Intensive care beds are filling up across Vermont’s hospitals. While the bulk of patients have illnesses other than Covid-19, health officials are watching the numbers closely as the state experiences a surge in virus cases and hospitalizations.
The number of open beds in the state is nearing single digits on some days, with the portion of occupied beds rising to roughly 90% — the tightest ICU capacity since the pandemic began more than a year and a half ago, according to data from the Vermont Department of Financial Regulation.
By comparison, ICU beds were occupied at a rate of 70% to 80% in late spring and early summer, according to officials.
The bulk of Vermont’s ICU staffed beds are filled with critically ill patients whose stroke, heart attack or other preventable condition worsened for lack of medical attention in the last 18 months, state leaders said this week.
Roughly 10% to 15% of the available beds are now occupied by Covid-19 patients, state leaders said.
Vermont reported nearly 600 new infections on Thursday, a new record. But current hospitalizations reflect a previous surge, since people don’t get critically ill right away. That could mean that Vermont may be in for another uptick in hospitalizations as the holiday season gets closer.
Staff vacancies have made it difficult to keep beds open, Gov. Phil Scott said earlier this week. State regulators said that on any given day, five to eight of the state’s ICU beds cannot be used due to lack of clinicians.
The state, already in the throes of a new surge attributed, at least in part, to Halloween activities, faces uncertain months ahead as the holiday season and colder weather could ratchet up transmission of the highly contagious Delta variant. Scott said Vermont’s high vaccination rate would likely prevent significant increases in the number of infected people out of the hospital. At the same time, the ongoing campaign to vaccinate children aged 5-11 could significantly decrease transmission.
Therapeutic options, including a pill developed by Pfizer, may help keep coronavirus patients out of the hospital, but that treatment likely won’t be available in time for the winter months.
With coronavirus hospitalizations on the rise in neighboring New Hampshire, freeing up intensive care beds by transferring patients out-of-state is no longer an option, said Gilman Allen, a critical care specialist at University of Vermont Medical Center’s ICU, the largest unit of its kind in the state.
“We are finding ourselves having to accept more and more patients from outside our catchment area,” Allen said. “I’ve accepted from New Hampshire, parts of Vermont that would normally otherwise have gone to (Dartmouth-Hitchcock Medical Center) or Albany because those hospitals are all full and they're refusing transfers.”
State officials and hospitals have taken some steps to reopen ICU beds that closed because of short staff. There’s been a major push to create additional space for patients ready to leave the ICU by freeing up bottlenecks at long-term care, rehabilitation and psychiatric. These efforts have been partially successful, but staffing challenges continue to thwart some of the progress.
Last month, for example, staffing issues forced the Brattleboro Retreat to shut down some of its newly reopened inpatient beds. The state attempted to address that challenge by partnering with the White River Junction VA Medical Center to offer additional psychiatric beds to non-veterans.
Human Services Secretary Mike Smith said these measures should buoy the state through a surge in the immediate future.
[Looking for data on breakthrough cases? See our reporting on the latest available statistics.]
“We’re worried about the holidays,” he said. “We want to get through the holidays, and then we’ll reassess at that point.”
Smith acknowledged that the state would need to come up with longer-term solutions to address gaps in its health care system.
Earlier this fall, Smith’s department, along with other regulators, launched an inquiry into appointment wait times after a Seven Days investigation revealed that some patients waited months or longer for appointments. The executive branch team plans to conclude the investigation before the start of the legislative session in Montpelier this January, with the goal of informing longer-term policies on these issues.
Meanwhile, UVMMC has been delaying or canceling surgeries when capacity is too tight. But it’s not a good long-term solution. When patients cannot get timely care, benign conditions such as high blood pressure can evolve into full-blown emergencies.
“If we delay an aortic aneurysm repair and three or four months later that aneurysm ruptures, that patient is going to end up in the ICU with multiorgan failure, on dialysis, possibly for weeks consuming that ICU bed,” Allen said.
But hospital staff have also attempted to clear up ICU beds faster by transferring critical patients to intermediary “step down” units for patients who are stable but still need closer monitoring.
“We’ll make it work,” Allen said. “That’s the bottom line.”
Scott on Tuesday called on Vermonters to make “smart, practical choices, starting with getting vaccinated.”
“None of us want to step backwards,” he said. “But we need your help to keep older or vulnerable Vermonters out of the ICU.”
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