Situation in hospitals 'critical,' please get a vaccine, leaders say
Representatives from UNC, Duke Health and WakeMed come together to discuss the COVID-19 crisis and a shortage of beds as more patients fill area hospitals.
impact of covid 19 on our local health care system which includes our hospitals as well as RMS system. Today you're going to hear from dr timothy plunk, Emergency department medical director at Duke Riley Hospital. Doctor linda Butler, Chief medical officer at U. N. C. Rex Healthcare dr Seth brody. Chief physician executive at Wake med health and hospitals. Doctor micro compass caY. Chief medical officer at wake med behavioral health and dr Jose companions Chief medical officer for wake County. After they make some brief remarks, I'll open the floor up to questions from the media at that time. If you could please type your name the name of your media outlet and your question into the chat box that would be great. And then I'll answer them in the order in which they are received. So with those directions let's go ahead and get started this morning. Dr timothy plunk with Duke Raleigh Hospital is our first speaker. Dr clunk. Yeah thanks for the opportunity to speak to the group here. I'm tim plunk and I'm the medical Director for Duke Raleigh Hospital's Emergency department. I'd like to begin by saying it's an honor to have been on the front lines of this pandemic. Working with a fantastic group of people for the past 18 months. This past year has presented incredible challenges for our hospital or providers, nurses, emergency services and to our community. Yeah it's hard not to be a little bit disappointed at this point with our current position we've had a lot of success is um but just as we felt like there was some light at the end of the tunnel over the past several weeks, it seems, we seem to be thrust back into another wave of this pandemic. What we're seeing in our emergency department is not just covid cases rising. Um It's also sort of the effects of an 18 month long pandemic that we're seeing. Um it's folks who have chronic conditions who haven't been able to care for themselves as well as they might have been. Otherwise, we're seeing folks who have lost their job, who have lost their insurance, who had changes in their family situation, um who maybe have lost folks in their family who may have been primary caregivers, Yeah, or had changes to their primary care. Um All these things have created gaps in people's resources that would otherwise keep them healthy, compounding all this. I think we see a county that is one of the fastest growing counties in the region. Um giving us a lot more people in general to care for what this all means for us in the emergency department as this new wave hits is that, that we're busier. Our patients are a little sicker, oftentimes very sick. Um and our staff is working harder and our lobbies are full, our wait times are higher than they've ever been at Duke Raleigh. I'm sure that other hospitals can agree to that as well. Uh And it's creating a great deal of stress and frustration, a very understandable frustration. I think a lot of people are waiting in our lobby, uh, and another lobbies around the country uh, longer than they ever thought they would have to wait for health care in this country. But like I said, we're not alone in this. I think this is a county thing. I think this is a triangle thing. I think this is a state thing and I think this is a a problem facing our country. Yes. Yeah. I would like to say that even before Covid, um our hospital in our hospital system regularly hit capacity levels during seasonal surges and we have a great team of people who are experts in managing these high volume times. This Covid surge adds a magnitude of pressure though. Uh and I I'd like to be the first on this group of people to to to recommend that folks out there in the community get vaccinated our ability to care for all the patients if you need care. Covid and non covid is very dependent on our community's ability to help stop the spread of this virus. I look forward to working with everybody here on this conference as well as uh in the county and in the region in whatever way we can um, to work together as a team uh, to get through this surge. That's all I have to say in my statement. Right. Thank you dr Punkin. Can you speak to the concern that people might delay or potentially not seek medical treatment at all because they're not sure where to go right now and maybe they don't even think their condition warrants medical attention. Well so the last thing that I would want to do would be to discourage anyone from seeking care. Um I think there are a lot of options out there. The first uh you know as an emergency medicine doctor you know the E. D. Is open 24 7. Um We see people for all kinds of things and for all kinds of reasons and we're happy to do so that's why we're here. There are other options though and I think it's important to familiarize yourself as a community member with those options. Um And use your best judgment. Uh There are primary care doctors offices, there are urgent cares, there are clinics you know clinics and the pharmacy. You know there are a lot of people that you can connect to uh to ask questions and a lot of people out there who are happy to help you find the right place for you to seek care if you have questions about that. Great thank you so much. Doctor Plunk our next speaker this morning is dr linda Butler with you and see rex healthcare dr Butler. Hi Daryn. Good morning everybody thank you for the opportunity to participate in the press conference just like wake med and Duke Raleigh the U. N. C. Rex has experienced extremely high volumes of patients. Um we have over 500 patients in our hospital today. I think 520 and we're at 439 bed hospital. That helps you put it into perspective. R. I. C. U. Beds earth full. And just as dr punk said the acuity of the patients we're seeing has definitely increased through this pandemic. Um Part of our high patient census is due to some difficulty really transferring out and discharging our patients. Um There's a lack of skilled nursing availability. Um Not just in Wake County but throughout the state we have difficulty finding placement for a geriatric dementia patients assisted livings are challenged with their behavior so they bring them to our emergency department and we end up caring for them in the hospital. Um We also have been faced with staffing challenges like all health care facilities or systems across the nation. Um You know there's a concern that even having a vaccine mandate at the end of september will have some staff choose to leave health care because they don't want to be vaccinated. But we know vaccinating is the right approach for our patients and our workforce and our community. Our clinicians have been caring for the community throughout the pandemic and just like the team at dew Brawley. They were exhausted. Um They still continue to provide very high quality safe care and it's surprising to me that our patient satisfaction scores are still quite good when I know how hard our teams have had to work. Um In particular the