Oregon hospitals in ‘crisis mode,’ Bend day care challenged by rise in RSV cases amid Covid-19 and flu
(Update: Adding video, info from Thursday OHA briefing, comments from RN, Munchkin Manor Day Care)
RSV cases increased five-fold between October 23rd and November 13th
BEND, Ore. (KTVZ) -- Hospitals are full, emergency departments are full, nurses are spread thin, and day cares are experiencing a drop in attendance amid what is now called by some a "triple-demic" of respiratory viruses, the flu and continued COVID-19 cases.
At Bend's Munchkin Manor, Day Care Director Christina Sharp said Thursday when children show respiratory syncytial virus (RSV) symptoms, she tells parents to also get their child tested for Covid-19 and the flu, to rule everything out.
“It seems almost pretty much every child at our day care has now had RSV or currently has RSV," Sharp said.
The day care currently cares for 22 kids, and they’ve been treating the crisis similar to the Covid-19 protocol.
Sharp listed how: “Lots of hand washing, sanitizing nonstop, monitoring, kind of pretty much doing daily health checks with the children, checking temperatures."
According to the Centers for Disease Control and Prevention, RSV is most infectious between three to eight days.
Symptoms include a decreased appetite, a runny nose, coughing, sneezing, a fever, and wheezing.
Dr. Wendy Hasson, medical director of the Intensive Care Pediatric Unit at Randall Children's Hospital in Portland, explained why the health care system is under severe strain during Thursday's Oregon Health Authority's briefing.
Hasson said, “I want to be clear that the crisis that we’re dealing with in pediatrics is a crisis of a lack of health care personnel, a lack of respiratory therapists, nurses, and support staff.”
In response to the crisis, Gov. Kate Brown said Wednesday she is exercising her executive authority under ORS Chapter 401 in response to a surge of adult and pediatric cases and hospitalizations of respiratory viruses –– including Respiratory Syncytial Virus (RSV), influenza, and COVID-19 –– across Oregon.
The executive order will give Oregon hospitals additional flexibility to ensure there are enough health care workers to meet current needs, allow them to draw on a pool of medical volunteer nurses and doctors, and take other steps to provide care to patients.
On Nov. 14, Governor Brown granted hospitals flexibility to address the rise in pediatric hospitalizations related to respiratory viruses, including RSV. The Governor’s new executive order will expand that flexibility to help health care workers and hospitals address the rise in adult and pediatric hospitalizations, and related critical strain on hospital capacity.
Megan Bovi, a registered nurse and Oregon Nurses Association member working in the pediatrics unit of St. Charles Bend, said she appreciates more state support, but there’s a downside.
Bovi said, "When she (Brown) declares these state of emergencies, the checklist of how she states them and what that means is pretty broad in general.”
Bovi said that can lead to changes within the St. Charles Health System that aren't necessarily beneficial for staff, like the pressure of a doubled patient-to-staff ratio.
Other than a much greater workload, the impact of that, Bovi said, results in less safe conditions.
Bovi addressed the immediate needs of the pediatric unit which includes bed capacity and staffing.
"A long term solution -- we need to be set up for our booming pediatric population. We need more of a pediatric facility," Bovi said.
She pointed to discussion about the National Guard coming in to aid in the health care worker shortage and strongly encouraged the option stating that although they may not be able to provide patient care, they can fill in the gap left behind from the 100 non-clinical care worker layoff by St. Charles Health System.
Bovi said, "Our facilities people, our dietary people, out housekeeping people -- all those people that are so amazing and help us do our jobs were laid off."
In addition to the governor’s executive order, the Oregon Health Authority is pursuing supplemental nurse staffing contracts of up to $25 million to help address critical workforce shortages. OHA expects more than 100 contract nurses and respiratory therapists to be in place in the next week.
At Thursday's meeting, state epidemiologist Dr. Dean Sidelinger said there’s been a five-fold increase in RSV hospitalizations in Oregon between October 23rd and November 13th.
In Central Oregon, OHA recorded 271 RSV positive tests as of Wednesday.
