Hospitals in low-vaccination states struggle as COVID-19 surges

Low vaccination rates in nearly half of the country are driving a spike in COVID-19 cases that has put the U.S. on the verge of another possible wide scale surge, healthcare providers warn.

More than two dozen states have experienced increases in COVID-19 cases over the past seven days, according to data from Johns Hopkins University School of Medicine’s Coronavirus Tracking Center.

States with the highest seven-day average increases in cases also have some of the country’s lowest vaccination rates. In Missouri, the rate of new cases over the past week was 127 for every 100,000 residents, only 46% of the state’s population have received at least one dose of COVID-19 vaccine and just 40% have been fully vaccinated, according to the Centers for Disease Control and Prevention (CDC). In the U.S. overall, new cases were 31 per 100,000, 56% of people have gotten at least one shot and 48% are fully vaccinated, CDC data show.

A closer look shows many areas within Missouri where the vaccination rate falls well below the already low statewide average. In multiple counties in the southwestern part of the state, less than 30% of the population has received at least one dose.

In southwestern Greene County, the sudden spike in cases has led to an influx of hospitalized patients. The number of COVID-19 related inpatients jumped from 76 on June 8 to 192 by July 8, according to data from the Springfield-Greene County Health Department. The number of patients in critical care more than tripled over that same period, climbing from 20 to 70.

CoxHealth is one of the health systems at the forefront. The chain, which serves patients in southwestern Missouri and northwestern Arkansas, has gone from having approximately 20 patients a day hospitalized for COVID-19 related illnesses in May to more than 100 by July, said Amanda Hedgpeth, vice president of hospital services for CoxHealth and assistant incident commander for the Springfield-based system’s COVID-19 response.

CoxHealth has continued to conduct weekly meetings of its incident command team since the beginning of the pandemic even during periods when cases were decreasing, Hedgpeth said. The health system took steps during the early months of the pandemic, such as building additional space for inpatients and making aggressive efforts to procure ample supplies of personal protective equipment, that will help it handle rising cases now, she said.

Staffing is a major concern, however. When CoxHealth hit its peak for COVID-19 patients this year back in January, the health system had 280 contract nurses and respiratory therapists to work alongside its existing workers. But many of those traveling healthcare professionals left after their contracts ended in May and June, Hedgpeth said. The suddenness of the current spike in cases has made recruiting more difficult, prompting CoxHealth CEO Steve Edwards to make a “call to action” on Twitter July 6 for nurses and respiratory therapists to join the team.

“Springfield, MO is struggling with surging Covid volumes,” Edwards tweeted. “Cox has plenty of ventilators, PPE, but our heroic RT staff need re-enforcements.”

Since Edwards’ tweet, more than 60 nurses and respiratory therapists called to offer help, Hedgpeth said. “This just continues to show why people get into healthcare,” she said. “When you have somebody put something like that out,the call to action is there and their hearts are in it.”

Maintaining sufficient staffing levels has also been a major concern at Missouri-based Mercy health system, where the recent rise in COVID-19 cases have led to calls for more healthcare professionals at its two hardest-hit hospitals in Springfield and Joplin.

Being a large system has helped Mercy redistribute supplies and personnel to help where there is the greatest need, said spokesperson Nancy Corbett. The health system has 25 hospitals across four states. But three of the states Mercy serves—Arkansas, Missouri and Oklahoma—are experiencing some of the highest increases in COVID-19 cases in the country.

Mercy fears that, as the Delta variant spreads to other states, the health system will lose that ability to reallocate resources, Corbett said. “Our hospitals across multiple states will be inundated with patients and we’ll face possible supply issues and co-worker fatigue,” she said.

Last week, Mercy notified workers that they must all be vaccinated by Sept. 30, in hopes that an immunized workforce will mean fewer staff members losing time to illness. A growing number of hospitals are implementing COVID-19 mandates for employees.

“As healthcare leaders in our communities, it is important we set the standard to prevent the spread of COVID-19,” Dr. William Sistrunk, infectious disease specialist at Mercy, said in a news release. “Vaccination is our best defense against the virus and already has provided many of our co-workers with the protection they need to care for our patients.”

Two INTEGRIS Health hospitals in northeastern Oklahoma also are seeing a significant increase in COVID-19 patients in recent weeks, said Kerri Bayer, the health system’s chief nursing executive. Both facilities are small and tend to transfer patients to larger hospitals, but the sudden influx of patients is making the other facilities too busy to take on INTEGRIS patients, she said.

“Everyone’s exhausted coming off of the pandemic,” Bayer said. “It’s like we never got a break.”

The health system’s other hospitals are providing clinical resources like supplies and expertise to the harder-hit hospitals, Bayer said.Those sites have slowly begun to be able to transfer patients to larger facilities, she said.

Healthcare providers have had more than a year of experience caring for COVID-19 patients. But the nature of the current surge is different: The vast majority of new cases are among those who have contracted the Delta variant. First identified in India late last year, the Delta variant has become the country’s predominant strain, now making up more than half of all COVID-19 diagnoses. Research indicates that the Delta variant is twice as contagious as the original version of the virus.

The spread of the Delta variant coupled with low vaccination rates in certain communities has led to younger, sicker patients being hospitalized for COVID-19—and they’re spending more time in the hospital than vaccinated patients who contract the virus, Corbett said. “Nearly all of them are unvaccinated. No one who is fully vaccinated has needed ventilator support,” she said.

Yet even among those patients who have gotten very sick, many still doubt their illness is COVID-19 related, Corbett said. Such attitudes highlight the challenges providers face in persuading those who have yet to get vaccinated to get the shot.

Hedgpeth hoped the recent increase in COVID-19 cases will serve as a warning for other parts of the country where vaccinations rates are low to redouble their efforts before they suffer a similar rise in cases.

“We hope that other areas of not only our state but also our country don’t go through the same spike we are, but it does give us concern for areas that have vaccination rates similar to what we do that they may see that same spike in cases that we’re currently seeing,” Hedgpeth said.


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