delta variant has caused a higher proportion of the admitted covid patients we're seeing to be placed in our ICU. So 40% of our covid patients are in an ICU. And what is very worrisome is the predictive models we have for this surge shows that we will have more patients hospitalist than we did in january and february. And we're going to have to care for those patients with less staff. Um Yeah and that and now we're having higher I see patients that even adds an extra burden. So are asked from the community is to seek care early and in the best place. And to turn it around slightly differently from what Dr Planck said early on go see your PCP. Your primary care provider knows you better than anyone else. And if it's a problem that can be taken care of at emerging care facility they are typically open seven days a week. They're not open 24 7 like the emergency department but many have 8 to 12 hour days where they can see patients. And then finally you know when you come to the E. D. Just be prepared to have a long wait because we're so full in the hospital that when patients are admitted sometimes we're holding patients in our emergency department or even up to a day. So there are several days during the week when our largest inpatient unit is actually our emergency department. So they're still seeing all of the other patients through a smaller number of beds or non traditional spaces. I believe that last month or even this month E. M. S. Had to wait for a couple of hours for a space to open up to leave a patient. And E. M. S. Has never had to wait in R. E. D. Before. Uh So that's just speaks to the volume challenges that we have and then just be patient with our staff. They are doing their absolute best taking care of everybody and we know no one wants to wait. But that's just the reality of our situation. And then my final plea is to urge everybody to get vaccinated. Um That's the most important thing you can do and then while you're out in the community right now even if you are vaccinated please wear your mask and practice good hygiene and hygiene. So that ends my comments Paterson in case the situation with covid in our community, the surge we're seeing does get worse. What are some of the steps that the U. N. C. Rex might take to respond to that. And we've already returned to some of our previous surge processes that we had in the hospital. We have, you know our covid debriefs, we've opened our command center backup monday through friday uh to help with collaboration. We're recruiting more staff which we have been doing before the surge and then we have decreased our elective or non emergent surgery volumes to make sure we have beds available for patients coming in through our E. D. We have not closed any beds for even with our staffing shortages. And we are looking at holding more patients in non traditional spaces like our pack use or procedural areas. We will also look at pulling some levers that we had earlier on going to a team approach to care and expanding iCU beds beyond our current footprint into the other. Other units were actually having people who are coming out of retirement. We have a retired nurse working in our monoclonal antibody clinic. We ramped that up to try and get more patients into that clinic to prevent admission. And we're also going to look at people who are in administrative roles who were clinicians in the past to come be extra hands on our units. So those those are just some of the things that we're um preparing for. Great thank you so much. Next up is dr Seth broody with Wakeman health and hospitals. Dr brody. Yeah. Well thanks thank you again for having me. Um as you're hearing from others, I think the message is going to be pretty similar. We're having a very similar experience to what you just heard from our colleagues and very similar to across the country um are covid. Yeah. You know this delta strain is highly contagious as everyone has heard. Right? It's it's a little different than before. It's leading to higher hospitalizations and it's impacting healthier and younger patients. So that that's one of the big difference is that we're all we're all seeing. Um and that has now led to our covid numbers Wake med have have we've surpassed our january surge already, We're already past it. Um So that's kind of been our experience and so leading to significant capacity issues. But as you've heard, the capacity issues are well beyond just the covid search. We have sicker patients coming in from for all types of reasons respiratory disease, heart disease, stroke, trauma, etcetera. You know, it's really um been there sicker a lot of as you heard before, chronic disease states have been delayed care for those for those issues have been delayed. That leads to patients coming in with more their acute illness on top of their chronic illness. Makes it all uh makes them sicker when they arrive and then it leads to longer lanes to stay. Right, so they end up staying in the hospital longer for the same, thanks for the same conditions. So, we had a baseline very high census, I think all the hospitals would say this before the surge. So then you take this surge and you place it on top of a very high census and pretty much at capacity prior to this surge. You can really just right there just on that sheer volume. You can see how your capacity issues become really significant. And then this population is requires the population of the positive covid patients now and particularly with Delta. Um They are very sick. We'll have as many as 10 to 12 patients a day transfer from our medical beds into our I. C. U. S. On certain days. And that's on top of the E. D. At the emergency department emissions. So the acuity the level of care that takes right so that that that impacts your staff who's just as everyone has said is just working so hard. Um There've been amazing. Our entire staff physicians to our entire city are a PPS our nurses, all staff has just been I think everyone I'll reiterate what I was saying. We cannot thank them enough. Um And we need more. It's the other theme you're hearing, we need more staff. That's one of the critical shortages. You add on the behavioral health and the mental health tsunami that's out there as people call it. Um And how that impacts beds and the discharges that you're you're hearing about as well and how it's hard to discharge people for many different reasons. It adds up to a significant capacity issue. Um Our patients then you know they're getting into the I. C. U. And they're having very long lengths to stay there as well. So your ICU beds are filling up. We keep expanding. We have expanded already. We've already gone into our search produces for ICU. So we were creative as all systems are now we have to create these new spaces for care. We've been doing that and they're safe spaces but they're not our normal spaces. Um So we keep expanding bed capacity but then you do run into the staffing issue right? You can we can create all kinds of new spaces but we have to have the staff and the staff that's adequately trained etcetera that that can take care of these really critically ill patients. So the two things the capacity