As a third, intense coronavirus wave bears down on Michigan, several hospital leaders from around the state said Thursday they have no choice but to postpone some surgical procedures to ensure they have the capacity to care for the crush of sick COVID-19 patients coming through their doors.
"We are really at a very critical junction," said Bob Riney, COO and president of health care operations for Henry Ford Health System, which is delaying some procedures Thursday and Friday at its Macomb hospital to manage the capacity crisis.
"After enduring the first two surges and the gains we made to bring down hospitalizations the past couple of months, none of us expected what we are seeing today. This should make all of us extremely concerned — not just the health systems and the hospitals, but the people of all communities across Michigan."
Michigan Medicine, the University of Michigan's Ann Arbor-based health system postponed a small number of non-emergency procedures through early next week, as did Spectrum Health's Grand Rapids hospitals.
Mercy Health Muskegon Medical Center canceled 13 procedures Tuesday because "they were in a crunch point," said Trinity Health Michigan Chief Clinical Officer Dr. Rosalie Tocco-Bradley.
"We're doing it hospital by hospital now, and we're doing it day by day," Tocco-Bradley said of capacity assessments at Trinity's eight Michigan hospitals, which include the St. Joseph Mercy and Mercy Health systems.
Michigan's COVID-19 case rate was highest in the nation Thursday, at 492.1 cases per 100,000 people, according to the U.S. Centers for Disease Control and Prevention. The state now also has the most coronavirus patients hospitalized and in intensive care unit beds in the U.S., said Sarah Lyon-Callo, the state's epidemiologist and director of the Michigan Bureau of Epidemiology and Population Health.
There's no sign the surge will slow down anytime soon.
Hospitalizations are doubling every 12-14 days, Lyon-Callo said. As of Thursday, 3,541 Michiganders were hospitalized with confirmed coronavirus cases — a 399% increase from 709 on Feb. 25.
The situation led the chairman of Michigan Medicine's surgery department, Dr. Justin B. Dimick, to plead for help from state and federal officials.
He tweeted: "We are starting to cancel surgical cases again to accommodate rapidly accelerating Covid-19 admissions. Entire state is high-risk. Bars and restaurants are open. People are out and about. No new restrictions. We need some help."
Dr. Mona Hanna-Attisha, the Flint pediatrician and public health advocate whose work helped to uncover the Flint water crisis, also took to Twitter to write about the urgency of the crisis.
She wrote: "Michigan: we need a vaccination SURGE and a two week PAUSE in everything else."
Andy Slavitt, White House senior adviser for COVID-19 response, would not commit Wednesday to sending a larger volume of COVID-19 vaccines to Michigan to quash the spread of the virus in the hard-hit state.
Rather, he said during a news briefing that health officials can shift the vaccine doses the federal government already has allocated to Michigan to regions where there are hot spots.
"We are in close contact, both through the CDC and direct conversations with the governor and her team, around what are the resources that could be most helpful at this point in time, as we do with other governors that find themselves in this situation," Slavitt said.
"Nothing is off the table in those conversations in terms of the kind of support that we can provide and we will keep the options open as we stay close."
Gov. Gretchen Whitmer said earlier this week that the state's third coronavirus surge isn't a public policy problem to be solved with COVID-19 health restrictions. Instead, she said Michiganders must double down on mask wearing, social distancing and hand-washing, while getting as many COVID-19 vaccines in arms as possible.
In an appearance Tuesday night on CNN, Whitmer was asked whether the state should again suspend youth sports until the current COVID-19 surge is under control.
“We did suspend sports for a quite a while, and, of course, there was a heavy effort to come to our state Capitol to protest that,” Whitmer said.
“We thought with these additional precautions — in terms of increased testing, increased ability to have these safety protocols, decreased numbers of people that can attend these events — that we would be able to do this safely. But we are seeing the spread continuing in teenage sports. And frankly it's something that we’re very concerned about. And that’s why we’re doing even more testing and possibly going further than we have."
She later said: "This may be one area that we need to do more in.”
CDC Director Dr. Rochelle Walensky suggested that the state should take steps now, such as restricting indoor youth sports or pause indoor dining, to rein in the spread of the virus.
"I would advocate for sort of stronger mitigation strategies ... to sort of decrease the community activity and shore up mask wearing," Walensky said during a White House COVID-19 Response Team news briefing.