Bovi said, “On my shift, I'm seeing between Day 0, so literally day-old babies, to age 5 getting hit the hardest.”
Sharp reinforced that if your child shows symptoms, you should keep them home.
"Even if they don't seem that sick, bringing them into settings like (day care) can really have an impact on other children," she said. "We had an infant that was in the hospital for four days -- goes to show it can really impact other kids lives."
But it's important to keep in mind RSV doesn't just affect kids. Adults ages 65 and up, those experiencing pregnancy, and those who are immunocompromised are also at risk.
OHA officials warned against exposing yourself and children to crowded indoor places like restaurants, indoor birthday parties, and grocery stores.
Dr. Hasson also highly recommends kids get the flu vaccine, to keep them out of the hospital.
The governor's office announcement continues below:
Since the governor issued her first executive order in November, pediatric hospitalizations for RSV have continued to climb. Influenza hospitalizations have risen rapidly and are expected to continue to increase in the coming weeks, with a disproportionate impact on young children, elderly adults, pregnant people, and people of color and tribal communities. COVID-19 hospitalizations have risen steeply as well.
"Our health care workers –– our nurses, doctors, and hospital staff –– are being pushed to their limits by this year’s combination of flu, RSV, and COVID-19 hospitalizations,” said Governor Brown. “As they do everything they can to keep Oregonians healthy and safe, we must all do our part to help them. Our health care workers are working around the clock to protect the people most vulnerable to severe respiratory illnesses––including our young children and seniors.
“I am asking Oregonians to come together to help our health care heroes this holiday season. Stay home if you are sick, stay up to date on your vaccinations, and consider wearing a mask in crowded indoor situations––especially if you are at higher risk for severe illness from RSV, the flu, or COVID-19.”
State health experts at the Oregon Health Authority encourage all individuals, particularly those at increased risk of severe disease (and their caregivers), to take steps to prevent RSV and other respiratory infections this flu season.
- Stay up to date on flu and COVID-19 vaccinations. (There is not currently a vaccine for RSV.)
- Stay home and avoid holiday gatherings and events when sick, and keep your child home when your child is sick, if possible.
- Cover coughs and sneezes, clean and disinfect high-touch surfaces, and regularly wash your hands thoroughly with soap and water or use hand sanitizer.
- Consider wearing a mask indoors, especially during crowded indoor gatherings and events, particularly if you or a friend or family member are at risk for getting severely ill from RSV and other respiratory infections.
A copy of the governor’s executive order, Executive Order 22-24, which rescinds and replaces Executive Order 22-23, is available here.
From The Associated Press:
Health Authority Director Patrick Allen at a briefing Wednesday told lawmakers that an Oregon infant born prematurely was recently treated in an adult intensive care unit because no neonatal ICU or pediatric ICU beds were available in Oregon, Washington or Idaho, Oregon Public Broadcasting reported.
Statewide, fewer than 5% of hospital beds are currently vacant.
Dana Braner, the chair of pediatrics at Oregon Health & Science University’s Doernbecher Children’s Hospital, said the state is running out of pediatric ICU beds on a daily basis, and that they've had to set up beds in surge spaces.
OHSU and other hospitals are taking those and other measures akin to those taken during the delta wave of COVID-19 last year. They've also been canceling some surgeries, officials said.
“It literally constitutes the greatest threat to children’s health in our state that we have seen in the last 30 years,” Braner said.
In mid-November, Brown in an executive order gave hospitals flexibility to address the rise in pediatric hospitalizations related to respiratory viruses. The latest order expands that flexibility.
Pediatric hospitalizations for RSV have continued to climb since mid-November, Brown's office said. Influenza hospitalizations also have risen rapidly and are expected to continue to increase in the coming weeks, according to her statement. COVID-19 hospitalizations have also increased, Brown's office said.
But hospitals have struggled with too many patients for available staffing for much of 2022, as nurses frustrated with working conditions have left bedside and acute care jobs, and patients have shown up on average sicker because care was delayed during the pandemic.
Allen said the state is working quickly to line up contracts with temporary employment agencies that provide travel nurses, and said some arrived at OHSU this week.
