Delaware hospitals declare COVID ‘crisis,’ saying they can’t provide ‘normal standards’ of care

The unprecedented and escalating spike in COVID-19 cases and hospitalizations led Delaware hospitals to implement a “crisis” level of care Monday because “it is no longer possible to deliver care according to normal standards,’’ said ChristianaCare, the state’s largest health care system.

About 4 in 10 patients at its two Delaware hospitals and one in bordering Elkton, Md., are positive for the coronavirus, ChristianaCare said in a news release about noon Monday. The patients were admitted because they are experiencing adverse symptoms of COVID-19 that require hospital care, or because the virus exacerbated underlying conditions.

The system’s facilities, including emergency rooms, urgent care centers, and medical practices, have been beyond 100% of capacity “for weeks,” hospital officials said.

Also Monday, Gov. John Carney re-instituted a universal indoor masking mandate that starts Tuesday at 8 a.m.

As of Sunday, the state’s weekly average for new daily cases was 2,771 — more than three times last January’s previous high mark. The current inpatient count is 714 — 250 more than last January’s peak.

State data show that 50 residents with COVID-19 have died in the last two weeks as the delta variant remains prominent but is being overtaken by the more-transmissible omicron strain.

“The health care system is under unprecedented strain,’’ said Dr. Janice Nevin, ChristianaCare’s CEO. “Never have there been this many people in our community who need hospitalization, emergency care, and other health care services.”

“We have taken this step to implement Crisis Standards of Care so that our caregivers have the flexibility and decision-making tools they need in order to deliver care to patients with the highest need at this time when the demand exceeds all available resources.”

Joining ChristianaCare in implementing crisis care are Bayhealth, TidalHealth Nanticoke, and Trinity Health Mid-Atlantic-Saint Francis Hospital.

The crisis was declared because of “challenges” it faces in providing patients with “staffing, space, and supplies,” ChristianaCare said.

The new, lower standard gives caregivers flexibility in areas such as:

• Advancing different care models.
• Simplifying documentation requirements.
• Changing workflows.
• Changing admission or discharge criteria.
• Modifying surgical and other procedural and diagnostic schedules.
• Adjusting how supplies are allocated.
• Changing how treatment resources are distributed.
• Redeploying clinical and non-clinical staff.
• Adjusting staffing standards including, among other things, staffing ratios, return to work, annual educational requirements, or credentialing requirements.
• Limiting the availability of non-urgent services.
• Adapting documentation, reporting, and approach to regulatory requirements.

ChristianaCare said, “decisions regarding the use of limited resources will be made in a just, equitable, and transparent way, and our caregivers will engage with patients and their family members about expectations and options of care.“

Dr. Ken Silverstein, chief physician executive, urged everyone to get vaccinated and boosted, saying that even though fully vaccinated people comprise nearly 30% of COVID-19 patients statewide, most people requiring inpatient care are unvaccinated or partially vaccinated.

National data shows that an unvaccinated American is 14 times more likely to die from COVID-related complications than a fully vaccinated person, ChristianaCare said. The death rate is 20 times as high as someone who has received a booster shot.

Silverstein urged people not to go to the emergency room for the time being unless they are experiencing a medical emergency. He also said not to go to the ER for a COVID-19 test.

He said patients who have heart attacks or are in bad car crashes will continue to get the highest priority for care. But for other patients, medications might not always get administered on the regular schedule and meal delivery will be affected, he said.

He also said supplies of monoclonal antibodies that some COVID-19 patients get are limited because of the crush of infected people needing treatment.

“The demand for health care services, like just an extraordinary number of people seeking acute care, emergency care, is outpacing our ability to supply it,’’ Silverstein said.

“This is the next step. This is to put frameworks in place so that we can deliver care to the patients with the highest needs at this time.”