The worrying improve in hospital stays in Covid-19 on a chart

More Americans are currently being hospitalized with Covid-19 than at any other time in the pandemic, a grim indicator of the third major wave of cases in the US could be the worst wave yet.

On November 11, 65,368 people were hospitalized in the United States after testing positive for the novel coronavirus, according to the Covid Tracking Project. This is significantly higher than the last high of 59,940 on April 15, when the New York City area was the epicenter of the US outbreak. (As the Covid Tracking Project notes, national and state hospital data were erratic and incomplete, and reported totals may continue to shift.)

Christina Animashaun / Vox

The data shows that Covid-19 has migrated to a new hot spot across the country Regions this fall. In the spring, hospital stays were mostly concentrated in the northeast. In the summer, more than half of Covid-19 patients were hospitalized in the south and west: states like Arizona, California, Florida, Georgia, and Texas.

Now the Midwest, Great Plains, and the Mountain West are the new hot spots, and some previous hot spots are warming up as well, and cases and hospital stays are starting to rise again. "There are so many places with so many people that the numbers are only dramatically higher," said Daniel McQuillen, assistant professor of medicine at Tufts and senior physician in the Infectious Disease Division at Beth Israel Lahey Health, at a Wednesday briefing for the Society of America for Infectious Diseases.

On November 11, Texas had the highest number of hospitalizations of any state (6,779). Illinois ranks second with 5,042 people in the hospital; Other Midwestern states like Michigan, Indiana, and Wisconsin have seen spikes in some cases in the past few weeks, and have now hospitalized more than 2,000 people each.

"The hospital stay number is the best indicator of where we are," Eric Topol, professor of molecular medicine and director of the Scripps Research Translational Institute, told Vox this summer. This is because the severity of the pandemic can be measured better than general Covid-19 tests, which only detect a fraction of cases and include milder cases. "We're going to reach new heights in the pandemic we've never seen before. Not that what we've seen before wasn't terrible enough."

Medical staff treats a coronavirus patient in the Covid-19 intensive care unit at the United Memorial Medical Center in Houston, Texas on November 10, 2020. Go Nakamura / Getty Images

Some states like Utah and North Dakota have fewer overall hospital stays, but also fewer hospitals and hospital beds – and they are now reaching a sad tipping point with hospitals operating at full capacity.

“Here in Salt Lake City we offer a lot (specialized infectious diseases and intensive care) to people in four states as far as Montana, Arizona and Wyoming. Our hospitals and nurses are extremely stressed, "said Andrew Pavia, the chief of pediatric infectious diseases at the University of Utah Medical School at the IDSA briefing. "Our intensive care units are full, but this also includes specially designed overflow intensive care units that use the time we had to plan."

Unfortunately, this was to be expected (although it was not inevitable). As the weather turned cooler and states could not fully control their outbreaks, transmission increased when people moved indoors. Almost every state that has had more cases and hospitalizations now has no major outbreaks in the spring or summer. As a result, residents were less anxious and took fewer steps to prevent the virus from spreading.

"There has been a political climate of distrust of the government and reluctance to take tough action," said Pavia. "Many of these states did not have mask mandates until recently, and some do not even have them today and have very limited restrictions on mass gatherings."

Deaths are also picking up again, reaching 1,592 on November 11, reversing a steady decline that began in early May after the first wave and in August after the second wave.

In total, 10.2 million Americans have tested positive for Covid-19 since the pandemic began, and more than 233,000 of them have died. With soaring hospital admissions and the fact that thousands of new cases are reported daily in several states, experts face a difficult late autumn and winter.

The new hospitalizations and the unsustainable pressures they put on the health system are also a reminder of the importance of states implementing and enforcing measures such as mandatory face masks, restrictions on bars and restaurants, and the federal government to address testing and contact tracing issues remedy. "It should be an all-points bulletin to really demonstrate this, otherwise there is no limit to where this could go," Topol said.

