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NGHS could hit staffing capacity in early May, peak in COVID-19 cases in early June, model shows
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N95 respirator masks are stored in bags along the wall of Northeast Georgia Medical Center in Gainesville. At the end of their shifts, employees put their masks in paper bags and place those bags in plastic bags with their names on them to extend the life of the PPE. - photo by Northeast Georgia Health System

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Update, April 30: Northeast Georgia Health System has adjusted its expectations on when it may hit staffing capacity, with that date now projected for May 22.

Previous story: Northeast Georgia Medical Center expects to reach its staffing capacity May 4 and its peak in COVID-19 patients the first week of June.

An influx of health care workers provided by the state could push that May 4 date back.

NGHS uses a projection model developed at the University of Pennsylvania that considers several factors such as regional population, social distancing, length of hospital stays and what percentage of people with COVID-19 are hospitalized.

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Nurses and staff work in a dedicated COVID-19 Intensive Care Unit on the fifth floor of Northeast Georgia Medical Center Gainesville’s South Patient Tower. - photo by Northeast Georgia Health System

As of Friday morning, the Northeast Georgia Health System was treating 132 patients with COVID-19 at its four hospitals and New Horizons Limestone, a long-term care facility. As of Friday afternoon, 239 COVID-19 patients had been treated and released from facilities, according to NGHS spokesman Sean Couch. 

The state Department of Health has reported 1,022 COVID-19 cases from Hall County and nine deaths as of 7 p.m. April 24, numbers that lag behind the NGMC data as state epidemiologists work to verify numbers submitted at the local level. The health system April 24 reported 1,094 positive cases among just the specimens NGHS and Longstreet collected. DPH and other providers also are collecting specimens for testing.

The state data also puts Hall County’s per capita rate at 493.4 per 100,000 residents, which is the highest in North Georgia.

Reasons why Hall is a hot spot for the virus may be related to socioeconomic trends. The virus has disproportionately affected the county’s Latino population, though hospital officials stress it’s an “equal opportunity virus.” 

“The most compelling trend we’ve seen in our data has been that the virus seems to be disproportionately spreading along lower socioeconomic demographics,” Dr. Supriya Mannepalli, chair of NGMC’s Infection Prevention & Control Committee, said Friday. “It’s reasonable to think that’s likely due to those households having less space to practice proper distancing, having multiple generations living together, having jobs where remote working isn’t an option, not being able to afford cleaning supplies, lack of access to accurate information, etc.”

While the numbers of patients have been increasing, NGHS has also worked to increase its capacity.

Carol Burrell, CEO of the health system, said in a Zoom call Wednesday with the Greater Hall Chamber of Commerce that ICU capacity at the Gainesville and Braselton hospitals has increased from 91 to 134 beds, and medical-surgical bed capacity has been increased from 472 to 522. The system has 108 ventilators, she said.

Couch said 38% of the system’s ventilators were in use Friday afternoon.

“These patients require much more acute staffing, sometimes two nurses to one patient in many cases. So, when we’ve added 50 beds, that would require an additional 100 nurses, which of course we obviously don’t have sitting in a back room anywhere,” Burrell said. “Plus, those that are here, they’re tired. It’s very intense work. They’re working overtime, and some of our employees are now testing positive.”

NGHS has been communicating with the state about staffing and with other health systems about the possibility of transferring patients, Burrell said. 

“We’ve taken some of our staff that are not trained in critical care and partnered them with our critical care nurses … so they can support that nurse so they can focus their skillset on the critical needs of the patient,” NGHS chief strategy executive Tracy Vardeman told The Times Wednesday. “We know that by May 4, if the model is correct, then even our ability to do those types of strategies, we’d be exhausted in terms of our staff’s ability to do that. We wouldn’t have enough staff to do that.” 

The Georgia Emergency Management and Homeland Security Agency is providing a 20-bed ICU unit at NGMC Gainesville that is expected to be operational May 5. The state is sending about 100 health care professionals — including nurses, doctors, respiratory therapists and emergency medical technicians — who will work with hospital staff at the unit, which could help with staffing shortages.

“In communities like Tifton and Gainesville, they’re having some hot spots there, mainly with the health care workers, which is one of the reasons that we have signed a contract with a private sector vendor for additional health care and medical teams, as well as having the National Guard medical teams that are deployed at all our hospitals to help them with that situation when it arises,” Gov. Brian Kemp said Wednesday during a telephone town hall with U.S. Sen. Kelly Loeffler. 

