TUPELO • The number of COVID-19 cases was already trending upwards when the Mississippi State Department of Health (MSDH) reported the highest single day increases this past week. Thursday saw the highest single day total, with 1,092 new cases. Previous highest totals also occurred in that time period, with 611 cases reported Tuesday and 550 cases reported Friday.
These combined numbers outpaced a combined five-day total of 1,646 total cases from June 17-21. In an interview with the Daily Journal, State Health Officer Thomas Dobbs said MSDH has seen a steady increase over the past few weeks, but several factors have led them to anticipate increased numbers.
“We’ve seen numerous outbreaks. It’s transitioned to a younger age population,” Dobbs said. “We’ve got a lot of cases coming in. It’s getting worse every day.”
Most concerning is the impact on the healthcare system already occurring. Daily hospitalization numbers have steadily creeped upward for the month of June, getting as high as 536 patients with confirmed COVID-19 on June 24.
Within the region, North Mississippi Health Services (NMHS) has seen variations within their daily inpatient numbers, getting as high as 50 inpatients June 25 and as low as 37 patients over the week of June 22-27. In an interview with the Daily Journal, Chief Medical Officer Jeremy Blanchard cited a Memorial Day surge as impacting admission numbers over the past few weeks, but said the hospital currently has capacity for more COVID patients. In response to entering a potential emergency situation, the NMHS team began organizing preparedness for crisis management in early February, basing modeling on resource consumption rather than number of patients.
“We knew from even before we were in our surge how many critical care beds we have (and) if we had to expand the critical care beds, how can we expand them,” Blanchard said.
At a briefing on Thursday, Dobbs said current case numbers already resemble the spiked numbers he hoped would occur during the fall, and worries the healthcare system would be overwhelmed in “next week or two weeks from now.”
“There’s a crunch now and it’s going to be a crash in the fall unless something dramatic happens. It’s continually worsening and there is not really a capacity to add the staff and the individuals that you would need to take care of people,” Dobbs said.
Factors driving the current spread
MSDH analysis shows that throughout the state, including in Northeast Mississippi, cases are occurring through generalized community transmission rather than through specific community events or places.
“It could be that they went to a retail place, they went to a party, they went to a restaurant, it’s just people spreading it around in the community. It’s not linked to any specific thing, and it’s people not wearing a mask, not social distancing,” Dobbs said.
The current concentration of new cases is from those ages 18-40. The health department has detected a “relatively cavalier approach and attitude about contracting the virus” within younger age groups, Dobbs said.
“To some degree, there’s some truth in the sense that younger folks are less likely to die than older people, but they’re absolutely driving the growth of pandemic,” Dobbs said. “They’re driving the spread to other people. They’re driving the cases that are going to infect vulnerable people that are going to kill them, so it’s reckless behavior that’s oftentimes against the law.”
A recent outbreak in Lafayette County among those ages 18 to 24, consistent with college students, was tied largely to fraternity parties and other social gatherings. Additionally, Lafayette County and Oktibbeha County, home to the University of Mississippi and Mississippi State respectively, have some of the largest case numbers within the region even despite the fact that students who are temporary residents are not currently counted in overall case counts. As of June 25, Oktibbeha County has 488 cases, and Lafayette claims 303 cases.
“When we look at Ole Miss and State, I understand kids are wanting to get back to normal, but it’s just not time for normal,” Dobbs said. “We just do not need to be meeting in large groups and we don’t need groups meeting together where you’re in close proximity for any period of time where you can spread it to one another.”
As additional severe cases and deaths occur as the spread moves up the age chart, the reality will be people not having access to the health services they need in an emergency or urgent situations, according to Dobbs. During the Thursday press briefing, State Epidemiologist Paul Byers noted that while there are ICU beds available throughout the state, individual hospitals may already be at capacity.
“We’re already getting reports of people showing up in the ER with a medical condition and they can’t find anywhere to go because all the hospitals are full or all the intensive care units are full,” Dobbs said. “This is something that’s happened now, and this is the summer. This is the slow time, more or less.”
