EVANSVILLE — Potentially the mother of all coronavirus super-spreaders, Thanksgiving is bearing down fast — and one local hospital leader has a warning.

Dr. James Porter, president of Deaconess Health System, spoke in calm, measured tones in an email this week — but Porter also was clear that COVID-19 can get worse and will get worse if something doesn't change.

It is an ominous prospect. Twenty percent of Vanderburgh County's total cases — a number that has been building since March 19 — have been reported in just the past 13 days.

"Any time we run above 87% capacity, additional measures are required to maintain normal operations. We are running in the 90% and above range frequently now," Porter wrote. "And unless public health measures are followed to reduce the spread of COVID-19, there is no reason to expect this to change.

"The upcoming holidays, and threat of influenza spreading, represent future risk of the situation worsening."

More: Vanderburgh, Gibson, Warrick counties report new COVID-19 deaths

More: Indiana has more per capita coronavirus hospitalizations than 44 other states

Deaconess is stressed enough already, said the hospital system's CEO, Shawn McCoy.

McCoy said Deaconess hasn't had to transfer any COVID-19 patients to other facilities out-of-state, but it also hasn't been able to take all patients.

"We have had to not take patients from out in what we call ‘the region,’ which is the 90 miles that surround us here," McCoy said Thursday after a COVID-19 press conference outside the Civic Center. "We’ve had to limit patients from coming in, in the past two weeks."

Managers of other local medical facilities have said local hospital systems are diverting some COVID-19 patients to them.

Diversion is something Deaconess strives to avoid, Porter wrote.

"We make every effort to avoid diversion without compromising patient and staff safety. For that reason, it is a rare occurrence for Deaconess to be on diversion," he wrote. "We are occasionally on diversion for short periods during the peak of influenza; however, that has not occurred in recent memory."

Janie Swedenburg, executive director at Pine Haven Health and Rehabilitation Center, said that facility has taken 44 hospital patients into its separate 12-bed COVID-19 unit since early October. Most have recovered and left.

"They were calling, like, ‘We need somewhere to place these people,’ so that’s when we started taking (COVID-19) patients," Swedenburg said.

Pine Haven is just helping to handle overflow, Swedenburg said.

"Anybody that needs a certain level of oxygen or a lot of cardiac monitoring, that’s not something we’re going to do here — but (patients) that just have your regular symptoms that are sick, so they don’t keep the hospital congested, those are the kinds of people (the hospitals are) getting to us, sooner rather than later," she said.

More: COVID: 3 reasons things could soon get worse in Indiana and Evansville

Signature HealthCARE of Newburgh also acknowledged accepting hospital COVID-19 patients into a separate and isolated facility.

"As the positivity rate in Warrick County continues to rise and the county is currently Code Orange per ISDH (Indiana State Department of Health) guidelines, and hospital ICU beds are needed for the community’s most critical patients, our calling is clear; to be of assistance to our citizens in need," said a statement provided by Signature spokeswoman Ann Bowdan Wilder.

"As a result, Signature HealthCARE of Newburgh currently has accepted 17 hospital admissions into our COVID-19 only Care Unit."

Thanksgiving is looming — and with it, risk

Local health and medical officials have begun to draw a bead on Thanksgiving, just six days away. Some 40% of Americans plan to attend a Thanksgiving gathering with 10 or more people, according to a recent survey commissioned by Ohio State University’s Wexner Medical Center.

Dr. Gina Huhnke, medical director of emergency departments at Deaconess, suggested in a Facebook podcast Monday that local residents should scale back the traditional holiday to help slow COVID-19's spread.

"We’ve encouraged everyone to maintain their social distancing, wear your masks and wash their hands – but in addition, don’t gather in those big family gatherings that you would normally have on Thanksgiving and Christmas and other holidays around this season," Huhnke said. "Make it a small gathering, just with the people that live in your home."

Lance Wilkerson, senior marketing coordinator at Deaconess, stamped the point home.

"We’ll have plenty of Thanksgivings and Christmases later," Wilkerson said alongside Huhnke.

More: Evansville's Deaconess one of the first in the state who will receive COVID vaccine

The risk can be quantified.

Using public data, the Covid-19 Event Risk Assessment Planning Tool offers daily county-level estimates of the odds of encountering at least one COVID-positive individual at a gathering of 10 or more people. The "Current Risk Level" in Vanderburgh County, as of Thursday night: 82%.

"People (should) really avoid crowds – even within families," said Joe Gries, administrator of the Vanderburgh County Health Department.

"We just want people to be careful, even when they do get together with friends on the weekends, to try to stay separated and try to wear your masks and do these things safely."

The warnings are not hard to understand in the context of the times. COVID-19 has carved a brutal swath across this community in just the past 13 days.

Vanderburgh County’s current run of cases began on Nov. 6, when the Indiana State Health Department's statewide dashboard recorded a record-setting 177 new cases in a single day. In the hours before the eye-popping number popped up on the dashboard at about 11 a.m. Central that day, Vanderburgh County stood at 6,981 cases reported since the first one emerged on March 19.

That means 20% of the county’s cases – 1,780 of 8,761 — have been reported just in the past 13 days.

Hospitals feeling the strain all over Indiana

No one has to ask whether the strain on hospitals is a statewide problem.

The Indianapolis Star reported Wednesday that Indiana now has more per capita coronavirus hospitalizations than 44 other states and the District of Columbia, according to their analysis of data from the COVID Tracking Project.

Roughly 44 out of every 100,000 Hoosiers were in the hospital Tuesday fighting COVID-19.

More: 'No more Stage 5.' What COVID-related restrictions are in place in Indiana now?

