he had COVID-19. A chest X-ray revealed tuberculosis.
“I haven’t seen a case of tuberculosis since, well, my grandmother had it, but I think it was a very long time,” he said. “This man had no access to health care. He’s been walking around Dover for, I don’t know, weeks or months.”
On Monday, the state reported 381 COVID-19 hospitalizations on its dashboard. But the true number of COVID-19 patients occupying hospital beds and requiring hospital-level care was much higher — 509 — because the state includes only infectious COVID-19 patients in its dashboard count, per standards set by the Centers for Disease Control and Prevention and Council of State and Territorial Epidemiologists, said department spokesman Jake Leon.
The New Hampshire Hospital Association’s dashboard reports both currently infectious COVID-19 patients and those no longer infectious but still using hospital resources because their conditions remain so serious. Those stays can last weeks.
The strain these COVID-19 patients are putting on hospitals led Gov. Chris Sununu and Health and Human Services Commissioner Lori Shibinette to look to National Guard troops to help hospitals with back-end jobs like laundry and dining services, and federal medical teams to assist in hospitals.
And they’ve pleaded with Granite Staters to get vaccinated; as of Tuesday, 67.2% of residents were fully vaccinated and 14.6% of those had gotten boosters, according to the CDC.
Of those 509 patients hospitalized Monday, 29.1% were fully vaccinated, .8% were partially vaccinated, and at least 60% were unvaccinated, according to the hospital association’s dashboard. But any of those counts could be higher because the vaccination status of about 13% was unknown.
Health care leaders say even the breakthrough cases are an argument for full vaccination because vaccinated patients who require hospitalization suffer less severe symptoms, need less intense care, and are discharged earlier. Those benefits also allow hospitals to free up resources more quickly for non-COVID-19 patients.
“Hospitals in New Hampshire are facing critical shortages in staffing, blood supplies, and available beds, including ICU beds,” said Steve Ahnen, president of the New Hampshire Hospital Association. “Our hospitals are not only seeing patients who are much sicker because they delayed care due to the pandemic, but also patients with COVID-19 who require increasingly longer periods of care due to the severity of the virus.”
Dr. Jeffrey Munson, medical director of Dartmouth-Hitchcock’s ICU, worked just before Thanksgiving treating many unvaccinated patients.
“It is really hard to capture how hard it is to take care of a young mother or a young father who is going to die for a disease that is preventable,” he said. “I think most people feel incredibly frustrated that there is this huge burden of disease that’s not only making it hard to take care of those patients, but it’s making it almost impossible to take care of the rest of the patients who still need our care and feeling like we can’t actually meet the needs of everybody.”
During a surge of delta patients in November, Wentworth-Douglass Hospital began turning away ambulances carrying heart attack victims because it was so overcapacity. Medical teams were treating patients in conference rooms, hallways, even the chapel.
Ambulances carrying heart attack victims were sent searching for other options.
“Where do you go? I don’t know, it’s up to the ambulance crew,” Lydon said. “They go up or down the Spaulding. They go up or down 95, and they try to find a hospital for you. That’s really not a very good system.
Ed Shanshala, chief executive officer of Ammonoosuc Community Health Services, which serves 10,000 people in the North Country, said his agency has seen a negative impact on its diabetes patients. Since 2008, it has met an industry-standard that less than 12% of those patients are below their health goals.
That climbed to 18 after the pandemic hit and put a strain on limited health care resources, and is now at 15%.
“There are normal health care things we all need on a regular basis,” Shanshala said. “And when a pandemic happens, the staff we have is the staff we have, and we have to do our best to concurrently meet the ongoing patient needs as well as stand up a public health intervention.”
The consequences can range from serious to deadly.
“The impact on those chronic health conditions may not be seen for days, months, and years,” he said. “The quality of people’s lives will be decreased, and I would anticipate the number of years in their life may be decreased as well, which is tragic and preventable.”
Coos County Family Health Services has had to scale back care because of COVID-19 outbreaks or staff shortages, a reality that’s made it hard when possible at all to keep up with physicals, the management of chronic diseases, and early invention.
“It’s difficult,” CEO Ken Gordon said. “I think we’ve worked hard to identify those who are most at risk and focus our efforts on them. At the end of the day, our focus on providing patients with the best we can offer is what we are after. When that gets compromised, particularly for reasons that are beyond our control, it leaves many feeling greatly dissatisfied and that they somehow failed their patients.”
Dartmouth-Hitchcock has gotten calls from as far away as South Dakota and Florida from health care providers searching for a hospital able to provide the specialty care a patient needs. Dr. Munson said it’s not uncommon to hear those providers say they’ve already tried 30 other hospitals.
“We’ve had a few patients that I can think of who were in small community hospitals elsewhere in the state and called us,” Munson said. “We didn’t have capacity and that patient got transferred to another hospital that has more capabilities but not as many as us.” That may be urgent dialysis or a procedure to stop bleeding. “Some of those patients are dying. Under normal circumstances, we would have moved that patient here,” he said.