As confirmed coronavirus cases hit their highest level since the pandemic began, hospitals across the country are reporting critical staff shortages. And those bottlenecks may only get worse in the coming weeks as thousands of the 1 million Americans diagnosed with Covid-19 last week gradually move to hospital.
According to an NPR analysis of the data released this week by the Department of Health and Human Services (HHS), more than 1,000 hospitals across the country have been classified as "critical" staff shortages as they face a dramatic third wave of Covid-19 are infections.
That is around 18 percent of all hospitals that report to HHS. Overall, 21 percent of hospitals in 40 states and Puerto Rico expect their staffing needs to increase in the coming days. Seven states are reporting bottlenecks in 30 percent or more of their hospitals. North Dakota – with one of the worst coronavirus outbreaks in the United States – is hardest hit. 51 percent of hospitals report bottlenecks.
Nebraska, Virginia and Missouri report that they are expecting the biggest upward movements they saw during the pandemic over the next week.
According to the NPR, the HHS data is incomplete as many hospitals do not share staff numbers with HHS. The agency has been collecting this data since July, but this is the first time it has been made available to the public.
This staff shortage results in exhausted and overworked doctors, nurses, and other hospital workers, and also carries the risk that if the staff do get sick themselves, no one will get sick.
Fear of overwhelming hospital systems was a large part of the news that accompanied the start of the US outbreak in March. By maintaining a reasonable number of cases and only admitting the sickest patients to hospitals, medical experts said, there was less risk of running out of space, ventilators, and other equipment to care for Covid-19 patients. This also meant that resources would also be available for non-Covid-19 patients.
With hospital stays and case rates at record highs, hospitals may soon run out of staff and space
Eventually, the curve flattened out – but if things get worse than ever, there is renewed danger for hospitals and health professionals to run out of space.
According to the Covid Tracking Project, 82,178 people with Covid-19 were hospitalized on November 20 – far more than the previous record of almost 60,000 in spring and summer. And on November 20, the US hit a record high of 192,805 confirmed coronavirus cases, breaking the previous day's record: 182,832 confirmed cases.
The Covid Tracking Project
As Vox's Dylan Scott explained, hospitalization is a so-called delay indicator. This means that the number of hospitalizations increases after an increase in infections, and not at the same time: it may take days or longer for an infected person to need hospitalization after receiving a positive test result.
This means that already stressed hospitals are likely to see an increase in the number of patients infected last week in the coming weeks, and providers struggling with these new patients could be overwhelmed by mid to late December if the cases get high after Thanksgiving increase.
Currently the hospitals are almost full. HHS estimates that by November 20, 73.66 percent of all inpatient beds in the U.S. will be full (including Covid-19 patients and patients seeking treatment for other illnesses), and that 60.62 percent of all beds will be full Intensive care unit are occupied.
When the virus was more contained in several hot spots at the beginning of the year – for example in New York and New Jersey – medical professionals from other countries and the US military were also able to travel and provide short-term personnel support.
Now that the virus is so widespread, there are fewer health care providers who can leave one community and support another.
This has led to dramatic reports from local media across the country as communities that have previously seen few coronavirus cases place increasing strain on their medical systems.
In North Dakota, where hospitals are at full capacity, hospital workers have been told that if they test positive for the coronavirus, they may continue to work as long as they have no symptoms. (Covid-19 is contagious even with asymptomatic hosts.)
The University of Utah Hospital in Salt Lake City opened an overflow intensive care unit two weeks ago, and officials there said it would be manned by doctors and nurses working overtime. In Muskegon, Michigan, a recently closed hospital has reopened and licensed nurses are being asked to retire to meet staffing and infrastructure requirements.
And as the pandemic has escalated in previously untouched parts of the country, rural hospitals, many of which initially lacked resources, are particularly hard hit.
Rural hospitals reaching their capacity can have a ripple effect if nearby urban hospitals are also overwhelmed. As reported by Jonathan Shorman, Sarah Ritter and Matthew Kelly of the Kansas City Star, Kansas City hospitals have "reached a tipping point where additional COVID scans could trigger a crisis," and may need to stop admitting patients from rural hospitals and leaving these patients nowhere and without access to care.
Overstretched hospitals will almost certainly lead to more deaths. As Julia Belluz from Vox explained, medical professionals are able to treat Covid-19 patients far better than they used to be, and the death rate has fallen:
Now there is strong evidence that common steroids like dexamethasone can reduce the risk of mortality in critically ill inpatients. It also seems helpful to lay patients on their stomachs instead of their backs (a practice known as proning).
While there is still much progress to be made, the approach to treatment has standardized over time, said Jen Manne-Goehler, an infectious disease doctor at 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.
In order to receive these improved treatments, patients must have access to doctors. And increasingly, it seems that access may be severely – and potentially dangerously – restricted in the coming weeks. According to the NPR, HHS plans to coordinate between hospitals to make up for staff shortages. When hospitals across the country are overwhelmed, it may not be possible to find the staff needed to save lives, either for hospital systems or for the federal government.
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