issues not just space it staffing, they go hand in hand. Um pediatrics. I'll mention one thing there too around Children's um Our hospital is also filled up uh from the Children's hospital respiratory syncytial virus. RsV we saw no cases in january. Winter is usually when you see it. Um There's the shift into the summer. We had 100 and 80 positive Rsv cases just in august alone Going from zero in January. And our COVID positive rate for those less than 18 has doubled compared to previously. Um schools reopening you know that's obviously concerning. So what have we been doing? Like I said we've been creating new spaces wherever we can. We keep expanding. Our I. C. U. S. Are wait times are very high despite that we've created lots of beds in our emergency departments that hold patients and patients can held for a long time. Um So they wait for beds as you can imagine as the hospital's full and you have long length of stay and you can't discharge folks. It backs that, that backs up the whole pipeline. Right? So it's hard to get people admitted even to be seen and treated and released his hard. Um, so those wait times are long, just like you were hearing for the other systems. Again, I would repeat the plea vaccination, wear your mask. Um, and when you're seeking care, which we know people will, uh, if you can avoid the emergency department, it's a good thing to do that. Um, and, and again, urgent care, whether it be adult pediatric orthopedic urgent care, there's lots of urgent care options. You call your primary care office, um, mental health, community community providers around mental health and your primary care offices etcetera. We're really trying to encourage folks to seek those options and telemedicine and virtual care by the way, which we all have available to folks. So, um, I think that's really important for our community to help in that way. Try to seek that care first and you, we can reassure them. They'll be elevated to hospital care if need be right. All of our, all of our folks do that. But really important to try those other options first. But I'd also like to thank the other healthcare systems. We've partnered throughout all of this a lot. There's been a lot of conversations between the health care systems and partnered in many, many ways throughout the entire pandemic And it's been a a very helpful thing to have the all the different systems communicate well and partner where we need to partner. Well it's great to see that teamwork. I do have a quick question for you because you mentioned patients with covid 19 being part of this situation that you're seeing, how many covid positive patients does wake med currently have and out of those how many would you say are unvaccinated? Yeah. We're now approaching 200 across our system. Um we have about that includes about 15 in our hospital at your home program as well. So we're trying to manage patients in their home where we take providers to them. So we're eclipsing 200 right now. Of those right around 90 give or take a percent or so. But if you just look in general, about 90% of that number unvaccinated The vast vast majority is still unvaccinated and that sort of plays itself out in the IMF. S. S. etc. So we're right around that 10% mark that are being emitted. They are vaccinated. There are breakthrough cases. We know that but the vaccine is incredibly protective still overall against hospitalization and you know real serious illness requiring the I. C. U. Uh etcetera. So um those are our numbers. Great, thank you dr brody for sharing that. Our next speaker is dr Michael Krumm Passkey with Wakeman behavioral health. Doctor Komarovsky. Good morning, thank you for having me. Um I think it might be somewhat unexpected to have the psychiatrist here talking on a news conference about Covid. But what we're seeing is unprecedented. Numbers of people with behavioral health needs in our communities. The most recent studies have shown that we have a 40% increase in the number of people who are experiencing symptoms of depression and anxiety as compared to pre pandemic numbers. So, what that means is people are suffering and they need care and they're concerned about where they're getting care. We've also seen people be reluctant to receive care when I think about people who need behavioral health care. I think about it on a spectrum. So, there are some some symptoms that you can take care of in the community. So, going to your primary care doctor, talking to a therapist, going to a local urgent care where you can really get help with the stress. Maybe medications help treat depression. Um, and we just want everyone to know that there are lots of resources available in the community to help. So don't avoid seeking care because, like, the medical conditions that we've talked about today, the longer you delay in that the worst the symptoms get and it can progress and then we get to a place where we're needing emergency care and things are much harder to treat. On the other end of the spectrum of mental illnesses, patients whose symptoms are so severe that they are not able to safely manage themselves in the community. People who have severe suicidal ideation or people who are experiencing psychosis to a level that they're not able to safely inadequately care for themselves. Those people require emergency care and they require inpatient level of care. So those people come to our emergency room or behavioral health providers like myself, start the stabilization process. We also treat medical conditions and make sure we really understand what's going on. And then we start the referral process for these people to seek care in in patient psychiatric hospitals. So psychiatric care is a very specialized service um that many acute care hospitals like Wake med does not have that service. So we rely on inpatient psychiatric facilities and we refer the people to those facilities to seek inpatient beds. The problem is, is we have a shortage of inpatient psychiatric beds across the state. Um, and so the wait times for those inpatient beds can be very long days and days. So patients are sitting in our emergency room who have no longer have medical needs and don't have a cute medical things that need to be addressed, but we can't get them to the psychiatric level of care that they need. So, as we've heard about the capacity issues that we're facing the acuity that's in our emergency room and frankly, emergency rooms are a very difficult place to seek mental health care because it can be a very loud, chaotic environment. That doesn't always feel great when you're struggling with depression or other things that are happening, it becomes a really difficult situation um, for all that are involved. So as we think about what's going on with the mental health situation, we really are working together as hospital systems to advocate for the care for us to use the resources that we do have wisely and efficiently. We're also partnering with our county, our state and our federal agencies to help levy resources to help us manage the care. And we're all working together to make sure that every adult and every child that has health care