The state is partnering with Jackson Healthcare, a Georgia company that helps health systems with staffing needs, to provide medical personnel for the unit, which will be located near NGMC’s North Tower.

“Through our internal team of recruiters and our partner agencies, our family of staffing companies find and place a wide variety of health care workers into both temporary and permanent positions across the country,” Shane Jackson, president of Jackson Healthcare, said in a statement. “We have teams that assist these professionals with travel and housing.”

Jackson Healthcare staff will start arriving in Gainesville over the next few weeks. One respiratory therapist started April 24, two more will start April 25 and a larger group that includes both nurses and respiratory therapists will start on Monday, April 27. 

Brenda Simpson, NGHS chief nursing officer, said collaboration with the state could delay the May 4 date projected when the health system could hit staffing capacity.

“Adding any staff and capacity at this point will obviously help, and we’re very appreciative of the state providing the unit, supplies and staffing,” Simpson said in a statement. “In fact, after some further conversations with the (Georgia) Department of Community Health this week, the state is helping us bring on additional staffing to support other areas of our hospitals as we continue to see an increase in COVID cases. Our hope is that work will push the May 4 date back.”

Staff from other areas of the hospital are helping on COVID units, but NGHS is working to limit this and staff are taking precautions, Simpson said.

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Specimen Processors inside the Northeast Georgia Medical Center Core Lab test blood for the hospital's needs Friday, April 3, 2020, in Gainesville. The lab also performs coronavirus testing. - photo by Scott Rogers

“We try to limit staff working on COVID-specific units from also working in other areas of the hospital — and they do not move between other areas during shifts. They also follow proper precautions for hand hygiene, and people help them put on (personal protective equipment) at the beginning of shifts and take it off at the end of shifts to watch for potential safety issues,” Simpson said. “They may work in a COVID unit one day, then go home and return to work in a different unit the next day.”

Georgia National Guard members are also serving at NGMC.

Vardeman said Kemp “did emphasize that they will continue to closely monitor existing and potential hot spots in our state.”

“We know that they recognize that we have some unique community needs here, specifically in Hall County,” Vardeman said, adding that the trends may be different than what is seen statewide.

Health care providers on the Zoom call Wednesday with the chamber encouraged people to take precautions to prevent the spread of COVID-19 as some businesses in Georgia reopen.

Dr. Shravan Kethireddy, medical director of critical care at NGMC, said people who are younger and without pre-existing conditions can still get very sick from the virus. The hospital’s sickest patient as of Wednesday is in the 30s, Kethireddy said.

“Infection is affecting able-bodied, working people that have little medical conditions. It’s taking weeks for them to leave the hospital,” Kethireddy said. “You can only imagine that if people are enthusiastic about going back to work, it’s not affecting simply just the nursing home folks and those with comorbid disease (multiple diseases) that we hear about in the news.”

If businesses reopen, they should take precautions to avoid further overwhelming the hospital with COVID-19 patients, Kethireddy said. 

“Continuing to shelter in place is critical, but if people are going back to work, the main thing is to have a very strong idea of what social distancing means and what their plan is going to be at work,” he said. “... What we don’t want is a surge of 30- and 50-year-old people coming in that end up requiring two weeks in the ICU. Some may not survive when we get to capacity. That’s the real fear.”

Mannepalli said the virus could return in the fall or remain an issue until then. 

“If we don’t do the right thing, this could just continue all the way to the fall,” she said. 

While NGHS urgent care and physicians offices, as well as the Longstreet Clinic, Georgia Department of Public Health and other providers, are offering testing locally, Michael Covert, chief operating officer for NGHS, said there are not adequate supplies for universal testing.

“In terms of being able to do it for the community, that would still be a great challenge,” Covert said. 

Kemp said the state set a record Wednesday by testing about 6,000 people, up from about 3,000 Tuesday. 

Mannepalli said COVID-19 symptoms that providers look for have also broadened as more information about the virus becomes available. Some of the less common symptoms include loss of smell or taste, she said.

“The first week, it tends to be very mild, and then towards the second week, past seven days, the symptoms start to worsen,” Mannepalli said. “So, it’s very important to monitor.”

She said about 45% to 50% of people with the virus never show symptoms. 

Mannepalli said it is important for people to stay home, wear masks when they go out and wash hands often. 

“Our guard is still going up, and we cannot loosen our guard now,” Mannepalli said. “Our frontline physicians and nurses are doing everything they can to prepare us to face this pandemic, but really what happens in the hospital will be defined by what happens in the community.”