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MADISON, Wis. — As the country’s third wave of COVID-19 threatens to become a tsunami and Americans debate whether to gather for Thanksgiving, surges in the Midwest are overwhelming hospitals and efforts to curb the spread of the coronavirus.
With records being broken in some form nearly every day, states such as Illinois, Indiana, Iowa, Michigan, Minnesota, Ohio and Wisconsin are relying on a range of efforts to rein in the pandemic, including direct appeals to the public from governors.
But as COVID-19 hospitalizations soar amid shortages of nurses and other health care workers, the situation in some places is becoming severe.
“We’re getting close to the breaking point,” said Dr. Jeff Pothof, chief quality officer at University Hospital in Madison, Wisconsin. The 505-bed hospital plans to open an eighth wing for COVID-19 patients soon, might place some patients in pre-op waiting rooms and is postponing procedures for others, such as those seeking heart valve replacements.
“If things don’t change, and I don’t have anything that’s telling me that it’s going to change, we could be in a position where we’re rationing care,” Pothof said.
At Franciscan Health’s hospital in Michigan City, Indiana, more than 90% of beds are occupied, with roughly a third filled by patients with COVID-19, a higher proportion than early in the pandemic.
“We are definitely heading down a path that’s not a good one for us,” CEO Dean Mazzoni said.
Dr. James Leonard of Northwest Health said all of the health network's hospitals in LaPorte, Valparaiso and Knox in Northwest Indiana are at capacity. If cases keep climbing at current rates, “we will actually be beyond our capacity to safely care for these patients and we’ll be looking downstate to get some help,” Leonard said.
Nationally, daily new cases surpassed 150,000 for the first time Thursday, and coronavirus hospitalizations exceeded 65,000. COVID-19 deaths, still below levels in the spring, have climbed more than 40% over the past two weeks and set records last week in places like Wisconsin, where health officials said just 8% of intensive care beds remained available.
The Dakotas and Wyoming had the country’s highest infection rates last week, but Iowa and Wisconsin weren’t far behind, according to the COVID Tracking Project. Activity in Illinois, Indiana, Michigan and Minnesota was also higher than in most states.
The unprecedented U.S. increases, following previous peaks in April and July, come as many Americans consider doing what health officials say they should avoid — getting together on Thanksgiving with family or friends outside of their immediate household.
“Unfortunately, the COVID-19 epidemic is worsening, and small household gatherings are an important contributor to the rise in COVID-19 cases,” the federal Centers for Disease Control and Prevention reported. In a recent directive, the agency recommended online celebrations or at least keeping in-person meetings very small, outdoors or well-ventilated, and wearing masks when not eating.
Ohio's Republican Gov. Mike DeWine reissued a mask order and said retail stores would be closed for 24 hours if inspectors twice found workers or customers didn’t comply.
In a televised address on Veterans Day, DeWine referenced soldiers who died for the country and asked for another form of sacrifice. “Today we all must do something far less dramatic, but very important,” he said. “Wear a mask, so that your friends, neighbors and family members might live.”
The previous night, Wisconsin Gov. Tony Evers, a Democrat, gave a similar address, announcing an order advising residents to stay home.
“It’s not safe to have others over, it’s just not safe,” said Evers, who cited a respected University of Washington projection that the state’s COVID-19 deaths, which reached 2,515 Thursday, would hit 5,000 by Jan. 1 without additional preventive measures.
DeWine, Evers and the governors of Michigan, Kentucky, Illinois, Minnesota and Indiana in April pledged to closely coordinate their pandemic responses.
Little has been said publicly about the effort in recent months, but last week Evers said the bipartisan group of governors is buying some protective equipment together and asking Congress to send more COVID-19 relief aid to states.
“We do talk regularly,” Evers said. “Primarily we look at different strategies that work or don’t work.”
'COVID storm'
In Illinois, COVID-19 hospitalizations reached a record 5,258 patients Thursday, in what Democratic Gov. J.B. Pritzker called a “COVID storm.”
Pritzker criticized local officials, some of whom declared they won’t enforce his restrictions on bars and restaurants.
