Hospitals ‘essentially full’ during fourth-wave surge of pandemic
Denise Shields has been a nurse for 21 years, and she calls the fourth wave of the COVID-19 pandemic “probably the worst thing I’ve ever seen.”
“There are some days that I go home and think that I don’t want to come back and do it again,” said Shields, an emergency department nurse at Northeast Georgia Medical Center’s Braselton campus, “but I get up and I come back because I love what I do.”
While Shields is resilient, she’s exhausted. So are her fellow NGMC nurses and healthcare workers.
The Northeast Georgia Health System has reached another critical point of the pandemic. As of Monday afternoon, NGHS reported 287 COVID-positive patients throughout its facilities, the most since January.
Seventy-four of those patients were being treated at the Braselton campus.
“So, in essence, our hospitals are full — they’re essentially full at this point,” said Carol Burrell, CEO of Northeast Georgia Health System, during a Monday media tour to highlight the issues hospitals are facing.
Emergency rooms and urgent care centers within NGHS are seeing higher volumes than ever before in the pandemic, increasing wait times.
Hospitals are so full that hallways, conference rooms and waiting areas are becoming patient-care spaces. Every patient room large enough has been converted to semi-private to maximize space. At the Braselton campus, a 1,400-gallon oxygen tank was installed in addition to the existing 1,500-gallon tank due to the rise in patients. At Gainesville, Monday’s media tour included a stop on what was formerly a traditional hospital wing that has been converted into a COVID critical care unit.
“In spite of all that expansion, we’re still full,” said Dr. John Delzell, vice president of education and incident commander for Northeast Georgia Health System.
Primary care locations have opened up to see patients, which has taken some of the case load off emergency rooms and urgent care.
Meanwhile, NGHS remains short staffed during this crisis. Workers took on extra shifts during the weekend to meet the surge in patients.
“Even with the capacity and space constraints, our No. 1 concern is staffing,” Burrell said.
Elizabeth Larkins, executive director of medical nursing services, said NGHS needs “about 500 more nurses than we have right now.”
Nineteen national guardsmen have been called into assist the Braselton and Gainesville campuses through early December, though 30 more have been requested, according to Delzell.
Officials at NGHS continue to implore the public to get vaccinated to stem the wave of cases entering their hospitals.
“I’ve been a nurse since 1997,” Larkins said. “This is the hardest thing I’ve ever been through in my nursing career. What makes this particularly heartbreaking is how unnecessary it is. If people would just get vaccinated my nurses would not have to go through the emotional heartbreak of watching young people die unnecessarily.”
Meanwhile, according to projections, the fourth wave peak is expected in mid-September with projections of 450-500 hospitalizations — far outpacing the previous peak of 355 patients in January 2021.
Shields pled with the public to stay patient when they arrive at the emergency room.
“We are trying very hard to see everybody at the right time … We take the sickest first, and we are trying just as hard as we can to make sure everyone gets seen and everyone gets good care,” she said.
Braselton campus intensive care nurse Brittany Ingram illustrates just how stretched ICU staff is right now.
Ingram said she and her colleagues are seeing three ICU patients at a time now with this latest COVID surge. The typical ratio is one ICU nurse per patient. Additionally, continual dialysis patients in ICU, who typically receive one-on-one treatment, are now being paired with another patient.
Ingram related a story where, due to limited staffing and a high-number of ICU cases, she had to care for a continual dialysis patient and an intubated patient simultaneously. She ran into a crisis where the dialysis patient coded and needed to be flipped over for CPR — which required the few available personnel on hand to help — all while the other critical-care patient ended up needing emergency attention, too.
“So, we spent so much time in there trying to code and stabilize that one, that were missing the signs of the other one going down hill,” she said.
Ingram noted that it takes six to eight people to fully revive someone from dying “and you’re working with three people, max.”
Ingram, who is working in the ICU at 26 weeks pregnant, said these conditions have taken a toll on the ICU staff.
“We cry a lot,” she said. “We spent more time at work than we do at home with our own families, so we’ve had to change our mindset to not being each other’s co-workers, but being a work family instead.
“We rely a lot on each other just to get through day-by-day-by-day.”
All the while, concerns about her own health and that of her family weigh on her as she works through another wave of the pandemic.
“It’s there,” she said. “I feel like if one of my family members contracts COVID, it’s not because they went to the local Walmart. It’s because I brought it home.”
The Braselton campus recently added a mobile tent unit to handle emergency-room overflow brought on by the fourth wave of the pandemic. The Braselton emergency department was never designed for the volume of patients currently going through there, according to Larkins, the executive director of medical nursing services.