needs, including behavioral health care needs have access to care when they need it in a way that's really comfortable for that. So my takeaway messages here are people are suffering, Mental health is on the rise, for mental health issues are on the rise. And if you have those issues or know someone that does, please don't avoid seeking care. So you get early know that there are resources available in the community. And if someone really is in danger or has life threatening issues associated with mental illness, please do come to the emergency room. Don't avoid coming because you know what's going on because we need to give you that level of care too. And we welcome everyone that comes in our door, um, to give them the right level of care. And we're working really hard to make sure that the services that you need are available to you. That's great. And for the average person who may be listening in today, how will they know what the tipping point is for them to seek help from the emergency department versus maybe behavioral health urgent care? Yeah, so many, perhaps most mental illness can really be taken care of outside of the hospital and maybe best taken care of, you know, a quiet, calm, nurturing environment really is ideal for when you're seeking behavioral health care. So, um, when the tipping point comes, when there is imminent dangerousness. So if someone is experiencing suicidal thoughts that they really, you know, you feel like you can't be safe or experiencing thoughts of hurting others or a level of psychosis, hearing things, seeing things, um not thinking correctly, um in a way that they're not able to meet, you know, keep themselves nourished, keep themselves safe, keep housing all those other things, then those are times that emergency care would be required. Okay, thank you so much. Our final speaker this morning is dr Jose companions with Wake County, he oversees RMS Department DR companions, Thank you, thank you all for for being here uh having this conversation with with the community. Uh first of all, I want to share that we value the partnership and the collaboration that we've had as an M. S. System, as wake County with all of the healthcare partners and colleagues throughout this. Uh you know, pandemic The last 18 months or so. Wake County M. S. Is also feeling stress of our strained healthcare system when we transport the patient to the hospital. We need to transfer care to the team in the emergency department and we just can just leave the patient if no beds are available and we have to wait for space to open up. So I wanted to understand that everything is interconnected and the longer we wait, less units may be available to respond to the next call and with our call volume at the highest level of emails history. The time delays can rapidly add up. I want to remind folks that we have a system in place to ensure that we're getting to the most serious calls first. Um We triage calls to ensure that our life threatening emergency conditions are being, getting the resources rapidly when they needed and if you need us we will be there. But the system is trust. There are more things as a community that we can do to improve the current situation. First we need everybody who is able to get the COVID-19 vaccine which will help prevent you from becoming seriously ill and being hospitalized to the virus. We also want to urge our community to avoid the emergency department unless you have an emergency health need. Please consider like our other colleagues just uh summarize here if you have health care needs. Getting early into your doctor's office, Look at the health options, urgent cares, all their clinic options for those less serious medical issues. These actions will help relieve the pressure on M. T. S. And paramedics and our hospitals. And make sure the people who need emergency care the most can receive it in a timely manner. Thank you. And dr companies you mentioned record setting AMS called. I am. What kind of numbers are we talking about? And and why do you think we're seeing such a historic increase in demand for services? That's a great question. So it's to give some context for fourth month in a row. Now Wake County M. S. Is running more than 10,000 calls in a in a month. So way KMs respond to 10,600. Uh No one calls in july And we're at a pace that will actually break 11,000 calls in August and we're averaging around 355 calls a day. We've had several days where we've had exceeded 400 calls in 24 hours. So in our view, the spike of demand for services and 911 is due to three things. And some of our colleagues here have summarized some of those points. But first we know that members of our community put off medical care during the beginning and throughout the pandemic for all the reasons that we all have discussed before. Certainly. Um this health care system already had limited capacity and now the delay in care uh that occurred throughout the beginning and different stages of the pandemic. Now everybody is trying to access the healthcare system for all kinds of reasons at the at the same time. Second the covid surge clearly plays a critical role because we're having um just dealt the variant which is more contagious. We're having people sick requiring inpatient hospital or high level of care. And third our county didn't didn't stop growing in the background. The pandemic. The wake county kept growing. Um So we have now more members of the community to serve. So I think all these things together have combined to feeling the stress and pressures we feel right now in the emergency services system in the community. Alright. Thanks doctor companies. So at this time we're going to take questions from the media again to our reporter friends, type your name, the name of your media output in your question in the chat box. I'll read them aloud as they come in. Um If there's any spanish speaking media on the call dr cabanas can respond in spanish just let me know that you would like to see that in the chat as well. And we actually had a few come in as everyone was offering of their comments. Uh The first one comes from josh zack. Uh he asks, we've heard in the past, the hospitals have had issues with staffing when hospitals reach or come close to capacity with several of the key health care systems moving to require their staff get vaccinated. How with Out would that add to strains on scheduling? For example, Wake Med will begin a vaccination requirement on November 12 and vaccination is a condition of employment. Are hospitals at risk of losing key frontline workers? Perhaps one of our physicians from one of the hospitals would like to respond. Um I can respond on behalf of U. N. C. Um are vaccine mandate date is September 21 and we do know that there is a certain percentage of our co workers who cannot get the vaccine due to medical reasons and those co workers are exempt. And typically those are probably co workers that we don't have in areas treating covid patients because of immune system issues. Then we have another cohort of co workers or teammates who would like to claim a religious exemption and those are being vetted at a system level committee. And if