FARMINGTON, N.M. — At San Juan Regional Medical Center, a message is scribbled on 1 of every 3 doors in the intensive care unit: “Anointed by Father Tim.”
That means the patient inside has received last rites from a Catholic priest and is not expected to survive. Every patient in the ICU has Covid and is on a ventilator.
Almost two years into the Covid pandemic, in yet another surge in hospitalizations, parts of the country’s health care system are still overwhelmed and understaffed, struggling to deal with a crush of cases among the unvaccinated.
No cases of the omicron variant of the coronavirus have yet been reported here in northwestern New Mexico, but more than half the patients at the hospital have Covid, and the ICU is at more than twice its licensed capacity.
The number of Covid patients who need intensive care is spiking again as hospitals around the country face acute staff shortages, a long-term trend worsened by the punishing conditions of the pandemic.
But this week, the staff at San Juan is being supplemented by Navy physicians, nurses and support staff members on loan from the Defense Department and by teams from the National Disaster Medical System of the Department of Health and Human Services.
The National Disaster Medical System has been a key emergency stopgap for hospitals. Like the National Guard, its teams typically deploy in response to natural disasters like hurricanes or earthquakes when medical resources are overwhelmed. But since early last year, they have been setting up in hospitals and other facilities on over 700 “missions” in 38 states and U.S. territories. The teams have been on constant rotation to ensure access to medical care — most have been deployed multiple times, some as many as 10 times since the start of the pandemic.
The military has also stepped in to fill the staff shortages. Since the delta variant emerged in the U.S. this summer, more than 400 medical personnel from the Army, the Navy and the Air Force have been deployed to help treat Covid patients in civilian hospitals in nine states.
San Juan’s CEO is blunt. Without the federal assistance, he said, the hospital would face “a clinical catastrophe.”
“The acuity and the number of ICU-level patients we have has created a need for these external resources that is just beyond description,” said the CEO, Jeff Bourgeois.
The federal support, he said, is “absolutely critical to our ability to survive this.”
Bourgeois said his facility is in it longest and most intense Covid hospitalization surge since the onset of the pandemic. San Juan serves a largely rural four-county area with high Native American and Latino populations, and low incomes and pre-existing conditions are common. All seven of the state’s regional hub hospitals, including San Juan, are well over their licensed ICU capacities, Bourgeois said.
ICU nurse Heather Robinson said that some days, “it felt like I was in a movie.” She added, “It did not seem real.”
Robinson, who admitted the first Covid patient to San Juan’s ICU in March 2020, said the current surge is the most distressing, as all ages are affected.
The flood of patients is being driven by the unvaccinated. In the past month, 81 percent of the Covid patients at San Juan — and 91 percent of Covid patients admitted to the ICU — have not been fully vaccinated.
The death rate is similar. Of 17 hospitalized patients who died from Covid, only one had been fully vaccinated.
An ongoing labor crisis
Shortages of hospital staff members — especially those with ICU experience — have added to the burden on medical systems. San Juan Regional Medical Center’s costs for outside staffing have increased by 373 percent over the past year, and they could be covered only because of federal funding.
The staffing situation at San Juan mirrors a national trend. An analysis by Premier Inc., a health care technology company that works with more than 4,400 hospitals and health care systems, found that turnover in high-stress departments like intensive care is up by nearly 45 percent compared to the 2019 pre-pandemic baseline, while overall turnover is up by nearly 23 percent across nursing departments. On average, more than 1 in 3 clinical team members has left a job since the pandemic began.
“The first wave [of shortages] was all about supplies, from masks to drugs,” Premier CEO Mike Alkire said. “The second wave has been all about staffing and labor and ensuring that there are enough caregivers for all of the patients.
“I talk to hospital leaders across the country each day. The exasperation I hear in their voices is so hard to describe,” he said. “But it comes through loud and clear. To deal with surges in Covid patients, after all the other pandemic-related issues they have been dealing with — and have it compounded by the ongoing labor crisis — is beyond the pale.”
Bobbie O’Connell, a team commander leading the National Disaster Medical System team sent to New Mexico for a two-week mission, said that even with the extra federal staffing, hospitals are still stretched thin.
“Covid is still very much here. It’s still hitting communities very hard, especially in the unvaccinated populations,” O’Connell said. “These are very bad, very sad situations that oftentimes don’t have a very good ending.”