The latest outbreak of Covid-19 is forcing US hospitals to take drastic measures – creating temporary facilities or preparing to transport patients to other cities and states – to avoid being overrun.
The number of Americans currently hospitalized for Covid-19 increased by 12,000 over the past month, reaching 41,753 on October 25, according to the Covid Tracking Project. Some hospitals are making plans to ration care if they have more patients than beds, the kind of worst-case scenario they were hoping to avoid.
The number of cases also continues to rise: the United States now averages nearly 69,000 new cases of Covid-19 each day, more than the previous peak in July. Hospitalizations lag behind cases because it takes time for a person to become sick enough to require hospitalization ‚and so this number is likely to continue to rise as well.
Deaths are already on the rise, with the United States now averaging more than 800 per day, and they generally follow the same trends as cases and hospitalizations with a slightly longer lag. (Fortunately, hospitals have figured out how to better treat Covid-19, leading to lower death rates. But still, more patients in the hospital will inevitably lead to more deaths.)
And the frightening feature of this new wave is that cases and hospitalizations are climbing everywhere. In previous waves, cases were decreasing in one part of the country while they were increasing elsewhere. But now the whole country is experiencing a surge at the same time.
All states except Hawaii, Delaware and Louisiana (and Washington, DC) have seen their number of cases increase in the past two weeks, according to Covid Exit Strategy. More than 40 states now have more people hospitalized with Covid-19 than 14 days ago.
Public health experts have long expected an increase in cases during the winter months, when social distancing becomes more difficult and colder weather facilitates the spread of the coronavirus. But these new data show that the tough days are already here.
And hospitals are feeling the strain, just like they did in previous outbreaks. The weekend brought many reports of hospitals taking emergency action to manage the influx of Covid-19 patients. According to Covid’s exit strategy, 20 states currently have more than 70 percent of their intensive care unit occupied; this remaining capacity could quickly decline if current trends continue. In some cities, hospitals have already reached their capacity.
Here are a few examples of hospitals pushed to the brink of the third wave of the pandemic.
El Paso, Texas sets up field hospital, orders mandatory curfew
El Paso County has enacted a mandatory curfew, from 10 p.m. to 5 a.m., after hospitalizations increased 300% in less than three weeks. A recent University of Texas study projected a 96 percent chance that the region would have more intensive care patients than beds by November 8, and an 85 percent chance that all hospital beds. are busy.
Several other areas of the state – around Amarillo, Lubbock, Wichita Falls, Abilene, Dallas / Fort Worth and Odessa – also have better chances than even of exceeding their intensive care capacity in the next two weeks. Statewide, the number of patients currently hospitalized for Covid-19 has increased from 3,190 on October 1 to 5,206 on October 25.
“We are in a phase of crisis,” El Paso County Judge Ricardo Samaniego said over the weekend, according to CBS News.
A field hospital is being created at the El Paso Convention and Performing Arts Center, initially with 50 beds, but the capacity to add another 50. More than 1,000 state and federal health workers have moved to the county in recent days to try and provide more support. As Vox previously reported, one of the issues that hospitals face during Covid outbreaks is staffing; sometimes they may have open beds, but not enough nurses and doctors to care for the patients.
Hospitals are also preparing to transport patients from the El Paso area to other areas of Texas with more beds available. Governor Greg Abbott raised the possibility to open a military hospital to civilians.
“Hospitals are reaching a point where they have grown, as much as they can, within their brick and mortar,” El Paso University Medical Center said in a statement.
Utah Hospitals Prepare to Ration Medical Care for Covid-19 Patients
Covid-19 has exploded in Utah in the past two months. On September 1, the state averaged less than 400 new cases per day; As of October 25, the average number of new daily cases had almost reached 1,500. Hospitalizations followed the same trend, with the number of patients currently hospitalized for Covid-19 having more than doubled from 145 to 313 in the same period. period.
With some hospitals already forced to activate their emergency capacity plans, hospital officials have started to develop criteria for how to ration care if they have more patients than beds available.
It could literally become a matter of choice for the patients who live and the patients who die. From the Salt Lake Tribune:
Greg Bell, president of the Utah Hospital Association, said state hospital administrators confronted Governor Gary Herbert with a grim list on Thursday: criteria they suggest doctors use if they are forced to decide which patients can stay in overcrowded intensive care units.
Under the criteria, which would require Herbert’s approval, patients who deteriorate despite intensive care would be moved first. In the event that the conditions of two patients are equal, the young have priority over the elderly, as older patients are more likely to die.
“We told him, ‘It looks like we’ll have to ask for these to be activated if this trend continues,” Bell said, “” and we see no reason why it won’t.
Utah hospitals also face the same staffing challenges as elsewhere: Although the state has created plans to create a field hospital in an exhibition center, medical leaders warn they have not. not the doctors or nurses available to fill these new beds. Health workers have described feeling overwhelmed throughout the Covid-19 crisis and are now being asked to do even more, months after the start of the pandemic.
“Hundreds and hundreds of nurses cannot work as they were [before] because of their own illness or infection in the family, or it’s moms and dads having trouble with school, ”Bell told the Tribune. “Some are exhausted, some are on leave because they have been doing this for seven months.”
Idaho hospitals plan to send patients out of state as beds fill up
Idaho set a record for Covid-19 hospitalizations over the weekend with 259 people currently hospitalized, up from 135 in early October. The state is also averaging nearly twice as many new cases as it was a few weeks ago, meaning more hospitalizations are likely to occur.
Hospitals might need to send patients to hospitals in other states when their beds fill up, a huge logistical challenge for facilities and an emotional challenge for families who can be separated from loved ones by hundreds of miles.
At least one hospital in northern Idaho has already planned for such an eventuality. Kootenai Health in Coeur d’Alene reported late last week that it had reached 99% capacity. The health care system will send patients to Portland, Oregon, or Seattle, WA if its numbers continue to rise, as neighboring hospitals experience the same increase and have no room to. take additional patients.
Another hospital, the Magic Valley of Saint Luke in Twin Falls, has announced that it will begin transferring children requiring hospitalization to hospitals in the state capital of Boise to keep more beds available for Covid patients -19.
The surge in hospitalizations at Covid will get worse before it gets better
There are other stories like this across the country:
- Wisconsin has set up a field hospital on the State Fairgrounds near Milwaukee. (Covid-19 hospitalizations in the state have doubled since the start of the month.)
- Hospitals in Kansas City, Missouri, are reportedly refusing ambulances because they have no beds available, and urban hospitals warn they may not be able to accept overflow patients from rural areas. (Hospitalizations in Missouri hit a new record last week.)
- Oklahoma City hospitals are activating their peak capacity plans to add more beds, call in additional staff, and possibly cut back on non-Covid services. (Oklahoma is yet another state that has seen a record number of Covid-19 hospitalizations in recent days.)
As cases increase, hospitalizations will follow and deaths after them. It’s an established model. It will get worse before it gets better.
But we can try to ease the burden on hospitals and their staff. As Vox explained at the start of the pandemic, the goal of social distancing is to suppress the spread of Covid-19 so that hospitals are not overwhelmed. It also gives hospitals time to set up their surge capacity and staffing plans.
It won’t be easy. The federal government is not going to provide more resources to hospitals for the foreseeable future, with hopes of another Covid-19 relief program before January. Some states and local governments continue to resist masked mandates (even in stressed areas like Idaho) and other social distancing restrictions.
Wearing a mask and keeping our distance is something each of us can do on our own to reduce the spread of Covid-19 and slow the rapid growth in hospitalizations. There’s no time to lose.
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