Officials at large West Michigan health systems say they are now treating as many COVID-19 patients as they did back in the spring when the pandemic hit hard, brought daily routines to a halt and hospitalizations were at their peak.
One hospital may soon delay elective procedures again, and hospitals may need to deploy emergency beds within weeks that state regulators approved in the spring, officials report.
After waning during the summer, the rate of new infections and COVID-19 cases have steadily grown through the fall.
While they report more preparedness compared to the spring, medical officers worry that if the present trajectory persists, the rising number of COVID-19 cases will stretch hospitals’ capacity.
“The second wave has clearly arrived. We just don’t know where we are on that second wave,” said Dr. Joshua Kooistra, Spectrum Health’s chief medical officer for West Michigan. “We don’t know if we’re near the peak or if we’re at the base. My fear is we’re at the base because we don’t see any sign really of things slowing down yet.”
Kooistra’s concerns are echoed by hospital officials in the region.
“We’re very much in a resurgence. This very much has become just as serious — if not more so — than it was in the spring,” said Dr. Matt Biersack, chief medical officer at Mercy Health Saint Mary’s in Grand Rapids.
“If we’re to keep people going to work, if we’re going to keep our kids going in school and keep our hospital systems functioning, then we really have to change our trajectory. We have to do all of those things we said were important all along,” Biersack said.
As COVID-19 cases rise at rates that are equal to or surpassing the spring, hospitals are in a far better position to respond, according to medical officers. That includes larger stockpiles of personal protection equipment and a far better understanding of how the coronavirus spreads, as well as how to isolate and treat people who contract COVID-19.
Testing capacity is also far greater today than in the spring, and improved clinical protocols for treating COVID-19 patients has led to lower mortality rates, Biersack said.
“We’re in a much, much better place, both as a hospital and health system and health care in general, than we were back in the spring,” he said. “We know a lot more about the virus than we ever did.”
A state database indicates most Michigan hospitals have more than 21 days of PPE on hand. Hospitals statewide as of late last week had 1,545 COVID-19 inpatients, 372 of whom were in intensive care units.
One day late last week, Saint Mary’s had 32 COVID-19 inpatients in Grand Rapids, just above its 31 per day average back in the spring, Biersack said.
The increasing number of cases comes after a week in September when Saint Mary’s had zero COVID-19 patients hospitalized, he said.
Spectrum Health’s COVID-19 inpatients as well now exceed a late May peak after growing since early October, Kooistra said.
As of Friday last week, Spectrum Health had 167 COVID-19 patients. Some of Spectrum’s hospitals now have double or triple the number COVID patients than in the spring, he said.
“We are going in the wrong direction,” said Kooistra, who cites public fatigue of the pandemic among a number of reasons for COVID-19’s resurgence.
“People are fatigued from masking, from social distancing, avoiding gathering in large groups, because we are a social society. We’re not used to having to do that,” he said. “People can tolerate doing that for a period of months, but I think the fatigue is just wearing on and causing those measures to break down.”
Citing the significantly increasing numbers of patients admitted with COVID-19, Spectrum Health last week revised visitor policies to “reduce the number of people in its Grand Rapids and regional hospitals and outpatient care sites.”
On top of the “pandemic fatigue” was the onset of cooler weather that keeps people indoors more and contributes to the transmission of the virus, said Dr. Ronald Grifka, chief medical officer at Metro Health-University of Michigan Health.
Metro Health’s COVID-19 cases started rising about three weeks ago after experiencing only single-digit cases for two months, Grifka said.
To stem the rising caseloads statewide, the Michigan Department of Health and Human Services this week extended emergency orders that reinstates restrictions on gathering sizes and requires bars and restaurants to collect contact information from customers to aid in contract tracing.
Plans for capacity
If COVID-19 cases continue to rise as they have the last few weeks, Spectrum Health could have capacity issues by mid-November, Kooistra said.
At Mercy Health Saint Mary’s, “We’re a few weeks out from really being strained as a hospital to keep up,” Biersack said.
“We need everybody to do their part to again flatten that curve and make sure that we have the capacity to treat patients who are ill and not strain our health systems,” he said.
Most hospitals across the region sought and quickly received emergency state approval in the spring to add temporary beds to handle a surge in COVID-19 patients. Altogether, hospitals in Grand Rapids, Muskegon, Holland, Kalamazoo, Battle Creek, St. Joseph and Lansing secured state approval to add more than 1,500 emergency beds, if needed.
Mercy Health, for instance, could add 200 beds in Grand Rapids and 723 if Muskegon under the emergency approvals.
“Within three to four weeks, if we continue this trajectory, we will have to really think creatively about our surge plan and execute on some of the emergency licensed beds that we applied for back in the spring,” Biersack said.
The 210-bed Metro Health Hospital in Wyoming had 31 COVID-19 inpatients as of Friday afternoon, more than triple the peak average back in the spring. The hospital has been operating at more than 90 percent capacity, Grifka said.
In addition to rising COVID-19 cases, Metro Health has to cope with staff getting sick, as well as a seasonal rise in viral illness that comes with cooler weather, he said. Metro Health administrators are now considering whether to delay elective surgical procedures, Grifka said.
“We’re getting stretched a little,” he said. “We may have to slow down.”
Michigan hospitals back in the spring were required under state executive order to postpone elective surgeries for several weeks to keep capacity available for COVID-19 patients and limit the spread of the virus, and “we thought we had passed that point in the illness, and now we’re re-engaging it again,” Grifka said.
His advice for people is to “be smart, wear your masks, don’t congregate in big groups, social distance and to be very careful.”
“We’re in a very tenuous state here,” Grifka said. “We didn’t get there before (in West Michigan), but we’re definitely there now and we need their help to help take care of them and keep our staff safe so that they can take care of them.”