Up to 10 patients can be seen in the mobile tent. Some days, the Braselton staff treats non-COVID patients with the extra space, but other days it becomes a COVID tent, depending on volume.
Patients have also been seen in hallways or put in the ambulance bay until a bed becomes available or sent to triage if a room was unavailable.
Shields, the emergency department nurse at the Braselton facility, said about 160-180 emergency patients are being seen daily. She said that total hit 200 one day about two weeks go.
“Which was the most we’ve ever seen at Braselton,” Shields said.
And those who are COVID patients are “sick faster and they’re younger” compared to the three previous spikes of the pandemic, Shields said.
Dr. Mohak Davé, medial director for the NGMC emergency department, said patients are entering NGHS emergency rooms with respiratory illnesses, feeling they can’t breathe.
“That’s a terrifying feeling,” he said. “We have to make sure that we can assure those patients that we are providing them the treatments that they need for this.”
Like Braselton, the Gainesville facility — which is also utilizing mobile units — is setting emergency room records in terms of the pandemic. According to Davé, the staff saw 320 patients of all types of illnesses and issues in a single day two weeks ago.
But with the presence of COVID and the delta variant, patients are much sicker and hospitalized at much higher rates and sent to ICU in much higher volumes than pre-pandemic levels, he said.
Davé, who noted the demands being placed on a nurses despite staffing shortages, said the emergency department will solider on.
“We were here for wave one, wave two, wave three and now wave four,” Davé said. “We know we’re not going away. It’s just a harder fight.”
Shields expressed similar feelings.
“It’s hard,” she said. “It’s frustrating … But I have one of the best teams (of nurses). I would say that’s probably been the best part, is to see how well we all come together as nurses and really try to take care of our patients.”
Terry Esco figures half of Braselton has his cell phone number by now.
The 62-year-old has spent the past three decades as the town’s police chief, presiding over a department that served a population of about 300 when he arrived in 1990 to a sprawling town that’s swelled to an estimated 13,000 residents.
Though the town has changed, his personalized approach hasn’t.
“Somebody wants to talk to me, I’ll call them back and talk to them,” Esco said. “And you have to do that. You have to be very involved as far as talking with people and helping people.”
Braselton town manager Jennifer Scott has witnessed that hands-on approach as long as anyone, having worked along side of Esco for over two decades.
“He’s a police chief who’s available to the community,” Scott said. “Most people have his cell phone (number). He doesn’t sit in an office. He’s actually out riding neighborhoods and meeting people … So, he’s a very approachable chief, and I think that’s something that our community appreciates. It makes it feel more like a small town when you know the police chief.”
Police work had long interested Esco while growing up in Hoschton. There, he often went on ride-alongs with then-police chief Slim Robertson.
Esco began his law-enforcement career as a deputy for the Jackson County Sheriff’s Office before taking over a bare-ones operation in Braselton in February of 1990. The department operated out of a double-wide trailer that sat next to where Cotton Calf Kitchen is located now. At the time, the town had just one full-time officer, two police vehicles and no cell phones, of course.
“You used to have to find a payphone to call into the sheriff’s department when you needed something,” he said.
Back then, Braselton police answered 20-25 calls per month — many of which were simply assists to the Jackson County Sheriff’s Office. 911 service did not exist in town.
The town also had no subdivisions, had just one convenience store and — in what’s often a hallmark of small-town America — had just one traffic light.
“I couldn’t tell you have many red lights we have now,” Esco said.
Today, police work is much different in Braselton, which now stretches into four counties compared to one in 1990. Esco’s department is paperless, everything is videoed and the department receives roughly 6,800 calls for service a month, a far cry from the 20-25 Esco handled at the beginning of the ‘90s.
The department also now has 19 sworn officers (it’s been approved to hire another in January), a civilian administrative assistant and more than 20 vehicles. Since 2005, it has been housed in a spacious, multi-storied brick building in the center of town.
Esco, whose tenure has spanned three mayoral administrations (a fourth mayor will take office next term), explained what’s kept him in Braselton so long.
“I lived here, grew up here and knew everyone here,” Esco said. “So that kept me here, obviously. The town has been great to me. I have no regrets.”
Scott said having the town having the continuity of a three-decade police chief is a major plus.
“His knowledge of the town’s geography, of the citizens, he knows how we’ve gotten to where we are,” Scott said. “He’s grown as a chief as the town has grown.”
While Esco’s describes the experiences in his post as exceedingly positive over three decades, there have been dark days, too. The hardest moment Esco said he and his department have ever faced came in in 2005 when Braselton police officer Todd Helcher passed away in an automobile accident one morning as his shift ended. Esco received the call that morning while attending a police chief’s conference in Savannah.
