Staff talk outside a patient's room in a COVID-19 intensive care unit at Bryan East Campus in December. The hospital is so full these days with both COVID and non-COVID patients that it often can't accept transfers.
Nebraska Gov. Pete Ricketts announced Monday that the state is bringing back an online dashboard to track COVID cases and hospitalizations.
Health care professionals who have turned to a central transfer center implemented to help get the sickest Nebraskans the care they need say the system isn't working as well as needed.
Gov. Pete Ricketts on Sept. 1 brought back the transfer center, a central clearinghouse for finding available hospital beds, as COVID-19 hospitalizations continued to rise.
The transfer center had first been used last year, with a fair amount of success, as hospitals in the state's more rural areas were able to find beds in the state's larger facilities for often critically ill COVID-19 patients.
That transfer center was run by CHI Health. The version brought back this month is being run by Nomi Health, the Utah-based company that ran COVID-19 testing operations for the state until earlier this summer.
The previous central transfer center focused mostly on finding beds for COVID-19 patients. The new version aims to find beds for any patient, but that's proven a challenge for those most in need of care.
Last week, during a media briefing, Bryan Health officials said the transfer center was not proving helpful in cases where very sick patients who were not stable needed to get to a larger hospital.
"The ability to transfer unstable patients is not there," said Bob Ravenscroft, Bryan's vice president of advancement.
Ricketts said Monday that no hospital CEOs have contacted him about problems with the transfer center.
However, Dr. Gary Anthone, the state's chief medical officer, said he was aware of concerns regarding the ability to transfer unstable patients, and he said there may be "some upcoming news" regarding that issue.
On Wednesday, the Nebraska Department of Health and Human Services said in a statement that the transfer center "continues to work with Nebraska medical facilities to ensure safe transport and adherence to the requirements that have been outlined to the providers."
The statement also said that a working group of coalitions, facilities, subject matter experts, NOMI and DHHS has been created to "address needs and feedback with the transfer center as well as to enhance standard operating procedures for operations going forward."
Dr. Kevin Reichmuth, a Lincoln pulmonologist, said part of the problem is that the hospitals in Lincoln and Omaha, which have more specialists available and offer the highest levels of care, are generally full.
"We live at the edge of hospital capacity literally every day," said Reichmuth, who treats patients at both Bryan and CHI St. Elizabeth in Lincoln.
As of Wednesday, there were 425 adult COVID-19 patients in the state's hospitals, according to the dashboard that Ricketts reinstated on Monday. More than a quarter of those patients, 119, were in intensive care.
But there also were nearly 2,300 adult patients and more than 200 pediatric patients in hospitals across the state for other reasons.
In addition, because of staffing shortages, the number of beds available for all those patients had dropped below 3,900 as of Wednesday, down from more than 4,200 last fall.
Many smaller hospitals have beds available, but when patients come in with medical needs the small facilities are not equipped to handle, a transfer becomes necessary.
Dr. Pete Lueninghoener, a family physician in O'Neill, said it's those kinds of cases he expected the transfer center could help with, but so far, that's not been the case.
Lueninghoener discussed the case of a patient who came into Avera St. Anthony's in O'Neill on Sept. 10 with a perforated bowel. Knowing the patient needed to be transferred immediately, staff there called the transfer center, but no one answered, he said.
Staff wound up making calls themselves -- 11 in all -- before finding a hospital with an available surgeon and an open intensive-care bed for the patient.
All the while, a medical helicopter waiting to transport the patient was tied up for hours.
"It was approximately four hours that the person had to wait to find an ICU bed capable of handling her case," Lueninghoener said. "She could have very easily died in our emergency department waiting for a bed to become available."
In another instance last week, he said O'Neill hospital called the transfer center trying to find a hospital for an unvaccinated COVID-19 patient who started to rapidly go downhill.
Staff did reach someone at the transfer center, but Lueninghoener said the person had no idea where O'Neill was.
"My impression was that he was definitely not located in our state and there was a good possibility that he was not even located in our country," he said.
In that case, Lueninghoener said the hospital could not find an open bed for the patient and wound up having to intubate him. He was transferred a day later.
Lueninghoener said the O'Neill hospital also worked with a call center in South Dakota, where its owner, Avera Health, is based. While staff there couldn't find an open bed either, they were at least helpful and checked in often to offer updates on the bed situation, he said.