Allen acknowledged those travel nursing contracts are an expensive and short-term solution to the problem. OHA estimates the $25 million will cover contracts for 10 weeks of temporary staffing support for the state’s hospitals.
The Oregon Health Authority held a livestream media and public briefing Thursday to provide its monthly update on COVID-19, as well as RSV and influenza activity. A recording of the briefing is available via YouTube here.
State Epidemiologist Dr. Dean Sidelinger said there was nearly a five-fold increase in RSV-associated hospitalizations in Oregon between Oct. 23 and Nov. 13, and rates remain the highest on record.
"The health care system is under severe strain," he said, noting that flu cases have doubled each week for five straight weeks, with test positivity jumping from 1% to 30%, while COVID-19 patients also have risen from 235 to 347 in the past month.
Additional information on RSV for parents and guardians
RSV is a common respiratory virus that usually causes mild, cold-like symptoms, such as runny nose, coughing and sneezing. Most infections go away on their own in a week or two. If you have questions about your child’s care, call your health care provider or visit an urgent care center. At this time, hospital emergency departments are strained. Parents and guardians should only visit the hospital if your child shows signs of severe illness.
Parents and guardians should immediately seek health care if their child is experiencing more severe symptoms of RSV, such as trouble breathing, dehydration, gray or blue color to the tongue, lips or skin, or significantly decreased activity and alertness.
More information on how to protect yourself and loved ones from RSV, the flu, and COVID-19 are available on OHA’s website.
Hospitals React to Governor's Executive Order
Oregon Assn. of Hosp. and Health Systems (OAHHS) - 12/07/22 4:15 PM
"We welcome Governor Brown's executive order, which will give hospitals the staffing flexibility and labor resources they need to address a crippling surge of patients with respiratory illness. But the reality is Oregon hospitals need the ability to adjust their staffing all of the time, not just during a surge that has intensified our capacity crisis. We have critically ill children in adult units and boarding in Emergency Departments who should be in pediatric intensive care units in Portland, but there are few available beds. We've been saying it for more than two years: our system is failing. The unfortunate position we find ourselves in today could have been prevented, and it wasn't."
Lisa Goodman, Vice President of Communications
Oregon Nurses Association Statement on Gov. Brown's Expansion of Hospital Capacity Emergency Order
Oregon Nurses Assn. - 12/07/22 3:05 PM
(Portland, OR) - Nurses represented by the Oregon Nurses Association agree that our state is in crisis. In fact, nurses in Oregon know better than anyone the true extent of this crisis.
Today’s executive order, which expands the hospital capacity crisis beyond pediatric units to entire hospitals and health systems, is necessary. It is also embarrassingly late and lacking in strong solution-driven policy directives. It opens the state’s coffers to wealthy hospital systems which have billions of dollars in cash reserves and heaps more stress on frontline health care providers who are already buckling under the pressure of these recurring surges.
More problematic is that this emergency order will give hospitals new ways to willfully ignore Oregon’s nurse staffing law – a law that most hospitals in Oregon already flout without consequence.
Historic Failure Enforcing Staffing Law
The Oregon Health Authority’s (OHA) own research clearly shows many hospital staffing plans don’t meet the requirements of state law, and many hospitals refuse to comply with their own staffing plans.
In 2021, OHA surveyed 15 hospitals and, as of October 2022, have accepted plans of correction from only 9 of them. One hospital, OHSU, is on its sixth plan of correction, nearly one and a half years after OHA cited them more than a dozen times for repeated non-compliance with the law, including failing to consider how nurses get meal and rest breaks and establishing minimum staffing levels in staffing plans. Hospitals’ willful disregard for the collaborative structures in Oregon’s nurse staffing law is extensively documented in the public record over many years.
OHA has also never issued a civil monetary penalty, even though 24 of 25 hospitals which underwent revisits from OHA received citations for repeated non-compliance. This shows hospitals make little to no effort to comply with state law. This is an ongoing pattern of blatant disregard for the staffing law, and for the voice of frontline nurses, which has been enabled by OHA’s refusal to enforce the law.