The Michigan Health and Hospital Association, which represents all 133 community hospitals in the state, has yet to urge lawmakers to tighten COVID-19 restrictions to flatten the state's curve.
"The situation in hospitals is evolving every day and our members are concerned with the rapid rise in hospitalizations, especially among younger residents," said John Karasinski, director of communications for the association. "At this time, we have not made any recommendations to the state on changing the status of public health orders in Michigan.
"Currently in place are requirements that individuals wear masks, which we know mitigate spread, and limit exposure to large numbers of people outside their household. We urge people to step up their vigilance as it relates to these proven preventive measures that are already in place, while getting vaccinated as quickly as possible. These things together — improved prevention compliance and vaccination — will stop this surge of the highly contagious and deadly variants widespread in Michigan."
Hospital leaders from Beaumont Health, Sparrow, Ascension Michigan and McLaren Health Care told the Free Press that although their hospitals are now full, they haven't yet had to limit or reschedule non-urgent procedures.
Beaumont is managing more than 700 hospitalized patients at its eight metro Detroit hospitals, the biggest COVID-19 patient load in the state, CEO John Fox told the Free Press Wednesday.
"The real question is if this curve continues, and we start to surpass what we did in our second surge and approach the first surge, that would be extremely difficult," Fox said. "And that's not a Beaumont issue, that's really across the entire health care system in Michigan."
If the volume of COVID-19 patients grows by another 30%, Fox said, it'll be too much to maintain care for coronavirus patients and all the other people who need medical help for other conditions.
"There's no way to continue some of the other services and absorb that kind of growth," he said.
State leaders need to "start looking at every tool in the toolbox to deal with this," Fox said.
Dr. Ken Berkovitz, senior vice president of Ascension and ministry market executive of Ascension Michigan, said if the trajectory of hospitalized patients continues to climb, "we may have to temporarily hold some of our elective work as early as next week" at its 16 hospitals.
Having enough trained staff — nurses and respiratory therapists and physicians — to care for all the patients and still administer COVID-19 vaccines is among the biggest challenges, hospital leaders said.
Many say they are tired from coping with 13 months of working through wave after wave of coronavirus infections, but they're also getting sick themselves.
Trinity Health has more than 350 employees either with COVID-19 or in quarantine because of exposure to a person with the virus, Tocco-Bradley said. And Henry Ford Health system has 249 employees who are off work because they've tested positive, Riney said.
"Our health care workers are exhausted," Riney said. "They're not just tired. They're exhausted. Day after day, night after night, throughout this pandemic, they have given their absolute all caring for patients under conditions that we have never seen in our lifetime.
"They need our support once again as we ask them to continue this journey and deal with this surge. We know that people are fatigued, but people's non-compliance with the safety measures that have protected us for months now are giving this virus new life, and they are causing a surge of hospitalizations in cases.
"Before you choose to go to a large gathering with no social distancing, we're asking you to stop and think about the exhausted nurses, doctors, therapists, and other medical professions in the emergency department and the ICUs those who cared for a loved one friend, neighbor or colleague who recovered from COVID.
"And for those that are still hesitant to get vaccinated, we're asking you to stop and think about those very same nurses, doctors, housekeepers and other health care team members who are working 24-7 to care for people getting sick from COVID while determined to keep all other clinical services, open and care for our communities so that no illness goes untreated."
Though hospitals are full, and employees are stretched to the limit, Riney and Tocco-Bradley stressed that people shouldn't avoid coming to emergency departments or calling their doctors if there's an emergency or a medical problem.
"One of the lessons we learned the first time, is that people need health care, and we don't want to turn anybody away or delay any cases that we don't have to," Tocco-Bradley said.
"I emphasize and re-emphasize that in spite of the surge again, it is far more dangerous for anyone to delay needed care than to come to the hospital or clinic to get the health care that you need," he said. "This is particularly important for anyone who's experiencing a medical emergency, chest pain, slurred speech, dizziness. Our emergency departments, no matter how busy, will take good care of you while also keeping you safe, and the delays will only complicate matters for you."
*This story has been updated.
Free Press staff writer Dave Boucher contributed to this story.
The Detroit Free Press, Bridge Michigan and Michigan Radio have teamed up to report on Michigan hospitals during the coronavirus pandemic. If you work in a Michigan hospital, we would love to hear from you. You can contact Kristen Jordan Shamus at email@example.com, Robin Erb at firstname.lastname@example.org or Kate Wells at Katwells@umich.edu.