Georgia’s health care system on the brink

Nursing professor Pattie Troyan gets a Moderna COVID-19 vaccine from RN Elham Roshanravan at the DeKalb COVID-19 drive through testing site at BrandsMart USA on Thursday in Doraville. DeKalb was forced to suspend testing at its county-run locations in order to devote its staff to vaccinating health care workers. (Curtis Compton / Curtis.Compton@ajc.com)
Nursing professor Pattie Troyan gets a Moderna COVID-19 vaccine from RN Elham Roshanravan at the DeKalb COVID-19 drive through testing site at BrandsMart USA on Thursday in Doraville. DeKalb was forced to suspend testing at its county-run locations in order to devote its staff to vaccinating health care workers. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

While hospitals overflow with COVID patients, vaccinations lag and testing slows

Health officials saw the surge coming and sounded alarms, but the holiday get-togethers went on. Now, the scenes officials have dreaded the most since the start of the pandemic are playing out all over Georgia.

Hospitals overflow with COVID-19 patients. Some nursing homes are erupting with new cases.

Vaccinations are behind, and, for lack of staff, some health districts are limiting COVID testing to get the shots to health care workers and the elderly.

Meanwhile, with deaths mounting, the Fulton County Medical Examiner’s office has deployed a refrigerated morgue truck to store bodies. A second truck is ready to go.

ExploreGeorgia EMS crews near 'breaking point'

“It’s hard to know where we’re headed because we’re in uncharted territory,” said Dr. Carlos del Rio, executive associate dean for Emory School of Medicine and a professor of global health and epidemiology at the Rollins School of Public Health.

If infections don’t slow, del Rio said, regions of Georgia could become like Los Angeles, where EMTs have been directed to give up on some patients if they can’t be resuscitated by CPR in the field. Those lucky enough to make it into hospitals will be cared for by overextended staff, some of whom may not be properly trained to work in intensive care units, del Rio warned.

“We’ve never been this bad in the pandemic so far,” he said. “A third of hospital beds right now across the state, on average, are occupied by Covid patients, and the numbers will continue to go up.”

Dr. Carlos del Rio said Georgia is in uncharted territory with the pandemic. (Bob Andres / robert.andres@ajc.com)
Dr. Carlos del Rio said Georgia is in uncharted territory with the pandemic. (Bob Andres / robert.andres@ajc.com)

Credit: Bob Andres

Credit: Bob Andres

Warnings ignored

All of this, every single bit of it, was predicted.

In October, the White House Coronavirus Task Force urged Georgia to step up efforts to slow the spread, emphasizing mask wearing and social distancing and avoiding gatherings.

“This is the moment to dramatically increase mitigation,” the task force warned again four days before Thanksgiving.

But Gov. Brian Kemp instituted no new restrictions.

ExploreComplete coverage of COVID-19 in Georgia

“Our citizens are the ones that solved the problem after July Fourth,” Kemp said at a press conference before Thanksgiving. “People did what we asked them to do. … If we do that, we’re going to get on the back side of this.”

But Georgians didn’t.

Just how bad are things now?

The rolling average of confirmed and suspected cases now is about double what it was in early December. On Friday, the Georgia Department of Public Health set a new record with 13,296 net new confirmed and suspected COVID-19 cases. The state also reported 80 net new confirmed deaths and another four deemed “probable.”

“We’ve never been this bad in the pandemic so far. A third of hospital beds right now across the state, on average, are occupied by Covid patients, and the numbers will continue to go up.”

- Dr. Carlos del Rio, executive associate dean for Emory School of Medicine

The number of people currently hospitalized with COVID-19 is 70% higher than Georgia’s worst day in the summer surge. That left Georgia in the week ending Jan. 1 with a rate of new hospital admissions worse than 45 other states’ — even worse than California’s, according to the latest task force report.

As of Thursday afternoon, no ICU beds were available in two of the state’s 14 hospital regions: Athens and Augusta. In nine other regions, 10 or fewer ICU beds were open.

At long-term care facilities last month, more than 3,600 residents and 2,400 workers tested positive statewide, both historic highs for Georgia.