It begs the question: what good is a law if nearly 75% of Oregon’s hospitals receive a “get out of jail free” card from the Governor and OHA to ignore it, and there are no consequences for doing so?
Unsafe Staffing Leads to Turnover – The Real Cause of Oregon’s Staffing Crisis
ONA’s recent statewide nurse survey points to unsafe staffing levels as the major cause of nurse turnover in Oregon’s hospitals – and turnover is the reason for our state’s nurse staffing crisis. Nurses report that 99% of units in Oregon’s hospitals are sometimes or never staffed appropriately. Half of nurses who responded indicated they are caring for too many patients on a majority of their shifts. An astounding 92% of nurses report missing rest and meal breaks, with 42% of them reporting missing these legally required breaks on most of their shifts. National research supports the experience of Oregon’s nurses; those reports show that one in four nurses are likely to leave the profession this year, and more than 70% of all health care workers are experiencing anxiety and depression due to workplace burnout.
We also know that burnout, turnover and insufficient staffing lead to devastating outcomes for patients. The research is unequivocal; increased risk of drug administration errors, missed care, delayed care, increased length of stay, increased incidents of hospital acquired infections, increased pneumonia infections, higher risk of death, and a higher risk of respiratory failure are all part of unsafe nurse staffing levels.
Nurses are leaving the hospital bedside in record numbers, and the recurrence of capacity crises like the one we are facing now is at the heart of that exodus.
Additional Steps Needed in Light of the Current Crisis
The announcement of $25 million in state funding to support hiring more staff, like traveling nurses, is welcome news – although we wonder how much more effective these funds would have been if made available four weeks ago. It strikes us, as it might most Oregonians, that the Governor and OHA are relying on the same short-term solutions to crises in hospital capacity over and over again. These efforts may help to alleviate the immediate crisis, but they do absolutely nothing to prevent the crisis from recurring.
The Governor, and the Oregon Health Authority, should be ashamed that it took them so long to act – particularly given the clear indications of a surge in respiratory illnesses swamping Oregon’s hospitals for the past month or more. For weeks, ONA and others have been publicly calling for a massive increase in public health communication, like what Oregon saw during the worst days of the COVID-19 pandemic, and OHA’s response has been lackluster at best.
OHA’s hands-off/open the checkbook approach is not a long-term solution to ongoing staffing problems, but this appears to be the best OHA is willing to offer. ONA is repeating our demands that OHA, and hospital systems, do more to immediately reduce the overwhelming strain on our members, including:
- An immediate cessation of all elective surgeries; respiratory therapists, nurses and other frontline health care workers should not be tied up in non-essential, high-profit surgeries while pediatric units are unable to provide care to ill children.
- Hospitals and health systems must notify the public, clearly and repeatedly, if and when they are triaging or rationing services.
- Hospitals with union represented workers must agree to bargain, as legally required, over all changes to working conditions that will result from changes in operations, including but not limited to a crisis standards of care declaration.
- Prior to the implementation of any crisis standards of care declarations, hospitals must guarantee all frontline health care workers – from environmental and food services to phlebotomists and certified nursing assistants and everyone in between - additional PTO and incentive pay for those who agree to take extra shifts.
- The Governor must call up the National Guard to provide support; every minute a nurse spends delivering food, emptying laundry baskets, or directing visitors in a waiting room is a minute they don’t spend at the bedside delivering patient care.
- Hospitals must bargain with all union represented employees within 5 days to ensure any actions taken by hospital administration do not violate legally enforceable collective bargaining agreements.
- Hospital management cannot shut out or ignore staffing committees. Oregon law provides clear direction on management’s obligations when deviating from staffing plans. Today’s emergency order does not mean that staffing committee work is irrelevant. We have seen hospitals abuse these emergency declarations in the past and nurses, and patients, are dealing with the results to this day.
- State funds must be accessible to all hospital systems, not just those with a big lobbying staff, and the use of funds by hospital systems must be transparent so Oregonians can be assured state dollars are being used for patient care services and not executive compensation packages.
