‘The system is overwhelmed:’ fifth wave stretches hospitals, EMS thin

The emotional toll on Grays Harbor County’s EMS and hospital workers during the fifth wave of the COVID pandemic bubbled to the top at a special Board of Health meeting on Thursday.

Grays Harbor County Public Health epidemiologist Ben Glosenger started the meeting with a look at the current situation in the county. There were 98 cases reported in a single day, Sept. 14.

In terms of cases, “we’re pretty much as high as we were in the third wave” over the winter, Glosenger said. The new cases per 100,000 population over a two weeks span metric has exploded, from around 200 in May and June to 1,000 or more currently.

Dr. Julie Buck has been in the health field in the county for 18 years and on the county’s COVID response policy group for almost two years. Currently, she is the Quinault Indian Nation EMS Medical Program Coordinator.

She’s seen a lot in her time in the county, and her emotions flowed during her presentation to the board of health about the toll the fifth wave is taking on local health workers.

“The system is overwhelmed,” she said.

Early in the pandemic talk was about flattening the curve, “and I think we did a fabulous job of that in this county,” said Buck. “Until recently, we actually had difficulty with people not going to the hospital when they should have for the usual problems, heart attacks, strokes and things like that.”

Buck said, “The last few months have been very different.”

Staffing at the hospitals, nurses in particular but “across the board,” is critically low. “Both hospitals have had to close inpatient beds because they could not find nurses. (Harbor Regional Health Community Hospital) closed an entire floor, trying to mobilize nurses to staff the ER, and there’s still not enough.”

Staffing issues are due in part to the high level of burnout and local staff moving on to less stressful, less dangerous jobs, said Buck. And EMS is also stretched thin.

“Even before COVID our EMS was understaffed,” said Buck. “We lose medics and EMT’s to the I-5 corridor routinely, we get them young, we grow them up, they go get better jobs. That’s just sort of our lot in life. We’ve had struggles with transporting patients because of lack of EMS staff for years, and even before COVID there was pretty routinely mandatory overtime for most agencies.”

Lack of hospital staffing means EMS has to transport longer distances to get to facilities that have available beds.

“Now there’s no place to get patients in the county, a lot of days that’s because the hospitals don’t have the nurses to take care of the patients when they are admitted, and those patients need to be transferred,” said Buck. Or, they are just treated in the ER and released because there aren’t any beds for new patients to be admitted.

Buck’s voice began to crack as she described hospitals having to go on “divert” status, meaning EMS has to travel as far as Pierce County to find an available bed.

“When hospitals go on divert it’s because they feel that it’s not safe for them to take even one more patient,” she said. “EMS is put in the position of having to drive long distances, either to the next hospital in the county and sometimes out of the county. At one point we were going as far away as Tacoma from the beaches for routine medical problems, and that puts a huge stress on the medics and EMTs.”

Staffing in EMS and hospitals is difficult to maintain in a county where resources during the best of times are not up to the standards of other services in more populated areas.

“It’s incredibly difficult to work in a system with so few resources that you feel you cannot care for your patients,” said Buck. “And this applies to nurses and medics and across the health care spectrum. If you go home every day and wonder if you did any good, and it feels like you could have done better ‘if only,’ that wears you out. That takes a toll.”

The county is fortunate to have a core of dedicated health care professionals, she said.

“We have amazing nurses, and doctors and medics who want to stay here and work hard and do their best because they know the system is better with them than without them,” said Buck.

As the emotions overwhelmed Buck, county health officer Dr. John Bausher broke in to talk about the frustration among public health officials at the low level of vaccinations in Grays Harbor County compared to state levels.

“In talking to our hospitals right now, all of the patients that are on ventilators and are in the ICU for COVID are unvaccinated,” said Bausher.

He continued, “The pressure on the hospital is enormous.” Beds that are usually occupied by patients with other diseases are filled with unvaccinated COVID patients, the treatment of whom is much more intense and is overwhelming the system.

Bausher related stories from his private practice of the struggle of severe COVID cases.

“I listened to families who actually bring in details of the loss of their loves ones who were unvaccinated, and sometimes it’s very graphic, reading every email that they had with them while they were being hospitalized until the email stopped and they met their demise,” said Bausher. “So on a personal level and from a colleague level, I don’t think the public really is understanding the pressure that the medical system is feeling.”

Vaccinations are an effective tool against COVID that can go a long way to knocking down the fifth wave and taking the overwhelming pressure off local health care services, said Bausher.

“I feel we have some tools but they are not being utilized (vaccines),” he said. “Yes, the majority of people will do well with this disease or survive without serious consequences. But when we have an advantage, and we don’t take advantage of a resource, it’s a conundrum to the medical community.”

Buck returned, saying vaccines were not designed to save everyone, but by getting vaccinated you’re taking the strain off the health care system.

“If you have all the adults vaccinated, which we know is never going to happen, you still have this pool of children that are not vaccinated,” said Buck. “They’re going to grow COVID, they’re going to make mutations, they’re going to give that back to people who are vaccinated, and they’ll make their own variants that will defeat the vaccination.”

She continued, “If we get people vaccinated, we decrease how many billions and billions of copies of this virus are made every day. Therefore, we decrease the number of mutations, therefore we decrease the chance of growing a variant that can overwhelm the vaccination.”

While some focus on the death rate, about 1.7% of all cases, Buck said that is not necessarily the worst outcome of COVID infection.

“I think that people who don’t live in medicine, they don’t understand that. Death is not the worst thing that can happen. There’s a lot worse outcomes than just not waking up in the morning. And we’ve seen that a lot with COVID,” said Buck.

”I have patients every day that 10 months or so out asking me, when am I going to stop being short of breath? When can I start jogging again, when can I walk down a hall without having to stop and catch my breath? These are 30 year olds. They didn’t die, they’re not going to make those metrics, but it’s not an all or nothing thing.”

Vaccinations are not about the individual so much as the community, said Buck.

“It’s never been just the individual, it’s been about the community. And vaccines are not completely safe, but nothing in life is,” said Buck. “It’s about doing the right thing, and doing the right thing is frequently not the safest thing. But you know, that’s where bravery comes in — doing the right thing even when it’s a little scary.”