that exemption is denied, then it is a condition of employment for them to be to be vaccinated. It's the safest thing for our patients is we feel medically the safest thing for them and all of the individuals they work with. Uh they at that point um have the option to be vaccinated or they resign from from their position and that does strain us when we're already working short but um like I said in my earlier comments. It would seem like the right thing to do for the broader community. Um you know we have tried to spend a lot of time educating about the specific vaccines and answering as many questions as possible uh and we will know as we get closer to that date or whether we have resignations along those lines. That being said, every other health care system also has a vaccine mandate. Their date might be slightly different but these are individuals who are probably contemplating leaving healthcare altogether and that's sort of why we're short to begin with. There was burn out before the pandemic and then just the stresses of taking care of of patients under these abnormal conditions with high senses and we have visitation rules P. P. E. Constraints earlier on all of those have now subsided. But it's just the overwhelming exhaustion of taking care of all these released sick patients that people are just choosing to leave and then you add in. Some people were leaving to be travelers because um there was that demand and if they were able to do that they could make a lot more money as a traveler. But then they're working in a system that they don't know and there's less familiarity so we're doing everything we can to retain our staff and we're looking to recruit and hire more. They do know and we interview them that the vaccine is a condition of employment. You know, I would add, I would um, agree with all that was said. You know, the vaccine mandate is there to protect our patients, to protect our colleagues, protect each other, protect the community. Um, and the scientific evidence for it is really solid and very good. It's excellent. Right? So it is really hard to go turn the other way and it's mandating vaccines is not new. Right? We have a flu vaccine mandate as well. It's been in existence for years now. We mandate vaccines all over the country and for Children, et cetera. I mean, we all know that, right? So this isn't a new concept really. Um, it's just so important. It's a great question because yes, that's one of the real downsides. We hope through education and answering questions and being open about the process and why we're doing it. We hope that keeps people. Um, and and we certainly have the same exemption process, et cetera. For all of those, you know, respecting all of those various issues. Same process. I think that's that's everywhere. Um, but in the end, if you're left with some folks just, it's just, it's one of those decisions you have to make that says for the better good read of everyone that we have to make that choice. Um, other systems that have done this across the country in the end, their numbers that lever are relatively small. But again, a good question because when you're staffing is short, uh, and you're struggling with that already, right? And keeping keeping up your staff, You really don't want to lose any frontline. Great frontline worker at all. And we hope we hope they don't, we hope no one leaves. I have no one leaves any health care system for that reason. Great. Thank you for those responses. And on the end of staffing, we have another question from Jason bruhn with W. U. N. C. Um, the local NPR affiliate, he asks, we have heard about staffing shortages and burnout, especially among nurses. Can you address staffing levels, particularly among nurses at your hospitals? And some of them may dovetail with what you've already said. Is there anything you'd like to add to those comments? I think we may be captured it then it is what it is. I think we're all doing things to try and retain our staff. You can sometimes put people in non traditional roles coming out. For instance, utilizing the M. T. S. And paramedics to, to help with respiratory therapy. That's another area that's very short staffed through this pandemic. Um, I don't think north Carolina is even graduating enough respiratory therapist to meet the open positions that we have across our health care system. We're offering loan forgiveness for those who are new graduates were offering, um, you know, contract bonuses for people to pick up extra shifts if they pick up extra shifts for a certain number of hours, we have a lot of work going into trying to make sure that we are supporting not just our nursing staff, but really all of our frontline caregivers. Uh and you know, if we can get more people to choose healthcare, um you know, that's kind of where we need to go further upstream in the education system, but that's not a quick fix. That doesn't help us for this pandemic. It will help us going forward. Um There's also a lot of workplace violence issues in health care that we're all trying to address as well with the behavioral health patients, the ones that are in our emergency department. Um You know, they can be impulsive. They can strike out our dementia patients who also have behavioral issues there up on our floors. That's why the assisted living facilities can't take care of them and they bring them here. And so our staff are faced with this. And we have hired protective services individuals. I know that Duke Raleigh wake med are having the same challenges. And it's hard to recruit people to work in an environment where you have long days. You have very sick patients. You have families that sometimes can be below belligerent. And then you have these, these individuals who are striking out and they can't help it as part of their disorder. But it's not a real attractive place to to want to come and work. People do it because they have a calling to help others. And that's why we all went into health care to begin with. But we need to address those other societal issues to really want to retract more people to come into nursing or any other health care profession. And to add two points to that, the market for nurses, nurses can move around too. So, you know, if they haven't, there's a lot of reasons why the nurses and other staff have left health care for all those stressors that you just heard. It's some people are maybe we're going to retire regardless. They move towards that. Their child care issues at home. There are all kinds of stressors that were mentioned. So that puts a big, you know, pull from the nurses. Um Also one thing that relates back to the vaccination question. We have folks out because of covid positive as well. Right? So that impacts your staffing also. So, you know, that that's a big stressor on the system as well at any time. You you don't know how many you're going to have, right? And they can't be working. So, uh that number is definitely increased with Delta as well. It's just hard for people to uh not not, you know, to avoid it completely. Um doesn't mean they're getting in the hospital getting it all over like the rest of the community. Um, but