Omicron variant pushes hospitals to breaking point
In Chicago, patients are cared for in hospital hallways and in office chairs.
In Farmington, New Mexico, military reinforcements were deployed to civilian hospitals more than 700 miles from San Diego.
And in Paterson, New Jersey, elective surgeries have been canceled. A gallbladder condition that may usually require removal? Try antibiotics first. A bone fracture for which you could normally go under the knife? Let’s get into a cast and crutches for a bit to see how you do.
“You don’t really have to invoke standards of crisis care to provide standards of crisis care,” said Anand Swaminathan, assistant professor of emergency medicine at Paterson’s St. Joseph’s University Medical Center. “It’s a huge challenge to provide care to as many patients as possible right now.”
This is America in the Omicron wave. US hospitals and their staff are now being tested in new and challenging ways unlike previous outbreaks of the pandemic, medical workers across the country told BuzzFeed News. Patients who might normally be admitted for observation are being sent home to keep beds available. Others wait 10 or more hours in emergency rooms to be seen, before perhaps giving up and being discharged altogether.
Reaching the breaking point is a deceptively slow process, but gradually Swaminathan said his hospital and others are losing the things they need to keep running efficiently. “This collapse is not going to look like an armageddon. It won’t happen all at once,” he said. “It’s going to be pretty quiet, and people aren’t going to notice until they call 911 and no one comes.”
As Omicron spreads, COVID cases rise to record highs in all 50 states. But given the variant’s relative mildness for most people, especially vaccinees, Anthony Fauci and others said it’s now more relevant to pay closer attention to hospitalization data than numbers. number of cases. Yet this too is alarming. More than 147,000 people are currently in US hospitals with COVID – more than at any time during the pandemic to date. CDC Director Rochelle Walensky said Wednesday that the seven-day average of hospital admissions rose 33% from the previous week to about 19,800 a day.
Importantly, these numbers include people with an incidental case of COVID, meaning they came to be treated for something else and also tested positive for the virus. But while that may sound less ominous, it can be misleading. COVID can be exacerbating underlying health conditions in some people and, crucially, the net effect on hospitals is the same: more patients occupying more beds and requiring special isolation and safety protocols so as not to infect others.
While new studies show that Omicron is less severe and requires around 70% shorter hospital stays than Delta on average, the incredibly transmissible variant is still spreading like wildfire, including among children, who are being admitted to hospitals with COVID at record rates. “The risk of hospitalization remains low, especially among people up to date on their COVID vaccines,” Walensky said Wednesday. “However, the staggering increase in cases – more than a million new cases every day – has resulted in a high number of total hospitalizations.”
All this while more and more medical workers are themselves testing positive and are being forced to sit on the sidelines, leaving their colleagues – at least, those who have not left the profession entirely due to burnout. – striving to treat patients who show up en masse in their ER with COVID, yes, but also for any other medical condition or traumatic injury.
The cruel irony, then, is that what appears to be the most widespread variant of the coronavirus is the one that threatens to overthrow the American hospital system.
“Before that, if you had an acute life-threatening or limb-threatening medical condition and you went to an emergency department in America, you would have the promise that it would be taken care of quickly,” Gabe said. Gao, an emergency physician at St. Luke’s Hospital in New Bedford, Massachusetts. “I don’t think we can deliver on that promise at this time.”
Not all hospitals are currently facing a crisis. Some who have already experienced huge waves are holding their own – for now. “In the first wave I had 400 COVID patients, now we have 100,” said Aaron Glatt, chair of the department of medicine at Mount Sinai South Nassau in Long Island, New York. “We have better treatments, we have a better understanding of the virus, but at the same time, two months ago I had 10 patients with COVID.”
