Hospitals brace for COVID-19 surge

Hospitals are facing rising pressure from a surge of coronavirus cases that is threatening to overwhelm their capacity, as the country braces for further escalation following Thanksgiving. 

Over 93,000 people are in the hospital with coronavirus, a record level, and the number is only continuing to rise, according to data from the COVID Tracking Project. 

The country is also recording more than 150,000 new cases every day, and the numbers are likely to only get worse given a burst of gatherings and travel from Thanksgiving. 

Hospitals around the country are steeling themselves for an already-strained situation to get even worse. 

The Association of American Medical Colleges (AAMC), which represents academic medical centers across the country, sent a document to its member hospitals last week reminding them of “crisis standards of care,” which are used to cope with an overwhelming number of patients. 

“From everywhere, I’m hearing an increasing, growing concern,” said Janis Orlowski, AAMC’s chief medical officer. “I expect we are going to have another significant surge in numbers and this is on top of what is already an extraordinary number of hospitalizations.”

Orlowski said she expects more hospitals will soon have to start implementing crisis standards, which include stretching resources in ways that would not be done in normal times. For example, a nurse could be caring for four patients at once instead of two, she said. 

“It’s not a complete drop-off like, ‘You get care and you don’t,’ ” she said. “Instead of getting 100 percent of care, you might get 90 percent or 80 percent.”

Hospitals are already taking extraordinary measures. As part of a two-week “pause” announced by the governor, Rhode Island sent out an alert to residents’ cellphones on Monday reading: “Hospitals at capacity due to COVID. Help the frontline by staying home as much as possible for the next two weeks.” A field hospital is opening in the state this week as well.  

Jeff Pothof, chief quality officer at the UW Health hospital system in Madison, Wis., said his hospital is already “past our normal capacity.” He said it is possible the hospital could get so overwhelmed that doctors are unable to care for people with heart attacks and strokes if there is another major surge following Thanksgiving. “If we see another surge on top of the surge we just had, that gets pretty dicey for us,” he said. “We don’t have too many more tricks up our sleeve.”

To provide more space for COVID-19 patients, the UC Health hospital system in Cincinnati on Monday converted its Cardiovascular Recovery Unit into surge ICU capacity. 

“The COVID surge here (and across the country) is requiring this finite group of doctors and nurses to work more under intensely emotionally and physically draining conditions every day – and we are burning them out,” said Amanda Nageleisen, a spokeswoman for UC Health. “Our healthcare workers can’t continue at this pace, and there’s only so many of them to deal with this surge.”

The University of Utah’s hospital has two extra teams taking care of COVID-19 patients in the ICU. 

“Everyone that you talk to is tired, particularly in the critical care units where it’s just grinding,” said Russell Vinik, the university’s chief medical operations officer. 

Health officials are urging the public to take precautions like wearing masks, maintaining distance from others, avoiding indoor gatherings, and washing hands in order to lessen the burden on health care workers. 

“Indoor social gathering is not something that should occur right now,” said Orlowski of AAMC. “It should be extremely limited.” 

Experts have also long warned that bars and indoor dining should be closed in hard-hit areas. Still, only 15 states have closed their bars, according to a tracker from the Kaiser Family Foundation. Further economic assistance that could cushion the blow of business closures has been stalled in Congress for months.  

“Close the bars and keep the schools open is what we really say,” Anthony Fauci, the government’s top infectious disease expert, said Sunday on ABC’s “This Week.”

Fauci said on NBC’s “Meet the Press” that he has been getting calls from colleagues in different states saying: “We’re at that point where we soon, if things don’t turn around quickly, we’re going to have a situation with capacity. Not only of hospital capacity, but staff. You know, what do you think we should do?”

Maryland Gov. Larry Hogan (R) tweeted a warning Monday that his state has its highest level of COVID-19 hospitalizations since May. 

“As this new surge continues, each and every Marylander must exercise personal responsibility in order to save lives and prevent our hospitals from overflowing,” Hogan wrote. 

California Gov. Gavin Newsom (D) tweeted that hospitals there are on pace to run out of ICU beds before Christmas. “Please stay safe & stay home as much as you can for next few weeks,” he wrote. 

Orlowski said there are now increasing problems with shortages of N95 masks and gloves for health workers, which she called a “canary in the coal mine” for further shortages of protective equipment as cases and hospitalizations mount further. 

There is some sliver of good news in that hospitalizations have started to dip slightly in recent days in some of the hardest-hit states, including North and South Dakota and Wisconsin. 

But Orlowski said she is worried that measure of improvement could soon be canceled out in those states by a new surge coming from Thanksgiving gatherings. 

A brighter light at the end of the tunnel comes from the promising news about both the Pfizer and Moderna vaccines being highly effective. 

Those vaccines could start being administered to high-risk groups as soon as December, but it will be several months before they are widely available to the general public, meaning the crisis will not be abating in the short-term. 

Still, initial vaccinations of health care workers starting in December would be helpful in maintaining hospital capacity by preventing doctors and nurses from having to stay home with the virus. 

“You’re burning at both ends,” said Vinik, the University of Utah doctor. “If we can at least get our front-line COVID workers vaccinated, the candle will only burn at one end.”