"We never heard back from the Nebraska call center after the initial contact," Lueninghoener said.
Reichmuth said situations like the one in O'Neill appear to be common. He said he's heard stories of many small hospitals having to make anywhere from 10 to 20 calls on their own trying to find open beds because the transfer center could not help them.
Dr. Robert Wergin, a physician affiliated with Seward's Memorial Healthcare Systems, said the hospital there has a strong working relationship with Bryan and he prefers to call there directly to see if he can find an open bed.
However, that doesn't always work these days, as Bryan often has no beds open.
Wergin said he has resorted to using the transfer center, and while he found staff there to be cordial and helpful, they were often unable to fulfill his request.
"I think it worked pretty smoothly, I just think there were no beds," he said.
Wergin said he's had to keep three or four patients at the hospital in the past couple of weeks that he would have normally transferred. In a couple of cases, he was eventually able to move them to Bryan after beds came open. In the others, the patients improved while at the Seward hospital and were able to go home.
While the outcomes were good, he said the situation pushed the hospital "to the limits of our infrastructure, equipment and staff."
"You just do what you have to do to take care of the patient," Wergin said.
What do we know about booster shots for COVID-19?
Why might we need boosters?
Answer: It's common for protection from vaccines to decrease over time. A tetanus booster, for example, is recommended every 10 years.
Researchers and health officials have been monitoring the real-world performance of the COVID-19 vaccines to see how long protection lasts among vaccinated people. The vaccines authorized in the U.S. continue to offer very strong protection against severe disease and death.
But laboratory blood tests have suggested that antibodies — one of the immune system's layers of protection — can wane over time. That doesn't mean protection disappears, but it could mean protection is not as strong or that it could take longer for the body to fight back against an infection.
The delta variant has complicated the question of when to give boosters because it is so much more contagious and much of the data gathered about vaccine performance is from before the delta variant was widely circulating. Delta is taking off at the same time that vaccine immunity might also be waning for the first people vaccinated.
Israel is offering a booster to people over 50 who were vaccinated more than five months ago. France and Germany plan to offer boosters to some people in the fall. The European Medicines Agency said it too is reviewing data to see if booster shots are needed.
When would they be given?
Answer: It depends on when you got your initial shots. One possibility is that health officials will recommend people get a booster roughly eight months after getting their second shot of the Pfizer or Moderna vaccine.
Officials are continuing to collect information about the one-shot Johnson & Johnson vaccine, which was authorized for use in the U.S. in late February, to determine when to recommend boosters.
Who would get them?
Answer: The first people vaccinated in the United States would likely be first in line for boosters too. That means health care workers, nursing home residents and other older Americans, who were the first to be vaccinated once the shots were authorized last December.
Booster? Third shot? What's the difference?
Answer: Transplant recipients and other people with weakened immune systems may not have gotten enough protection from vaccines to begin with. They can now receive a third dose at least 28 days after their second shot as part of their initial series of shots needed for them to be fully vaccinated. For those with normal immune systems, boosters are given much later after full vaccination — not to establish protection, but to rev it up again.
What questions remain?
Answer: Still unknown is whether people should get the same type of shot they got when first vaccinated. And the nation's top health advisers will be looking for evidence about the safety of boosters and how well they protect against infection and severe disease.
Global access to vaccines is also important to stem the pandemic and prevent the emergence of new variants. Booster shots could crimp already tight global vaccine supplies.
What about the unvaccinated?
Answer: Dr. Melanie Swift, who has been leading the vaccination program at Mayo Clinic in Rochester, Minnesota, says getting more shots into people who haven't yet been vaccinated at all is "our best tool, not only to prevent hospitalization and mortality from the delta variant, but to stop transmission." Every infection, she says, "gives the virus more chances to mutate into who knows what the next variant could be."
"People who took the vaccine the first time are likely to line up and get their booster," Swift says. "But it's not going to achieve our goals overall if all their unvaccinated neighbors are not vaccinated."
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education. The AP is solely responsible for all content.
Reach the writer at 402-473-2647 or molberding@journalstar.com.
On Twitter @LincolnBizBuzz.
Matt Olberding
Business reporter
Matt Olberding is a Lincoln native and University of Nebraska-Lincoln graduate who has been covering business for the Journal Star since 2005.
