If current COVID-19 trends continue, there will come a time when Decatur Morgan Hospital is unable to care for every patient, pulmonologist Dr. James Boyle said Monday.
“We now realize it is quite possible to exhaust all of our resources, and we might have to decide which patients get the resources we have available,” Boyle said during the weekly local news conference on the coronavirus pandemic.
As of Monday, Decatur Morgan Hospital had 95 confirmed and presumptive COVID-19 in-patients, including 17 patients in the COVID-19 unit at the hospital’s Parkway campus. A total of 16 COVID-19 patients are in intensive care, and all of them are on ventilators.
Boyle, medical director of the intensive care and critical care units at the hospital, said although some people believe COVID-19 is comparable to the flu, the number of patients on ventilators at Decatur Morgan indicates otherwise.
“I don’t know how to deal with all the people that think this is just like the flu. I’ve been practicing in this county since '98, (and) I’ve never had more than two or three people on ventilators with the flu in the last 20 years,” he said. “To have 16 patients on ventilators with an illness we don’t usually have is just unprecedented, which is the word of the year I guess.”
According to the Alabama Department of Public Health, Morgan County added 882 cases of COVID-19 in the week ending Sunday, for an average of 126 new cases per day. The total number of confirmed and probable cases in Morgan County is 9,464 as of Monday afternoon, while the total number of confirmed and probable deaths is 78.
Decatur Mayor Tab Bowling said during the news conference that Morgan County’s positivity rate is just under 53%, meaning just over half of individuals who are getting tested for COVID-19 are testing positive.
Boyle said the numbers of COVID-19 cases, deaths and hospitalizations have climbed significantly since he last gave an update at a Decatur news conference in September.
“Our number of hospitalized patients have increased by fourfold,” Boyle said. “The number of deaths have also more than tripled.”
Boyle said a shortage of staff, in part due to staff testing positive for or being exposed to COVID-19, has been the hospital’s main difficulty in treating COVID-19 patients.
“Our biggest problem is not necessarily finding rooms or even finding ventilators, it’s maintaining staff,” he said. “If we had 100 ventilators, we couldn’t use them all. We just don’t have the staff to maintain that. All of that just stresses the system to the point that we don’t have the physical bodies to take care of all these people.”
Boyle said the hospital is not yet to the point of having to decide which patients receive treatment, but if the upward trend in cases and hospitalizations continues, it is a possibility.
“We’re not close to that today, but you have seen that in the last three months all of these numbers have quadrupled. We cannot quadruple these numbers (or) we will reach that point,” Boyle said.
Boyle said the hospital has formed a committee which will decide which patients receive treatment if it gets to the point where there aren’t enough resources for everyone.
“It becomes an ethical dilemma to proportions; it would take days to go through,” he said. “We will exhaust every possible avenue that we have. If it’s a ventilator issue, we will put people in our ICUs, we’ll put them in our post-op units, we’ll put people on ventilators in the operating room if we need to. But somewhere along the way, we run out — we don’t have a respiratory therapist to take care of (the) equipment, or we don’t have nurses to give the medicines. You know, this all comes to a stop when you don’t have a nurse.”
Like other doctors and health officials, Boyle said he expects a spike in hospitalizations following Christmas.
“We anticipate that we’ll have another surge in admissions after Christmas. Counties all over north Alabama have reached record numbers of new cases in the last week,” Boyle said. “I am praying for a Christmas miracle. I hope the forecast models are wrong. I pray the number of infections and deaths go down after Christmas.”
Boyle said people should reconsider family gatherings this Christmas to avoid a spike in cases.
“I do need your help. I need you to be the courageous voice in your family that stands up and says, we do not get together as family this Christmas, so we can get together next Christmas,” Boyle said.
Boyle said 238 doctors and nurses at the hospital have received their first dose of the COVID-19 vaccine since Wednesday.
“Decatur Morgan was not on the list to receive the initial doses,” Boyle said. “We were vaccinated through the generosity of Athens Limestone Hospital, and I would like to thank them tremendously for that.”
Boyle said he experienced minor symptoms from the vaccine, including tenderness at the injection site.
Decatur Morgan Hospital has not yet received the Moderna vaccine, which received emergency use authorization from the FDA on Friday.
“We are expecting our shipment of the Moderna vaccine either (today) or Wednesday,” hospital spokeswoman Noel Lovelace said.
The Huntsville Hospital system has administered a total of 1,707 vaccines to health care workers as of Monday.
Strain on Staff
Boyle said hospital workers are trained to deal with death, but the high number of patients dying of COVID-19 has been hard on the staff.
“That’s part of what we do, that’s part of our training. The difficulty this year is just the tremendous number. We can’t grieve for one patient before we have to go take care of another, and we can’t grieve with the families like we normally grieve,” Boyle said. “We’re going to see suffering from this pandemic for years to come. That’s really the hard part.”
Boyle said many of the COVID-19 deaths are from intensive care patients, while some have died before they could be moved to intensive care, or while in hospice care.
Boyle said he’s disappointed by the number of people who aren't taking precautions, despite the climbing numbers. He said he’s not confident that stronger mask mandates would help.
“The other thing that’s a little disappointing is that we can’t get people to do the basics, to wear a mask, to separate. It’s easy to go in a convenience store and see people not wearing their masks. It’s a little defeating,” he said. “I don’t know if stricter (mask requirements) would make a difference. People have to decide, do they care about others, and like Dr. (Anthony) Fauci said, I don’t know how to get you to do that.”