Holiday COVID-19 transmission likely to determine Vermont’s ICU capacity this winter

Published: 11/19/2021 10:03:50 PM
Modified: 11/19/2021 10:03:59 PM

The number of coronavirus cases that result from holiday gatherings will be a deciding factor in Vermont hospitals’ capacity in intensive care units ahead of peak flu season, according to state officials.

“We’re in a very concerning moment, and our hospitals are already stressed and strained, as they have been for months,” said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems.

Vermont’s ICUs are operating at 85% to 90% capacity, up from 70% to 80% in the late spring and summer, according to state officials and Department of Financial Regulation data.

The recent increase is being driven primarily by pent-up demand from critically ill patients whose stroke, heart attack or other preventable conditions worsened due to lack of medical care earlier in the pandemic, officials said. At the same time, COVID-19 intensive care admissions rose almost 30% since the beginning of October, according to state data.

Now, a relatively small COVID-19 surge could put significant pressure on the system.

At the same time, holiday celebrations — such as Thanksgiving next week, followed by Christmas four weeks later — are an opportunity for young, unvaccinated children to come in close contact with older adults who did not get their booster shots, Mike Pieciak, commissioner of the Vermont Department of Financial Regulation, said in an interview Wednesday.

The end of the holiday season also typically marks the beginning of peak flu season for ICUs in the Northeast, according to state officials. Ski and snowmobiling injuries, as well as tourists needing critical care, can strain the state’s roughly 100 critical care beds in ICUs, said Gilman Allen, critical care doctor at the University of Vermont Medical Center.

The state’s ICU capacity strategy thus far has hinged on helping hospitals cover the cost of staffing additional beds ahead of the holiday season. Earlier this week, for example, Secretary of the Agency of Human Services Mike Smith said his department would pay to staff 10 intensive care beds in the coming weeks, bumping the state’s overall bed capacity to about 110.

Smith said his agency is also working to relieve the pressure on ICUs indirectly by facilitating the transfer of up to 80 non-ICU patients to long-term care facilities across the state.

The administration took a similar tack a few weeks ago when Smith’s agency pledged to spend up to $1.4 million to staff 80 long-term care beds for the next few months.

Pieciak says these staffing strategies would likely see the state through the next four to six weeks.

“Once you get on the other side of January, that older population should be really highly covered by the booster,” he said. “And then you get the benefit to the fully vaccinated 5- to 11-year-olds, come early January, which should help with our overall case rates as well.”

Carri Chan, who studies hospital operations at Columbia University in New York City, said crunched ICUs are bad for patients and providers. Intensive care patients in units nearing capacity tend to develop complications that could make them sicker and get them readmitted more often. They are more likely to die prematurely, Chan said.

“There’s obviously a concern that if you get a big increase because of some random event, it might be that some patients just aren’t able to get the access to care they need,” she said.

During Gov. Phil Scott’s weekly news conference Tuesday, Health Commissioner Mark Levine suggested several steps Vermonters could take to ensure a safer Thanksgiving celebration, including asking other guests ahead of time if they are vaccinated, keeping gatherings small, getting both PCR and rapid tests before the meal and another test five to seven days afterward, and avoiding gatherings if anyone feels sick.

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