that's another stressor on on top of it regarding staffing, definitely we have a few more questions that have come in. The next one is from lily and Donahue is cBS 17. She says dr brody mentioned that RsV is filling the Children's hospital on top of an increase in covid 19 patients. Why is RsV so prevalent now and was not so much in the winter? And could other illnesses like this in both the adult and pediatric populations continue to stress the health care system as we get closer to fall in winter. Yes. Um The first part of that question on R. S. V. I wish I knew I've been reading that we're looking for those answers. I don't have I don't know that anyone knows for certain. Clearly RsV is usually more of a winter illness, respiratory illness. Um That that leads to admissions uh commonly um That does happen although most people do not get hospitalized or even including Children. But that's that is something we've always seen. Something has clearly happened here related to this pandemic that has shifted it probably and there's theories about kids being out and about now again where they were cooped up right for all this time wearing mask and then we released and everyone's out and now RsV is spreading that's sort of the simplest and most direct explanation of why now. Um But there could be other reasons that I don't know that could explain. That's probably the most straightforward one. I don't I'm not going to guess beyond that as far as what's coming this fall That is very concerning. We were fortunate, which is interesting probably because everyone was wearing mask or so many people wearing masks. We had a very, very low, we had incredibly low flow rate. We had almost no emissions from flu. Um, it was incredibly low, but our usual year we peak right in late fall winter and you, we fill up the hospital at that time of year, regardless without covid without a pandemic with flu. Um, so as far as flu and RSP and all that happening, we are definitely concerned that on top of all the things we've been discussing here that will have flu patients on top of that as well. Um, so that is very concerning both for adult and pediatrics and Children. It's, we're worrying about both. Um, we, we had a time recently from RsV where are are picky was full with patients. It fluctuates, but if we're already there in the summer, we're definitely worried about what's coming. Well in our next question has more to do with our SB So I'm going to read it next. It's Patrick thomas was spectrum news and he says, I interviewed a mother last night whose child recently battled a case of RsV was hospitalized and is now recovering. She said she saw up close what hospital overflow due to COVID-19 is like wake med. She says nurses and staff were doing all they can, but it is worrisome when you don't know what's going to happen next. What would you say to parents to what should you say for parents to expect when they bring their child through the hospital doors with RSV. Yeah. Well first things first. Yes I can I I feel bad that we all feel badly that folks are waiting for care right? And waiting we're waiting for a bed doesn't mean they're not receiving any care because they're coming through our Children's E. D. Emergency department and they're being seen and care is initiated but they're often waiting. Um That's not that's not no care that is waiting for the next level of care in the hospital into a hospital bed etcetera. So there's still providing care is the first thing we do in those scenarios when they're waiting is we we are providing that care in an emergency department. The negative of that is it's not it's not the ultimate uh and it backs and it just creates more of that right? It creates a backup in that emergency department. You can't you can't see other people there's longer waits in there in the waiting room it's address. So those those patients holding like that are getting care but they're creating it creates other issues. Um We have the staffing. It's just it is a constant stress though on that to keep keep that level of care there and we have it and we're doing it and we're finding folks it's a constant daily effort. So when they do get admitted um as she said, the folks are working really hard, that's noticeable to patients. Um and I think that this is true everywhere. Um they're working hard and they're working hard to maintain that level of care. So I would reassure them, they're still getting the top level of care and best care, but there are times when you're waiting for certain services, there's there's no no doubt about it. We try to triage that the most critical services are always provided and then you do the things that that can wait. Those are the things we allowed to wait. Yeah. I also add that, I know I'm not the only emergency department who is uh working towards having a system where there are providers and triage. Um and oftentimes uh even though it may not be completely obvious to everyone that you are getting seen by providers, you are getting cared for um from from the moment you enter triage, there are nurses uh and other texting our lobbies, um lab work and x rays are getting done while you're waiting in our in our lobbies. Um You know, you know, this is sort of, I think also a national trend as well uh to to deal with surges, but you know, I would just, you know, offer that out to folks who are wondering and or sitting in a waiting room somewhere wondering what's happened. People are looking at you and looking at your labs and looking at your X rays and the nurses in the lobby or are watching and repeating vital signs and making sure that everybody who needs, um, you know, a higher level care is getting to that higher level of care. Great. Well said, uh, we have about six or seven questions left. So I'm going to cut off the entering of any more questions into the chat to make sure that we one get to all the questions that have already been asked and two, we get these doctors back into their emergency departments because as you've heard, there are great needs there and they have to go to work. But I do commit to getting back to everyone who has already asked a question. So let's get rid to it, brian Anderson says, uh, for any of the focus on the panel, if someone goes to the hospital for something besides covid 19, how often are they in the waiting room and how likely are they to become infected as a result of their presence in the hospital? In other words, how concerned should someone be that they will get covid if they choose to go to the hospital. That's why we instituted that all patients and all visitors need to wear a mask upon entry. And uh, you know, we test every one of our admitted patients. So before they end up in a bed in our hospital, we know what their covid statuses. Um, but we will test immediately based on symptoms, but the masks really just as they protect you in the community, they protect you in a waiting room. We also don't allow visitors to stay in our waiting room so that we can continue to physically distance our our patients. Um so that they have enough space and they have their mask on and that will protect them while they're going through and