As the Green Mountain State’s pandemic-strained hospitals and schools brace for another coronavirus surge driven by holiday gatherings and the Omicron variant, Gov. Phil Scott repeated an optimistic mantra at his weekly press conference: Vermont is as ready as it can be.
“We’re prepared,” he said Tuesday. “But I think it depends on the intensity of the storm.”
The state’s modeling team at the Department of Financial Regulation offered a grim assessment for the coming weeks. Vermont could see as many as 600 to 1,000 new cases a day, up from a current daily average of about 450.
If these predictions come true, the state would shatter its Dec. 8 record of 739 new cases. Two of the state’s systems that have been particularly throttled by the pandemic — health care and education — would face another round of blows.
The state’s 14 medical centers — stretched thin by burnout, staffing shortages and an onslaught of critical patients — may well reach a breaking point if hospitalizations follow suit, said Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems.
“There’s a good chance we would see our hospitals in a really difficult, if not overwhelming, situation,” Tieman said.
Meanwhile, several school officials said there is little that schools can do to address such a surge. They similarly are already grappling with staffing shortages, inflated workloads and growing concerns of a student mental health crisis.
“I think that superintendents and administrators are just resigned to the fact that it’s going to happen and that we have to deal with it,” said Libby Bonesteel, superintendent of the Montpelier-Roxbury school district. “And there really isn’t a choice in that matter for us.”
‘Bated breath’ at hospitals
Catastrophic surges in other states offer some clues about what that might look like across Vermont’s hospital system.
Colorado hospitals began turning away some patients in early November to alleviate crowding. Maxed-out medical centers in West Michigan have been refusing patient transfers. In neighboring New Hampshire, Dartmouth-Hitchcock Health — a hospital chain caring for thousands of Vermonters — has sounded the alarm as well. The generally taciturn health network is begging residents to get vaccinated.
Vermont isn’t far behind.
With beds in the region in short supply, patients who are quite sick are stuck at small rural hospitals that are not set up to care for them. Other patients get transferred as far as Rhode Island or Philadelphia for advanced care.
A large increase in cases would only exacerbate these issues, said Rick Hildebrant, chief medical director at Rutland Medical Center, a mid-sized referral hub with more than 100 licensed beds.
“It’s just not going to be in the same way that we’re used to delivering care,” he said. “We may have to care for patients — critical care patients — outside of the ICU. We may have to care for hospital patients in an endoscopy suite — those places that we’ve done before, we may need to do again.”
In nearby New York state, reports of new cases are up 80% since Omicron was first discovered there in early December. The flu — historically a primary driver of hospital admissions in January and February — also appears to be spreading.
“We very well might see the flu season spike at the same time, which is not what we want to see, obviously,” said Mike Pieciak, commissioner of the Vermont Department of Financial Regulation.
With Delta, roughly 2% to 3% of Vermonters with coronavirus end up in the hospital, Pieciak said. Of those hospitalized, about 10% to 15% wind up needing intensive care. If hospitalizations rise at the same rate with Omicron, Vermont could see a sharp increase in hospitalizations in January.
[Looking for data on breakthrough cases? See our reporting on the latest available statistics.]
Preliminary reports out of South Africa and the United Kingdom show Omicron infections tend to be less severe, but the variant’s rapid spread still could overwhelm hospitals. Even mild illness could worsen staffing shortages at hospitals as health care providers stay home to recover.
“Having a single nurse practitioner or nurse or physician from the inpatient setting out sick will cripple our system,” said Michelle Wade, a hospitalist at Gifford Medical Center, a 25-bed hospital in Central Vermont. “Really, that is how fragile our system is.”
Executives at the rural hospital have tried to hire temporary clinical staff, also known as travelers, but none have been available.
At the University of Vermont Medical Center, which currently employs more than 350 travelers, rising cases are already causing delays in care.
“We are planning for all possible scenarios,” hospital President Stephen Leffler said Tuesday.
Part of that plan could include additional surgery cancellations, a strategy the Burlington hospital used throughout the summer.
Dawn Godaire, a registered nurse at the health network, said a Covid-19 surge could ratchet up demand for monoclonal antibodies to treat the virus.
The problem? The same clinical staff caring for sick patients or testing people may also be involved with managing these ad-hoc infusion clinics. There may not be enough staff — or space — to accommodate everyone who needs that service in the case of a significant surge.
“We’re sort of all collectively holding bated breath to see what most holidays deliver,” Godaire said. “I think from just my perspective, my hope is with the Omicron variant, what we’re hearing is that a Covid infection tends to be more mild and how that will play out. I don’t know, but we are prepared, and we’re actively talking about how we would staff if we see a significant uptick in requests.”
Will schools look any different?
For many school officials who have spent months grappling with Covid-19 outbreaks, that anxiety is more muted.
“Am I worried?” said Bill Olsen, superintendent of the Rutland City School District. “Well, we don’t want a surge, but we’ve been through a pretty rough patch for the past six weeks or so. So I’d be interested to see what a surge looks like if it’s any different than what we’ve already (had).”
In interviews and via email, five superintendents from across the state said they had few plans to address a post-holiday surge beyond their usual testing and contact tracing regimens.
Bonesteel, from Montpelier-Roxbury, said her district is ordering extra KN95 masks for teachers. In Rutland, Olsen said his schools are making sure they have enough laptops and power cords in case classes are shifted online.
But for the most part, districts plan to simply continue their usual Covid-19 routines. Across the state, the vast majority of schools are equipped for or are conducting “test-to-stay” — a testing program that allows students to remain in class after seven consecutive days of negative tests, according to Agency of Education spokesperson Ted Fisher.
In Barre, where schools have been battered by a surge of Covid-19 cases, officials plan to start a test-to-stay program after the holiday break. But a post-holiday surge could throw a wrench into those plans, Barre Unified Union School District Superintendent Chris Hennessy said.
“(It’s) dependent on what the situation is over this holiday and if cases continue to spike up like crazy,” Hennessy said. “If they do, it’s going to make it very challenging to do (test-to-stay).”
The district is planning to “just press on,” Hennessy said. “Nothing major beyond that.”
Superintendents in other districts outlined similar plans — or the lack of them.
“(We’re) actually not really doing anything much different than what we’re currently doing,” said Brooke Olsen-Farrell, superintendent of the Slate Valley Unified Union School District.
In the governor’s weekly press conference Tuesday, Secretary of Education Dan French offered few concrete details on school strategies to deal with Omicron but said officials were “evaluating the Omicron variants and its potential impact on school operations.”
State officials also are reviewing policies around contact tracing and testing in schools, but it’s not yet clear what new procedures could look like.
“That work is ongoing (and) has been ongoing for a while,” said Ted Fisher, an agency spokesperson. “We’re not at the point where we have anything to announce yet.”
The state had previously planned to recommend on Jan. 18 that schools whose student bodies were 80% vaccinated could lift their mask mandates. French said that move likely would be delayed.
Beyond that, the secretary offered few concrete plans to address a potential surge, recommending only that students get vaccinated and boosted, and that schools “conduct additional testing sessions after the holidays.”
The silver lining, officials said, is that many students likely will come back to school Jan. 4 either fully vaccinated or boosted.
But beyond a potential surge in schools, some officials are worried that Omicron will exacerbate already dire staffing shortages in schools.
“Are we going to have enough people — qualified people — in our schools to offer what we need to offer kids?” Hennessy said. “I think that’s going to be the story of 2022. I really do.”
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