Renewed pandemic batters staff, forces hard choices at Confluence Health

Renewed pandemic batters staff, forces hard choices at Confluence Health

WENATCHEE — In the last week, two expectant mothers ill with severe COVID-19 at Central Washington Hospital have undergone emergency C-sections, in hopes of relieving their respiratory distress and saving the lives of their children.

That and other alarming insights were disclosed Monday by Dr. Mark Johnson, infectious disease specialist with Confluence Health, in a media briefing hosted by the Washington State Hospital Association. Nineteen percent of COVID-19 tests administered by Confluence, the hospital and clinics system serving four central Washington counties, are now returning positive, Johnson said, and the Delta variant of the novel coronavirus is challenging his ICU and every other hospital across the state.

From late June to early July, Johnson said, the hospital averaged five to eight inpatient COVID cases daily. That shifted in late July to August; as of Monday, there were 36 hospitalized COVID patients, five of them requiring a ventilator to breathe for them.

Johnson used one day’s tally from Aug. 23 as a case illustration: Of 37 admitted patients with severe COVID, 14 were considered to be in critical condition, requiring the highest intensity of care. None of those 14 were fully vaccinated against COVID-19.

“So in other words, we’re seeing very sick unvaccinated persons,” Johnson said.

On Aug. 23, patients’ ages ranged from 23 to 86. But of the 14 critically ill patients, more than 40 percent were age 40 or younger.

“And in the last week, we have had two third-trimester unvaccinated pregnant person admitted to the hospital with severe COVID, who had to undergo emergency C-section,” Johnson said. “So this is very telling data. This reminds us again that COVID-19 is becoming a pandemic of the unvaccinated, and we know that people who are vaccinated are still going to get COVID. This Delta variant is just so infectious — so we know we’re going to see breakthrough cases, and we are.”

Dr. Tanya Sorensen, a maternal fetal medicine specialist with Swedish Health in Seattle, said in cases of pregnant women with severe COVID-19, C-section or induced delivery might be required to save late-trimester children and to alleviate respiratory distress in their mothers, whose lung capacity is reduced during pregnancy.

“For the first time during the pandemic, we are seeing huge numbers of sick pregnant women,” she said. “Really sick women. I’m in touch with my colleagues around the state. We’re seeing ICU admissions, we’re seeing maternal deaths, we’re seeing babies born prematurely, either to help the mother breathe or to rescue the baby because the mother’s hypoxic. It’s really heartbreaking.”

That reinforces the need for women to vaccinate for COVID-19, before pregnancy or at any stage during, the medical professionals said.

“Because so relatively few pregnant women are vaccinated, they are much more susceptible,” Sorensen said.

Among other facts Johnson touched on during the briefing:

  • Sixteen percent of all positive COVID test results last week at Confluence’s drive-through testing site, 615 N. Emerson Ave., were attributed to vaccinated people. “But most of these patients aren’t ending up in the hospital,” Johnson said of those cases.
  • One critically ill patient in their 50s currently at CWH is fully vaccinated, Johnson said, but that patient is also immune-compromised, meaning they cannot mount the full response to viral infection that an average patient might.
  • When unvaccinated patients enter critical COVID care at CWH, Johnson said, “The vast majority of them are expressing supreme, profound remorse when they find out how terrible this disease is.”
  • Of all inpatients now being treated for all afflictions at Central Washington Hospital — in the COVID ward and beyond — 24 percent have tested positive for the virus. “That is untenable,” Johnson said.
  • “Our staff are incredibly exhausted. … We have critical staffing shortages. We intermittently are not able to accept transfers. Bed space is at a premium. We’ve of course curtailed elective cases. The healthcare system is really struggling as a result of this.”
  • Confluence has a critical shortage of blood culture vials, hampering its ability to diagnose a range of infections beyond COVID-19.
  • Prior to the rise of Delta, with its increased infectiousness and transmissibility, epidemiologists said a 67 percent minimum rate of vaccination among all people would greatly reduce the pandemic’s impact. Johnson said the rate may now have to hit 85 to 90 percent to have the same effect.

“Delta has changed the game,” he said. “… Because these variants keep emerging, our immune system isn’t adept enough to provide immunity for the next variant six months from now. So we know the vaccines provide a much more robust, durable and predictable immune response than naturally acquired infection, and also reduce the risk of having to go through severe COVID illness.”