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Hospitals in Richland and Crawford counties are not hanging out the "no vacancy" sign due to the rapidly rising wave of COVID-19 cases.
But officials with OhioHealth and the Avita Health System this week made it clear -- the trends are all headed in the wrong direction and weary local medical workers need residents to take steps to slow the spread.
"We need you to be just as passionate today as you were at the beginning of this pandemic," said Joia Crago, director of nursing for Avita, which has hospitals in Richland and Crawford counties.
Dr. Gavin Baumgardner, vice president of medical affairs for OhioHealth Mansfield Hospital and OhioHealth Shelby Hospitals, said local facilities are not exceptions to the problems outlined by Gov. Mike DeWine during his bi-weekly press conferences.
"To reduce the spread of COVID-19, we need everyone's help to flatten the curve again in order to keep the community healthy," he said.
"COVID-19 has created its own set of unique circumstances that we wouldn't experience during flu season. Our COVID-19 units require greater support due to the complexity of the patient and need for proper personal protection equipment," Baumgardner said.
Since the pandemic reached Ohio in March, one of the goals has been to protect hospitals and medical facilities from becoming overwhelmed, something that has occurred in other states and cities.
North central Ohio had been successful thus far, not coming close to filling local hospital beds with COVID patients or intensive care units. While Richland County has triggered many different indicators in the state's Public Health Advisory System that began in July, it has not met the ICU bed usage threshold.
In this indicator, which measures the region, it's flagged if the percentage of the occupied ICU beds in each region goes above 80 percent for at least three days in the last week and if more than 20 percent of ICU beds are being used for COVID-19 positive patients for at least three days in the last week.
But the spike in new COVID cases, including 642 in Richland County alone in the last two weeks, the emerging trends are worrisome. There has been growth in outpatient visits due to the virus, as well as visits to local emergency rooms.
It was not known Thursday the exact number of current, local hospitalizations, but that number was 58 a few days ago and likely on the rise, given other indicators.
Every county in Ohio is now considered "high incidence" for spread of the virus under standards set by the U.S. Centers for Disease Control and Prevention -- 100 cases per 100,000 residents.
As of Thursday, Richland County's incidence rate is five times that at 530 cases per 100,000 residents, up from 366 a week ago. It was 91.62 per 100,000 residents in mid October.
Those rising trends of outpatient and ER visits are indicators that have led to a steady increase in hospitalizations and ICU usage, which has quadrupled across the region in about one month.
On Oct. 14, just 5.5 percent of ICU beds in the region were being used by COVID patients. That number hit double digits at 10.5 percent on Oct. 21 and has continued to climb, hitting 21.8 percent on Nov. 16.
Officials at the local hospitals monitor bed and ICU usage on a daily basis.
Chris Adler, director of safety, security and emergency preparedness for Avita, said the system still has space, but is preparing for to create more, as well as monitoring the situation in other facilities.
"One of the biggest issues we are seeing is that this is not just an Avita problem, a Richland and Crawford county problem ... it's a state and national issue," he said, indicating that the ability to move patients to other sites becomes tougher as those hospitals and facilities also fill.
"The community needs to be concerned about this. In March and April, we didn't see these kinds of numbers and it gave us time to prepare. We are seeing it now. I don't think it's something to be afraid of, but it's here and it's not going away soon.
"People should do what they should have been doing all along (wearing a mask, social distancing, avoiding unnecessary personal contacts, etc.)," Adler said.
Baumgardner said as the non-COVID patient load has stayed high and the COVID census has increased, OhioHealth Mansfield Hospital has activated its surge plan to create more space.
"We anticipate that we will experience another jump in cases and another surge in hospitalizations due to holiday gatherings," Baumgardner said. "As we head further into winter, flu cases tend to be on the rise. With that in mind, we have spent months preparing for additional surges in patients."
The situation is the same, even in smaller and more rural hospitals.
"Earlier on in the process, we were worried about PPE and supplies. Now, it's manpower and resources. People are tired. I work with amazing people. Every day, they perform miracles, but they cannot perform magic," Bruce White, chief executive officer at Knox Community Hospital, said Thursday.
White said the intensive care units at KCH had no COVID-19 patients two months ago and now that number is 30 percent.
"We have to buckle down as a state," White said, adding that KCH "flirts" every day with maximum patient usage. "This is not a drill."
Physical space is one concern. Keeping a sufficient staff of healthy medical workers to care for ill patients is another. Officials at OhioHealth and Avita monitor this area, also.
"We are pretty fortunate in that we have three campuses," Crago said. "We have a larger pool of staff. When the census is up in one area, we can shift some people around. We do have some staff out due to COVID, but we have an amazing staff here who have stepped up to fill in until other workers get back."
Baumgardner pointed out OhioHealth is the largest employer in the region and that its associates live in the areas in which they work.
"Oftentimes, our associates are a reflection of the community. We are seeing more COVID-positive associates, primarily due to community exposure, as well as more associates on quarantine at all levels," Baumgardner said.
He said OhioHealth would not allow staffing to compromise patient care.
"Over the weekend, we accepted (patient) transfers based on staffing, not on bed capacity. Any diversions are on a case-by-case basis, and we strive to keep care local. Our emergency departments are open and busy," he said.
"In order to boost our labor resources, we are offering a pandemic pay increase in hours and bonus, redeploying nurses, hiring new associates, and accepting travelers for nursing and other clinical occupations.
"We are also working closely with our hospitalists to streamline the discharge process. We know COVID-19 has added a complexity at work and at home for our associates and providers, and we appreciate the hard work they are doing to care for the community," Baumgardner said.
Officials at both local caregivers both said behavior of local residents is essential to beating back the virus.
"Please consider alternative plans for holiday gatherings in order to avoid exposure," Baumgardner said.
"As you go about your day-to-day life, take precautions to reduce the spread of COVID-19, as well as flu, by wearing a mask over your nose and mouth, providing social distance (at least six feet) from others, thoroughly washing your hands and limiting gatherings," he said.