“That was a hard thing to do, driving back from Savannah, trying to figure out how you were going to have to deal with it,” Esco said. “Because I hadn’t had to deal with anything like that, even though I had been here several years.”
Esco said that Helcher is the only Braselton officer he’s aware of that has died in the line of duty. The chief pointed to the outpouring of community support in that moment.
“The community was awesome,” Esco said. “They stepped up and we had a fundraiser here … It was pretty neat to see people come out and do what they did for the family.”
Helcher’s son, Holton, who was 6 when his father passed away, ended up following in his father’s footsteps and is now a patrol officer on Braselton’s force.
As Braselton has grown, Esco’s department has been able to navigate the issues that come with that growth. The town was named the safest in the state in 2020 for all municipalities its size.
“I think it has a lot do to with the way we do our aggressive patrolling and visibility,” Esco explained. “That has a lot to do with it.”
Still, Esco is concerned about retaining personal as the department moves forward, noting an overall trend of officers leaving law enforcement work. Esco has seen that in his own department with recent departures.
“I had three leave last month and got completely out of it, and one of them had been with me for six years … ,” Esco said. “That’s obviously going to be a challenge going forward as far as getting good qualified people. And that’s what you have to hire, good qualified people.
“You can’t just hire anybody.”
Esco also points to crime moving out of large cities like Atlanta and toward places like Braselton, which sits on the periphery of metro area and can be accessed by two I-85 exits.
“They get off at these two exits that we have and do their crime in some cases,” he said. “And there’s people who are moving in that do crimes. It’s not just people off the interstate by no means. It’s pretty much balanced all the way around.”
Esco said he has “no plans of retiring of retiring just yet,” hoping to continue in his position “for at least a few more years.”
He noted the support he’s received over the decades from town leaders.
“I’ve been very fortunate that every mayor and council member that we’ve elected in the town has always been very supportive of me and the department,” Esco said.
After 31 years into the job, the chief with the readily-available cell phone number is still looking to help people — which is why he said he got into the profession in the first place.
“And that’s what I’ve always hopefully tried to do,” Esco said. “When somebody does have an issue, you try to guide them the way they need to go.”
East Jackson Comprehensive and Jackson County high schools transitioned to virtual learning this week due to the impact of COVID. The two county high schools will have virtual learning for two weeks (virtual learning began Monday, Aug. 30).
Additionally, students at several schools in the county are now required to wear face coverings due to the rapid spread of COVID-19 in recent weeks. Students at Maysville Elementary, North Jackson Elementary, East Jackson Middle and West Jackson Middle schools have been required to wear face coverings since Monday, Aug. 23.
"These schools were identified as higher risk because of the number of positive cases, clusters and spread rate. The face covering requirement is for one month and we will continue to monitor all of our schools' data," said Jackson County School System public relations officer, Andrea Briscoe.
Across the Jackson County School System, there were 234 new cases reported last week among students and staff.
Since the beginning of the school year, the district has had 628 cases.
As of Friday, Aug. 27, the Jefferson City School System reported 42 active cases among students and staff. That's 0.9% of the student/staff population, up slightly from the week prior (0.8%).
In the Commerce City School System, there were 44 active COVID cases on Friday, Aug. 27. That's up from the week prior when there were 19 active cases among students and staff.
The district announced some adjustments to the daily schedule at Commerce High School to help minimize opportunities for large gatherings. Beginning Monday, Aug. 30, students began reporting directly to their first block class instead of meeting in the lunchroom. CHS also eliminated ROAR time from the schedule, resulting in a later start time (8:20 a.m.). The school still opens at 7:20 a.m. and bus routes remain the same.
A dance at Commerce Middle School was also cancelled this week to "err on the side of caution."
According to the Department of Public Health, there have been 1,040 new COVID-19 cases reported in Jackson County over the past two weeks.
The 7-day moving average in the county is 82 cases per day.
There was a spike on Aug. 28, with 124 new cases reported in the county on that day, the highest daily total since January. The highest peak was on Jan. 5 with 140 new cases reported on that day.
Since the start of the pandemic, the county has had 10,620 COVID cases, the 7th highest county in the state per capita following Chattahoochee, Stewart, Whitfield, Miller, Toombs and Bacon counties. Jackson County was previously ranked 8th in the state, but surpassed Hall County this week.
Two more deaths were reported in the county this week, bringing the total to 147 since the start of the pandemic. There have also been 13 probable COVID deaths.