ExploreHow hospitals are dealing with the coronavirus pandemic

Another alarming count: Georgia’s long-term care facilities reported in December that 350 residents died from COVID-19 —the most since August. In a recent two-week period, an average of 15 long-term care residents a day have died of the infection.

The rapid spread of the virus is a harrowing portrait of a national failure under the Trump administration to contain the pandemic. Georgia officials also ignored repeated warnings from public health experts inside and outside government to take dramatic steps to mitigate spread.

To make matters worse, on Tuesday, the state announced the first confirmed case of the U.K. strain of the coronavirus, believed to be far more contagious than the strain that has stricken more than 22 million Americans.

Though the variant is not believed to be more lethal or cause more severe illness once a person is infected, it spread so rapidly in England that hospitals are overrun, prompting a third national lockdown.

At a press conference Friday, Kemp again defended Georgia’s response and said that some states with tougher restrictions and lockdowns also have health systems that are overflowing.

ExploreGeorgia grapples with growing frustration over slow COVID-19 vaccination program

‘Previously unimaginable’

In ordinary times, the cardiac intensive care unit at Piedmont Atlanta Hospital dealt with a patient death about once a week, sometimes less, a registered nurse there told the AJC.

For the past six months, death is a daily occurrence.

“One day we lost a husband and a wife,” said the nurse, who asked that her name not be used for fear of disciplinary action. “We actually put their hospital beds in the same room, so that they could pass together. I don’t believe they were aware, for most of the time.”

Other nurses say they are struggling with fatigue and morale. Sometimes patients and family members take out their fears and frustrations by verbally abusing hospital staff.

Two marked trailers sit parked outside the Fulton County Medical Examiner's Office. With COVID-related deaths mounting, the office has deployed a refrigerated morgue truck to store bodies, with a second truck ready to go. (John Spink / John.Spink@ajc.com)
Two marked trailers sit parked outside the Fulton County Medical Examiner's Office. With COVID-related deaths mounting, the office has deployed a refrigerated morgue truck to store bodies, with a second truck ready to go. (John Spink / John.Spink@ajc.com)

Credit: JOHN SPINK / AJC

Credit: JOHN SPINK / AJC

Meanwhile, with some nurses out sick with the virus, and others who have left for better-paying travel nurse jobs, there’s the constant fear of not being able to provide all the care patients need. “When a code is called,” the nurse said, “there may not be anybody to respond to it.”

In a written statement, a Piedmont spokesman said the staff is “stretched and tested in previously unimaginable ways” but is “committed and resilient.”

Every hospital interviewed by the AJC had emergency room patients who needed admission waiting on gurneys and recliners in hallways and waiting rooms.

“We, like I’m afraid everybody in the city, are just struggling right now with capacity,” said Grady Healthcare Chief Medical Officer Dr. Robert Jansen. “With this recent incredible increase in the number of COVID-19 patients, it is stretching all of us to our very limits.”

Unlike the pandemic’s first shockwave, said Dr. James Black, an emergency room physician at Phoebe Putney Health System, there is little slack anywhere in the system now. “When the entire health care system needs the same resource all at the same time, that makes it difficult to meet the needs of the public.”

Doctors say field hospitals, such as the one that re-opened at Georgia World Congress Center, are probably helpful. On Thursday, the facility had 24 patients from across the state, and by Saturday hoped to have enough workers in place about 190 people including doctors, nurses, technicians and administrative personnel — to operate five dozen beds.

The ambulance bay at Grady EMS was full Friday morning. Concerns from a surge of COVID-19 cases has health officials alarmed. (John Spink / John.Spink@ajc.com)
The ambulance bay at Grady EMS was full Friday morning. Concerns from a surge of COVID-19 cases has health officials alarmed. (John Spink / John.Spink@ajc.com)

Credit: JOHN SPINK / AJC

Credit: JOHN SPINK / AJC

But that won’t solve all the hospitals’ problems because the field facilities can’t take critical patients or specialized cases, doctors say.

The surging cases are also a constant fear in nursing homes and assisted living facilities. Since the pandemic’s onset, their residents have been pummeled. More than 3,300 have died of COVID-19, about a third of the state’s confirmed deaths.