- Major systems like Providence (which recently reported having $12 billion in unrestricted cash and investments) or OHSU (whose FY21 audit report indicates access to over $4.1 billion in assets) must be held accountable for their expenditures, while rural hospitals and facilities serving underrepresented communities must be supported.
A Plan for Real Change
Finally, ONA reiterates our long-held belief that the cause of Oregon’s capacity crisis is one created by hospital executives who put corporate profits before patients and their caregivers. One need only look at PeaceHealth’s recent decision to close an urgent care clinic in Eugene, on the day before Thanksgiving and in the midst of the growing “tripledemic” threat, to realize that healthcare systems in Oregon put their priority on the bottom line and not on the health of our communities.
ONA’s proposed Safe Staffing legislation, to be considered by the Oregon legislature next year, will require OHA to take enforcement of the state’s staffing law seriously, will empower OHA to levy significant financial fines on hospitals who choose to ignore the rule of law, and will put minimum safe staffing standards in place to prevent future abuses of nurses in the workplace. ONA believes that, if hospital systems are serious about making change, they would sign on to support our legislation today.
Unsurprisingly, and tragically, here we are again: Oregon is facing yet another crisis in hospital capacity, and yet again, nurses and other front line health care workers are expected to triple-down and get on with it. Yet again, nurses are wondering if they can stand up to their latest impossible task and what the costs will be to themselves and their colleagues, and, yet again, the Governor and the Oregon Health Authority act too late, and with too little respect for the impact of these weak recommendations on nurses and their healthcare colleagues.
To the Governor and OHA, ONA says, “Do better. Do more. Do it now.”
Learn more about ONA’s efforts to put an end to the cycle of unsafe staffing at www.SafeStaffingSavesLives.com.
The Oregon Nurses Association (ONA) is the state’s largest and most influential nursing organization. We are a professional association and labor union which represents more than 15,000 nurses and allied health workers throughout the state. ONA’s mission is to advocate for nursing, quality health care and healthy communities. For more information visit: www.OregonRN.org.
Thursday news release from the Oregon Health Authority:
Physicians join state officials in urging public to wear masks indoors
As surging respiratory cases are overwhelming Oregon hospitals, masks are effective in slowing disease spread, officials say
(PORTLAND, Ore.) — Cases of influenza and respiratory syncytial virus, or RSV, are surging in Oregon, forcing hospitals into crisis mode as they struggle to manage heavy demand for adult and pediatric beds, health officials said today.
The surge prompted a stark warning from Portland-area physicians who have experienced, first-hand, how patients and the state’s health care system have been affected during the hospital capacity crisis: If people don’t start wearing masks indoors more, they put themselves and those around them – especially young children and older adults – at risk of severe illness, or even death.
“Masking works,” said Wendy Hasson, M.D., medical director of the pediatric intensive care unit at Randall Children’s Hospital at Legacy Emanuel. “Anytime you have to go to an indoor crowded area during this surge, if you and your child can wear a mask, that will help protect the (health care) resources.”
Hasson was one of three clinicians who joined Dean Sidelinger, M.D., M.S.Ed., health officer and state epidemiologist at Oregon Health Authority, today for OHA’s monthly COVID-19 media briefing. The briefing, which focused this month on all the circulating respiratory viruses putting strain on hospitals this season, also included Ray Moreno, M.D, chief medical officer at Providence St. Vincent Medical Center, who has a background as an emergency department physician; and Matthias Merkel, M.D., Ph.D., senior associate chief medical officer at OHSU Health, Oregon Health & Science University.
A recording of the briefing is available via YouTube at this link.
Sidelinger kicked off the briefing by calling the situation facing Oregon’s hospitals “extremely serious.”
“Today, more hospitals are reaching a point of crisis in their adult bed capacity just as our pediatric hospitals moved to crisis care standards in the past two weeks,” he said. “The combination of surging flu, RSV and COVID-19 cases is pushing hospitals past their current ICU bed capacity, which never happened during the darkest days of the COVID-19 pandemic in Oregon.”
