/As COVID-19 hospitalizations near 100,000 in US, experts fear facilities soon be overrun by patients and a lack of staff

As COVID-19 hospitalizations near 100,000 in US, experts fear facilities soon be overrun by patients and a lack of staff


John Bacon
 
| USA TODAY

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COVID-19: What nurses and doctors in hospitals want us to know

Doctors and nurses working in hospitals across the country are sharing the realities of COVID-19.

The number of hospitalized COVID-19 patients nationwide stood on the brink of 100,000 Wednesday, an alarming statistic fueling enormous strain on the health care system and its brave but beleaguered workers.

Some experts said the total, compiled by the COVID Tracking Project, could soon double. Robert Glatter, an emergency room physician at New York City’s Lenox Hill Hospital, said the country has reached a “dangerous inflection point.”

“I wouldn’t be surprised if we stand at 200,000 people hospitalized in the next month,” Glatter told USA TODAY. “Explosive growth of the virus has the potential to overrun our ability to provide care. Not only for patients with COVID-19 but also for basic medical conditions.”

Many hospitals will be forced to suspend elective surgeries and other routine operations, set up temporary field hospitals and stretch staff to the limit, experts said.

California Gov. Gavin Newsom said intensive care beds across the nation’s most-populous state could be full by mid-December. He warned that “drastic action,” including tightened stay-at-home orders, could come within days.

Little Rhode Island has a big problem, too. The state‘s Emergency Alert System issued this message to residents this week: “RIGOV COVID ALERT: Hospitals at capacity due to COVID. Help the frontline by staying home as much as possible for the next two weeks. Work remotely if you can, avoid social gatherings, get tested. If we all decrease our mobility, we will save lives.” The state established two temporary field hospitals with a capacity of almost 1,000 beds to meet the fast-rising demand.

New Mexico’s 534 intensive care beds were at 101% of capacity Tuesday – the highest rate in the nation, according to U.S. Department of Health and Human Services estimates. New York Gov. Andrew Cuomo said hospitalizations have reached a level not seen since the state was the focal point of the virus last spring.

“Our No. 1 priority is hospital capacity,” Cuomo said. “That has always been my nightmare.”

COVID-19 infections soar: A look at restrictions in your state.

Hospitalizations nationwide have soared well above previous pandemic highs of about 60,000 in the spring and summer virus surges. The November death toll of 36,918 fell short of monthly totals for April and May. Experts said November’s fatality total was lower – despite more than double the number of infections – because of several factors, including improved treatment plans and the higher concentration of cases among younger patients less likely to succumb to the virus.

Ogbonnaya Omenka, an associate professor and public health specialist at Butler University, said it is normal to view the death toll as the primary gauge of the severity of a disease, but the hospital crisis shows there are other ways besides mortality that an infectious outbreak can pose dire challenges.

Glatter said the coming months could be a nationwide reminder of last spring in New York, where lines formed outside emergency rooms and hospitals devoted all care to COVID-19 at the expense of treating strokes, heart attacks, overdoses and other illnesses.

Data will reflect a corresponding spike in “excess deaths” as a result of the coming surge, he said.

US coronavirus map: Tracking the outbreak

Will hospitals run short of health care staff?

The availability of critical medical staff – intensive care unit doctors, ICU nurses, ER doctors and respiratory therapists – will determine whether the supply of care can meet the fast-rising demand.

“People are our most precious resource, dictating our success or failure as a country in this time of need,” Glatter said.

Hospital employees can be exposed to the virus at work, at home and in their communities. The impact on health care workers became so severe in North Dakota that Gov. Doug Burgum issued an order last month allowing staff who test positive for the virus but show no symptoms to keep caring for COVID-19 patients.

In many states, those who test positive are sidelined two weeks. Troy Clark, president and CEO of New Mexico Hospital Association, said nurses and therapists exposed to the virus often wait up to four days for test results. If the test is positive, health workers are out an additional 10 days, even without symptoms.

The Centers for Disease Control and Prevention issued guidelines Wednesday that could shorten those quarantines but not enough to eliminate the major bottleneck of finding enough doctors, nurses and respiratory therapists to take care of patients.

“That’s where we’re stressed,” Clark said. “While there may be physical beds, there is not a nurse, a nurse tech or respiratory therapist to care for those patients.”

Rick Pollack, CEO of the American Hospital Association, said COVID-19 is putting “an unprecedented strain on our heroic front-line caregivers” and on the health care system. 

“They are understandably experiencing physical and mental fatigue after months of fighting against COVID-19,” Pollack said.

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Vaccines not an immediate answer

 The vaccines expected to win emergency authorization in coming weeks won’t provide an immediate panacea. Omenka warned that although the participants in vaccine clinical trials are ideally selected to represent the general population, it’s unknown how the findings “will translate in real life.”

Melissa Nolan, an infectious disease expert and professor at the University of South Carolina, said holiday travel and the fast-rising number of infections could cause mutations that lessen the effectiveness of the vaccines.

Some surveys indicate that almost half of Americans may not be willing to get vaccinated.

“The reality is that the bulk of the population will not begin vaccination until early spring, making this a daunting challenge, especially in light of ‘vaccine hesitancy’ that complicates our efforts to vaccinate Americans,” Glatter said.

Increased travel and socialization mean increased risks of exposure and infection. Flu season also remains a factor.

“We are in holiday season, and Christmas is coming, followed by the new year celebrations, so it is within reason to expect an ongoing spike in cases and hospitalizations,” Omenka said. “The number of hospitalizations might reach almost double the current number by the end of January.”

A person’s illness may not require hospitalization, but the number of those seeking help could strain the quality of care or the health professionals themselves, Omenka said.

Even if the vaccine is found to be as effective in the general population as in the clinical trials, it’s not clear how long the immunity will last. Social restrictions and their continuous fine-tuning, according to emerging evidence, are really “our best approaches at the moment,” Omenka said.

CDC: Quarantine times may be shortened to 7 or 10 days, down from 14

Not all the indicators are gloomy as New Year’s approaches. College students, roundly criticized in some areas for failing to follow mitigation efforts such as masks and social distancing, could be building a resistance to the virus, Nolan said. She said early data indicates a high amount of antibody prevalence among some groups – up to 50% of college students in some areas might have antibody protection.

“So that means that coming back for the spring (semester), we are hoping to have lower transmission in some populations,” she said. “We could be talking in January about how college campuses are some of the safest places in the country.”

Still, the experts continue to urge Americans to wear masks in public, practice social distancing and wash hands often. Travel and gatherings remain on most do-not-do lists.

“The vaccine is the expected exit strategy,” Omenka said, but the nation can’t  “hurriedly step away or discard certain public health measures that have been found to be helpful in mitigating COVID-19.”

Contributing: Ken Alltucker, USA TODAY; Jack Perry, The Providence Journal