But as bad as the situation has been so far, it worsened after Thanksgiving, said Tony Marshall, president and CEO of the Georgia Health Care Association, which represents nursing homes and assisted living centers.

ExploreFrom December: Deluged hospitals warn of rationing care

Woodstock Nursing and Rehab Center avoided any major outbreaks until December, when 100 residents tested positive, according to its reports to the Georgia Department of Community Health. The home reported three COVID-19 deaths as of Wednesday.

A nursing home in Dalton, Wood Dale Health and Rehabilitation, also had no outbreaks until last month, when it reported 65 new COVID-19 cases and 13 deaths.

Neil Pruitt Jr., the chairman and CEO of PruittHealth, one of Georgia’s largest nursing home providers, monitors the COVID-19 data every day for his multi-state operation. His charts reveal spikes for both residents and staff, mimicking the uptick in cases in the nearby communities.

“I’m extremely concerned about where we are,” Pruitt said.

The first doses of the authorized vaccines were designated for health care workers and residents and staff of long-term care facilities. Captain David Weems (right), at Chattahoochee Hills Fire & Rescue, receives a Pfizer-BioNtech COVID-19 vaccine from Rebekah Revels, deputy chief nurse at the Georgia Department of Public Health, at Wolf Creek Amphitheater in late December. (Hyosub Shin / Hyosub.Shin@ajc.com)
The first doses of the authorized vaccines were designated for health care workers and residents and staff of long-term care facilities. Captain David Weems (right), at Chattahoochee Hills Fire & Rescue, receives a Pfizer-BioNtech COVID-19 vaccine from Rebekah Revels, deputy chief nurse at the Georgia Department of Public Health, at Wolf Creek Amphitheater in late December. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

Sluggish rollout

All this makes getting vaccines into arms a critical priority. But the rollout has been sluggish, with the state nowhere near completing vaccination of all of its willing nursing home residents, workers and front-line healthcare workers — those who are supposed to be in the very first wave.

Still, the governor earlier this month decided to expand the state’s already stretched vaccination efforts to the state’s 1.5 million people aged 65 and older — if doses are available.

In Fulton County, the announcement forced a scramble. Health officials didn’t get word until a couple of hours before Kemp’s announcement and soon were deluged with requests for vaccinations they can’t fulfill.

“We’re overloaded. I’m not going to sugarcoat that,” said Lynn Paxton, Fulton County’s district health director.

Stretched thin on staff, Fulton workers have shifted from doing coronavirus tests to vaccinating, giving over some of its testing sites to a nonprofit testing group.

Fulton isn’t alone in shifting resources.

Dr. Maria Wynens gets a Moderna COVID-19 vaccine on Thursday at the DeKalb COVID-19 drive through testing site at BrandsMart USA in Doraville. DeKalb was forced to suspend testing at its county-run locations in order to devote its staff to vaccinating health care workers. (Curtis Compton / Curtis.Compton@ajc.com)
Dr. Maria Wynens gets a Moderna COVID-19 vaccine on Thursday at the DeKalb COVID-19 drive through testing site at BrandsMart USA in Doraville. DeKalb was forced to suspend testing at its county-run locations in order to devote its staff to vaccinating health care workers. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

DeKalb County was forced to suspend county testing for most of this past week and leave that effort to other facilities, in order to devote its staff to vaccinating health care workers.

“I absolutely made that decision,” said Dr. S. Elizabeth Ford, DeKalb’s district health director. “Getting vaccine into our health care workers is critical so they can assist us in vaccinating the rest of the population.”

She added, “We are already completely overwhelmed.”

In Cobb County, where beginning Tuesday vaccine will be available by appointment to the expanded group, the Jim R. Miller Park will be the full-time vaccination site. It had been a full-time testing site. The health department will continue to offer testing at satellite locations throughout Cobb and Douglas counties.

To offer vaccines, the North Georgia Health District 1-2 said starting Monday it will reduce testing to one hour a day in Fannin, Gilmer, Murray and Pickens counties, which rank among the hardest hit by new COVID-19 cases in Georgia.

