***AUTHOR’S NOTE: Under ordinary circumstances, most hospitals would not grant media access to their ICU, nor would our news organization seek it. The extreme seriousness of the situation in hospitals across West Virginia led WVU Medicine officials and us to come to the conclusion that this information needed to get out to the public. While in the COVID ICU, our staff did not enter any patient rooms and did not interfere with patient care. All of the video and still images associated with this series of reports was reviewed by WVU Medicine officials to insure patient privacy.
MORGANTOWN, W.Va. – For weeks there has been a lot of talk about how the most recent COVID-19 surge has put an immense strain on West Virginia’s hospitals, but what exactly does that mean and what does it look like? WVU Medicine recently invited us inside one of the busiest COVID ICUs in the state to get a better understanding of the situation.
On a recent day, a lone room was empty in the Medical ICU at WVU Medicine’s J.W. Ruby Memorial Hospital in Morgantown. With a waiting list stretching around the state and beyond, the room, like every other one in the ICU, would soon be home to a very ill COVID-19 patient. Patients that the ICU doctors describe as being “on the precipice of death.”
Moments after we stepped inside the ICU, tones rang out over the loudspeaker: “Adult code blue, eight Southeast, adult code blue, eight Southeast, adult code blue, eight Southeast, adult code blue, eight Southeast,” a male voice repeated.
Without being prompted, Dr. Alison Wilson immediately launched into an explanation: “Adult code blue is where there is a respiratory arrest, meaning someone’s in extremis, unable to breathe or oxygenate adequately. Eight Southeast is our COVID floor. So right now, what you’re hearing is a patient who has reached the limits of what they can do with either bi-pap or high flow (oxygen), and they’re putting them on mechanical ventilation. Whether that’s a young person or old person they’re in for a long road.”
This ICU full of COVID patients isn’t just a problem at the hospital in Morgantown, it’s affecting hospitals, on varying levels, all over West Virginia and the region.
We asked Dr. Wilson where the patients in the ICU were coming to Ruby Memorial from and she quickly listed off smaller hospitals from all over the state: Beckley, Berkeley, Bluefield, Greenbrier, Teay’s Valley and Wetzel were the first that came off the top of her head.
Being one of the largest hospitals in West Virginia, it’s not uncommon for very ill patients to end up at Ruby Memorial, but why are so many being sent to Morgantown right now? Dr. Wilson explained: “Because some of their normal referral places are also full. So Wetzel would usually go to Reynolds or to Wheeling, Wheeling also is working really hard and they have a very sophisticated ICU, but they’re now in their third level of expansion of ICU overflow. They only have so many nurses and physicians too. So as those places get saturated, then we can’t offload the small hospitals with the really limited resources. The skilled nursing facilities are either full or closed for various issues and all the long-term acute care facilities where a patient could go for a gradual wean off the ventilator, once their severe illnesses rectified, are completely full. So there’s no place for them to go.”
Dr. Wilson is the executive director of the Critical Care and Trauma Institute at Ruby Memorial. She is also the chair of the West Virginia Committee on Trauma, making her one of a few medical professionals in the state who help decide which patients get moved to different levels of care, from hospital to hospital.
Making those decisions is not an easy task, made all the more difficult by the state’s rural characteristics. “One of the biggest challenges that we have in West Virginia is that we don’t have a whole lot of large expansive or tertiary care centers, and so we really rely on our community hospitals and in particular, the critical access hospitals to be able to provide initial care for evaluation and stabilization. The state, for a long time, has relied then on the ability to be able to get patients out of those critical access hospitals and get them to larger community hospitals, such as United Hospital Center(in Bridgeport) or Berkeley(medical center in Martinsburg). Then eventually if they need tertiary care, get them onto the larger centers such as WVU at Ruby or CAMC(Charleston Area Medical Center),” details Dr. Wilson.
Getting patients through that process, to the level of care they need, is taking time. Prior to the recent surge, that time was measured in hours, now it’s measured in days. “Being able to get those patients to the higher level of care has been encumbered in what used to be a couple of hours, is now sometimes three to eight days,” Dr. Wilson told us.
During those transfer delays, patients are staying in smaller hospitals that are not designed or staffed to provide long-term care, causing an additional set of challenges. Providing oxygen is a large part of the treatment given to many COVID patients. Some of the older facilities, like Braxton County Memorial Hospital, in Gassaway, were built with smaller diameter oxygen pipes, that were never intended to care for patients over long periods of time, Dr. Wilson explained. Meanwhile, at Camden Clark Medical Center, in Parkersburg, the demand for oxygen has caused issues keeping that building’s system properly pressurized, Dr. Wilson said, leaving staff there doing “advanced math” on a daily basis to PSI levels correct. Wetzel County Hospital, in New Martinsville, has only two respiratory therapists on its staff, Dr. Wilson says. Those therapists are the ones who work to get patients on ventilators and to manage their oxygen flows. It’s a 24-hour process.
“We have gotten to the point, throughout the whole state, really of really overwhelming the local resources. And I think the brunt of it is really felt on the front end at the small critical access hospitals and small community hospitals. I mean, God bless them. They’re working extra hours with very limited staff trying to do the best they can,” Dr. Wilson said, summing up the situation.
Dr. Wilson went on to tell us that all of issues are not just affecting COVID patients:
“I hear people say, well, you know, if people chose to stay unvaccinated, then they made their choice. Right? But that’s not true. Only 50% of the people they’re calling to transfer are COVID patients, with a lot of other patients who this is affecting: the dialysis patient, the heart failure patient, the trauma patient, the stroke patient, the heart attack patient. There’s really no one who’s getting an ICU bed anymore, out of caution. We’re now not able to offer that level of care, not just here, but at any of the big centers. Every one of these patients have at least one organ system that’s failing and many of them have multiple organ systems that are failing.”
“It’s impacting others. For example, we are having to prioritize patients who have brain tumors. The brain tumor patient is being impacted by all the other institutions being overwhelmed. So it’s not just COVID care. It’s cancer care, it’s orthopedic care, it’s heart care. I’ve not seen a system overwhelmed to this degree and for this period of time. And my concern is that if it’s sustains and, and the public view or understanding is such that they think the world is back to normal, that I’m not sure what that end point is.”
***This is the first in a multi-part series. Throughout the series, we will hear from many ICU members about what it has been like working throughout the pandemic and what role staffing shortages are having on the situation. We’ll learn more about a last ditch medical procedure for COVID patients, known as “proning.” We’ll also hear from ICU doctors and nurses about the majority of their patients who are unvaccinated. Additional stories will be posted on this website and will air during West Virginia Tonight, during the week of Oct. 4, on WBOY(Clarksburg/Fairmont/Morgantown), WOWK(Charleston/Huntington), WTRF(Wheeling/Steubenville), WVNS(Beckley/Bluefield) and WDVM(Hagerstown/Martinsburg).