‘It’s just bad’: Charlotte hospitals are filling up with COVID patients — and surge isn’t over

An intense and growing demand for treatment in Charlotte-area hospitals is pushing intensive care units closer to full capacity, with the number of COVID-19 patients surging alongside staggering increases of new infections.

A Charlotte Observer analysis of public federal health data shows that about 90% of intensive care unit beds in Mecklenburg County hospitals were occupied at the end of December, the most up-to-date figures available. Around half of that number were COVID-19 patients, according to the data from the U.S. Department of Health and Human Services.

By contrast, ICU beds were reported to HHS as 77% full in late August — when the average number of new coronavirus cases detected daily in Mecklenburg was about one-fifth the current level.

To deal with recent increases, hospital representatives say they continue to treat some non-critical COVID-19 patients at home and periodically transfer others to nearby facilities with available beds. And at Novant Health, a spokesperson said, the hospital is “calling for qualified nurses to return to the bedside and are contracting with traveling nurses and support staff.”

Charlotte hospital systems Atrium Health and Novant Health say there is still more they can do to increase bed capacity — though staffing limits provide a bigger hurdle.

Throughout the pandemic, health care systems have been planning for how doctors and nurses will cope with spikes in coronavirus infections and sick patients. The average number of people hospitalized in Mecklenburg has more than doubled in the last month.

Mecklenburg Public Health Director Gibbie Harris on Thursday acknowledged Atrium and Novant are feeling heightened strain on resources amid a post-holiday influx of new infections. But she and hospital leaders did not sound the alarm on dwindled capacity.

“Especially this time of year, in the winter, when we’re seeing other viruses that are creating problems in our community,” Harris said in a news conference. “That is not an unusual percentage of hospitalization.”

Novant says it has already increased its capacity by 60%. Both hospital and public health officials emphasize: Although the pandemic has led to unprecedented stress on health care workers, people with non-COVID illnesses should not avoid seeking care at the hospitals.

Atrium told the Observer in a statement that more can be done to increase the number of empty beds.

“At Atrium Health, during peak times, we can flex bed space to create additional capacity as needed,” the statement reads. “Because of this, providing an overall capacity number can be misleading, since it can change from one day to the next. For example, if we are at ‘x’ percent capacity one day and we add to the number of available beds in a facility to serve an increase in patients, the overall capacity percentage will decrease.”

Meanwhile, the HHS data — which measured ICU bed capacity for the week beginning Christmas Day — showed all of the county’s seven hospitals had more than 85% of their critical care beds filled. Five Mecklenburg hospitals had more than 90% of their ICU beds taken. And one facility, Atrium Pineville, was over capacity, data show.

Data from January was not yet available.

An analysis of the HHS data, done by the University of Minnesota Hospitalization Tracking Project on Dec. 31, showed similarly high occupancy in hospitals in nearby Rowan, Stanly and Cleveland counties. In the eight counties surrounding Mecklenburg, the number of beds occupied in ICUs ranged from 74% to 99%.

Hospitals across the state continue to be inundated. All North Carolinians must stay vigilant and stay home as much as possible to avoid overwhelming public health infrastructure, Dr. Mandy Cohen, the N.C. DHHS secretary, said in a news conference Wednesday.

“Hospitals are feeling the strain, and this is incredibly worrisome,” Cohen said, later adding this is the most worried she’s been since the start of the pandemic.

Days after Christmas, Mecklenburg County’s COVID positivity rate shatters record

During a county commissioners meeting earlier this week, Commissioner Leigh Altman offered a bleaker account: She heard the hospital systems in the Charlotte area were “basically at zero capacity.”

Harris responded: Mecklenburg Public Health was available “to support the hospitals any way we can.” The health department, hospital leaders, first responders, emergency management personnel and government leaders from across Charlotte, Mecklenburg and the six towns hold regular COVID-19 briefings to closely monitor and respond to the pandemic.

Altman said she wondered if it was time to start “ringing the alarm” on hospital capacity.

The hospitals are “the ones that have to let us know if and when they need help,” Harris had told Altman.

In a statement this week to the Observer, Novant officials said: “Make no mistake about it: we are concerned by current inpatient numbers, which are at historic highs, as well as modeling that does not show the decline we need to see. We do, however, have additional surge planning levers we can pull, enabling us to continue caring for all critical and non-critical patients.”

Rising hospitalizations

Mecklenburg’s 14-day moving average of hospitalizations in early January was 466. The number is more than twice as high as the previous peak, when the 14-day average hit 198 people on July 29, according to an Observer analysis of Mecklenburg Public Health data.

“This is a critical time for our healthcare systems and for our communities,” Novant Health said in a statement from a spokeswoman. “While we have begun to administer the long-awaited vaccine, it’s imperative our communities understand that we are not out of the woods yet with community spread at an all-time high.”

The accelerating rate of COVID-19 hospitalizations in recent weeks is concerning, officials and health experts agree.

”Like all hospitals across the state and around the country, the number of patients has increased in recent weeks,” Atrium said. “This is exactly why medical experts have been advocating and stressing the critical need for the community to stay home, wear a face mask and wash their hands frequently.”

On Wednesday, Mecklenburg recorded more than 530 people hospitalized with COVID-19 — a record. What’s more, each day between Dec. 28 and Jan. 4 marked a new record for COVID-19 hospitalizations.