This impacts both COVID and non-COVID patients alike “because if there’s no beds, there’s no beds,” Dobbs said. Currently, people are going wherever they can find a bed, sometimes traveling hundreds of miles in order to receive care because beds are not available. Dobbs already received reports of people in Laurel going to the coast or places they wouldn’t normally be transported, and other places are beginning to be stressed. Much of the tension in the system is due to cases being identified in the central band of the state in areas such as the Jackson-Metro area, the East-Central part of the state, Hattiesburg and Laurel, but Dobbs said that is changing to include a growing case burden on the coast and within Northeast Mississippi and DeSoto County.
NMHS is not currently at capacity and is not seeing an impact on their elective surgeries, Blanchard said. Instead, they are experiencing impacts with their nonsurgical and non-COVID patient groups. As patients return, Blanchard said they have to balance moving personnel who would have been used in the COVID-19 unit to the non-COVID areas of the hospital. Any crunch would be in managing staff to take care of patients.
“Where we are at, and I know others are at too from multiple conversations across the nation, is that we’re all facing the challenge of how do we have adequate personnel to take care of the patient's needs,” Blanchard said.
Blanchard emphasized that while daily admission numbers vary, they monitor the length of stay for patients once they are admitted to measure the consumption of inpatient resources.
“It’s not necessarily how many admissions you get today as much as how many admissions have you had for the last few days, and your ability to then manage them, to discharge them in some way that determines whether you have a surge in your hospital or not,” Blanchard said.
Potential future impact
To address the potential needs, Dobbs said every hospital has an expansion plan, and it will be important for hospitals to make sure those plans are actionable and if they staff it, because “the reality of them having to do it is likely,” Dobbs said. However, having enough staff to take care of patients is becoming the most pressing concern. During Thursday’s press briefing, Dobbs said “the breakout hospital is a fallacy in reasoning because there’s no staff.”
“It’s not a location issue, it’s a staffing issue, and that’s something that has to be addressed,” Dobbs said.
While MSDH will utilize federal resources if needed, MSDH anticipates potentially having to cancel elective procedures in some regions in order to depopulate hospitals. Dobbs said it is not something hospitals want due to it being financially difficult and creating challenges in meeting community health needs and working on an organized system of care. In the meantime, MSDH is working with healthcare partners to ensure they have expandable capacity, Dobbs said during Thursday’s briefing.
NMHS has never been in a place where they haven’t had adequate personnel, Blanchard said, but he notes the possibility within all US institutions that capacity could be overwhelmed on a staffing level if people continue to disregard masking and social distancing.
NMHS will adjust resources as needed to respond to any potential flux in COVID patients. One way is by acting as a system rather than an institution, designating ICU beds in both North Mississippi Medical Center and additional ones in Amory and West Point that the hospital can flex to if needed, Blanchard said. Another is having non-ICU beds for COVID-19 patients in their other six facilities so they can move patients to the same or similar level of care in all seven facilities.
“We adjust those based on personnel capabilities, but we are not at capacity. We are able to manage those and at times, we have accepted patients from other facilities and also move facilities as we go through this management of manpower,” Blanchard said.
The number of patients NMHS can manage will be determined by their ability to provide care, Blanchard said, but noted they have prepared by having adequate supplies to protect nurses, doctors and patients, managing visitation to avoid transmission into the institution, universal masking policies, and having beds to handle patients.
Blanchard said the pandemic represented “an incredible, dynamic medical situation” where prevention lies primarily in the hands of society.
“If society were to wear a mask appropriately, to wash their hands and appropriately social distance, we have evidence … (that) we could actually be in a place where our economy is open,” Blanchard said.
He thanked those who are currently following safety measures and caring about healthcare workers in North Mississippi.
“Together, we can do this. Alone, none of us will be successful,” Blanchard said.
At Thursday’s briefing, Byers and Dobbs emphasized the importance of taking action now to prevent disastrous results in the future.
“If people do that, we will see (a) downturn. We will see decreases in cases if people are separating, if they’re social distancing, if they’re wearing a mask,” Byers said. “... Our goal, all along, has been to protect those most vulnerable, to protect the impact on the healthcare setting, and that’s what we’ve got to do.”