According to Sidelinger, Oregon saw an almost five-fold increase in RSV-associated hospitalizations in Oregon’s children between Oct. 23 and Nov. 13. Although RSV-associated hospitalizations peaked during the week ending Nov. 19, rates of hospitalization remain higher than during any previously recorded peak.
“While the worst of RSV is behind us, many sick children will continue to require specialized care during the weeks to come,” Sidelinger said.
Influenza cases doubled each week for five consecutive weeks, with test percent positivity jumping from 1% to 30% between Oct. 18 and Nov. 28. That’s led to a rapid rise in influenza hospitalizations since late October, particularly among people 65 and older, whose hospitalization rate has seen a 10-fold increase.
This year’s influenza season began earlier than normal, with high levels of the virus seen across the country, Sidelinger said.
“We do expect flu activity to maintain its upward trajectory into the winter, particularly as the holiday season and gatherings with loved ones continue,” he said.
And the COVID-19 pandemic clearly “is not over,” Sidelinger explained, as demonstrated by significant increases of cases of the virus this season. Percent positivity and COVID-19 levels in wastewater have risen, signaling increased community spread and spurring a 48% increase in the number of COVID-19-positive patients in hospitals in the past month. ICU hospitalizations have also gone up 30%, but the number of COVID-19 deaths has remained flat.
All four physicians emphasized the critical importance of using the precautions that had proven themselves throughout the pandemic as effective strategies for preventing transmission not just of COVID-19, but also other respiratory viruses. It’s especially important, they said, now that people are considering attending indoor gatherings with friends and family to celebrate the holidays.
“Now is not the time to go to crowded indoor places like indoor birthday parties, play places, restaurants, grocery stores,” Hasson said. “Anything you can do to keep your child out of a crowded indoor area will help.”
In addition to avoiding crowded indoor spaces, Moreno explained, people can help reduce the pressure on hospitals by taking care of themselves and others.
“Get immunized for influenza. Get your booster for COVID. It is not too late. Please get immunized. And don't gather if you're sick, even just a little sick. Really, that protects other people.”
Merkel advised people to assess their risk assessment – if they have a loved one at home who is “really likely to not do well with an infection right now,” they should protect that loved one and themselves from the next infection.
“Definitely wear a mask if you go in public places,” he said. “Definitely get all your vaccines to really minimize the risk that you are the next patient in one of our totally full emergency rooms, waiting for the next ICU bed to be made available for you.”
Hasson noted that she has admitted many patients over the last two weeks with the flu, but that she has “not admitted a single patient who has received a flu vaccine.”
“Flu vaccines work. They keep kids out of the hospital, and I cannot stress this enough,” she said. “If you have been on the fence about getting your flu vaccine, now is the time to get one immediately to keep your child out of the hospital.”
OHA is working closely with Gov. Kate Brown’s office to provide relief to Oregon’s strained hospitals, including bringing additional health care providers – nurses and respiratory therapists – from out of state to help ease hospital capacity issues. The agency also is pursuing up to $25 million in additional state funding for supplemental nurse staffing contracts.
He highlighted Brown’s Dec. 7 executive order, which continues and expands her Nov. 13 emergency declaration to provide additional flexibility to Oregon hospitals. This will ensure there are enough health care workers to meet current needs; hospitals can draw on a pool of medical volunteer nurses and physicians; and other critical steps can be taken to care for patients.
In addition, OHA is communicating regularly with the health care, public health, laboratory and emergency preparedness communities through the Health Alert Network, or HAN, to provide updates on the surge response; medical, treatment, vaccination and testing supplies; investigative guidelines and clinical recommendations; and prevention and health promotion messages.
“We know what works to keep our families and our neighbors safe: wear a mask when you’re in crowded indoor places this winter and stay up to date on your vaccinations,” Sidelinger said. “Masks work. During the worst of the COVID-19 pandemic, Oregonians wore masks at higher rates than people did in most other states. Oregon had one of the lowest COVID-19 death rates in the nation. Our hospitals were never overwhelmed. And we saved more than 5,000 lives.”
