Months into a pandemic and now seeing a surge in COVID-19 cases, South Carolina's hospitals have been able to add ventilators, stock up on protective gear and increase space if they must. But the one finite resource they have found they can't scale up on a moment's notice: People.
Lessons learned in March and April have put hospitals in a better position to manage a surge in coronavirus cases. Reports of shortages in supplies and space are now few and far between. The chief concern now is that if South Carolinians continue to shirk guidance to wear masks and socially distance, hospitals may not have enough people to provide care to patients.
Across South Carolina, 1,404 patients were hospitalized with COVID-19 on Wednesday, just the latest in a string of daily records.
State emergency planners have said South Carolina can add 10,000 patient beds if necessary, roughly double hospitals' current capacity. Finding the nurses, doctors and technicians to care for those patients is a much tougher problem.
Intensive care units at Tidelands Health were 96 percent full Wednesday, the Grand Strand hospital group announced. The number of patients hospitalized with COVID-19 at Tidelands stands at 47 — close to 20 percent of all beds at the system's two hospitals.
Gayle Resetar, Tidelands' chief operating officer, said staffing has become the health system's biggest challenge.
"It's not that we don't have enough beds," she said.
Tidelands Health has brought in travel nurses, hired new people and is offering incentives to work overtime, Resetar said. South Carolina hospitals are competing with other states for temporary staff, some with just as attractive beaches and warm weather.
Pennie Peralta, vice president and chief nursing officer at Roper St. Francis Healthcare, said the Charleston nonprofit is also dealing with a shortage in manpower. But Roper St. Francis has gotten creative, creating a pool of employees from throughout the hospital system to screen patients at entrances and pulling nurses out of administrative jobs to work directly with patients.
"This is the most nimble we've ever been," Peralta, who joined Roper St. Francis in 1978, said. She is confident Roper St. Francis' people can rise to the challenge.
Peralta said the system has added plenty of ventilators and space. Luckily, fewer patients need the aid of the breathing machines now, in part because health experts have learned more about how to treat the disease and in part because hospitals are seeing more young patients than before.
Roper St. Francis has equipped new rooms for COVID-19 patients and expanded bed capacity. Worst-case scenario plans call for classroom space to be used, though that has not been a necessity yet.
The health system has also begun to worry about teammates falling ill themselves. Given the thousands of people they employ, hospitals can expect at least some of their staffs to test positive and require a 10- to 14-day quarantine. Resetar said the same of Tidelands.
Dr. Lee Biggs, chief medical officer for North Charleston-based Trident Health, said all staff have been trained to work with COVID-19 in their relative professions.
He said Trident Health has the staff and resources needed to manage the growing COVID-19 population of patients. In the spring, the private hospital company built in the ability to triple the size of its ICUs. Patients who don't need critical care can stay in a dedicated 40-bed unit. But even with added space, staff remains the hardest resource to increase.
"We can triple the size of the ICU," Biggs said in late June interview. “I can’t create three times the staff that I would need.”
The influx of coronavirus patients into hospitals comes after a difficult spring for the health care workforce. Most hospitals in South Carolina aggressively cut staff when they were forced to stop elective surgeries and fewer patients showed up to their facilities. Staffing numbers in hospitals are not back to full force yet.
During a board meeting in late June, leaders at the Medical University of South Carolina said they have hired back about half of the roughly 1,300 people who had been laid off beginning in early April. Initial plans called for the staff to be back in full force by July, the end of the fiscal year.
Spokeswoman Heather Woolwine said in a statement MUSC is expanding its workforce to treat greater numbers of COVID-19 patients. New hires were made, and travel nurses were brought into the fold. The state-backed health system is also cross-training registered nurses to be ready to treat patients in critical care.
Woolwine said the COVID-19 population inside hospitals generally requires more staff to care for them. The disease also keeps people in the hospital longer than average, sapping employee resources.
In Dillon County, one of McLeod Health's seven Pee Dee hospitals has been reporting it is perilously close to capacity, with 97 percent of available beds filled with patients on the July Fourth holiday. That number has steadied in the last few days.
Jumana Swindler, spokeswoman for McLeod Health, did not answer the newspaper's questions about whether the hospital had brought on additional staff but said the Pee Dee-based hospitals are prepared to handle a surge in COVID-19 cases.
"We also have the capacity to transfer patients to our other facilities if needed," she said. "At McLeod Health, regardless of COVID-19, we adjust our staffing based on volumes and plan accordingly."