Western Pa. hospitals on alert as covid cases surge

Hospitalizations are on the rise in Western Pennsylvania, but the region’s health systems are projecting confidence in their ability to maintain capacity as covid-19 cases surge again.

“We’ve been planning and preparing for a variety of surge situations over the past many months,” Dr. Rachel Sackrowitz, chief medical officer of UPMC’s ICU Service Center and executive vice chair of critical care medicine, said Wednesday.

From the beginning of the pandemic, hospital capacity has been a chief international concern. Several states have reported overflowing facilities as their infections spike this week, especially those in the West and Midwest.

There were 4,711 new covid-19 cases reported in Pennsylvania on Wednesday, the highest daily increase since the start of the pandemic. Statewide, there were 2,080 individuals hospitalized, 417 of whom were in intensive care units and 193 of whom were using ventilators, according to the state Department of Health.

Allegheny County also reported a record number of new cases Wednesday, 336, along with 35 more hospitalizations from Tuesday. Westmoreland County has repeatedly broken its own records for daily case increases and on Wednesday reported its second highest since March, 138 new cases.

Meanwhile, the latest metrics report from Carnegie Mellon University, which measures risks in each county and region with the goal of assisting reopening decisions, puts Allegheny and Westmoreland counties at a relatively low risk for ICU capacity issues. There are several other counties in Western Pennsylvania marked as high risk, however, among them Beaver, Washington and Greene counties. According to the report, ICU capacity risk is calculated by dividing the number of individuals ages 60 and older by the number of unoccupied ICU beds.

Sackrowitz said covid-19 patients make up less than 7% of UPMC’s inpatient beds, amounting to 395 patients. Though hospitalizations are rising, she said compared with the spring, those patients are far less likely to need intensive care, and those who do need ICU treatment are less likely to need ventilation. UPMC’s mortality rates, ICU rates and ventilation rates have dropped by 50% since spring.

Experts attribute this pattern to more widespread mask-wearing and improved treatment options that weren’t available early in the pandemic. Sackrowitz said UPMC is enrolling patients in REMAP clinical trials, a trial platform being used to test several covid-19 therapies, including antibody treatments developed by UPMC. Patients are seeing better outcomes with the use of corticosteroids and high-flow nasal oxygen as an alternative to ventilation, she said.

Falling from 30% in the spring, only 14% of UPMC’s currently hospitalized patients require ventilator support, Sackrowitz said.

“Not only have we learned a lot about the virus itself, how to identify it, how to treat it and how to mitigate its spread,” Sackrowitz said, but “we’ve also learned a lot operationally, in terms of how to effectively utilize our entire health system’s resources.”

UPMC has seen its greatest influx of patients in Altoona and western Maryland. Of the system’s 395 patients, 117 are from these regions — about 30%.

“When one area needs assistance, the whole system can respond, to aid,” said Dr. Don Yealy, senior medical director and chair of the Department of Emergency Medicine at UPMC and the University of Pittsburgh.

Allegheny Health Network is also seeing higher hospitalization rates over the past few weeks. Chief Medical Officer Dr. Don Whiting noted that the level of illness has decreased dramatically since the spring.

“People were a lot sicker and a lot more critically ill, then,” Whiting said. “It was a much, much higher percentage of people with very, very severe medical problems.”

As of Wednesday, there are around 107 covid-19 patients across AHN. Whiting estimated about 10% of those patients are in ICU beds; there are less than 20 people on ventilators, he said. There aren’t any AHN hospitals that stand out as having higher-than-expected hospitalization rates, he said.

AHN received local and national attention early in the pandemic for sidestepping nationwide shortages of PPE, purchasing protective elastomeric masks from MSA Safety — traditionally used in industrial environments — that can be sanitized and reused. Whiting said those masks are still in use.

Whiting is confident that across the region’s health systems, hospitals are in a good position when it comes to PPE and capacity.

In Westmoreland County, Excela Health is caring for 54 covid-19 patients, along with another 18 who are under investigation, according to spokesman Rob Firment. Only six of those patients are on a ventilator, a small fraction of the 75 that are available system-wide.

“We have no capacity concerns and a very adequate supply of PPE,” Firment said in an email.

But Excela is seeing an increase: Firment said 62% of the system’s total hospitalizations have come in since Oct. 1. There have also been 32 deaths related to covid-19 since that date, which is 63% of all covid-19 deaths at Excela since the beginning of the pandemic. These figures coincide to an ongoing surge of cases in Westmoreland County in the last several weeks.

“The number of positive cases per 100,000 people in Westmoreland County over the past 14 days is 289,” Firment pointed out. “A month ago, that number was 137.”

Health experts across the region’s symptoms implored individuals to continue following guidelines from the Centers for Disease Control and Prevention and local entities: mask-wearing, hand-washing and social distancing. That will be the real determinant, Whiting said, to the level of cases and subsequent hospitalizations in the area.