Dartmouth-Hitchcock, slammed with COVID cases, reshuffles to plan for surge

  • NH DHHS graphic NH DHHS

Valley News Staff Writer
Published: 12/9/2021 6:35:40 AM
Modified: 12/9/2021 6:35:13 AM

LEBANON — Dartmouth-Hitchcock Health officials pleaded on Wednesday with the roughly 35% of Granite Staters who remain unvaccinated against COVID-19 to get the shots now, as the current surge strains the health system.

“Too many people are still refusing to get the vaccine,” D-HH CEO Joanne Conroy said during a news conference held virtually where she also expressed concern about misinformation being spread about the vaccine. “That needs to stop today.”

New Hampshire has the highest per-capita rate of new COVID-19 cases in the country. Hospitalizations are higher than they’ve ever been during the pandemic. In addition, New Hampshire has the lowest vaccination rate of any New England state, D-HH officials said.

There were 74 patients hospitalized with COVID-19 across the D-HH system on Wednesday, including 35 at Dartmouth-Hitchcock Medical Center in Lebanon, said Susan Reeves, executive vice president of DHMC. Statewide there were 462 people hospitalized with COVID-19, according to the New Hampshire Department of Health and Human Services.

By the end of the month, D-H’s modeling predicts that the system will reach 100 patients, with at least 70 at DHMC alone, said Cassidy Smith, a D-H spokeswoman.

Due to the surge, which comes amid a workforce shortage, many Twin State hospitals have postponed surgeries and are having to send some patients far out of state to receive necessary care.

Conroy, who also urged mask wearing, hand washing and social distancing, said that those remaining unvaccinated are more vulnerable to serious illness due to COVID-19 and are taking hospital beds that could otherwise be used for patients experiencing other illnesses such as heart attacks or strokes.

She noted that 140 people died of COVID-19-related illness in New Hampshire last month.

“It may only get worse over the next group of holidays,” she said.

On Wednesday, Dr. Benjamin Chan, New Hampshire’s state epidemiologist, announced 11 new COVID-related deaths, for a total of 40 in the past week and an average of six deaths a day.

It “continues to be our strong recommendation (that) everyone 5 and older get vaccinated,” he said during a state news conference with Republican Gov. Chris Sununu.

On top of the increase in new COVID-19 cases, DHMC now also has some patients who are no longer considered COVID-19-positive, but who are still sick enough to remain hospitalized, said Dr. Edward Merrens, D-HH’s chief clinical officer. He also noted that 20% of COVID-19 patients in the hospital are younger than 40 and those who remain unvaccinated are 14 times more likely to die of the disease.

The health system has halted elective procedures, such as hip replacements, for the most part. Such are “situations that need to be done (but) can be put off sometimes for weeks while we manage a crisis,” Merrens said.

The bulk of those who are hospitalized with COVID-19 have not been vaccinated, although D-H is seeing some breakthrough infections, said Dr. Michael Calderwood, DHMC’s chief quality officer. Since Dec. 1, 72% of admitted patients with COVID-19 are unvaccinated, 86% of those in intensive care, he said.

In light of the ongoing surge, DHMC, which has 396 licensed beds, was preparing to further limit visitors and is now requiring people entering the hospital to put on a new surgical mask. Cloth masks are no longer allowed, Reeves said.

The health system also has canceled all indoor D-H-sponsored celebrations this month, including on-site potlucks and luncheons, as well as events that were to take place off-campus, Audra Burns, a D-H spokeswoman, said in an email.

“We believe that canceling these gatherings will help keep our patients and staff safe and will reduce the risk of COVID-19 transmission within our communities,” she said.

D-H also is encouraging other people to limit large gatherings amid the latest surge and to wear masks when they do gather, she said.

Chan said it’s been a long two years and he understands that people may need to gather together this holiday season, but he encouraged them to do so while taking precautions, including vaccination, limiting the size of gatherings, and testing following travel or a known exposure to the virus.

Meanwhile, DHMC is about halfway through a seven-part surge plan, Conroy said.

Reeves said DHMC officials currently are looking for more space within the facility to expand for critical and emergency care. On the extreme end of the surge plans, the Lebanon-based medical center would expand into an auditorium space, but that’s not in the immediate future, she said. For now, the “No. 1 priority” is expanding critical care space, she said.

DHMC is the state’s sole academic medical center and Level I adult and pediatric trauma center. As such in normal times, DHMC takes many of the region’s sickest patients. But of late, staff at smaller hospitals in both Vermont and New Hampshire have had trouble finding intensive care beds for patients in need of that level of care.

Other officials in the D-HH system also stressed the urgency. Tom Manion, CEO of the 25-bed New London Hospital, said that recently an ambulance had to take a patient from New London to Providence, R.I., for necessary care. While the number of COVID-19 patients is surging, others who may have delayed care earlier in the pandemic are also coming to the hospital, he said. At the same time, hospitals are short-staffed.

The “staffing shortages that we’re facing right now in all departments (are) severe,” Manion said. “(It) makes the burden even heavier for the staff that we do have.”

Hanover resident Dr. Alison Kapadia, an emergency medicine doctor who is a member of the leadership team at Cheshire Medical Center in Keene, N.H., said in a phone interview that during one shift last weekend she had a patient on life support in the emergency department for 30 hours. After hospital officials called 25 other hospitals, the patient was eventually transferred to one in Connecticut, she said.

Kapadia said there are three harms of boarding a patient in the emergency department for more than four hours: The risk of death for the patient increases; the wait time for other patients increases, causing some to leave without being evaluated; and it wears on staff.

“(The) emergency department is not built for taking care of patients long-term,” she said. “That’s not our mission.”

Having to look patients and family members in the eye and tell them that there isn’t a bed for them nearby adds stress on hospital workers.

“It is huge,” she said. “It wears you down real quick.”

Sununu, in his news conference with state health officials, announced a series of efforts aimed at expanding hospital capacity and allowing long-term care and rehabilitation facilities to open up more beds to take patients who are no longer in need of hospital-level care.

The state is expecting a 24-person team from the Federal Emergency Management Agency to arrive at Elliot Hospital in Manchester as soon as this weekend. A second team of 30 paramedics, focused on relieving pressure in crowded emergency departments, is expected to arrive in the state next week, and some of them could come to DHMC, Sununu said. In addition, the state plans to deploy 70 members of the New Hampshire National Guard to assist hospitals with “backroom tasks” such as food service and clerical work.

“This is an all-hands-on-deck effort,” Sununu said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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