INDIANAPOLIS — The Indiana Hospital Association is adding to the voice of state officials asking Hoosiers to buckle down on practicing safety measures that can help reduce the spread of COVID-19.
That ask comes on the heels of the state seeing a recent sharp rise in hospital admissions for the coronavirus, hitting before seasonal flu has started to become an impact for hospitals.
On Oct. 14, Gov. Eric Holcomb made a strong plea to Hoosiers not to grow lax and to redouble efforts to protect themselves and others against COVID-19. Since entering Stage 5 of the state’s reopening plan on Sept. 26, Indiana has seen a steady spike in new cases, positivity rate, hospitalizations and deaths.
Holcomb said Indiana is heading in the “wrong direction.”
The Indiana Hospital Association, which represents nearly 170 hospitals across the state, is urging Hoosiers to continue to wear face masks, and practice other recommended safety steps, as hospitals across Indiana are seeing a spike in coronavirus cases.
“We were very pleased to see Gov. Holcomb extend the statewide mask order and are grateful for his continued leadership,” said Indiana Hospital Association President Brian Tabor.
“We are seeing hospitalizations pick up significantly, which is especially concerning as we approach flu season. If we double down and wear masks, regularly wash our hands, and practice social distancing, it will go a long way in tamping down COVID-19. Communities rely on their hospital and caregivers, especially during the pandemic. We need Hoosiers to do their part to support caregivers on the front lines caring for patients, including those with COVID-19,” he said.
At the beginning of the pandemic, once the virus started spreading widely in Indiana in March, the state had more than 1,700 Hoosiers admitted for COVID-19 by early April.
The good news was that, even in those early days of the pandemic, hospitalizations were on a downward trajectory. After making slow progress for about a month, total admissions began dropping once the state hit May and were in a steady fall through late June.
From a local high point of 1,579 patients on May 4, the total hospital census fell to an all-time low point of 595 patients by June 26.
Around that time, Indiana started seeing a second surge in cases following the Fourth of July weekend and hospitalizations started rising again. However, during the summer, a majority of cases were being identified in younger patients, who generally fare better and do not require more serious care.
Hospitalizations crept up to a high of 1,009 total patients as of Aug. 5, but then started another slow decline as the state’s situation improved. Numbers deflated slowly through September, hitting another valley at 759 total patients on Sept. 21.
Since then, however, new admissions have been on a sharp increase.
In less than a month since that Sept. 21 valley, the total hospital census has nearly doubled, hitting 1,357 total patients as of Oct. 13. That’s a number the state hasn’t seen since May 13.
Overall hospital capacity remains good, with about 32% of the state’s available intensive care unit bed space open and available.
The state also has about 78% of ventilators available, although ventilators have lost importance since the early days of the pandemic as physicians have learned through treatment that early mechanical intubation of COVID-19 patients can actually be worse for them than other interventions. Ventilators generally only come into use now for the most serious cases.
That being said, the state’s ICU capacity has been shrinking as admissions have increased.
On Sept. 21, 45% of the state’s total ICU beds were available, which has since shrunk to 32%.
The state does have the ability to create additional surge capacity — temporary spaces in hospitals that can be set up and mobilized to treat excess COVID-19 patients — however physicians have stated those makeshift wards stretch staff and resources when needed in an emergency.
Indiana State Health Department Chief Medical Officer Dr. Lindsay Weaver spoke about the crunch on hospital resources during Oct. 14's statewide press conference, noting that some regions of the state are already hitting their max.
“We are seeing an increased need for the specialized care of people with COVID,” Weaver said.
Indiana State Health Districts 2, 6, and 10 are already facing “critical ICU bed shortages along with personnel shortages,” Weaver said.
District 2 represents north-central Indiana, including St. Joseph, Elkhart and Kosciusko counties just to the west of the four-county area. District 6 is east-central Indiana including Madison County (Anderson) and Delaware County (Muncie) and other rural counties surrounding. And District 10 is southwest Indiana around the Evansville metro, which has been one of the state’s biggest hotspots in recent weeks.
Northeast Indiana is covered by Health District 3, which includes the four-county area, Allen and Whitley Counties and five counties to the south of those.
In District 3, about 23% of ICU beds are available, lower than the state average.
The district has likewise seen a sharp increase in hospitalizations over the past few weeks, rising from just 55 patients admitted on Sept. 12 to 129 as of Oct. 13.
The region has seen a major spike in new case activity, too, rising from a rolling average of about 89 cases per day as of Oct. 3 — a figure that was in line with an average that oscillated from about 70-90 cases per day since mid-August — to 145 cases per day across the region as of Oct. 13.
The average positivity rate across District 3 has risen from 4.4% on the last day of September to 6.3%, an increase of almost two full percentage points and still rising.
Weaver said the statewide increases in cases and hospitalizations are troubling now because the state hasn’t even started to see the impact of seasonal influenza yet, which typically is at its worst during December, January and February.
“This is especially concerning because we have not begun to see the typical increase in ICU bed usage from influenza,” Weaver said. “Our hospital systems have done a fantastic job building their intensive care and ventilator capacity, but that should be our insurance plan it’s not something we want to have to use at full capacity.
“It is critical our hospitals maintain their ability to care for Hoosiers with other life-threatening illness like cancer, heart disease and strokes,” Weaver said.