Across the state, hospitals have resorted to “safety relieve valves,” including postponing elective surgeries and trying to discharge patients sooner to keep more beds available. But in some circumstances, the efforts are still insufficient, said Mark Holmes, director of the UNC-Chapel Hill Cecil G. Sheps Center for Health Services Research.

“We’ve seen a pretty significant increase in hospitalization for COVID over the last two weeks,” Holmes told the Observer. “Given the tight supply we reported in December, this continued increase is highly concerning.”

COVID cases in Mecklenburg could remain high through mid-February, county warns

Staffing levels

Staffing levels are more concerning than bed capacity, according to Novant.

“We can easily add physical bed capacity, but cannot as easily add the clinical care teams that support them,” Novant said in a statement. “We are redeploying team members, calling for qualified nurses to return to the bedside and are contracting with traveling nurses and support staff.”

Holmes echoed that concern for the state.

“It’s one thing to have beds,” he said, “but each patient needs someone to care for them, and as healthcare professionals approach a year of battling a global pandemic, keeping staff healthy remains a continuing challenge.”

On Thursday, county health director Harris said “quite a few” hospital employees are currently in isolation or quarantine due to COVID-19 exposure or symptoms. She said some small hospitals in the county are on diversion right now, meaning they are rerouting patients to hospitals with more capacity.

Harris was not sure which hospitals, or how many, were on diversion.

Atrium did not respond to questions about diversion. Novant told the Observer that hospitals, “once all additional resources have been exhausted,” are typically placed on diversion for just four hours or less.

“To safely care for the patients present in our facilities, there are instances when Novant Health follows the industry-wide practice of redirecting incoming ambulatory patients to facilities with more manageable capacity,” Novant said in a statement.

The strain on hospitals to treat a growing number of coronavirus patients is intense, and leaders say they’re worried it will deter others from getting emergency help for non-COVID problems. As they’ve done throughout the pandemic, local leaders stressed for the public to not delay seeing doctors or calling 911 to get help for chronic and life-threatening medical issues.

“Today, we have the necessary beds, staffing and PPE to care for all those who need it,” Novant said. “We need the help of our communities to ensure this continues to be the case in the weeks ahead.”

Healthcare coalition

Mecklenburg County is part of the Metrolina Healthcare Preparedness Coalition, intended to make collaboration smoother when local and state agencies respond to emergencies, including the COVID-19 pandemic. It also serves Burke, Cleveland, Catawba, Lincoln, Gaston , Iredell, Cabarrus, Union, Stanly, Anson, Richmond and Scotland counties, according to the coalition’s website.

“We absorb a lot of the overflow from the nearby rural counties that have smaller facilities. It’s very easy for them to get overwhelmed,” said Michael Thompson, associate chair of the Public Health Sciences Department at UNC Charlotte. “Even though we have … capacity now, that can be drained very quickly.”

Throughout the coalition, 305 ventilators are in use, with 556 available, according to data from the North Carolina Department of Health and Human Services on Friday. But bed capacity offers a bleaker picture into rapidly depleted medical resources.

State data show 429 ICU beds are filled, with only 24 open. There are an additional 234 potential licensed beds, but it is unclear how many already exist in the hospitals or whether they might need to be created through surge capacity.

The current influx of hospitalizations is likely still due to Thanksgiving gatherings, based on the incubation period of the virus and the time it takes for symptoms to worsen, Thompson said. That means it could take at least another week to see the initial hospitalizations tied to Christmas — and another two weeks for New Year’s.

Thompson warned the looming surge could happen gradually, with family and friends traveling to see one another over the lengthy holiday season.

“I haven’t tried to do a precise estimate — it’s just bad,” Thompson said of hospital capacity forecasts. “The sheer number of people testing positive is still growing. A certain percentage of those people will end up being hospitalized.”

Field hospital

In late December, Samaritan’s Purse announced it would build a 30-bed emergency field hospital in Lenoir. The field hospital will treat patients from Caldwell UNC, Appalachian Regional Healthcare System in Boone, Carolinas Healthcare System Blue Ridge in Morganton and Catawba Valley Health System and Frye Regional Medical Center, both in Hickory, the News & Observer reported.

The field hospital construction once again raises questions for Mecklenburg, which briefly considered building one ahead of a potential COVID-19 peak last year.

In early April, Novant and Atrium asked the county to build a 3,000-bed field hospital operating out of UNC Charlotte residence halls. At the time, the county had reported 601 COVID-19 cases and three deaths. That request was quickly scaled down, and later dropped, with hospital administrators saying they believed existing facilities could handle coronanvirus demand.

At this point, there are no plans for a field hospital in Mecklenburg, Harris said Thursday. But if the hospital systems once again requested a field hospital, Harris said it could be set up in as little as two weeks. Field hospital construction would be directed by the State Emergency Management, Harris said.

Harris said Mecklenburg is currently in a better place than more rural regions because Mecklenburg residents have access to two hospital systems, Atrium and Novant.

Gavin Off contributed to this article.

Editor’s note: This story has been updated to include information from Atrium Health on hospital capacity and to include the latest hospitalization data from Mecklenburg Public Health on Friday.