In Cherokee and Whitfield counties, testing will be limited to three hours per day on weekdays, the district office said.

It’s a devil’s bargain, experts say. The White House task force says vaccinations must ramp up, but so must testing to detect cases, especially in younger people who might not have symptoms but spread the infection. Insufficient testing blinds public health authorities to the scope of outbreaks, and the inability to isolate cases exacerbates spread.

“The idea that local public health agencies would be able to shift resources from testing and controlling the pandemic in communities to vaccinations is a failed strategy from the start,” said Dr. Harry J. Heiman, a clinical associate professor at the Georgia State University School of Public Health.

At a press conference on Friday, Kemp said his administration is working to post information on the DPH website to help eligible people find locations to book appointments to get the vaccine. The system would help those eligible in the initial phase of the vaccination to get scheduled for shots as doses become available. Kemp said the state hopes to ramp up to about 80,000 doses administered per week.

Meanwhile, at some hospitals and long-term care facilities, many are refusing vaccination.

North Georgia’s Union General Hospital System, which operates hospitals in Union and Townes counties, received about 800 doses of the Moderna vaccine but as of last week had administered only about 600 shots to its 1,400 employees, according to CEO Kevin Bierschenk.

“I’m really trying to push it, but we’re only seeing about 30 to 40 percent of people wanting to take it,” he said. “It’s like the rest of the state. Everybody’s got that scare factor. But we’re giving it to everybody who wants it.”

At PruittHealth nursing homes, the majority of front-line workers are turning down the shots, according to data that PruittHealth posts on its website.

“That is unacceptable,” Neil Pruitt said. “We won’t defeat the pandemic with those numbers.”

Workers’ social media feeds are filled with misinformation about the vaccines, he said. Plus, they’re concerned about the process that approved the shots and placed them first in line to get them. He is pushing out an education campaign and offering incentives to get more vaccinated.

“If not, we’re going to be dealing with Covid for years,” Pruitt said.

Georgia still has time to avoid the worst-case scenario, said Georgia Public Health Commissioner Dr. Kathleen Toomey.

But in the end, she said, it’s up to Georgians to keep the system from collapsing.

“It’s going to require everyone’s commitment to wear a mask and social distance, even as we are running out of bed space,” she said. “Let’s stop the spread of the virus so we don’t need hospital beds.”

AJC Staff Writer Ben Brasch contributed to this article.

THE CHALLENGES AND OPPORTUNITIES

As Georgia enters perhaps its worst phase yet of the pandemic, Public Health Commissioner Dr. Kathleen Toomey identified both challenges and opportunities:

Opportunity: Monoclonal antibodies are becoming more widely available in Georgia, Toomey said. These laboratory-made proteins that mimic the immune system’s ability to fight off COVID-19 can be given in an outpatient setting. This should help reduce stress on hospitals, she said.

Challenge: Toomey said the biggest surprise in the vaccine distribution is a well-documented hesitation among health care workers, especially those in rural areas, to get vaccinated.

Opportunity: Many older Georgians are often urgently seeking the opportunity to get vaccinated. Toomey said that may be because they remember the rollout of the polio vaccine when they were children. She said she herself and others her age lived through the experience where a vaccine halted a terrible health threat. “We don’t even think about polio anymore,” she said.

Challenge: Toomey said the COVID-19 vaccines are more complicated to handle and administer than other vaccines, which makes it difficult to vaccinate lots of people quickly. She said the supply is also not coming in as quickly as people would like. The state is also having trouble tracking how many vaccines have been given, because those giving the shots aren’t quickly recording them in a state database.

Opportunity: In spite of the challenges, Toomey said the vaccine does offer a light at the end of a long tunnel. She said public health officials are “very excited” about the availability of the vaccines and that they are working hard to make them available to everyone willing to take it.

Challenge: Georgia continues to struggle to get its citizens to wear masks, practice social distancing and isolate if they are exposed or test positive. Some still don’t believe the virus is real or actually deadly, Toomey said. “In 2021, I still have people tell me that these numbers are made up or artificially inflated,” she said. “I just say I wish that were the case.”

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