In mid-March, as coronavirus spread through the state, New Hampshire hospitals prepared for the worst.
They paused all non-essential procedures to preserve inpatient beds and their limited amounts of personal protective equipment. Some of the most profitable services for hospitals, like surgeries and cardiac care, were paused for months.
Now, nearly eight months later, the state is seeing similar infection rates of COVID-19. This time, though, New Hampshire hospitals don’t plan on stopping elective procedures any time soon.
In many ways, hospitals say they are more prepared to handle a surge of patients this time around.
Personal protective equipment, though more expensive than before the pandemic, is more easily accessible. The science behind managing the virus has been refined. Hospitals have rigorous testing procedures in place to prevent the spread of the virus within facilities.
Nick Larochelle, the Medical Director for the Concord Hospital Emergency Department, said the hospital has been using the last eight months to devise policies to safely offer elective procedures during another surge of COVID patients.
Last week, that surge arrived. Concord Hospital saw the highest number of COVID patient admissions to the hospital since May, Larochelle said. The hospital turned on negative pressure machines to filter the air and imposed limitations on visitors. Larochelle said there are no plans to delay non-COVID related procedures, though.
The decision to pause non-essential procedures in March cost the state’s hospitals hundreds of millions of dollars.
The New Hampshire Hospital Association predicted hospitals in the state will lose $700 million by the end of the calendar year. Some hospitals, like the Catholic Medical Center, had to furlough hundreds of staff members and lay off about 70 employees as a result.
“We did so because it was the right thing to do, but it has had disastrous financial consequences for hospitals all across New Hampshire,” Steve Ahnen, president of NHHA, wrote in a recent blog post.
But the plan to continue elective procedures isn’t all financial.
One study out of England estimated that when screening is delayed, as it has been during the pandemic, there is a 10% reduction in 5-year survival for breast cancer and a 16% reduction in survival for colorectal cancer. Another analysis predicted it could take three months to clear the backlog of surgical cases in the country.
Greg Baxter, chief clinical officer for SolutionHealth and president of Elliot Health System, said that fact played a large role in their decision to keep elective procedures running.
“You do have real instances of people who have had a delayed diagnosis,” he said. “When you put off a diagnostic test or procedure, some percentage of the time your outcomes are not going to be as good as they would be with a more timely diagnosis.”
Of course, these plans are subject to change. Hospital administrators almost obsessively watch the state’s daily numbers.
Baxter says his staff has become experts at “toggling” between different levels of service depending on the severity of COVID-19 cases in their area.
“We’ve got some muscle memory from the spri ng about how to shut things off and how to turn them on again,” he said. “I’ve been doing this 20 years and I don’t know anyone who’s ever done that before.”
The impact on hospitals is still relatively low — as of Saturday, COVID-19 patients comprised less than 3% of inpatient beds in the state, according to data from the U.S Health and Human Services. However, spikes in hospitalizations often lag weeks behind spikes in cases, and, right now, New Hampshire is seeing an unprecedented number of positive tests.
Baxter said he feels confident the hospitals are certainly more prepared now than they were in the Spring, but that doesn’t mean he doesn’t worry about the impending spike. Since labor day, the number of COVID patients in his healthcare locations has jumped from no cases to about 20 cases.
“No one knows whether in the next few weeks we’re going to see not a linear rise in hospitalizations, but an exponential rise,” he said. “If the community is not a strong partner in this, we could rapidly find ourselves with hospitalizations that will outstrip our resources.”