How One Health System Balances COVID Surge, Vaccination Drive

Ken Terry

January 07, 2021

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As COVID-19 infections, hospitalizations, and deaths reach new highs nationally, one healthcare system in Texas is managing the surge thus far, and is well on its way to vaccinating its entire staff.

Houston Methodist, which includes an academic medical center and six community hospitals in the greater Houston area, has vaccinated (or is about to vaccinate) 60% of its employees, Marc Boom, MD, the organization's president and CEO, told Medscape Medical News.

The healthcare system recently offered its employees a $500 bonus (to be paid in March) on the proviso that they get vaccinated by then. Eventually, Boom said, COVID-19 vaccination will be mandatory for employees, as flu shots have been at Houston Methodist for the past 15 years.

The healthcare system is currently challenged by the biggest surge in COVID-19 cases since July. Houston Methodist is now caring for about 740 COVID-19 patients, up from 140 in September, Boom said.

However, its hospitals are nowhere near running out of ICU capacity. While they have more patients in med-surg beds than ever before, Boom said, there are 130 patients in their ICUs, compared with 190 at the peak of last summer's surge.

"So we have some room to go," he said. "The latest surge has forced us to curtail some elective procedures that might need ICU time and that can be safely delayed."

Houston Methodist has also avoided staff shortages, partly by not laying off any staffers in 2020. Moreover, the staff is not feeling overwhelmed, Boom said. "Our people are seasoned veterans, they've been through this twice, particularly the big surge in the summer. Morale is good, they're working hard, and people have gotten a little bit of hope from the vaccine."

The only cause for concern about staffing, he added, is the current shortage of traveling nurses, whom Houston Methodist used quite a bit last summer. To make up for that shortfall, the system is adjusting schedules so that nurses can be moved around. For example, a nurse who normally cares for people after surgery can now help in the ICU.

Ramping Up Vaccinations

As of today, Houston Methodist had administered about 30,000 first doses of vaccine and close to 4000 second doses, Boom said. Of the 30,000 first doses, about half were given to the hospitals' employees. So 15,000 of the system's 26,000 staff members had been vaccinated.

In addition, he noted, another 2000 to 3000 affiliated physicians had gotten their shots at Houston Methodist. While thousands of other physicians provide services at Houston Methodist, many of them admit patients to other systems, and they might be getting vaccinated there, he said.

The remainder of Houston Methodist's vaccine supplies are being administered to people outside the hospital system, according to Texas' vaccination schedule. The first group includes firefighters, home healthcare workers, hospice workers, and physician office staff, Boom said. The healthcare system has also begun to vaccinate patients who are 75 or older.

Some hospitals in New York and California have used only a fraction of the vaccine supplies they've received. But Boom says Houston Methodist has administered the majority of its vaccine doses.

"We're getting vaccines into arms within days. Our supply is expected to come in today. If it does, we'll have more unused doses until we catch up with them," he said. "To schedule effectively, we try to have a few days' supply on hand. It's a weekly shipment, so the best way to schedule is to space it out evenly over the week."

Yesterday, he added, "we vaccinated the most patients we've ever done — about 4500 — and we continue to ramp that up." He said the system has hired additional clinicians to carry out the vaccination program.

Outpatient physicians have offered to help, he said. At some point, Houston Methodist will launch a mass vaccination program on weekends, when doctors can vaccinate people outside of office hours.

Supplies are Rate-Limiting Factor

No provider in the state is getting as much vaccine supply as they'd like, and that's the "rate-limiting factor, much more than the ability to vaccinate," Boom said. One reason for the shortfall is that nursing homes are being prioritized — a decision he strongly supports. In a few weeks, he said, most patients and staff at nursing facilities will be vaccinated, and the supply to hospitals should improve.

In the meantime, he said, about half of the Houston Methodist staff have rushed to get vaccinated. Another 30%-40% of employees have taken a wait-and-see attitude, but they're increasingly getting on board after seeing that 15,000 of their colleagues have been safely inoculated. 

One factor in the increasing acceptance of the vaccine has been the system's 800 employed physicians, 80% of whom have already gotten shots. "Those are the people who are the most educated and science-based, so they set the example," he said.

He estimated that around 10%-15% of the staff are still reluctant to be vaccinated. "We'll continue to work them with multiple strategies," including the $500 bonuses, he said.

Overall, Boom is fairly optimistic about the future, though he said the next 4-6 weeks will be tough. "I don't see an end to the curve we're on, but I'm hoping people have gotten the holidays out of their system and are ready to hunker down for a while," he said. "In theory, when we get this surge under control, and the vaccines start kicking in — barring some horrible mutation — this should be our last peak, and that gives us all some optimism. When we get over this peak, because of the vaccine rollout, we're going to continue to see this [infection rate] come down, and it should be our last surge."

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