Weekly Covid Roundup: Nursing shortage causing strain as cases continue to drop
Number of new cases fell 42 percent from a week ago
Daily Covid-19 case numbers and hospitalizations for New Hampshire continued their rapid decline last week and have now fallen far below the peak of the first wave in December 2020.
According to data from the state’s official Covid response dashboard, New Hampshire averaged 242 new cases per day for the week ending Tuesday, down 44 percent from a week earlier. The seven-day average for the share of antigen and PCR tests coming back positive was 7.6 percent, down from 12.8 two weeks ago. According to NH Hospital Association data, as of Wednesday a total of 211 people were hospitalized with Covid, including 95 with active infections and 116 who are Covid-recovering, which means that they are no longer infectious but still need inpatient care for Covid-related illness. The number of total hospitalizations is down from 327 two weeks ago.
The rapid drop in cases and hospitalizations has brought some relief to hospitals, but health care workers emphasize that the built-up strain on the system will dissipate more slowly.
“We continue to see very sick patients in the hospital, some with an incidental finding of Covid-19,” said Dr. Jose Mercado, Dartmouth-Hitchcock Medical Center’s Covid Response Leader, in an email to the Collaborative. “This leads to higher than normal volume of patients in the hospital who require more resources for their care.”
Martha Wassell, director of infection prevention at Dover’s Wentworth-Douglass Hospital, says that her team feels the strain on their resources in two specific ways.
“The first is the number of patients in the Emergency Department who are seeking care for their mental health,” Wassell said in an email to the Collaborative. “While not a new problem, it seems to have been exacerbated by challenges directly or indirectly related to Covid-19.”
“The second challenge that creates stress across the organization is the recovery from staffing challenges. Across the country, many healthcare workers have recently left the profession, burnt out from work stressors and discouraged by the mis- and dis-information spread by anti-vaccination groups. These healthcare workers left a void at the bedside, and also took with them a great amount of institutional knowledge.”
Nursing team leaders across the state emphasized the impact of these vacancies in emailed comments to the Collaborative.
“This has been an absolutely shocking time in health care, and one that has continued since the start of this pandemic in early 2020,” said Martha Leighton, chief nursing officer at Manchester’s Elliot Hospital. “Burnout, combined with an increase in high-demand care due to the latest surge of Covid created a perfect storm of stress for our staff.”
Jennifer Torosian, associate chief nursing officer at Manchester’s Catholic Medical Center, echoed these concerns.
“Staffing was a significant challenge before the pandemic,” she said, “but it’s much worse now. Our nursing vacancy rate is hovering around 20 percent. That’s nearly doubled from two years ago.”
Dartmouth-Hitchcock is experiencing similar issues, but to a lesser degree, says Michelle Buck, the hospital’s vice president of inpatient nursing.
“Our turnover has increased approximately 6 percent since the beginning of the pandemic,” Buck said, but she emphasized that they were planning to refill those positions with permanent staff.
For some hospitals, however, refilling those roles has been difficult so far.
“We are actively recruiting and using a long list of tactics to attract candidates,” said CMC’s Torosian, “but the number of applicants still isn’t matching the number of openings. It’s highly competitive right now and we’re finding a large number of nurses are attracted to travel jobs and per diem positions — not full-time, traditional positions.”
This kind of challenge has encouraged Wentworth-Douglass to consider the use of more flexible schedules, said Sheila Woolley, the hospital’s chief nursing officer.
“We know that we have to make innovative changes to meet the needs of bedside nurses, and as a team we are working on strategies to achieve this. We are looking at innovative scheduling practices, such as weekends only, mom’s/dad’s hours, etc. We’ve surveyed our staff to ask them for ideas and we have a group that is working on implementing those now.”
The good news is that the burden on hospitals has continued to decline overall.
The statewide per capita case count is down by 42 percent over the last two weeks and now sits at 44 per 100,000, according to an analysis of CDC data by the New York Times. The states with the highest numbers are Maine and Idaho at 80 and 81, respectively.
If case numbers were to increase again, hospitals may lack staff but now they likely do have enough available equipment to deal with a surge. According to data from the NH Hospital Association that was updated on Wednesday, there are 30 staffed adult ICU beds available in the state, up from 26 two weeks ago, out of a statewide total of 220. Ventilators remain plentiful, as they have been for most of the last few months.
Unvaccinated patients made up 33.7 percent of all hospitalizations for active Covid infections, according to NHHA data as of Wednesday, while patients with some level of vaccination made up a significantly larger share, at 51.6 percent. Within this group, patients with their vaccinations fully up to date comprised 28.4 percent of the total. (Vaccination status was unknown for 14.7 percent.)
In the NHHA data, “fully up to date” means that patients have received their primary series vaccines and any boosters as recommended by the CDC.
The large share of vaccinated patients who have been infected with omicron echoes the latest CDC analysis of vaccines’ effectiveness against the variant. That analysis concluded that breakthrough infections in people who are vaccinated are likely to occur, even though people who are up to date with their Covid-19 vaccines and get Covid-19 are less likely to develop serious illness than infected patients who are unvaccinated.
It remains difficult, however, to know exactly how many of the state’s confirmed Covid patients have severe illness. This is because data reported to the Hospital Association does not distinguish between patients who arrived at the hospital because of severe Covid symptoms and patients who arrived without severe Covid symptoms, but tested positive during routine screening.
Regardless, the statewide numbers for Covid-related deaths continued to drop last week. An average of 2.6 Granite Staters were dying from Covid each day as of Sunday, according to the latest data on the state’s Covid dashboard. This number is down significantly from 11.6 at the end of December 2021.
As of Wednesday, there were 1,598 active Covid cases diagnosed in New Hampshire, down from 5,818 two weeks ago. There have been 295,701 confirmed cases and 2,368 Covid-related deaths in the state since the pandemic began.
Vaccinations and tests
Data from the NH Department of Health and Human Services and the federal Centers for Disease Control and Prevention still do not agree on how many Granite Staters have been vaccinated, but both sources show that the total share of the population that is fully vaccinated has continued to slowly increase in recent weeks.
DHHS data on the state’s Covid dashboard shows that 56.8 percent of Granite Staters are fully vaccinated this week, as compared to 55.5 percent in mid-December. Data from the CDC shows a similar trend, increasing slightly from 66 to 70 percent during the same period. After an initial surge in vaccinations, the share of the population that is fully vaccinated has increased slowly since last July. The share of Granite Staters who have received their first dose of any vaccine has hovered at 95 percent since late December, according to CDC data. The gap between DHHS and CDC data in terms of the total number of shots administered is now roughly 832,000 doses.
According to the CDC, “fully vaccinated” means someone has received two doses of a two-dose vaccine or one dose of a single-dose vaccine, while “up to date” means they have also received a booster or additional dose.
The share of Granite Staters who are now up to date is 21 percent, according to the latest CDC data.
The CDC continues to recommend that anyone over 5 years old get vaccinated. For adults, they recommend getting one of the mRNA vaccines (Pfizer and Moderna), rather than Johnson & Johnson, but the CDC emphasizes that any vaccine is better than being unvaccinated. For children between the ages of 5 and 17, the CDC recommends getting the Pfizer-BioNTech pediatric vaccine.
Everyone who is eligible should get a booster shot, the CDC says. According to their latest guidance, the amount of time you should wait after finishing your primary series varies by vaccine. For Moderna and Pfizer-BioNTech, the wait is five months, while the wait for Johnson & Johnson vaccines is shorter, at two months.
People can register for a vaccine or for a booster by visiting vaccines.nh.govor calling 211.
This article is being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.