US hospitals start to be overwhelmed amid record coronavirus cases

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As confirmed cases of the coronavirus reach their highest levels since the start of the pandemic, hospitals across the country are reporting a critical staff shortage. And those shortages could only get worse in the weeks to come, as thousands of Americans out of the one million Americans diagnosed with Covid-19 last week start requiring hospitalization.

According to an NPR analysis of data released by the Department of Health and Human Services (HHS) this week, more than 1,000 hospitals across the country have been identified as “sorely” understaffed as they face a dramatic third wave of Covid-19 infections.

This represents about 18% of all hospitals that fall under the HHS. In total, 21% of hospitals, representing 40 states and Puerto Rico, expect their staffing needs to increase in the coming days. Seven states report shortages at 30% or more of their hospitals. North Dakota – which has one of the most severe coronavirus outbreaks in the United States – is the hardest hit, with 51% of hospitals reporting shortages.

Nebraska, Virginia and Missouri expect the biggest increases they have faced during the pandemic next week.

According to NPR, the HHS data is incomplete as many hospitals do not share their workforce with the HHS. The agency has been collecting this data since July, but this is the first time it has made it public.

These staff shortages translate into exhausted and overworked doctors, nurses and other hospital workers, and also present the risk that, when the employees themselves fall ill, there will be no one to cover them.

The fear of overwhelming hospital systems was a big part of the “flatten the curve” message that accompanied the outbreak in the United States in March. By limiting the number of cases to a reasonable number and admitting only the sickest patients to hospitals, medical experts explained, there was less risk of running out of bed space, ventilators and patients. other equipment essential to the care of Covid-19 patients. It also meant that resources would also be available for non-Covid-19 patients.

With hospitalization and case rates at record highs, hospitals could soon run out of staff and space

Ultimately, the curve was flattened – but with cases worse than they ever were, hospitals are again at risk of running out of space and health professionals.

As of November 20, 82,178 people had been hospitalized for Covid-19, according to the Covid Tracking Project – far more than previous records of nearly 60,000 reached in spring and summer. And on November 20, the United States hit a record 192,805 confirmed coronavirus cases, breaking the previous day’s record: 182,832 confirmed cases.

The Covid monitoring project

As Vox’s Dylan Scott explained, hospitalization is what’s called a delayed indicator – this means that the number of people hospitalized increases after, rather than in parallel, an increase in infections: it can take days or more for an infected person to need it. hospitalization after receiving a positive test result.

This means that already overcrowded hospitals are likely to start seeing an increase in the number of infected patients last week in the coming weeks, and that providers dealing with these new patients could be overwhelmed from mid to late December if cases increased sharply after Thanksgiving.

At the moment, hospitals are approaching their capacity. The HHS estimates that as of November 20, 73.66% of all inpatient beds in the United States are full (including both Covid-19 patients and those seeking treatment for other illnesses), and that 60.62% of all ICU beds are occupied.

When the virus was more confined to several hot spots earlier in the year – in New York and New Jersey, for example – medical professionals elsewhere, as well as the U.S. military, were also able to travel and provide short-term staff support. .

Now, with the virus so prevalent, there are fewer health care providers able to leave one community and support another.

This has led to dramatic reports from local media across the country, as communities that previously saw few cases of coronavirus begin to experience strain on their medical systems.

In North Dakota, where hospitals are at full capacity, hospital workers have been told they may continue to report to work even after testing positive for the coronavirus, as long as they do not show symptoms. . (Covid-19 is contagious even in asymptomatic hosts.)

The University of Utah Hospital in Salt Lake City opened an overflow intensive care unit two weeks ago, and officials said it would be made up of doctors and nurses who would work hours additional. In Muskegon, Michigan, a recently closed hospital has been reopened and RNs are being asked to come out of retirement to meet staffing and infrastructure needs.

And as the pandemic began to explode in previously untouched parts of the country, rural hospitals, many of which initially lacked resources, have been hit particularly hard.

Rural hospitals reaching capacity can have a ripple effect if neighboring urban hospitals are also overwhelmed. As the Kansas City Star’s Jonathan Shorman, Sarah Ritter and Matthew Kelly reported, Kansas City hospitals have “reached a tipping point where additional COVID admissions could trigger a crisis” and may have to stop accepting patients rural hospitals, leaving these patients with nowhere to go and no access to care.

Overwhelmed hospitals will almost certainly result in more deaths. As Vox’s Julia Belluz explained, healthcare professionals have become much better than they once were at treating Covid-19 patients, and the death rate has declined:

Now, there is strong evidence that common steroids like dexamethasone can reduce the risk of death in critically ill patients. Resting patients on their stomachs rather than their backs (a practice known as pronation) also appears to help.

While there is still a lot of progress to be made, the treatment approach has become more standardized over time, said Jen Manne-Goehler, an infectious disease physician at Brigham and Women’s and Massachusetts General Hospitals. When she started treating Covid-19 patients in the spring, it was as if the practice changed every few days. Now it’s easier – and it definitely helps in survival.

But to receive these improved treatments, patients must have access to doctors. And increasingly, it appears that access could be severely – and possibly dangerously – limited in the coming weeks. HHS plans to coordinate hospitals to make up for staff shortages, according to NPR. However, if hospitals are overwhelmed across the country, finding the staff needed to save lives may not be possible, for hospital systems or for the federal government.

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