Amid the brutal late summer surge of the coronavirus, Dr. Phillip Coule, chief medical officer at Augusta University Medical Center, too many times had to do the unthinkable — turn away a patient.
Like most other clinicians around the state, he didn’t have enough room at his hospital.
Then, he got the call: An adolescent COVID-19 patient at a rural hospital was on the verge of death. Coule used telemedicine to get to the boy’s bedside and direct advanced care until a bed opened up in Augusta.
“That resulted in us being able to save a life,” he said.
Hospitals around the state spent harrowing weeks in crisis mode, turning conference rooms into ICUs, postponing some surgeries and calling on frontline workers to take on extra shifts.
Now, though, the number of COVID-19 patients in Georgia hospitals has plunged 66%, down to 2,046 Thursday from a record high of 6,040 on Sept. 7. Over the next few weeks, that trend is likely to continue, according to the U.S. Centers for Prevention and Disease Control. That will make it less likely that hospitals will have to turn away patients in need.
“It’s a relief that our numbers have gone down,’’ said Dr. Kathy Hudson, chief medical officer for Phoebe Putney Health System in Albany. “That’s a tremendous relief.”
Still, health care leaders expressed a bit of caution in their public messaging. Hospitalization numbers are still much higher than they were in late spring, before the highly contagious delta variant hit. And delta — or any other variant that is likely to come along — isn’t done with Georgia. There’s likely to be another wave, as seen repeatedly throughout the pandemic, and it could be accompanied by a winter flu season that is worse than normal, they say.
“It feels like it’s not going away yet,” said Dr. John Delzell, who serves as vice president of medical education at Northeast Georgia Health System in Gainesville. “Everybody is taking a breath, but I don’t think anyone is relaxed.”
There are many reasons why Georgia is still vulnerable, experts said.
Too many people are still not fully vaccinated. And cooler weather and the holidays are likely to increase the chances for more outbreaks, not to mention the prevalence of pandemic fatigue, which will make people less likely to mask up and follow social distancing rules.
“There’s still a sizeable chunk, roughly 30% of the population in Georgia, that are sitting ducks for delta,’' said Dr. Felipe Lobelo, an associate professor at Emory University School of Public Health. “This virus is just really good at ripping through the fabric of society and finding those people who are not vaccinated.”
Indeed, an overwhelming majority of patients who have landed in the hospital during the delta wave have not been vaccinated.
Among them: children who have no access to a vaccine yet. In August, more kids than ever were suffering from cases so severe that they needed to be hospitalized.
What’s more, Georgia isn’t anywhere close to hitting the threshold that experts say is needed to curb the spread of the virus. Only about half of eligible Georgians are fully vaccinated, and research shows 65% to 70% of a population needs to be to prevent another wave of infection.
There’s yet another concern: People without timely access to a booster dose could become more susceptible to infection.
“There’s possibly some people who were vaccinated eight and nine months ago whose antibodies may be depleted or low and could be subject to exposure,” said Bill Lee, a member of the statewide Coronavirus Task Force and chief executive officer at Evans Memorial Hospital in Claxton, 50 miles west of Savannah.
‘Our worst experience’
The latest surge of the coronavirus took health systems by surprise.
Before delta, Georgia hospitals saw the number of COVID-19 patients drop into the single digits at times. By June 19, just 419 Georgians were hospitalized with COVID-19 statewide.
But by mid-July the numbers began climbing, and August and September saw repeated hospitalization records.
“This was our worst experience with this pandemic far and away for both adults and pediatrics,” said Dr. Stephen Thacker, associate chief medical officer at Memorial Health University Medical Center in Savannah. “And, almost by order of magnitude, it was quite impressive when you look at it.”
Physicians had not seen so many young sufferers and such a rapid onset of symptoms. Earlier in the pandemic, hospitals saw patients a few weeks after the onset of symptoms; with delta, patients were coming in — in far worse condition — four days after symptoms began.
Over just a week or two, at Phoebe Putney the number of COVID-19 patients “just took off,” said Hudson, the Albany system’s chief medical officer.
“This was our worst experience with this pandemic far and away for both adults and pediatrics. And, almost by order of magnitude, it was quite impressive when you look at it."
By Aug. 21, the system hit a peak of 214 COVID-19 patients. But as of Thursday, the number dropped to 53, she said.
Virtually every other hospital in Georgia is also reporting significant declines, according to data from the U.S. Department of Health and Human Services.
At peak, Lee had four to five patients on ventilators at his tiny Claxton hospital. “We had more admissions and more acuity patients and sicker patients in August than we had in all of 2020,’' Lee said.
Now, the hospital has two COVID-19 patients, he said. Neither is on a ventilator.
New strategies
Why did the numbers fall? Lobelo, an epidemiologist, said that infectious respiratory diseases often have a six to 10-week ramp up and a six to 10-week decline.
As case rates have tumbled, so have hospitalizations.
Another reason: Delta patients tended to be younger than those infected in earlier waves. Hospitals were able to provide treatments that oxygenate the blood, which don’t necessarily work with elderly patients affected during the initial surges.
“That has allowed us to manage this a little better,” Coule said.
Health care officials also say they have adopted strategies that ensure more accurate diagnosis and treatment. That allows them to reduce admissions and to move patients through a hospital more quickly.
Outpatient monoclonal antibody treatments, which help halt the progression of the disease, also are keeping more patients out of the hospital, Hudson said.
And some beds opened up as Georgians died. State data show 5,008 confirmed COVID-19 deaths since Aug. 1. CDC, though, is forecasting a decline in deaths across the U.S. over the next four weeks.
Meanwhile, health care leaders say they are getting ready for the next surge by stocking up on personal protective gear and other supplies and lining up more staff.
But the public also needs to do its part, said Dr. Marybeth Sexton, assistant professor of medicine in the division of infectious diseases at Emory University School of Medicine.
That means, she said, taking precautions to avoid the spread of the disease — and getting fully vaccinated.
“Now is a critical time to continue safety measures to prevent another surge this winter,” Sexton said.
Staff writer Helena Oliviero contributed to this report.