they're being seen. Um we do cohort all of our COVID-19 patients into particular. I see us and on certain floors behind double doors more for staff awareness so that they will wear their personal protective equipment. But they all have door shut and we have really good air exchange in the hospital with HEPA filtration and scrubbers. So you should go if you have an issue that requires R. E. D. And know that you'll be placed appropriately so that you will not have a risk of getting covid. I really think the hospitals are a safer place than going out in the community of people aren't wearing masks, so you should be reassured, you will safely be treated and you will not pick up covid while you're here. All right, thank you. Our next question is for dr companias, it comes from Richard straddling with the news and Observer. He wants to know what would a normal monthly number of VMS calls have been before the pandemic. That's a great question. So just for context, uh 2020 when the when this sort of initial part of pandemic? And sort of the initial stay at home and those orders everybody sort of volume sort of completely sort of dropped. But when you look back to a kind of a 2019 better baseline, You will see just to give some context similar time frame. This year we were averaging around closer to 300 or so calls a day and we're now around three, 157 calls a day in average. And then there's days that we've had 400. So I give you a little bit of a of a context of Of that difference. Um clearly the experience that we're seeing in the community with over 10,000 calls a month. It's a complete New uh thing for us that we've never had that threshold before. We've had prior months of 9200 calls a month for those kind of things. But you know in pace to 11,000 calls in August, it's concerning the the rapid increase in demand. Uh We all know in our health care systems and E. M. S. That there's always a natural annual growth rate. But this experience is just very rapid compared, it's not our normal uh rate of growth that we are accustomed to in health care. Thank you so much. Our next couple of questions are from Darren thomas from W. R. A. L. His first question is how much of the lack of available beds is the increase in patients from covid and how much is low staffing levels? I would say for us at wake med currently um it's not due to staffing. We've been able to even though that's an incredible stressor. We've been able to accommodate that thus far. So and we've expanded beds so that tells you the stressors that puts on your staff. What I just said right we've expanded our capacity all over and then stretched our staff that is lower than previously as others have said right to still cover all of those patients. Um There's only a point though you can stretch that rubber band, right? I mean it's so that that's where your that's where it gets tougher as the numbers keep going up and and the strain of the covid surge on top of that and you have to keep creating all of these new spaces and the level of care as we keep saying right, it's it's very labor intensive. That's one of the differences where a nurse may be able to manage uh different you know different medical conditions that they've dealt with for years and years and years, right? And know how to do it and it's it's a less sort of labor intensive. These patients require a lot of care. Just the donning and doffing and putting on all your equipment, your your your protective equipment takes time. Um Pruning patients. One of them really common things we do and they require oxygen etcetera, really takes time. It's it's not your normal level of care, even out of the it's not your normal level of care. So it's that's the that's the stressor. We've we've been we were starting at that point where again, it's the staffing concerns you because as you keep these numbers keep rising, which they currently are. Uh you know, you start to see where that just stretches more and more. So that's where we are currently. I think everyone might be a probably a similar situation but it differs depending on unit you're talking about etcetera gets down to that sort of that level of detail and you have to have the right people to cover the right things. You can't just say, I've I've just found 20 more nurses and the ambulatory practices right? In primary care and we're just gonna move them in the hospital and we're good. We have 20 more nurses. That's not how it works. Right? A lot of them haven't been in a hospital in a while, so you have to train them and then you have to put them in the right place, right at the right level of care. So it's it's a complex puzzle. I agree 100% with what Dr. Brody said we're in the same situation. Uh we've continued to keep our beds open. We have not closed any beds, even though we are challenged on the staffing front. And I think that kind of goes to his next question, which is, you know, how is the capacity for your hospital now versus where you would like to keep it? Where were well, we would like to keep it. That's that's sort of a loaded question. I think that was harder to answer. Um But what I'll say is, I mean, we were all of our hospitals in the area and I was like, we were full before this happened, right? Where all the reasons we said so, you know, and that that was already a bit of a stress. So what, where I would say where we'd like to keep it, your goal would be, could you easily create surge spaces and stuff like that where it's safe and you can provide the best care for all of the additional patients and you can continue the care that you did. That's your ultimate goal. You can continue to take care of the community for their chronic diseases, their acute diseases that are non covid, right? Not impact that at all. And then create search bases and be able to keep expanding beds to accommodate every single covid patients. That's your ultimate goal, right? I mean, that's what you want to do. Um and that's what we try to do. But what happens is as you create more and more of these search basis, which we have no choice. We are um you then have to think about shrinking down those other services, right? You have to start to think about how do we do that? That's when you're operating rooms are impacted, what kind of cases can come through, you know, and that's why we don't talk about elected versus non electric surgery. Talk about it's time sensitivity, right? You don't want to delay the surgery that needs to be done in three or four days because of covid, you can delay surgeries that can wait a month or two months or etcetera. Right? It's more about timing of the surgery. Most surgery is not quote elective. It's a bad term really, Right? It's semantics, but it's not a good term. So it's really about time sensitivity. When does it need to be done if someone has a cancer diagnosis? Could you wait another week? Sure. But how many of you would want a family member to wait months for cancer surgery? I think the answer is you wouldn't. Right. So that's time sensitive. Uh, it doesn't need to happen tomorrow. Probably not. But you don't want to wait a month either. So it's those decisions are hard. So there's always that