'We've been in Crisis for a Long Time': Bryan Health CMO on Operating at Capacity, Monitoring Omicron

Dec. 21, 2021, 10:45 a.m. ·

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Dr. John Trapp
Bryan Health Chief Medical Officer Dr. John Trapp. (Photo courtesy of Bryan Health)

Statewide, there are around 520 people hospitalized with COVID-19 as of December 20. In a news conference on Monday, Nebraska Gov. Pete Ricketts said 27% of hospital beds in the state are open, and 16% of ICU beds are available.

Those numbers vary when you focus in on certain health districts, especially in metro areas. In Douglas County, there are only 8% of open, staffed ICU beds. In Lincoln, Bryan hospital leaders say they're seeing a similar situation.

Nebraska Public Media's Jackie Ourada spoke with Dr. John Trapp, the Chief Medical Officer of Bryan Health, to get an update on how the hospital system is holding up with more COVID-19 cases heading into the holiday week.

Jackie Ourada, Nebraska Public Media: Dr. Trapp, let's start with what Bryan Health is seeing right now.

Dr. John Trapp, Bryan Health Chief Medical Officer: We have been busy. I would say that we have continued to be at capacity now for a number of months, ever since we saw the rise of the delta variant really in late July, early August. What I mean by full is that we have opened up several COVID-dedicated units where we try to consolidate our COVID patients. One of those is for more of a general progressive care area. And then we have a partial COVID unit in our ICU. And because we've been at capacity now for a number of months, we continue to put in restrictions, including visitation restrictions for patients families. We have continued to limit elective surgeries, and what I mean by elective surgeries – these are really surgeries that can wait at least 30 days. The challenge with that is we've been limiting those surgeries now since August. So, we've seen some challenges with that. And just last week, we made a decision not to allow any type of non-urgent surgery that requires an overnight stay.

Ourada: On Monday, the state's chief medical officer Dr. Gary Anthone said hospitals in Douglas County are getting to the point where they're having conversations about 'crisis care standards,' because of the number of patients they're seeing. Is that something Bryan Health is weighing too?

Dr. Trapp: That's always a challenging question. We've been in crisis for a long time, whether we declare it or not. We have seen the impact of our decisions on patients and their care, and that surgeries have been delayed. Some of these surgeries are very necessary surgeries, including cancer-type surgeries, bastardization type procedures. We've not been able to take in transfers – patients that we normally would take. Some of these patients are critically ill, and we simply don't have the bed or capacity to accept these patients and transfers. Some these patients may be critically ill with COVID or due to other causes. It seems to me to represent some level of crisis.

Now, there is a format of crisis standards of care when a hospital is simply overwhelmed. Really, those 'crisis standards of care' were intended during acute events that were time limited. So we've been cautious to move that direction because we don't see that this is going to change for any foreseeable future. But already, Jackie, today we're seeing some rations and care that we are having to provide with not able to accept patients or to limit the their availability to surgeries that they need for other types of treatment or care.

Ourada: I wanted to hit on something else that was brought up at the governor's news conference: monoclonal antibody treatments. I should note that both Dr. Gary Anthone and Gov. Pete Ricketts did say that antibody treatments do not replace being vaccinated and are still encouraging everyone to get vaccinated. But the governor and Dr. Anthone mentioned that some doctors are just refusing to give those monoclonal treatments. Can you walk us through why that possibly would be and just explain more about that type of treatment?

Dr. Trapp: I think monoclonal antibodies are an important strategy or tactic in our ability to fight off this disease. Remember, currently monoclonal antibodies remain under emergency use authorization. So, there is a limitation on the number of antibodies that we can administer. But you have to meet the criteria to be approved for this. This is not up to the discretion of a physician. So I don't know really, from my perspective, know of very many, if any, physicians refusing to administer them. I think there may be confusion on who qualifies for them.

But you know, in order to qualify for monoclonal antibodies, you have to have a positive PCR or antigen test. You had to have had symptoms within the last 10 days. So, if it's been longer than 10 days, you do not qualify, and you have to be considered as high risk, or 'progressing to severe COVID-related disease,' or require hospitalization in the near future, if you don't receive these. So I think that those are some of the risk factors that may cause of confusion. Other risk factors – older age 65 or older, obesity, pregnancy and chronic kidney disease, diabetes, immunosuppression, heart disease, chronic lung disease, and other factors that all put you at risk. Also, people who are excluded include people currently hospitalized for COVID-19. So, if you're hospitalized for COVID-19 and require oxygen, you don't qualify for this treatment. So, I don't know when you say doctors don't want to do that. I don't think it's because of the desire not to do the work. I think there may be some confusion about the appropriate indications. And then it's a limited resource, and then making sure that you received those monoclonal antibodies at the right timeframe, i.e. within 10 days of symptoms. Outside of that, again, you don't qualify for that treatment.

Editor's note: This conversation has been lightly edited for clarity.