‘No ICU Beds to Be Found’

IU Health Methodist Hospital in downtown Indianapolis has been running over capacity for several days now, and that was after a tough week last week.

Timothy Ellender, MD, a critical care specialist at the hospital, tweeted on Tuesday, “It’s here. Hospitals are full. No ICU beds to be found. Holding in ER, PACU.”

In an interview Wednesday, Ellender told MedPage Today that patients “who need to go to the ICU have been stuck in the ER for 24 hours because there are no beds available. Post-operative patients are stuck in the PACU recovery area well over 24 hours because there are no beds available.”

Methodist has had to turn away patients from other IU Health facilities who needed the more complex care it could provide.

“They rely on us to offload complex patients, but we can’t take them anymore,” Ellender said. “That has already occurred.”

Like other Midwestern states, the outlook for Indiana and its capital city is growing more dire. State-wide, COVID-19 cases plateaued at the 700/day level in August. Then, at the beginning of October, the average bumped up to 1,000/day, which quickly became 2,000/day.

By early November, the state hit 4,000 cases/day, and topped 8,000 on Nov. 14. It has since settled back but only slightly.

“When we saw that boost, we knew we were in for a wild ride,” Ellender told MedPage Today.

On Wednesday, three hospital leaders joined Gov. Eric Holcomb (R) in a press briefing, urging people to wear masks and social distance to keep the virus from spreading. (Holcomb didn’t attend the briefing in person because he was under quarantine following a potential exposure, as members of his security detail had tested positive for coronavirus.)

The state health department reported a 60% increase in COVID-19 hospitalizations over the past 2 weeks, with a total of 3,040 COVID-19 patients hospitalized as of Tuesday — far more than was seen during a previous spring peak, according to Health Commissioner Kristina Box, MD.

“We are on an exponential growth curve right now and we do not expect it to turn around quickly,” Box said during the briefing. “In the next several weeks, we will continue to see cases climb, individuals hospitalized and, unfortunately, more deaths.”

Indiana has had a statewide mask mandate in place since July, but it doesn’t have much enforcement behind it, Ellender said. In the state’s larger cities, there’s more compliance, but in rural areas, there are “a lot of non-believers,” he said. “Even the city isn’t free of deniers. You can still go into a grocery store and find people without masks.”

The COVID-19 pandemic has now collided with a typical uptick in serious illness usually seen in the fall and winter months, particularly among the elderly, he said. Methodist Hospital can’t rely on St. Vincent’s or Eskenazi, the other nearby health systems downtown, because “they’ve been closed [for new admissions] on and off for the last 2 weeks. They come on and off diversion.”

While capacity varies from day to day, and all the hospitals aren’t full up every day, “we are just at the beginning of this, which is concerning,” he said. “We know the numbers are going to swell in the next 2 weeks.”

Methodist has already reduced elective procedures, while still trying to catch up on the more important ones that were postponed during the initial surge, and plans further reductions, Ellender said.

Two tents are set up in the hospital’s parking lot that can accommodate 20 patients each, but staffing will be an issue, Ellender said. Staffing troubles that were present before COVID-19 have only worsened, especially regarding nurses.

“Staffing is marginal at best when we’re in an easy period of the year,” he said. “It’s going to be much worse during this uptick.”

“The problem is that all of the U.S. is experiencing a surge simultaneously,” he noted. “In March, nurses signed up to go to New York. I don’t know if we’ll see that because everyone is drowning.”

Of its 34,000-member workforce, IU Health had 686 employees quarantined as of Wednesday, Chief Medical Officer Mark Luetkemeyer, MD, said during the press briefing. Ellender said healthcare workers there have stayed relatively healthy, as they’ve had sufficient personal protective equipment (PPE).

“If our colleagues do get [COVID],” he said, “it’s usually community-acquired. When we let our guard down, that’s when we fall victim to the virus.”