sort of pull in those patients. Do they end up in the hospital, Do they not? You know, those kind of things. So it's it's a again, it's a complex puzzle to try to put together for everybody. Um, And when you pull on one lever, it affects the other almost always. Um, So it's a like I said, it's about surge capacity and then maintaining the care of the community otherwise? And that's our goal? Absolutely no. Another way to look at this, just from a different perspective is all of the hospitals are used to surging. We do it every flu season and typically you surge for three or four months and then summer it gets better. Our staff gets vacation, our volumes drop or physicians can take vacation with their families and then you you kind of recharge for the next surge, which happens again during the flu season. That just didn't happen. And so we've had an 18 month long flu season going into a worse flu season. And I think that's really where we are. We want to go back to the previous life where we have a 14 month surge. We're used to doing it. It's always been that way and not have this this perpetual need to stretch and take more and more and more patients. So that's a different way to look at it. Although dr brody described our lives right now perfectly and where we wish we would be. But that's just not our reality this year. Great points um are almost last question comes from Andrea Blanford with abc 11, she says among those hospitalized with Covid, who are they dr brody specifically? Can you elaborate beyond just vaccinated and unvaccinated? Are these young people who are generally healthy and athletic? Are these people with comorbidities or other diseases such as obesity and diabetes? And what would your message be to people about maintaining overall healthy lifestyles right now? Yeah, that's a good question. There's been a shift in demographics of those who are hospitalized with covid for sure. During Delta. Um, it has, as I said earlier, it has definitely impacted younger and healthier patients. One of the comments I hear from our ICU doctors that so it's really stressing folks from the emotional component of taking care of people is they'll say these are people that should only be in the hospital because they fell off a skateboard. That's one of the comments that always strikes me right. You do not expect them to be in there and then being intubated for, you know, for covid. This is not so they do not have a lot of comorbidities. Um of course we have people that do right. If you're in a no compromise and you do have a lot of comorbidities. We have, we have plenty of patients like that. In the first round of this. The first search, we saw a lot of that uh more of the elderly, more of the Cold War with lots of comorbidities etcetera. But a lot of that population got vaccinated, Especially over 65. Um we did a good job in this community across the board getting the elderly and those folks in nursing homes etcetera, vaccinated? Um so it made a big difference, Delta as you've heard all across the country where I think our average age is almost 20 years younger than it was in the first search so much younger. Um Not as many co morbidity is of course people have, but we're seeing people without them, that that is almost um then then the vaccination is the other big one. And then we'll see comorbidities. Uh, we will see those who are vaccinated. I think the rate of them having comorbidities is a little bit higher as a percent. So it speaks again to the protection of vaccination if you're healthy and vaccinated, your chance of being hospitalized is reduced 25 to 30 fold. You know, basically it's way way down. So those who've gotten very sick and are vaccinated, we are seeing almost all of those have significant comorbidities. So that's where I say that, but we're seeing pretty healthy, relatively healthy people who are younger unveiled and you know, and unvaccinated, etcetera. Uh, we saw a big demographic shifts earlier to around um, around the social determinants of health in different parts of our community, uh, including race, etcetera. Um that's still there too, to a degree. Um different vulnerable communities still seem to be um uh, admitted at a higher rate than you'd expect, but that also reflects access to, you know, vaccination, etcetera. Um as it always has. So that's still there too, to some degree. Right? Well, this is our final question for everyone. It's from chad flowers with W. R. L. He asked how would you describe the overall condition of hospital health right now? Would you say it's critical, stable? How would you describe it? Mm interesting question. Um I would say critical but stable. Um Why am I saying that? I guess more important than the words? Uh It's critical because we were you know, when you're creating new spaces in cuba including converting lobbies into hospital areas, right? That's critical. Um Are we able to, I'm saying stable because we're able to do it and we're doing our jobs and we're taking care of people so it's stable on that degree but it's critical. Um It's critical from a staffing perspective, we're doing our jobs are taking care of everyone, but how far can you stretch? Uh We had a critical levels with staffing Yes. Uh I think all of us would share in that. So that would be my answer. I take critical but we're stable and that we're still marching forward and we're still doing our everyone's doing their jobs uh to the highest level. They can I agree with dr brody that it's critical for all the reasons that we've talked about and during this press conference and I think since we have not yet reached our projected peak. Uh I know that uh at Wake med they've already exceeded kind of where they were last um last surge and were predicted to exceed our peak as well. I would say it's guarded. Um We tend not to be as reactionary. Um And you know people in healthcare stay calm. We go through codes and doctor dr Planck is in the E. D. And it's got a lot of chaos around him and he stays calm. So I think that's why the public is not understanding how critical it is right now and again. I would just use this opportunity to say please get vaccinated so that you do not end up a patient in one of our hospitals. Um We don't want your business, we want you to be healthy. Um That would be kind of what I would say. Great well thank you to our media who have participated in today's news conference. Thank you to all of our amazing physicians who have been on this call this morning. We appreciate everything that you are doing um in this challenging time to keep our community members safe. So thank you so much for that. And has everyone has been saying if you have not gotten your vaccine yet or you haven't gotten fully vaccinated yet, we can help you with that easily of Wake County. Just go to our website wake up dot com forward slash vaccine and we have places all across the county where you can get a free shot. So thank you everybody for joining us today and this will conclude our news conference. Like I said it's about sympathy right? You don't want to delay a surgery that needs to be done in three or four days because of covid all in those patients health care.