Mission Health North Tower hospital in Asheville, NC, is owned by HCA.
Mission Health North Tower in Asheville. Colby Rabon / Carolina Public Press

Kat Phillips spends her days in UNC Medical Center’s surgical intensive care unit caring for some of the sickest patients in the hospital.

Some are on ventilators, dialysis and ECMO machines, devices that remove a person’s blood and oxygenate it to bypass poorly performing lungs. When the patients leave the unit alive, the nurse said, they’re the exception — only about 40% get better.

And they all have COVID.

“The patients are a lot sicker than they were, they’re a lot younger,” Phillips said, referring to differences between now and earlier in the pandemic. “And the majority of patients we see are unvaccinated.”

The late summer surge of COVID-19 hospitalizations — driven by the delta variant and a state population that remains nearly 50% unvaccinated — has severely taxed an already burdened health care system.

That’s according to a survey of North Carolina hospitals by the NC Watchdog Reporting Network, which found that facilities are diverting patients, converting areas to COVID wards and delaying procedures to cope. Hospitals say patients are getting sick faster and staying sick longer, extending inpatient and intensive care unit stays across the state.

The result: More hospitals are reporting critical shortages of staff to serve people in need of medical care.

“A lot of us love what we do, we love the critical thinking aspect of it,” Phillips said. “We love taking care of the sick. But we are also really tired and burned out. 

“It’s a lot of death and it’s the new normal, I think,” she added. “A lot of death around here.”

Diverted patients, longer stays

Over the past several weeks, the number of hospitalized COVID-19 patients has surged across North Carolina to a near historic high of about 3,800. That’s a tenfold increase in just two months.

As of Wednesday, about 1 out of every 5 patients in North Carolina hospitals have the virus, data from the U.S. Department of Health and Human Services shows.

People with COVID make up a greater proportion of those in intensive care. Federal data shows that 2 out of every 5 people in these units have COVID.

That rapid growth appears to have leveled off as the number of newly admitted COVID patients has fallen, although it’s too early to tell how the Labor Day weekend affected the spread of the virus. 

To get a deeper sense of how the pandemic is impacting health care across North Carolina, the N.C. Watchdog Reporting Network surveyed hospitals and hospital systems representing more than 120 facilities across the state. The survey sought to gauge the impact the current surge is having on access to hospital facilities, scheduling of elective procedures and staffing.

Several hospitals have at some point in the past three months limited the number of new patients coming into their hospitals. That includes Mission Hospital and its affiliates in Western North Carolina, UNC Southeastern Hospital in Lumberton, UNC Medical Center in Chapel Hill, AdventHealth in Hendersonville and Duke Hospitals and Novant Health at multiple locations across the state. 

They did it either by reducing transfers or diverting incoming patients to nearby facilities.

All of the hospitals and hospital systems said their ability to accept new patients and transfer patients fluctuates based on their capacity, largely dictated by the number of COVID patients.

“This is a fluid, day-to-day situation,” said Leigh Whitfield, a spokeswoman for Lake Norman Regional Medical Center in Mooresville.

At Novant Health, which has hospitals near Charlotte, Winston-Salem and Wilmington, spokesperson Megan Rivers said the hospital has diverted patients across its own system and other local hospitals to manage wait times for the emergency room and other beds.

A spokesperson for WakeMed in Raleigh said it created surge spaces to increase capacity to care for a high volume of patients coming to the emergency rooms at its hospitals, as necessary.

The volume of patients is only one of the stressors on an already strained system. Nearly every hospital that responded said COVID patients are staying longer than patients hospitalized with other illnesses.

At the Statesville-based Iredell Health System, that’s the difference between 4.5 days for a non-COVID patient and 10 days for someone moderately ill with the virus.

“This is partially due to a five-day treatment coupled with patients continuing to need a much longer course of treatment with steroids and oxygen due to the lung injury that is caused by COVID infection,” Iredell Health spokeswoman Meagan Kowalski said.

Within the Veterans Affairs health system in North Carolina, the average length of stay for a veteran hospitalized with COVID at the Fayetteville VA Medical Center since June 1 was 20 days, compared with a five-day average stay for non-COVID patients. Veterans being treated for COVID at the Salisbury VA Medical Center were staying more than nine days, compared with a three-day average stay for non-COVID patients.

