Hawaii hospitals still full ahead of the holidays

Hospitals in Hawaii remain full — even if not with COVID-19 patients — heading into the holidays.

The hospital census on Wednesday was at 2,447 patients, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, a continuation of a trend indicating a “new normal” this year.

The average number of patients for December so far is at 2,458 a day, he said, which is higher than the averages from the past three years — just under 2,000 a day for the years 2019 and 2020, and under 2,200 a day in 2021. On some days this year, the number has surpassed 2,500.

“The challenge continues to be the overall hospital census,” said Raethel. “We’re still struggling to get sufficient health care workers, and still having challenges with getting enough staff at long-term care facilities. We’re continuing to see this new normal which is very high census levels.”

A new emergency rule was granted Dec. 5, the day of Gov. Josh Green’s inauguration, he said, which allows traveling nurses to work in Hawaii for 90 days without applying for a state license as long as they meet certain requirements. If they stay longer, they can work while applying for a state license.

This emergency rule is in place for 120 days, and applies to a broad range of nurses — from licensed practical nurses to registered nurses, advanced practice registered nurses, and certified registered nurse anesthetists.

This was needed due to Hawaii Department of Commerce and Consumer Affairs delays in the processing of professional licenses required to work in the state, including those of traveling nurses. That prompted an initial emergency rule over the summer, which expired on Friday.

Raethel said there are currently between 500 to 600 traveling nurses working in Hawaii on a given day.

Fortunately, the high number of patients in Hawaii is not being driven by COVID-19, influenza or respiratory syncytial virus, he said, as is the case for some places on the U.S. mainland.

On Wednesday, there were 55 COVID-19 patients in hospitals, with eight in intensive care, according to HAH. For the week, the daily average of COVID-19 patients per day dropped to 66 compared with 70 the previous week.

Raethel said at a press conference last month that although the pandemic is one factor driving up the hospital census, there are others, including an aging state population and patients who are more ill, requiring longer stays.

He said Wednesday there are anywhere from 200 to 300 patients a day waiting to be discharged to a long-term care facility. These facilities — due to staffing shortages — are unable to admit patients.

Given how full hospitals already are, officials are keeping a close eye on trends this winter and hoping there will be no surges resulting from RSV, flu or new COVID-19 variants in coming months.

“Because our hospitals are so full,” said Raethel, “we’re very sensitive to any potential outbreak that would exacerbate the stress.”

Those working the floor at hospitals, however, are feeling the stress from the volume of patients and getting burned out, according to Daniel Ross, president of the Hawaii Nurses Association.

“We’ve been full, over capacity, almost every single day that I’ve been at work,” said Ross, a registered nurse at The Queen’s Medical Center. “There are holds in the emergency room — the patient’s admitted but they’re waiting for a bed to open up.”

The union is asking the hospital for written assurances that patients will not be held in hallways for long periods of time or overnight waiting for a bed to open up. This puts stress on the staff and is not safe, he said.

The union would like the hospital to stop admitting patients if it is over capacity, he said. Once stabilized in the emergency department, patients can be transferred to other hospitals that do have beds.

“I would say almost all health care workers are burned out right now,” he said. “That’s one of the things that’s contributing to the shortage, because people are saying, ‘I don’t want to do this any more.’”

As the year comes to a close, COVID-19 case counts have been in a holding pattern, with up-and-down fluctuations and an uptick recorded the week after Thanksgiving, but no indications of a sudden upward surge, so far.

The Hawaii Department of Health on Wednesday reported a seven-day average of 180 COVID-19 infections per day compared with 182 reported on Dec. 7. The state’s average positivity rate was also about the same, at 6.4% compared with 6.5% the previous week.

Health officials continue to urge Americans to get the new bivalent booster before holiday celebrations because it targets the original strain as well as omicron subvariants BA.4 and BA.5.

Some studies have shown they are also more effective than the earlier monovalent booster against newer, immune-evasive subvariants such as BQ.1 and BQ.1.1, which together, are quickly rising to dominance in the U.S.

To date, 78.3% of Hawaii’s population has completed the primary series of COVID-19 vaccinations, according to the Health Department. A total of 238,610 residents, or 21.4% of the state’s eligible population, have received the new bivalent booster.

The bivalent booster is now federally approved and available to children as young as 6 months old.

Moderna’s bivalent booster is available to children ages 6 months to 5 years old if it has been two months since completing a primary series with the monovalent Moderna COVID-19 vaccines.

Pfizer’s bivalent booster is available to children 6 months to 4 years old who either have not yet begun their three-dose primary series of the Pfizer COVID-19 vaccine, or who have not yet received their third dose.

DOH said 6,900 doses of the bivalent boosters for the younger keiki — including both Pfizer and Moderna — arrived in Hawaii Wednesday morning. Another 3,300 doses are in transit.

DOH also reported four more deaths among Oahu residents, bringing the state’s coronavirus-related death toll to 1,748.

HAWAII’S HOSPITALS

>> 2019/2020: Average of just under 2,000 patients a day

>> 2021: Average of just under 2,200 patients a day

>> Nov./Dec. 2022: Average of 2,400-2,500 patients a day

Source: Healthcare Association of Hawaii