Indiana has shattered coronavirus records on a near-daily basis since the end of October, a distressing trend as the state enters the winter months. The Hoosier state set a record for hospitalizations at least 14 times since the beginning of November. More Hoosiers with COVID-19 are in the hospital now than at any point during the pandemic.

New daily cases averaged around 4,800 so far in November, compared to October's average of about 1,910 cases per day.

These trends come as hospitals are struggling to keep their wards staffed. Brian Tabor, president of the Indiana Hospital Association, told IndyStar last week that Indiana hospitals were competing with health systems across the Midwest and beyond for temporary employees to fill the gaps.

Porter has been sounding the alarm about Deaconess staff for weeks.

"While we are well-equipped to handle these high census days, our staff depends on occasional breaks from this intensity to rest and recover and get ready for the next surge," he wrote in an email a month ago.

"The current COVID-19 surge has made every day a high census day for our staff. We are concerned about the ability to keep this intensity up over a long period. These high census days, and the urgency that surrounds this high patient need, affects all departments of the hospital, but especially our bedside staff in the ICUs and other hospital units."

Dan Parod, president of Ascension St. Vincent Southern Region, and McCoy, the Deaconess CEO, acknowledged their hospital systems make counseling available to stressed employees.

The St. Vincent workforce is experiencing COVID-19 like the community does, Parod said. That means a higher number than usual are out because they have symptoms. Or maybe they're quarantining because they know someone who had symptoms.

Both major local hospital systems are hiring to fill in the gaps, Parod said.

"We do what we do every day. We do the best we can with the staff that we have," he said. "I think both facilities have tried to recruit and hire additional staff to fill in for that gap."

Asking staff to work extra shifts has become an imperative, said McCoy. But the nature of COVID-19, the suffering and death front line workers see — there's a psychological impact.

"Our people are resilient and they’re tough — but mentally, this is starting to take its toll," McCoy said. "There's no doubt that it’s occurring, and it’s not just here in Evansville. It’s everywhere across the world."

What role does age play?

According to the Centers for Disease Control and Prevention, the increase in hospitalization rates nationally has been primarily driven by an increase in infections among adults 50 years and older. About 40% of the positive cases in Indiana were among Hoosiers 50 and older, compared to about 32% during each of the three prior months.

Due to the rapid increase in cases, however, the raw numbers paint an even starker picture. More than three times as many Hoosiers over 50 — 24,630 — tested positive for the coronavirus in October than in July.

More: Maximum of 500 fans will be allowed at University of Evansville basketball games

Hospitalizations have also increased within this age group. At least 3,700 Hoosiers over 50 were hospitalized with COVID-19 in October, according to the Regenstrief Institute. Older adults are more susceptible to severe illness from COVID-19, and that risk increases with age, according to the CDC.

Positive cases in Vanderburgh County have largely hewed to the state's patterns, according to the ISDH dashboard.

Statewide, 14.4% of cases fall in the 50-59-year-old age group compared to 13.8% in Vanderburgh County. But while 11.1% statewide are 60-69, the number is 12.1% locally.

Statewide, 6.7% are in the 70-79 group compared to 6.8% in Vanderburgh County. In Indiana, 5.2% are 80 and over, but the number is slightly lower locally at 4.9%.

Huhnke said on Facebook Monday that it's not just the elderly in Deaconess’s COVID unit.

"We have had some young people – teenagers and young adults – who are otherwise healthy, no other medical problems, requiring intensive care treatment and mechanical ventilation," she said.

It's hard to refute the impact COVID-19 has had in nursing homes.

On Oct. 21, the day Gov. Eric Holcomb announced members of the Indiana National Guard would be drafted into a new state initiative to curb the virus at long-term care facilities across the state, ISDH's dashboard reported that 2,205 nursing home residents statewide had died due to COVID-19. That was 58% of the state's total deaths.

The number on Thursday was 2,701. That's 55% of total deaths.

It is possible to measure with some precision the current level of COVID-19 growth in local nursing homes where the novel coronavirus has hit hardest. In some facilities, staff cases are up more than resident cases. That is, if the numbers the state offers are correct.

State data as of Oct. 27 said Pine Haven had 59 resident positive cases, six deaths and 16 staff cases. The latter two numbers are unchanged in data updated Wednesday that goes up to Nov. 11, although resident positive cases are up six.

But Pine Haven director Swedenburg disputed those numbers, saying more staffers and fewer residents have acquired COVID-19. Swedenburg pegged the number of staff contracting the coronavirus at 27, not 16. It's almost as high as the number of residents Swedenburg said have acquired the virus, 35. But those cases happened months ago, she said. There have been none in the past two weeks.

The ISDH dashboard named at least two other local nursing homes that it said had seen larger increases among staff members than among residents.

Holcomb has been vocal about nursing homes.

"It does not start inside our long term centers. It starts outside, in the community. Those rates have a lot to do with community spread. That’s the origin," the governor said in a COVID-19 briefing last month.

"This has everything to do, again – I’ll say it for the fifth time – has everything to do with our actions and our inactions. It’s because too many are ignoring science and are rolling the dice as if, again, somebody’s going to pay that bill for us."

'Otherwise, we’re going to be in a lot of trouble'

Hospital capacity? It's "a fluid number and varies shift to shift based on staffing availability and use of overflow capacity, which can be ramped up and sustained temporarily to manage through surges," Porter wrote in his email this week.

Deaconess makes whatever staffing adjustments are needed, the health system president wrote.

"And though we sometimes don’t have the staffing we would prefer, it is always safe staffing, or we would go on diversion," he wrote.

On Facebook Monday, Huhnke acknowledged that the mantra of handwashing, social distancing and mask wearing is months old — and perhaps tiresome enough that some refuse to believe it. But she said people need to listen.

"Otherwise, we’re going to be in a lot of trouble in a couple of weeks," she said.

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