“What will it take to make this real for you?” Pritzker asked. “Do we have to reach a positivity rate of 50% like we’re seeing in Iowa today? 50%? Are you waiting for health care workers to get sick to a point where you don’t have enough staff in the local hospital to cover the next shift?”
Hospital officials agreed the situation was becoming a crisis. “If we don’t get the numbers down, it’s only a matter of time before the hospitals will run out of beds and staff,” said Danny Chun, spokesman for the Illinois Health and Hospital Association.
While the first surge in April and May was mainly in the Chicago area, “it’s now statewide,” Chun said.
A consortium of health care professionals predicted Illinois will surpass its ICU capacity by Thanksgiving and daily COVID-19 deaths will peak by mid-December.
“These trends affect not only COVID-19 patients; if hospitals are overwhelmed, care will suffer for those with other unforeseen emergent conditions, such as heart attacks, appendicitis, cancer diagnoses, and motor vehicle accidents, all common conditions,” the Illinois Medical Professionals Action Collaborative Team said in a letter.
Bed capacity isn’t the only concern. Using more beds requires expanded staffing at a time when many hospital workers are themselves out sick after contracting COVID-19 or being exposed to someone who has, said Dr. Marci Moore-Connelley, chief medical officer of Southern Illinois Healthcare, which has COVID-19 units at its Carbondale Memorial and Herrin hospitals.
Those staff who can still work are often stressed, said Melissa Reidy, clinical coordinator at Carle BroMenn Medical Center in Normal, Illinois.
“The patients we’re seeing are really sick. They need a lot of care,” Reidy said. “COVID is unlike anything that I’ve experienced in my 12 years as a nurse ... When (nurses) are working four or five, 12-hour shifts a week, it takes its toll.”
At Decatur Memorial Hospital, Dr. Ted Clark pointed to charts depicting the growth of COVID-19.
“You see that red line ascending into the clouds?” said Clark, chief medical officer. “That is our rolling seven-day positivity rate. And if you think of this epidemic as a train, that is the speed that we’re moving and it tells us how fast this is expanding in the community and what the downstream effects are going to be.”
The hospital has four times more COVID-19 patients than earlier in the pandemic and expects the number to rise. “If we’re now nearly doubling our seven-day positivity rate, we can anticipate the doubling of our future in-patient cases,” Clark said.
In Mattoon, where surrounding Coles County had record new cases, health department administrator Diana Stenger summed up the public health message about the coronavirus.
“It’s everywhere,” Stenger said. “People are continuing to gather together in social environments."
Managing for now
Indiana is also seeing record numbers of COVID-19 cases, with more than 6,600 reported Thursday, as its testing positivity rate and number of daily deaths approach highs set in April.
COVID-19 hospitalizations have more than tripled in a month in the Hoosier state, exceeding 2,500 last week, according to the Indiana State Department of Health.
But while Mishawaka-based Franciscan Health reports high volumes of COVID-19 patients at its hospitals in Crown Point, Dyer, Hammond, LaPorte, Michigan City and Munster, the health system is “safely managing” patients, said Mazzoni, the CEO.
“We remain hopeful that, through all of the efforts we know mitigate transmission of this virus — masking in public, social distancing, frequent handwashing, isolating if symptomatic — we will see hospitalization rates plateau soon,” he said.
Methodist Hospitals in Gary and Merrillville in Northwest Indiana also have seen a surge in patients.
But, CEO Matt Doyle said, “We are confident that we have the staff and resources to care for these patients and we are taking steps to ensure that we can continue to accommodate all those who need care, such as expanding the number of isolation rooms in our hospitals.”
Statewide, nearly three-fourths of ICU beds were in use mid-week but more than three-fourths of the state’s ventilators remained available, the health department said.
"This data also is utilized to make decisions on when additional medical equipment, beds and personal protective equipment such as gloves, masks and gowns may be needed," said Marie Forszt, a spokeswoman for Community Foundation of Northwest Indiana, the parent company to Community Healthcare System. "At this time, there is abundant PPE as well as capacity in the healthcare system to handle the volume of cases."
Reopening plan
In response to the rising cases, Indiana Gov. Eric Holcomb recently removed the state from the final level of his five-stage reopening plan in favor of specific COVID-19 prevention guidance for individual counties.
