Many might have assumed that the days of packed local hospitals in the greater Houston area would already be behind us given how new COVID-19 infections and hospitalizations have been trending downward for several weeks now, and given the hundreds and thousands of residents who have gotten vaccinated in the past few months.
While local hospital leaders aren’t sounding the alarm about capacity concerns, we heard a similar story from leaders at St. Luke’s and Houston Methodist: hospital beds and emergency rooms are regularly filling up as both health systems continue to manage coronavirus patients on top of all the folks finally heading to the hospital for care they may have delayed due to the pandemic, all while the number of patients coming into local emergency rooms is already hitting pre-COVID levels.
Roberta Schwartz, Executive VP of Houston Methodist Hospital in the Texas Medical Center, told the Press that it wasn’t surprising to hear that the Houston Methodist ER in Sugar Land was recently so busy it had to turn away ambulances temporarily.
“The emergency rooms and the hospitals are very full,” Schwartz said.
When we asked Dr. Brad Lembcke — Chief Medical Officer at St. Luke’s — about the current status of his hospital system’s bed count and ER capacity, he said “We’re full, I guess is probably the two-second version.”
Schwartz explained the ambulance diversion could have happened because Houston Methodist’s Sugar Land ER was temporarily jam-packed and wouldn’t have been able to quickly process new patients, a situation she said many Houston hospitals have found themselves in recently. She explained that sometimes other hospitals end up with overrun ERs at a given moment when Houston Methodist is less full, and then ambulances are instructed to divert their patients to Houston Methodist.
Lots of Schwartz’s colleagues around the country have told her their hospitals are seeing lower numbers of emergency room visits than they did before COVID. “That is not the case at Houston Methodist,” Schwartz said, “and seems not to be the case in Houston.”
St. Luke’s is also seeing a similar trend of ERs packed with more patients than in other parts of the United States, Lembcke said. While “a lot of places report only recovering to about 80 percent of what their prior volumes were,” he said, St. Luke’s main downtown hospital is now seeing ER numbers that have “just about reached the pre-COVID states.”
Even though coronavirus hospitalizations have fallen after the winter surge, local hospitals continue to deal with steady numbers of COVID-19 patients. At Houston Methodist, the number of coronavirus hospitalizations has plateaued in recent weeks, and at a level higher than where that patient count leveled-off at after the first two surges in the spring and summer of 2020.
Schwartz said that after the first surge last spring, coronavirus hospitalizations at Houston Methodist fell to around 50. Following the summer surge, they averaged “about 100 COVID patients on a daily basis.”
“When we came down from this latest surge in December and January, we’re settling in at about 180 to 200,” Schwartz said.
“If you had a normal load of patients, and you add on 200, that would put some stressors to the system, and I think that you’re seeing that across Houston. And this comment on saturation is not just us, it’s lots of hospitals,” she said.
Lembcke said that St. Luke’s average number of coronavirus hospitalizations these days is “maybe a little higher” than what they saw right after the summer surge. “But it’s more consistent. It’s been pretty stable over the last month or so.”
When asked about why Houston’s hospitals are still so full, Schwartz said she and her colleagues have a few educated guesses.
“We do know for sure — 100 percent, this is documented in many papers — that people have delayed their care in many cases, and are coming in with later stage illnesses,” many of whom whose conditions got bad enough that they needed emergency care, Schwartz said. Some of those patients “were people who said ‘I don’t want to get COVID from going to the hospital or to the doctor.’ We know that.”
Lembcke said St. Luke’s is also seeing non-emergency room patients coming in at similar rates to this time of year in the Before Times, which he believes is because patients overall feel it’s safer to venture out for medical care than it was earlier in the pandemic. “Our numbers in March and April show really recovery basically to our prior volumes of cases, and even our prior mix of cases.”
“We do know for sure — 100 percent, this is documented in many papers — that people have delayed their care in many cases, and are coming in with later stage illnesses.” — Roberta Schwartz, Houston Methodist
“Pretty uniformly, those have recovered,” Lembcke said.
Schwartz also pointed to how many folks have had “some residual issues” after they had COVID-19, including heart and neurological conditions that can require medical treatment and sometimes extended time in the hospital.
And even if there are empty beds available, they’re not too useful if a hospital doesn’t have enough nurses to staff them all. Hospital staffing has been difficult throughout the pandemic, Lembcke said, and has at times limited the number of patients local hospitals can handle.
He brought up how many burnt-out nurses have retired from the profession after battling through the most harrowing months of the pandemic, and how the massive vaccination campaigns local hospitals are running require pulling nurses in to help out.
“Any vacancies that we have are becoming filled,” Lembcke said, “but across Houston, across Texas, across the United States, the demand for nursing is still out over the supply.”
“I think we’ve all come to the realization we’re going to be taking care of COVID for a while,” Lembcke said. “And so in our budgets and our plans for the future, we’re going to have COVID units. That’s in our game plans now.”
Schwartz agreed: “I think we have to have a recognition that regardless of vaccination, everyone is telling you there’s going to be a low level of COVID in our society for, I’ve heard, many years.”
She described another trend she’s seen across all Texas Medical Center hospitals: coronavirus patients are younger on average than they’ve ever been, and some are in need of serious long-term care.
“We are now doing lung transplants on some of the COVID population. And some of those patients stay before they have their transplant,” Schwartz said, cautioning that the belief many have that the coronavirus can’t seriously harm younger people is misguided and dangerous. “Young doesn’t mean immune. It does not equal immune. We are transplanting people in their 20s and their 30s.”
“There were no signs that COVID would take them from where they were to a transplant, ” she said.
Although St. Luke’s and Houston Methodist are buzzing with patients these days, Lembcke and Schwartz both stressed that area residents who need medical help shouldn’t be worried about not being able to get the care they need.
They said one of the benefits of having the massive Texas Medical Center in our backyard is that even if one hospital is slammed on a given day, there are enough hospital beds in the area to handle demand, even if some patients might have to get shuttled over to a different provider than they usually see.
“It’s tenable,” Lembcke said. “Are there days when we’re tight? Absolutely. But like I said, it’s something that is constantly improving.”
Schwartz said Houston Methodist is “constantly watching to make sure that the people who need us and the people who need the beds can get them when they need them.
“[But] 200 people don’t always leave when 200 people come,” she said. “You are the opposite problem of a hotel. You cannot control your front door, and you cannot control your back door.”
“What you can do,” she continued, “is the best job in-between those two doors.”