Since June 1, UNC Medical Center in Chapel Hill reported an average length of stay for all COVID patients at a little more than nine days, with more than 16 days for ICU patients. That has pulled up the average stay for all patients to an average of nearly six days, a spokesman said.

Victoria Dunkle with AdventHealth Hendersonville said the hospital is currently seeing younger and sicker patients. Although the average length of stay for patients with respiratory infections and inflammation, which includes COVID-19 patients, is 5.66 days, Dunkle said sicker COVID-19 patients are staying an average of 13 days, with some being in the hospital’s care for a month or more.

Many hospitals also reported having to delay some elective procedures at some point in the past three months, with some hospitals specifically canceling surgeries that would require an inpatient bed.

‘Simply not enough staff’

In the meantime, two of the state’s largest health care groups are sounding alarms.

The N.C. Nurses Association released a survey conducted in late August that showed nurses are burned out and reeling from the impacts of a staffing shortage that existed before the pandemic, which has only worsened since.

“I’m really concerned about nurses out there right now and I’m even more concerned about the long-term impact this will have on individuals and the profession,” association CEO Tina Gordon said in a statement.

Roughly 77% of the nurses the association surveyed said their facilities have a severe or moderate shortage of nursing staff.

And that finding is backed by data from the U.S. Department of Health and Human Services.

The number of hospitals in North Carolina reporting critical staffing shortages has tripled in three months, from four to 12, according to federal data.

But exactly which hospitals — or which departments — are experiencing those shortages isn’t clear.

Hospitals report staffing information daily to the federal health agency, and it’s up to each facility to determine whether a critical shortage exists. But that number is only released statewide. While the government does collect data about which positions are experiencing staffing issues — ranging from ICU nurses to respiratory therapists — federal officials don’t provide that data to the public.

Hospitals across the state are feeling that shortage, but it’s worse at rural hospitals, hospital responses to the Watchdog Reporting Network’s survey show.

“There simply is not enough staff to care for all of the patients who need a hospital bed,” said Amber Cava with Sampson Regional Medical Center in Clinton.

“Due to the health care worker shortage, we are highly reliant on travel/crisis nurses. These nurses are in high demand, and we must win the bidding war amongst every other hospital,” Cava said.

Tatyana Kelly, a spokeswoman with the N.C. Hospital Association, said the staffing shortage was a problem before the pandemic and has only gotten worse over the past 18 months.

“We cannot keep accommodating the waves of folks that are presenting in our facilities,” Kelly said.

Many hospitals have had to convert extra rooms and wings of a hospital into COVID wards to handle additional patients, making the staffing shortage worse, Kelly said.

The result has been delays in treating patients for non-COVID injuries and illnesses and the cancellation of nonemergency procedures, she said.

Kelly said her association’s modeling shows that the delta variant surge will likely peak by October in North Carolina, depending on a host of variables, including vaccination rate and whether people continue traveling.

About two-thirds of adults in North Carolina have received at least one shot, a rate lower than about 30 other states and the District of Columbia.

Health care workers and hospital administrators all point to the state’s relatively low vaccination rate as a reason for the delta variant’s continued spread in North Carolina.

Getting vaccinated, they said, is the best way to keep people out of the hospital.

“It takes all of us to do our part,” Kelly said.

This story was jointly reported and edited by Laura Lee, Kate Martin and Frank Taylor of Carolina Public Press; Sara Coello of The Charlotte Observer; Cathy Clabby and Tyler Dukes of The News & Observer; Nick Ochsner of WBTV; Michael Praats of WECT; Travis Fain, Ali Ingersoll, Amanda Lamb and Ashley Talley of WRAL; and Jason deBruyn of WUNC.

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The NC Watchdog Reporting Network is a cooperative effort of investigative journalists representing seven news organizations across North Carolina. Participants include Carolina Public Press, the Charlotte Observer, the News and Observer, WBTV, WECT, WRAL and WUNC. Email CPP's news team at info@carolinapublicpress.org to contact the NC Watchdog Reporting Network.