Newly reported COVID-19 cases set state records for three straight days, and Johnson County added close to 100 new cases a day for the past two days.
As a result, Johnson Memorial and other area hospitals are gearing up for a local surge.
The 4,714 new cases reported by the Indiana State Department of Health on Friday were the state’s highest single-day level of the pandemic, eclipsing the previous record of 4,462 new cases officials reported Thursday.
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In Johnson County, 93 new cases were reported Friday, the second highest ever reported in a single day; 84 cases were reported Thursday.
Indiana’s seven-day rolling average for newly confirmed coronavirus cases rose to 3,576. That is the highest level the state has seen during the pandemic and more than quadruple the seven-day rolling average of 858 newly confirmed cases the agency reported on Sept. 22 — the day before Gov. Eric Holcomb announced his decision to lift nearly all of Indiana’s restrictions while extending the statewide mask mandate.
As cases rise, so are hospitalization rates, positivity rates and the death toll, according to data from the Regenstrief Institute.
The increases have caused alarm among health experts but have not prompted state officials to take any additional precautions to slow the spread of the virus.
Dusting off plans
State health department data shows 2,001 Hoosiers are hospitalized with COVID-19 — the largest number Indiana has seen since officials began releasing those counts last spring, early on in the pandemic. Of those hospitalized, 541 are in intensive care units.
More than 71% of Indiana’s intensive care unit beds are in use, according to the state health department, and just 621 beds were available as of Thursday.
Indiana’s 37 new COVID-19 deaths reported Friday raised the state’s death toll to 4,547, including confirmed and presumed coronavirus infections.
There is likely to be an increase soon for some of the same metrics in Johnson County, as admissions had gone up in the past 24 hours and the positivity rate is increasing, said Dr. David Dunkle, president and CEO of Johnson Memorial Health.
“What worries me is that when you look at the state as a whole, there is an increase in severity of the disease,” Dunkle said Friday. “So far we have been lucky, but I fear that might not always be the case.”
Johnson Memorial staff on Friday were treating four COVID-19 patients with severe cases, up from one or two at a time in recent weeks, Dunkle said. During an earlier peak in the spring, the hospital was treating seven patients, he said.
Staff at Franciscan Health, on the southside of Indianapolis, were treating 30 to 35 COVID-19 patients. The hospital has seen a significant increase in COVID-19 patients in the last three to four weeks, said Dr. Christopher Doehring, vice president of medical affairs.
“There’s significantly more, but it’s not unmanageable by any means,” Doehring said.
Franciscan is also not yet hitting the number of COVID-19 patients it had in the spring, when it fluctuated between 60 and 90 patients at a time.
“We’re not seeing as high numbers of patients needing to be on ventilators in the ICU,” Doehring said.
The patient load at Johnson Memorial is also still manageable, but Dunkle said he is dusting off contingency plans hospital staff came up with in March but haven’t had to use yet.
Since March, Johnson Memorial has been looking at best practices to achieve better outcomes and the best infection control possible, Dunkle said. Part of that was stocking up on drugs that show promise with treating the disease, such as steroids and Remdesivir, and stocking up on personal protective equipment in preparation for a potential surge, he said.
Franciscan is preparing for a surge by stockpiling PPE, Doehring said. The hospital can handle double its current patient population, he said.
At Johnson Memorial, four of the 10 beds in the COVID-19 unit are filled, and there are two more isolation rooms that can be used if needed, Dunkle said. In a worst-case scenario, regular rooms could also be used for COVID-19 patients, as long as the door stays closed to trap in the virus, he said.
Franciscan’s worst-case scenario would be pausing elective care to make space for more patients, Doehring said. If that were to happen, doctors would evaluate the need for elective procedures and reserve enough beds for those most in need, he said.
Pandemic fatigue
Local health officials, along with the state’s health commissioner, Dr. Kristina Box, attribute the recent surge to pandemic fatigue. Nine months into the pandemic, they see people flouting coronavirus prevention measures in alarming numbers.
Dunkle has heard firsthand from patients who caught the virus after relaxing precautions. Though the patients were aware of the recommended precautions, they chose not to take them and paid the price, he said.
“What I’m seeing is that they have let their guard down, they have gone outside their social bubble and knowingly put themselves at risk … It is more young people. Those in the age group of 60 and above are still taking precautions,” Dunkle said.
Though nine months of safety precautions has been overwhelming for many, the need for precautions has not decreased, he said.
A statewide mask mandate is still in place. Guidelines say face coverings should always be worn when around people outside your household, whether inside or outdoors.
Health officials say masks are needed to protect others. An infected person may shed particles of the virus for 48 to 72 hours before the person develops symptoms, Centers for Disease Control and Prevention research shows. Also, up to 40% of those infected with COVID-19 may be asymptomatic, according to the CDC.
All ages at risk
Health care professional urge people of all ages — not just those considered at risk — to keep up precautions, such as hand washing, social distancing, mask-wearing, avoiding large gatherings and seeing only people within the same exposure group.
With a virus health care professionals know so little about, everyone is at risk.
“Getting COVID is certainly still a game of Russian roulette … There’s no population that’s guaranteed not to have a risk of dying,” Doehring said. “The question is, how many empty chambers are in your revolver? For some people, there may be one empty chamber, and for others, there may be 200. But there’s still a bullet in there somewhere.”
Though it is more rare, young people without co-morbidities such as obesity, diabetes, breathing problems or heart disease can experience a severe case of COVID-19.
“Younger people do typically have a less severe disease, but if you talk to doctors, nurses … they’ll tell you unfortunate stories about how it can affect young people,” Dunkle said.
Research of the virus and the disease it causes is ongoing and there is still much to learn. But doctors are much better prepared to fight it and, hopefully, have better outcomes, they said.
Treatments such as high-flow oxygen in replacement of ventilators, therapy treatments to prevent blood clots, steroids to drive down inflammation, antiviral medication and convalescent plasma from people with COVID-19 antibodies, all play a role in creating those better outcomes for hospitalized COVID-19 patients, Doehring said.
There were fewer deaths and more positive outcomes in recent months because treatments have advanced, he said.
“While patients are still dying, it’s not at the same rate as it was back then (in March). If you look at the numbers, individuals who are getting sick are younger and healthier,” Doehring said.
CDC data shows up to 80% of those infected may have a mild case, but a mild case may still include complications and long-lasting effects. Even those with mild cases may have symptoms for more than a month after the initial infection, according to the Harvard Medical Journal.
