Indiana could face critical care bed shortage

INDIANAPOLIS (WISH) – Coronavirus cases are at an all-time high as we head into what the Centers for Disease Control is calling the darkest time of the coronavirus pandemic to date. 

Hospitals across the country are experiencing staff shortages and critical care beds are near capacity.

But, how does Indiana compare to other states and should Hoosiers be concerned?

On Wednesday, Indiana State Department of Health reported 91 additional deaths, bringing the state’s death toll from COVID-19 to 5,688. A total of 6,655 new COVID-19 cases were reported Wednesday, meaning 350,970 Hoosiers have tested positive for the virus.

News 8 spoke with Dr. Brian Dixon, director of public health informatics at the Regenstrief Institute, to get some answers. 

Gillis: We have COVID-19 cases rising. We have hospital beds reaching capacity in certain states. There’s concern about a staff shortage. Dr. Anthony Fauci says we should brace ourselves for a surge upon a surge of the coronavirus. There is a way to track these variables nationally, but Indiana specifically has what’s called a ‘data dashboard’ that you and your colleagues developed. We spoke about this back in the summer. Remind us about this data dashboard and what it collects and how it helps Indiana keep track of COVID-19 cases among other things. 

Dixon: So, the dashboard we have in Indiana created at the Regenstrief Institute was designed to really help both the public and our health systems really track what’s happening in the communities around them. 

A lot of times the hospitals and clinics will have an information system that they use for their patients so they know what’s happening in their facilities. But they don’t always know what’s happening in the counties around them. So, the dashboard really helps to track things like admissions to the hospital, those discharged from the hospital, how long people are staying in the hospital from COVID-19. So, these are all the people who tested positive for COVID-19 and we track people who go into the hospital, people who don’t go into the hospital, people who need intensive care in the hospital and individuals who die in the hospital as a result of COVID-19. So, we’re really tracking all of those things and trying to make those metrics available as broadly as possible so people understand the situation where they live in Indiana. 

Gillis: So you have these hospitals almost talking to one another across the state. 

Dixon: Yes. Through the dashboard they talk to one another on a regular basis and the data really helps them talk to each other about what’s happening in their neighboring systems and counties. 

Gillis: I understand that this is updated daily. Today we had about 5,700 new cases of COVID-19. We had 38 deaths that were reported this morning. How is Indiana faring in terms of these variables that we’re talking about? Hospitalization rates, ICU admissions, disparities in deaths and infections, successful discharges and staffing capacity and available beds? How are we doing?

Dixon: Well, a lot of the metrics point to the fact that we still have a very high level of both infection occurring in the state as well as health care utilizations. We still have not really begun to decline or plateau with respect to hospitalizations. We continue to increase. Some people are being discharged, but then more people come in with COVID-19. We know that hospitalizations and death data lag behind infections. So, we are expecting to see continued levels of high mortality and we really expect to see an increase in mortality over the next couple of weeks. 

Same thing with hospitalizations. We believe we are going to maintain a very high level of hospitalizations over the next couple of weeks before–hopefully–coming downward as we’ve seen some infections again sort of plateau in the last weeks. That would tell us that hopefully soon then we’ll stop kind of the larger number of people coming into the hospital, but we also are anticipating a bump again after Thanksgiving and–as per Dr. Fauci’s comments–we’re expecting that at the state level, too. 

Potentially depending on where we see infections this week. We’ll be watching the infections this week and then we’ll be able to use that data to anticipate what we might be able to see with hospitalizations.

But in terms of how we compare to other states we’re kind of right in the mix with our neighboring states in the midwest. We’ve seen some states that were very very high before Thanksgiving like North Dakota and South Dakota begin to come down sharply. But a lot of our neighboring states remain kind of high and so we remain at similar levels to most other states. With deaths we are a little bit higher than some of our neighboring states with the exception of Illinois. They are kind of outpacing us a little bit there. Of course, they have a larger population. But we see that Indiana is faring very similarly in terms of other states in the Midwest and Ohio valley. 

Gillis: I want to circle back to something you had said. Is the influx of patients coming into the hospitals infected approximately equal to the number who are being discharged? Or did I hear that incorrectly?

Dixon: I mean, they are. Obviously some people are passing away when they are in the hospital, but generally some people who are…the average time a person spends in the hospital is ten days. Some people are a little bit less than that and some people are a little bit more than that. So, on a given day the number of people admitted does not necessarily equal the number of people who are discharged.

But over the last several weeks we have seen people come in, be hospitalized and then be discharged. And that pattern seems to be continuing to happen where we see, for example, on a given day maybe 175 people statewide get admitted and maybe another 150 to 200 people get discharged. So, it fluctuates a little bit. But it’s generally in the same range. 

Gillis: We had talked about this surge upon a surge and projecting what may happen in these next couple of weeks, especially since the CDC said a couple of weeks ago we should really brace ourselves for a very dark period before we turn the corner. Should we be concerned about staffing needs and hospital beds? Or do we have it managed?

Dixon: I do think it’s something we should be concerned about because…and the reason we should be concerned is two fold: the number of regular hospital beds isn’t as much of a concern as it is for critical care beds and we are kind of exceeding capacity in many hospitals in Indiana, especially in smaller communities. They don’t have enough critical care beds to begin with and we’re exceeding capacity there. So, that means patients are being transferred to other hospitals. I think that we should be concerned with the fact that we may eventually run out of those critical care beds in the state of Indiana.

I think the bigger concern is the burnout of the staff. These staff who work with COVID-19 patients day in and day out…they have to go through a large kind of set-up time to put on all of the PPE that they wear and they see people on ventilators and people struggling and being battling this disease and people passing away and that takes an emotional toll on our healthcare workers. A lot of them are really getting to the point of mental exhaustion and also physical exhaustion for some of the long hours they’ve been having to work.  

So, even if we don’t run out of the actual beds that people lay in COVID-19, I think we’ll run out of staff who are available to take care of those patients if we don’t start to plateau and begin to come down and if we don’t really take this disease seriously. I would say to people who haven’t been taking it seriously…you really need to. If for nothing else, do it for the sake of these poor health care workers who have been working long hours and really should not be put on such stress for so much time because it has been months for some of them now that they’ve been dealing with this pandemic. 

News 8’s medical reporter, Dr. Mary Elizabeth Gillis, D.Ed., is a classically trained medical physiologist and biobehavioral research scientist. She has been a health, medical and science reporter for over 5 years. Her work has been featured in national media outlets. You can follow her on Instagram @reportergillis and Facebook @DrMaryGillis.


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