Michael Daignault, an emergency physician at Providence St. Joseph Medical Center in Burbank, Calif., said he was so shaken by the spike in cases in his area last winter that he felt the current moment was more manageable. . Before, patients could stay for weeks or months at a time in intensive care, but now it tends to be different. “The majority of patients admitted have less severe disease. The average length of stay has decreased,” he said. “It’s faster turnover. We are able to take care of it. “
But Daignault and Glatt said they have always experienced staffing shortages, with hospital workers sick with the virus. They also noted that they lived in states with relatively high vaccination rates. New York, for example, has nearly 20% more fully immunized people than Missouri, where the total number of hospitalizations is now above its previous worst levels.
“Hospitals in Missouri are slammed,” Missouri Hospital Association spokesman Dave Dillon said. “Hospitals are delaying non-emergency care, housing patients of all kinds in emergency departments due to lack of space, and are experiencing significant labor issues.”
“I don’t know what else to tell you. These are very difficult times,” he said.
In Idaho, the state with the lowest vaccination rate where less than half the population is fully vaccinated, Omicron’s push could be disastrous. Many hospitals there have only recently withdrawn from crisis care standards following an overwhelming wave of Delta cases in September. Susie Keller, CEO of the Idaho Medical Association, said its members had barely caught their breath from the trauma and were now looking at the likely prospect of another wave. “They feel completely beleaguered,” she said. “It’s another thing on top of everything else.”
Keller implored those in his condition who have not had a vaccine to do so, lest they take a hospital bed that could go to another person who has had their shots and comes for treatment for COVID. or something else, only to discover medical assistance is in short supply. “It’s absolutely unfair and it’s a very sad situation,” she said. “My heart really goes out to those people who are trying to do the right thing and for circumstances beyond their control end up in a hospital where the resources aren’t there.”
There are signs that some places affected early by Omicron have seen the worst of their tip in infections, although hospitalizations have previously tended to delay the number of cases by around two weeks.
But other states have yet to hit their Omicron peak, including Arizona, where at a Tuesday press briefing, Marjorie Bessel, clinical director of Phoenix-headquartered Banner Health, who employs more than 50,000 people in the American West, pleaded with people to be patient with staff in the days and weeks ahead. More employees are calling in sick, she said, which means patients are waiting longer than normal.
“We’re busy in our clinics, we’re busy in our urgent care, we’re busy in our emergency departments and we’re busy in our hospitals,” Bessel said. “We also understand that we are not yet at the top of the Omicron variant.”
In an effort to reduce the total number of sick medical staff at any given time, the CDC announced just before Christmas that asymptomatic medical workers could return to work after seven days, instead of 10, if they tested negative. Medical staff who received their reminders no longer need to self-quarantine at home following high-risk exposures.
A Manhattan emergency physician, who asked not to be named in order to speak freely about conditions at his hospital, said the CDC policy change has reduced nursing shortages at his facility, but he noted that Doctors still often performed nursing duties, such as administering intravenous infusions or discharging patients.
“There are obviously concerns,” he added. “I think there’s still no solid evidence on how long you’re contagious, and I think that’s a rule made out of understandable necessity, because otherwise we wouldn’t have enough medical staff, but at the individual level, it is difficult to reckon with the idea. to return and potentially infect other staff.
Across the city of Brooklyn, another ER doctor not authorized to speak to the media said she also had to take on more duties typically done by nurses or patient care technicians, in addition to her own work. She has only been a practicing doctor for a year and a half, but the shortage of staff makes her feel more overwhelmed than ever. “Sometimes it’s so busy that you don’t even have time to think or have any feelings about what’s going on,” she said, “but after your shift is over work, it kind of hits you, this wave of exhaustion.”
Gao, the Massachusetts doctor, said he noticed classic symptoms of burnout in himself and other colleagues. When he goes to work on a Monday morning and sees 35 or 40 patients admitted to the emergency room and another 20 to 30 in the waiting room, he knows that he is going to have another difficult week. It takes some mental and physical resilience to choose to work in the ER, but he fears he’s already been broken by it.
“It’s terrible. It’s awful. It’s the moral wound of it all,” Gao said. into which someone could adapt, and that person’s health care should not be hanging by a thread as a result of these efforts.”
Peter Aldhous and Dan Vergano contributed reporting for this story.