There’s some good news buried in North Carolina’s rising COVID-19 hospitalization numbers
The number of people with COVID-19 in North Carolina hospitals each day has increased 61% since June 1 and topped 1,000 for the first time on Thursday.
But within that single measure of the state’s growing coronavirus outbreak lies some good news, according to hospital and public health officials. While overall hospitalizations have increased, the number of seriously ill COVID-19 patients — those who must be treated in an intensive care unit — has remained steady.
The number of hospital patients with COVID-19 statewide has grown from an average of 690 the first week of June to 991 on average this week, according to the state Department of Health and Human Services. On Friday it hit a new high of 1,046.
But the number of COVID patients in ICUs during that time has remained between 275 and 325, says Dr. Mandy Cohen, the secretary of Health and Human Services.
“We’re seeing more patients in the hospital but less of them needing that highest level of severe care that we would see in hospitals,” Cohen said at a press conference this week. “That is a good thing.”
Duke Health, WakeMed and UNC Health all report a similar pattern. The portion of COVID-19 patients requiring ICU care at UNC Medical Center in Chapel Hill has gone down, says Dr. David Wohl, an infectious disease physician at the UNC School of Medicine in Chapel Hill.
“At times, our COVID ICU was at the brim,” Wohl said. “Now it’s receded to where the majority of our admitted patients are on a non-ICU COVID floor.”
The trend should help extend the state’s limited supply of ICU beds, staff and equipment even as the demand on hospitals to treat COVID-19 grows. North Carolina hospitals have about 3,200 ICU beds statewide, compared to more than 21,200 beds for less seriously ill patients.
Several factors could explain why relatively fewer COVID-19 patients are ending up in the ICU.
Cohen credits better treatment, including wider use of the antiviral medicine remdesivir and the steroid dexamethasone, which reduces inflammation caused by the virus. She also cited increased use of “proning” or placing patients on their stomachs, which has been found to help them breath and take in more oxygen and in some cases avoid the need for mechanical ventilators.
“I think there are a number of things we have learned about this virus, and it’s keeping people out of the intensive care unit,” Cohen said.
Younger patients fare better
Another factor behind the relative decline in ICU use is the changing demographics of people entering the hospital with COVID-19, says Dr. Chris DeRienzo, WakeMed’s health system chief medical officer. Earlier this spring, DeRienzo said, the largest group of COVID-19 patients at WakeMed was 65 and older, many the result of outbreaks at nursing homes and long-term care facilities, and more than half of coronavirus patients were in the ICU.
In May, WakeMed began seeing more COVID patients between age 40 and 64, and now less than 40% of WakeMed’s coronavirus patients need the ICU, DeRienzo said.
“In general, younger folks tend to fare better,” he said.
A growing number of younger COVID-19 patients also has helped keep ICU patient counts steady at Charlotte-based Atrium Health, said Dr. Katie Passaretti, the health system’s medical director of infection prevention.
“The people with the ICU stays are still older individuals, people with multiple medical problems. That population hasn’t really changed,” Passaretti said. “But we are seeing more cases in 20- to 40-year-olds, and our pediatric cases have also increased.”
Passaretti said another factor in the rise in hospitalizations is that Atrium hospitals are testing more patients for coronavirus, including those in the hospital for reasons other than COVID-19. A patient in for a broken back who tests positive for coronavirus will be reported to the state as a COVID-19 patient, even if they don’t have any symptoms.
But hospital and state officials say these incidental COVID-19 cases account for a small fraction of the state’s daily COVID hospitalization count.
“The reality is that most of the COVID-positive patients came in with COVID,” said Dr. Joseph Rogers, chief medical officer for Duke University Health System. “They weren’t found.”
Virus becoming more distributed
The changing demographics of COVID hospital patients reflects the spread of the virus through the population. DeRienzo said over time WakeMed saw outbreaks among first African Americans and then Latino residents reflected in its case counts, but now all racial and ethnic groups are represented.
The virus can move undetected from one person to others before someone gets sick, said UNC’s Wohl. That makes tracking a particular person’s infection back to a source more difficult.
“It’s not all meat-packing plants; it’s not all nursing homes,” Wohl said. “This is becoming a little bit harder to peg as it becomes more distributed. That’s what makes it more dangerous. That’s what worries me.”
The state Department of Health and Human Services collects demographic data about people who test positive for coronavirus. The state knows, for example, that Hispanics account for 45% of cases in the state but only 10% of those who have died from the disease.
But DHHS doesn’t collect demographic data on those with COVID-19 sick enough to require hospitalization. Hospitals themselves gather this data in different ways, Wohl said, so pulling it all together in a useful and coherent way would take some effort. As a result, though, there isn’t an accurate picture of how the state’s COVID-19 hospital population is changing over time.
“I think we’re all touching the elephant on different sides, and it’s hard to get a grasp of it,” Wohl said.
Cohen, the DHHS secretary, says the state’s effort to gather coronavirus data from hospitals has been focused on capacity, and getting more detailed demographic information about hospital patients with COVID-19 has not been a priority.
“From our perspective, what we’re trying to assess is how many beds do we have, how many beds do we need,” she said. “We saw how COVID-19 was overwhelming hospitals in other countries and even here in New York, forcing those health systems to make devastating decisions that not only impacted those with COVID, but also anyone needing hospital-level care. We’ve had to focus on capacity to protect public health.”
DHHS does collect hospitalization data by geography, so residents of the Charlotte area, for example, can see what it looks like when Cohen and Gov. Roy Cooper say, as they did on Thursday, that they’re concerned about rising hospitalization numbers there. So far, DHHS has not presented that information on its website but plans to “very soon,” Cohen said.
