Washington Hospitals and Health Care Workers Recover After a Terrible Winter due to COVID-19
In January 2022, health officials in King County (Seattle, Washington) issued an urgent plea to the public. The message: for everyone to do what they could to help reduce the pressure on county hospitals, which had seen a 700% increase in admissions from December 2021. Officials said the surge in hospitalizations – driven by the extraordinarily contagious Omicron variant of the virus that causes COVID-19 – led to postponed surgeries and long delays in care for patients. In a post on the county’s public health blog, Dr. Paul Ramsey, the CEO of UW Medicine, University of Washington Medicine CEO stated that health care workers needed the public’s help to slow the surge.
The Omicron wave started at the end of December. The number of new cases went up quickly, increasing the number of patients and decreasing the number of available staff at the same time.
Dr. Tim Dellit is the Interim CEO for UW Medicine in Seattle and the Interim Dean of the University of Washington School of Medicine with a background as an infectious disease physician. During the pandemic, he also led the UW Medicine response, in partnership with the President of UW Medicine Hospitals & Clinics. Speaking about King County, Dr. Dellit says, “We reached 8,000 cases a day. We saw significant capacity challenges across all health care systems in our state. Within our system, we peaked at 204 hospitalized patients with COVID-19 on January 23rd and have seen a gradual decline since.”
As of late-June, Washington had one of the highest vaccination rates in the country. According to the Washington State Department of Health more than 82 percent of the population 5 and older have received at least one dose of a COVID-19 vaccine while almost 75 percent of people 5 and older are fully vaccinated. While vaccination protected many people from being hospitalized during the Omicron surge, more than 25 percent of people in the state had not received a single dose of a COVID-19 vaccine.
While the winter Omicron surge caused more hospitalizations than any other point in the pandemic, Dr. Dellit says the biggest difference with the Omicron surge was the impact on staffing. “Vaccines are most effective at preventing severe disease and hospitalization, not necessarily preventing infection. As we saw with Omicron, we had large numbers of staff out due to infection or exposure which impacted our staffing even though the vast majority were not that sick,” explains Dr. Dellit.
At one point, 800 UW Medicine employees were out, either due to community infection or household exposures. The absences were on top of the existing national shortages of health care personnel, especially with nurses. According to Dr. Dellit, an estimated 20% of nurses across the nation left the profession during the pandemic. This meant the baseline staffing shortages were exacerbated by the Omicron surge. Dr. Dellit adds, “We are going to see these long-lasting impacts around capacity challenges, especially given the postponed care and the ongoing staffing challenges within health care and the labor market in general.”
On the practitioner side, UW Medicine paid residents (physicians in training), fellows, and faculty for additional work beyond their scheduled clinical activities, known as “moonlighting.” Dr. Dellit says, “With the postponement of non-urgent surgeries and procedures, there was a significant impact on our revenue. Labor costs went up because UW Medicine had to bring in outside individuals to help staff during that period of time, given baseline staffing challenges compounded by employees out due to COVID-19 infection or exposure.”
Thousands of Washington residents saw their medical procedures delayed due to the pandemic, as hospitals prioritized COVID-19 patients. UW Medicine recommended patients get vaccinated and provided staff vaccination at their workplace. Dr. Dellit says, “We did quite a bit of education around the importance of vaccination, but the focus was on patient and staff safety and less on maintaining a functional society or any impact on rescheduling of routine care.”
Governor Jay Inslee instituted an emergency order that paused all elective care, which included procedures not expected to cause harm to the patient if delayed for three months. It did not define harm. Elective and non-urgent surgeries were put on temporary hold from March through May 2020. It was an effort to conserve hospital space, staffing personnel, and protective equipment. From January through February 2022, non-urgent surgeries and procedures were again put on hold due to another emergency order from the governor. Non-urgent surgeries and procedures started to resume gradually, starting in March 2022, as the hospitals were still very full.
Dr. Dellit says, “We worked closely with our surgical teams to review each case individually and then we had to prioritize the cases based on the safety and medical needs of the patients… It will take months to get through the backlog.” At UW Medicine, nearly one-third of surgical and procedural cases had been postponed during the pandemic as of the end of 2021. UW Medicine usually does about 60,000 operations a year.
The increase in hospitalized patients with COVID-19 also impacted UW Medicine’s surgical training programs. The residents were at risk of not doing enough of the different types of surgical cases required for them to complete their training. Due to the impact on training, UW Medicine was granted emergency category status through the Accreditation Council for Graduate Medical Education during the surge. Gaining ACGME emergency status was important in how their training programs were evaluated and understanding that their surgical trainees may not be able to achieve the normally required numbers of surgical cases due to the postponement of non-urgent surgeries and procedures due to the COVID-19 Omicron surge and impact on care in their hospitals.
UW Medicine first set up their COVID-19 incident command on February 29, 2020. Dr Dellit says, “We never stopped, and we’ve utilized that incident command to align and coordinate our response across our hospitals and clinics so that our policies are the same, our approaches are the same from an infection prevention standpoint, and that has been one big benefit. It has brought us together as a health care system.”
The biggest challenge right now, according to Dr. Dellit, is the work force. It’s not only the staffing challenges, but the overall absolute exhaustion of health care workers and the toll that the last two years have taken. He says health care workers have continued to step up as the pandemic wears on, but the sense of energy and response has declined. “We started vaccinating health care workers in December of 2020, and there was such a sense of hope that we were going to see that light at the end of the tunnel that we were going to be potentially through the end of the pandemic in the next few months. That never materialized.”
Dr. Dellit adds, “When the Delta and Omicron surges hit, it just became incredibly demoralizing… The divide you have in society really weighs on our health care workers. When you look at protests against vaccination, when you look at protests against masking, and we see the impact it has on our health care systems… it’s really challenging for clinicians and staff.”
As the calendar turned from winter to spring, the situation improved, and Dr. Dellit does see some light at the end of the tunnel. “I’m cautiously optimistic in the sense that with Omicron and more people vaccinated this will push us more into an endemic phase.”
He believes we will get to the point similar to influenza or other respiratory viruses where we will need vaccination at some sort of interval, but we will be able to live with COVID-19. He hopes we won’t see such devastating impacts on our health care system or the overall effects that previous surges have had. The biggest unknown is what will happen next fall.
Dr Dellit says, “It’s hard to predict what will happen as new variants continue to emerge, but hopefully the impact will be less through the summer… One thing we have learned through the pandemic is how difficult it is to predict the future, but we are in a better place now than a year ago.”
He adds that one of the biggest priorities coming out of the pandemic has to be the well-being of those in the health care industry. “We have to rebuild our resilience, focus on the well-being of our people in order to build that foundation in order to recover. I think that is the biggest challenge we have. We can’t underestimate the impact the last two years have had on our health care workers.”
If there were another pandemic, Dr. Dellit’s advice to whoever is in charge would be, “Focus on the people, function as a system, and really collaborate with not only internal partners, but across all health care systems in coordination with public health.”
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