How are Vermont's hospitals faring? In 1st week of January, they're managing amid COVID surge, staff testing positive

Hospitals across the state are contending with severe staffing shortages amid higher-than-usual demand for services, from COVID patients and others.

Still, several hospital leaders say they’re not in crisis mode. Many medical centers continue to perform elective surgeries and more ICU beds are now available across the state than in recent months, according to a COVID modeling report released by the state this week.

The same cannot be said of many hospitals in New Hampshire and the North Country, where unvaccinated COVID patients are overwhelming hospitals, and preventing other patients from getting care.

In the first week of January, VPR spoke with representatives from three Vermont hospitals: Dr. Stephen Leffler, the chief operating officer at the University of Vermont Medical Center in Burlington, Meg Oakes, a nurse leader and senior director of quality and safety at Rutland Regional Medical Center, and Dr. Trey Dobson, the chief medical officer at Southwestern Vermont Medical Center in Bennington.

VPR spoke with hospital leaders separately and over the course of the week. Below is an edited version of those conversations.

VPR: How busy are your hospitals right now?

Dr. Trey Dobson (Southwestern Vermont Medical Center): Volume in both the inpatient (the emergency department) and outpatient setting (people going to doctors’ offices) continues to be high. And of course it's compounded by the fact that hospital systems are facing staffing shortages. That really does make a double whammy there — you get more volume and less staff to take care of those patients.

Meg Oakes (Rutland Regional Medical Center): We had a little lull last week, where we were just regular busy. Now we're back to — I don't feel like we're at a crisis or on the precipice of a crisis — but this is not business as usual.

Are you short staffed because people are out with COVID?

Dr. Stephen Leffler (UVM Medical Center): We have about 150 staff members who have tested positive for COVID. We have about 400 total staff who are in some kind of protocol to be sure they either don't have COVID or are safe to return to work (out of about 8,500 employees). Our employee health team is doing an unbelievable job. But it's very stressful for them right now. They're getting many, many, many calls, as you can imagine, every day.

Dobson: The good news is our staff are highly vaccinated and boosted and so most all of them are asymptomatic or have minor symptoms. But regardless, they have to be out for a certain amount of time.

Oakes: There are many variables at play here. The staffing is the most worrisome one. Because there comes a point, which we're not close to, where you can't run all your services if you don't have sufficient staff.

What are other challenges for health care workers?

Oakes: All the staff are weary of this. Weary from the worry that goes with it. We’re also bearing an emotional burden that’s associated with doing the work. And a physical burden. Because for [staff in] the emergency department (ED), where they’ve been in N95s for most of the last two years — they’re not comfortable. It’s hard to talk through them. And people’s faces — I've noticed when I see some people who are working a lot in the ED — they just have kind of a permanent mark from the N95.

How is the omicron variant playing out? 

Oakes: It seems, so far, like omicron is not causing an increase in hospitalizations proportional to the number of cases. And I'm certainly hoping that's true. Because if it does, then that's going to be a very different situation for us and for the rest of the hospitals in Vermont.

Leffler: The numbers of COVID in the hospital are as high as they've ever been, but less people are in the ICU. And we're watching that carefully. I don't think we can say for sure yet, because omicron is still relatively new in the U.S. and in Vermont, but the trend so far is, it seems people are a little less sick. They need to be in the hospital not quite as long. Meaning, we're turning over a lot of people. We’re sending home a bunch of COVID patients every day, they're just refilled with new people who’ve gotten sick with COVID.

Are you seeing any vaccinated, healthy people hospitalized with COVID?

Dobson: The majority of the patients that are hospitalized — greater than 75% — are unvaccinated. The patients that are placed in the ICU, typically 85% of them, are unvaccinated. Those that are vaccinated and boosted and get admitted to the hospital with COVID-19 typically have serious underlying medical conditions or are the elderly, because they are at risk despite vaccinations.

Leffler: The people that have been fully vaccinated, that unfortunately do need to be admitted — it’s typically for a very short time, it’s typically not in the ICU. They're typically in for one night and then go home. And unvaccinated people are typically here longer, they're sicker, they're more likely to be in the ICU, they're more likely to need more aggressive care.

Are you delaying elective surgeries? 

Dobson: They're still proceeding as planned. Every day we take a look at our in-patient census — primarily the ICU census, which is driven by COVID patients — and we determine whether any cases should be postponed a week or rescheduled. We've had to do that on a few occasions, and the patients understand completely. We schedule it for three days later or one week later, so that we can make sure we have the staff to take care of everyone.

Oakes: Thus far, we've been able to do the important elective surgeries that people have been waiting for, but that would have been canceled the way we were living in the first wave of COVID.

Leffler: We, unfortunately, do have some elective procedures that we are delaying right now. Working with the state, we added five extra ICU beds to be prepared for whatever came from COVID. That had an impact on the number of cases we could schedule in our operating rooms. We're also having some staffing challenges with people out with COVID. We're trying to make sure that the cases that really shouldn't be delayed aren't. We’re sorry for any impact that has on any of our patients.

Has the national blood shortage impacted the hospital?

Leffler: We are squeaking by right now, but it is concerning.

Dobson: It hasn't impacted us yet. It is on the verge. Certainly, for emergency situations, we need that O-negative or O-positive blood and that is in extreme short supply. So I would encourage people to give blood. I think the best approach would be to give blood and get boosted. Those are the two things we can all do to help in our current situation with our health care resources being finite and right at the limit.

I’ve heard reports of people coming to the emergency department looking for a COVID test who don’t need hospital-level care. Is that happening? Is it a problem?

Oakes: We do have that happening. And every one of those visits we do a medical screening exam, we talk with them to make sure that they're not ill. Because once a patient is here in the emergency department, there's a certain level of care we both want to, and are obligated to provide.

My ask would be for people who really just want to know if they have COVID, to please not come to the ED. I want anybody who thinks they're sick enough to be at the ED to come to the ED.

Looking at the rising case numbers, what are you thinking about for the weeks ahead?

Dobson: When you see the cases rise like this, it's very anxiety-provoking, especially to health care workers. I feel good that our high vaccination rate and our fairly high booster rate in the state is going to keep the need for hospitalizations down somewhat. But there will be an increase in hospitalizations. It would be foolish to ignore the increased number of cases — it's almost doubling every several days — and think that we won't have some effect on increased hospitalization. I do feel that really the next 30 days are the most tenuous in our region.

Anything else you want to add?

Dobson: I want to recognize how hard the nurses and doctors — clinical staff and non-clinical staff — who are working in our health system.

Leffler: I'm just so grateful for all the employees who work at the medical center, but actually, in all health care in the state of Vermont. It's so hard right now. And everyone's doing an unbelievably good job.

Lexi Krupp is a corps member for Report for America, a nonprofit national service program that places journalists in local newsrooms to report on under-covered issues and regions.

Have questions, comments or tips? Send us a message or get in touch with reporter Lexi Krupp @KruppLexi.