COVID surge hits Kona Community Hospital: Facility implements contingency and crisis staffing plan amid staffing shortage

The current surge in COVID-19 cases on the Big Island has resulted in a staffing shortage at West Hawaii’s largest hospital.

In response, Kona Community Hospital on Tuesday activated its contingency and crisis staffing plan, which permits exposed and COVID-positive staffers to continue caring for patients while following DOH and CDC guidelines.

Judy Donovan, marketing and strategic planning director for the Kealakekua-based hospital, said the “shortage of personnel is the result of staff who have been directly exposed to or tested positive for COVID-19 in the midst of the most recent spike of infections in Hawaii.”

About 25 staff members from various departments have tested positive, Donovan said Wednesday. She was unable to provide a figure for the number of exposed staff. Approximately 90% of the facility’s 500-plus employees are vaccinated.

“We did not make the decision to activate contingency and crisis staffing lightly,” said Chief Nurse Executive Diane Hale. “This strategy is absolutely necessary, and it is the right decision so that we can continue to protect the health and safety of patients and staff.”

On Wednesday, 68 patients were hospitalized at the 94-bed facility with just four of those being COVID-positive. All four COVID-positive patients were vaccinated, according to Donovan, and none was being treated in the hospital’s intensive care unit.

Contingency staffing is currently in place hospital-wide, said Donovan, noting the decision to implement the strict staffing strategies aligns with current guidelines provided by the CDC and state Department of Health. Under this model, exposed staff is permitted to work, but remain in quarantine under the Department of Health.

“Being in quarantine or isolation at work means you are still doing quarantine procedures, which is wearing N95 at all times on campus, take all meals and breaks alone, preferably outside and appropriate physical distancing,” she explained.

Daily testing isn’t necessary for these employees, however.

“In the past, they would be out on quarantine, but now with the new CDC guidelines, they don’t have to quarantine from work. They can come to work as long as they remain symptom free and test at day five after exposure. If they are negative, they continue working,” Donovan said.

Staff members who do test positive for COVID-19 still must follow guidelines already in place for isolation, testing and returning to work. However, some staff that test positive may still work under the crisis staffing model, so long as they are either asymptomatic or mildly symptomatic.

“You can be asymptomatic, and positive, so you are a carrier, but you are never going to get sick, so you can be useful, but you can get somebody else sick, so you have to go into a strict mode of infection prevention,” she said. “We are following the strictest infection guidelines and our staff wear all of the appropriate PPE all the time and the patients are required to do the same. If that is happening, the infection won’t spread.”

The hospital’s emergency department has been operating under the crisis staffing model since Tuesday. The model will be implemented on a department-by-department basis based on a daily assessment of capacity and personnel need. Any staff working under the model must adhere to isolation guidelines while at work, and remain under the care of the DOH.

“Right now, only the emergency department is in that mode. We can float nurses from department to department, except for specialty nursing such as OB, ICU and ER,” Donovan said Wednesday. “That’s how we are managing it right now.”

Healthcare Association of Hawaii spokesperson Stacy Wong said the organization is working in partnership with the state Department of Health and Hawaii Emergency Management Agency to bring in more than 700 health care traveler staff to assist with the surge of COVID-19 patients statewide. Information has been given to FEMA, which would be the federal agency that approves the request and pays for the staffing.

“We are awaiting word on the FEMA approval. If granted, the staffers would arrive this month,” said Wong.

Donovan said Pro Link Services, the agency used to secure temporary staff, has about 26 health care workers ready to come to the Kona hospital as soon as FEMA approves the request.

In addition to the staffing shortage, the emergency department, which has implemented crisis staffing, has seen an uptick in patients seeking treatment. The department is averaging 65 to 70 ER visits per day, with a large spike in patient referrals for Regen-cove antibody therapies from community physicians and clinical providers. Amid the pandemic, the hospital has typically seen 55 to 65 patients a day.

However, such Regen antibody therapies do not appear to work on the new variant, prompting the hospital to stop offering the treatment for those with the omicron variant. The hospital is also out of other antibody therapies.

“The omicron variant is NOT neutralized by Regen antibodies. Therefore, KCH will no longer offer Regen-cove antibodies as a COVID therapy. Please do not send patients to the emergency department for antibody therapies. We will have no antibody therapies available for the near future. Our pharmacy is ordering Sotrovimab, which will be effective against the Omicron variant. However, we have no information as to when to expect a delivery, and what the administration criteria will be,” a letter sent to community medical providers from the hospital’s Incident Command Team stated.

In addition to the temporary staffing strategies, visitor restrictions have been reinstated as another measure to mitigate the potential for further exposure within the hospital.

Exceptions to the no-visitor policy have been made for those giving birth, children receiving care and patients receiving end-of-life care. A support person can accompany a patient in the obstetrics unit; pediatric patients may have one parent/guardian; and end of life exceptions are being made on a case-by-case basis.

Donovan said Kona Community Hospital would reopen to visitors when it is considered safe for both patients and staff.

“The biggest thing the community can do to help is having people curtail their activity right now and always keep a mask on, wash your hands. That would help here, because we won’t see as many people come through the emergency department,” Donovan said. “I know people are sick of hearing the messaging, but the fact is if you are diagnosed positive, then you fall under the care of the Department of Health and you have to quarantine, and they will check on you. Be very careful. If you don’t need to go somewhere, don’t go there. If you have to go to work or school, do it safely. But it is better to curtail yourself.”

Kohala Hospital, the other Hawaii Health Systems Corp.-affiliated hospital in the West Hawaii region, is faring better with no current staffing shortages, Donovan said.

A spokesperson for HHSC’s East Hawaii region did not respond to a request for comment on staffing at Hilo Medical Center and Ka‘u Hospital.

Queen’s North Hawaii Community Hospital said Wednesday that The Queen’s Health Systems-affiliate is “doing OK with staffing.”

“But like everywhere, it is a challenge when staff members have to be out of work due to possible exposure or infection. Luckily these numbers are not significant and the vast majority of our staff are vaccinated. We are providing staffing incentives, travelers, and have a request in for FEMA nurses, all to help support our very hard working staff,” said Lynn Scully, hospital spokesperson.

Like Kona Community Hospital, Queen’s North Hawaii Community Hospital is awaiting more doses of Sotrovimab. The hospital has already administered the initial doses it received to high-risk outpatients in the ER.

“We are awaiting additional supply. We are also waiting for PAXLOVID, an oral antiviral now available under Emergency Use Authorization by the FDA for treating COVID-19 in outpatients with mild to moderate disease,” said Scully.

The Waimea hospital is continuing with a two-visitor policy. Visitors must be vaccinated and undergo a screening prior to entry, however.