The hospitals are running out of staff and beds for Covid-19 patients

The good news is that infectious disease experts believe many hospitals are much better prepared for surges in Covid-19 patients than they were in the spring. For the most part, they have the equipment they need and how to use it. They also have a more standardized protocol for treating the sickest patients.

However, hospitals in hotspots across the country are exhausting their staff, equipment and beds. Doctors warn that the worst scenario of hospital resource overload is in sight if their states cannot better control the coronavirus.

An aerial view of the Field Hospital for Coronavirus Patients at the Ernest N. Morial Convention Center in New Orleans, Louisiana on April 4, 2020. Chris Graythen / Getty Images

"ICU beds don't care about people – they need staff," said Pavia of the University of Utah's School of Medicine. “And one of the things that many Western nations have in common is a relative shortage of people that we need for the very sick during such a pandemic: doctors in the intensive care unit, probably most importantly nurses in the intensive care unit, and doctors in infectious disease respiratory therapists . These people have been working flat out for eight or nine months and after three months they are exhausted and stressed. "

Personnel is a universal problem in hot spots. Utah Governor Gary Herbert said the state must call in extra-state nurses to help with the wave, and officials and health care providers in South Dakota, Tennessee, Arizona and Wisconsin are also requesting them:

I have received many emergency inquiries for nurses in WI but that was worrying. 4 of these hospitals are in Milwaukee County. Others have gone into crisis / surge mode. This is really serious. I usually click "Not Available" but I have a hard time saying no to this one.

– Bree O’Connelly RN @ (@BrianaOconnelly) November 6, 2020

In Texas, officials in El Paso and Lubbock are setting up medical tents to respond to the rapid rise in hospitalized Covid-19 patients and a dwindling number of hospital beds. “El Paso, Texas, has almost no beds in the intensive care unit. Lubbock, same thing, ”said McQuillen.

"We're the eleventh largest city in the state of Texas and have two field hospitals on our way into town," Jarrett Atkinson, Lubbock's city manager, told KCBD on Tuesday. "I can absolutely assure you that in my career I never thought we'd send field hospitals to Lubbock, Texas."

Medics wait outside an apartment to rush a woman with possible Covid-19 symptoms to hospital in Austin, Texas on August 7, 2020. John Moore / Getty Images

According to McQuillen, both El Paso and Lubbock were "much less strict with their populations (which dictates simple things like wearing masks and social distancing)". He compared this to Massachusetts and other northeastern states, where tough measures during the spring rise made a big difference in reversing the steep rise in cases and hospitalizations. But too many states have ignored this critical lesson and are now paying the price.

Daily deaths are creeping back in but are still well below the previous high

As daily hospital stays increase in Covid-19, another key metric, daily deaths, hit 1,562 on November 11, its highest level since May during the first surge, according to the Covid Tracking Project. This is a ominous sign that deaths could reach unprecedented levels in the coming weeks and months as cases and hospitalizations now hit new highs.

Experts say fewer people being hospitalized will die during this winter stage of the pandemic compared to spring. As Julia Belluz of Vox reported, mortality in the US and Europe has improved significantly in recent months as doctors' understanding of Covid-19 and its treatment has improved:

Well there is strong evidence of this Steroids like dexamethasone can reduce the risk of mortality in critically ill inpatients. Putt Patients rest on their stomach instead of their back (a practice known as proning) also seems to help.

While there is still much progress to be made, the approach to treatment has standardized over time Jen Manne-Goehler, an infectious disease doctor at the Brigham and Women and Massachusetts General hospitals. When she started treating Covid-19 patients in the spring, the practice seemed to change every few days. Now it's leaner – and that undoubtedly helps with survival too.

That said, if hospitals in the hardest-hit states run out of beds and staff to treat the incoming patient flow, more people who could have been saved may die. When ICU staff are overloaded, "ICU patients just haven't received the same level of attention," intensive care doctor Lakshman Swamy, who works with the Cambridge Health Alliance, told Belluz.

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