New Orleans Hospitals Overstretched From COVID, Brace for Ida

 Katherine Baumgarten, MD, couldn't get into her house for a month after Hurricane Katrina.

Now, she and her co-workers are hunkered down at the Ochsner Health Jefferson Highway main campus in New Orleans, ready for storm-related emergencies -- at a hospital on the banks of the Mississippi River that is already full up with COVID-19 patients -- hoping for the safety of their own homes and families.

"We've already been worried about this fourth COVID surge, now we're worried about our homes flooding, or not having electricity for weeks or a month," Baumgarten, who is the medical director of infection control and prevention at Ochsner Health, told MedPage Today. "We have to re-live the anxiety [of Hurricane Katrina] while worrying about getting through not just the hurricane itself but also the aftermath."

Hospitals in New Orleans and all over Louisiana are running near capacity due to COVID-19 as they brace for Hurricane Ida, which is expected to come ashore as a Category 4 storm on exactly the 16th anniversary of Hurricane Katrina.

While COVID hospitalizations have come down from a recent peak -- Gov. John Bel Edwards said during a Saturday press briefing that the 2,450 COVID hospitalizations statewide represent a 20% drop over the last 10 days -- hospitals have been maxed out, and the usual steps of discharging patients and evacuating coastal hospitals ahead of a storm haven't been possible.

Baumgarten said her team reached out to other hospitals in the northern regions of Louisiana, but they were stretched too thin to take any evacuations. Ochsner itself turned down 175 transfers last week, she said.

Ochsner Health is one of the largest health systems, with seven hospitals in the New Orleans area and partners with several more statewide. Baumgarten said the team is most concerned about their Chabert and St. Anne facilities, which are in the direct path of the hurricane: Chabert is in Houma, and St. Anne is in Raceland. New Orleans itself is on the eastern edge of the storm's trajectory.

The system has tried to discharge as many patients as possible ahead of the storm, though reports have noted it's difficult to discharge COVID patients, who are often on oxygen, or are on ventilators.

While the system's COVID consensus has come down recently -- Ochsner Health has 658 COVID patients across its seven main hospitals, from a peak of 1,000 a few weeks ago -- that's "still not enough to relieve anything," Baumgarten said. "We've had more patients during this surge than any other at its peak."

During the fourth wave, Ochsner's flagship Jefferson Highway campus had to re-open seven COVID units, and most are still open and full, Baumgarten said. The majority of those patients -- 87% to 91% depending on the facility -- are unvaccinated, she added.

Another challenge is that 75% of those in the ICU are on a ventilator right now, she said. With this latest surge in younger people, they appear to decompensate more rapidly, so physicians have had to rely on ventilators more frequently, she said.

She said the plan now is to call in a lean group of doctors, nurses, and staff who started their shift early Sunday morning and will stay there until it's safe to leave. COVID precautions make it harder to house staff overnight so they'll use the on-campus hotel, but will also likely stay on air mattresses in patient rooms and offices.

A second group is set to come in and take over whenever that's possible, perhaps Monday night, she said.

"Our emergency departments are ready to go," Baumgarten said. "We'll do what we have to do. People may be waiting for beds if we're not able to open them soon enough, but we won't turn people away."

The health system has certainly learned from Hurricane Katrina as its Baptist campus, formerly called Memorial Medical Center, was at the center of the controversy documented in the book, Five Days at Memorial.

For instance, the Leonard J. Chabert Medical Center in Houma has been shored up over the years to make sure it can withstand the hurricane forces coming at it, she said.

Systemwide, facilities have adequate supplies, including water and fuel trucks, and generator capabilities, Baumgarten said. It has vehicles that can get through high water, including boats and large trucks, and "we do have plans that if we had to evacuate we could do it" once the winds have subsided.

It's the staff she's most worried about: "Our staff is really stretched thin and fatigued over four [COVID] surges," she said. "A hurricane on top of that is really stressful for them."

But emergencies like this have the effect of bringing everyone together, she said.

"With Katrina, we learned there's something about this setting where you really rely on the people around you," Baumgarten said. "There's a sense of unity in it. We need that now, at a time when everything is so divided."

https://www.medpagetoday.com/special-reports/exclusives/94269