Holcomb, a Republican, begged Hoosiers to take COVID-19 seriously and to make a personal commitment to wearing a face mask, social distancing and practicing good hygiene so the state doesn't have to take additional remedial actions.
"Unfortunately too many of us, and around the country, have let our guards down," Holcomb said. "Stage 5 has been viewed by some as a reason to return to the days before we ever heard of the words 'COVID-19' or 'pandemic' in a modern-day sense.
"Rather than doing the things that we had been doing that allowed us to open our restaurants and shops and museums and attractions to full capacity — while maintaining social distancing and wearing mask coverings — too many have said 'We'll just ride it out, and if I get it so be it.' And that brings us to where we are today."
Taking the place of the stage 5 reopening the state achieved Sept. 25 is a color-coded county map that shows 78 of Indiana's 92 counties in orange, including Lake, Porter, LaPorte and Jasper counties in Northwest Indiana.
Nine counties, including Newton County, are in the highest-possible red category, while five counties are one notch below orange in the yellow category.
Holcomb said all businesses soon will be directed to post signs on their doors informing customers and employees that face masks must be worn on the premises, and businesses must ensure only people wearing face coverings are admitted.
The governor is making $20 million available to local governments to support COVID-19 event plan reviews, education and compliance programs, as part of an effort to ensure Indiana hospitals maintain the ability to care for all Hoosiers in need.
"Our frontline medical personnel — our nurses and assistants and doctors — are exhausted and overwhelmed, and need us all to do the things that we can, on the outside, that will slow the number of patients that need hospitalization and their treatment on the inside," Holcomb said.
'Blowing up'
Minnesota, where COVID-19 activity was considerably lower than in neighboring Wisconsin for most of September and October, reported a record 7,228 cases Thursday as it, too, became a hotspot.
Winona Health, the only hospital in Winona, is monitoring the situation, CEO Rachelle Schultz said.
“The surge that appears to be underway right now due to the high positivity rate in our community is being watched closely and we evaluate beds, staffing and supplies and all of our services so that we are prepared,” she said.
In Iowa, pleas from hospital and public health officials have been in unison: All residents must do their part to slow the spread of COVID-19 or Iowa hospitals may soon become overrun by patients infected with the virus, and then Iowa’s health care workers, too, may become overwhelmed by the surging patient load.
“It is starting to get dire,” said Dr. Matthew Sojka, chief medical officer for Mercy One-Northeast Iowa.
Iowa on Tuesday reported a record 230 new COVID-19 hospitalizations, blowing past the previous high of 181.
In southeastern Wisconsin’s Kenosha County, where COVID-19 cases and deaths are “skyrocketing,” the testing positivity rate was 29%, said health officer Jenn Freiheit.
“That’s as high as it’s ever been, and that’s really, really bad,” she said. “You want your percent positive rate at like 4 to 6% in order to control a virus.”
With coronavirus hospitalizations increasing, “it’s just blowing up,” Freiheit said.
The county's efforts to interview people who test positive and reach those with whom they have been in close contact can't keep up, as is the case throughout most of the state. “Public health as a system is extremely stressed,” she said.
'Long hauler'
Western Wisconsin “is in crisis," the La Crosse-based Coulee COVID-19 Collaborative declared earlier in the week. "Every metric we track is gravely concerning, and projections show that without a significant change in behavior by everyone in our community hospitalizations and deaths will continue to increase,” the group said. “This is an emergency.”
Northwest of Madison, Sauk County Health Deputy Director Cathy Warwick has experienced the coronavirus professionally and personally.
Warwick contracted COVID-19 in July after her husband, a pharmacist, became ill. Though she initially had mild symptoms, Warwick has continued to experience “brain fog,” fatigue, trouble sleeping, muscle aches and, most surprising, hair loss.
She is considered a “long hauler,” someone with lingering complications of coronavirus infection.
“I think that what people don’t understand is that we don’t have enough information yet to know how many people will have lasting troubles from this virus, and have it not be acute, but have it be chronic,” Warwick said. “I’m hopeful that it’s going to get better, but I don’t know."