Hospitals are adjusting to a 'new normal' of COVID-19. Staffing and morale are among the top concerns now.
UNC Johnston is like a lot of other hospitals in North Carolina right now. The big spikes in COVID-19 patients that stretched the health system to nearly its breaking point are in the past. Hopefully for good. But the coronavirus is going to be a way of life for a long time - and that’s meant long-term changes for hospitals.
Sheila Camp works the front desk at UNC Health Johnston, the hospital in Smithfield, about 30 minutes southeast of Raleigh. She runs everyone that passes her through the same set of questions, ones she's asked hundreds, if not thousands, of times by now.
"Any Covid symptoms? Fever, cough, headache, loss of taste or smell?" she asked. "Have either one of you tested positive for Covid or been exposed that you know in the past 14 days?"
"No," came back the answer from two women coming for a visit.
"You're all set. Have a good day," Camp said.
UNC Johnston is like a lot of other hospitals in North Carolina right now. The big spikes in COVID-19 patients that stretched the health system to nearly its breaking point are in the past. Hopefully for good. But the coronavirus is going to be a way of life for a long time - and that’s meant long-term changes for hospitals. On this Friday in July, Johnston had 13 COVID-19 patients. That’s a lot compared to the last five months, but not as high as a year or two ago.
"We have seen this week, in particular, just a couple that have needed intensive care," said Ruth Marler, UNC Johnston's chief operating officer. "So that's a little concerning with this particular variant because we haven't seen that with the B.A.4, the Omicron B.A.4 we did not see that."
Still, with more than three-quarters of the state's adult population vaccinated, and more than half of those boosted, Marler said it's not as bad now as the past two years.
"We're still cautiously optimistic that we're going to continue to see not as much of a need for hospitalizations," Marler said. "Length of stays that are going to be lower. And less (requirement for) life support like ICU level care."
The slowdown has allowed hospitals everywhere to take stock of their policies for all infectious diseases. One thing that will likely stay in place for many, is the ability to make negative pressure rooms.
Using a heavy duty fan and H-VAC vent, this keeps the air pressure in a room lower than in the hallways. This contains airborne contaminates, like the coronavirus, to the room. Michael Green works in engineering for UNC Johnston. He connected the vent to the blue machine a bit larger than a kitchen garbage can and flicked it on.
"High, medium, low. That's it," he said. "That's all there is to it."
The air runs through multiple filters that catch all virus particles before sending the air back to the main return. But the machine and duct are noisy and a bit ugly. Also, hospitals sometimes need positive pressure rooms, for patients who don't have infectious diseases and who are immunocompromised, so doctors want to keep outside air from coming in. So when COVID-19 numbers are low, the engineering team can remove the fans, and bring them back only if needed.
Of course, nurses still gown up before entering a room with a COVID-19 patient.
Brittany Thomas always wears a mask, but she tied the gown around her waist and pulled on latex gloves as well. She says she does this to protect herself, her loved ones and her other patients.
It's the one thing if you ask me what I think about the most, is our teammates and how they're doing mentally. And how they're holding up. Then also having the numbers and the people needed.Tom Williams, hospital president of UNC Health Johnston
"It is a lot but you get quick at it. And you learn how to do it fast so you can get in and out and do what you need to do," she said.
It's Thomas and the rest of the hospital staff at all levels that administrators are spending a lot more time thinking about.
"It's the one thing if you ask me what I think about the most, is our teammates and how they're doing mentally. And how they're holding up," said hospital president Tom Williams. "Then also having the numbers and the people needed."
Hospital long range planning now thinks about workforce more than new operating rooms or lab space.
"Now the first question is: Do we have enough staff? Are we going to have the nurses? Are we going to have the respiratory therapists? Am I going to have enough primary care doctors to meet the needs of the people moving in to Johnston County?" Williams said.
Burnout has been well documented throughout health care during the pandemic. And hospital leadership know they need to help. Angie Parker is a nurse who helps in her own way. She started singing for patients. They responded really well and have asked her to continue. She got Williams to sing a duet with her.
Hospital leaders know COVID-19 will linger for months and even years to come. They hope the worst spikes are stuck in the past, but say they are ready for sick patients when they arrive.