Things are so dire in Kentucky, hospitals may put COVID-positive nurses back to work

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Disinformation about COVID-19 vaccines is fuelling a "pandemic driven by fear" in Kentucky, says Dr. William Melahn.

Dr. Melahn is the chief medical officer at St. Claire Regional Medical Center in Morehead, Ky., one of 20 Kentucky hospitals experiencing critical staffing shortages during a dramatic surge in COVID-19 cases.

Kentucky saw 4,849 new confirmed and probable COVID-19 cases and 65 deaths on Wednesday according to the latest available data from the state's health department. The state currently has 2,074 COVID patients in hospital, 549 in intensive care units (ICU), and 338 on ventilators. More than 89 per cent of the state's ICUs beds are full, according to the federal Department of Health and Human Services.  

The surge is being driven by low vaccination rates, says Melahn. Overall, 56 per cent of the state's population has received at least one vaccine dose. That drops to 45.72 per cent in Rowan County, where Melahn works, and just 35 per cent for the area his hospital services.

Meanwhile, hospitals are so desperate for staff, the U.S. is deploying National Guard teams to help, CNN reports. And if things get much worse, Melahn says St. Claire's will have to bring back nurses who have tested positive for COVID just to keep things running.

Here is part of his conversation with As It Happens guest host Peter Armstrong. 

Give us an idea of just how stretched you're feeling at the hospital right now.

I would say that we're having hopefully a once-in-a-lifetime historic surge of patients needing care.

We're a small rural hospital in eastern Kentucky in a part of the country known as Appalachia. And to give you a good flavour of what's going on, 31 days ago, we had one in-patient with COVID. We usually take care of a total of 75 in-patients per day, all told. This afternoon, I have 67 COVID inpatients.

That shift, it went so fast, and at a time when it kind of felt like we were just starting to see the light at the end of the COVID tunnel. How does that feel when you think about it?

It's very tiring and it adds to the fatigue. We live here in a vaccine desert. So our overall catchment area, the area around our hospital that we serve, has about a 35 per cent vaccine rate, which is abysmal. And so we kind of dreaded this, but we honestly sort of felt like we knew it was coming.

You must be able to draw a direct line between this surge you're seeing and that low vaccination rate.

Oh, absolutely. There's data that clearly shows that regions and United States states that have lower vaccination are seeing much higher hospitalization slopes and numbers.

You know what the remedy is. And by the time they get to you, it's too late.

We're engaged in the remedy, too. We've been the vaccine administration hub since December of 2020.

We are not upset at our patients. We're upset about the disinformation or misinformation that's out there that really fills them with fear. What we have observed is this is a pandemic driven by fear. I mean, these people are afraid of being vaccinated. 

What do these patients that are coming in unvaccinated tell you about why they didn't want to get the vaccination, and what may prevent them from getting it even in the condition they're in?

It's almost always fear. You know, there's some reason that they've been told that this is not needed or it's going to hurt them. The ones that really tug at my heartstrings are the ones who truly believe that by not being vaccinated, they're preventing harm to themselves.

What [are] your staffing issues?

I would very frankly describe it as a crisis. 

Before this started, I told you we usually averaged about 75 people who were inpatients per day. With that level, we were 15 nurses short in our nursing staff. And we have not overcome that shortage at all, and we're averaging the 67 COVID [patients] today — plus other patients, by the way, which don't stop coming — and I've got the same shortage.

We've hired two nurses in six weeks. And nobody can find [nurses]. There's a really big hospital up the road about 100 miles from us. They are short 200 nurses.

I'm hearing that some of these hospitals are actually considering recalling nurses who have tested COVID-positive. Is that something that you've been forced to consider as well?

Yes, we have a plan for that, actually. And it is approved by the state department of public health, in crisis staffing, which we are in, that if we have COVID-positive staff who are … feeling well, that we can use them in COVID-only units. We have two COVID-only units that we can do that with, and that's certainly on the table already. I don't think we're doing it today, but it's on the table.

With the current situation, how would your hospital be able to treat some kind of a major car wreck or other kind of emergency if that happened right now?

We're a regional rural hospital, so we don't do complex trauma. We're a first receiver for complex trauma, but then for that really complicated trauma care, they go to the university hospital.

Well, that's breaking down now because we just don't have that ability to do it. Even the emergency medical services are bogged down.

So if we had a local disaster, I told our regional planning committee the other day that we'd be out of luck.

Are there nurses or doctors or hospital staff that can come from other parts of the country to help alleviate some of the crisis right now?

What we're finding is everyone around is going through the same thing. That doesn't mean that all hope is lost.

This week we declared, actually, an official disaster, and that allows us to make some flexible changes. We're a health system, so we have a system of rural clinics around us. We've already pulled all those nurses and some of those doctors in.

But we are in talks with our military to bring in some military nursing staff and military medical staff. And that discussion is ongoing today.

Do you have hope? Do you have a sense [of] how to get to a brighter, better day?

Usually, in an infectious disease pandemic, the more rapidly it rolls out, the more rapidly it falls off. So … if you want to call that a positive, that's something that we're looking forward to.

Written by Sheena Goodyear. Interview produced by  Niza Lyapa Nondo. Q&A has been edited for length and clarity.