America's Hospital System Is On The Ropes After Many Bouts with COVID

The Atlantic Jan 7, 2022 |HEALTH|”Hospitals Are in Serious Trouble” “Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.”


Read The Atlantic for all the details.


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The recent surge in COVID on the heel of previous waves is slowly crippling our already overtaxed hospitals. According to Anand Swaninathan (ER physician in NJ) what’s happening “It’s not a dramatic Armageddon; it happens inch by inch.” Hospitalizations have increased from 40,000 in November 2021, to 65,000 on Christmas 2021 to 110,000 now in January 2022. Across the country health-care workers report similarly to Kit Delgado (ER physician in PA) that “the volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before.”


Experts fear it could get worse as hospitalizations for COVID typically follow after the rising cases of COVID are reported. Good news though, is that patients infected with the highly transmissible Omicron variant are less likely than patients with the Delta variant of COVID to require a ventilator. “COVID [Omicron but not Delta] patients are being discharged more easily. Fewer [Omicron patients] are critically ill, and even those…seem to be doing better.” In rural and urban areas with many residents unvaccinated many present with Delta and they are not faring better than the COVID patients last January 2021. Those patients may have access to ventilator therapy but are waiting in the ER for space in the ICU.


“During this surge, record numbers of children are also being hospitalized with COVID.” Children generally do better than adults “but the number of patients is high” and experts worry about “long COVID and other long-term complications.” Children present with respiratory symptoms but their disease course is unlike “many [adult] patients [that] have classic advanced symptoms, such as pneumonia and blood clots.” Many of the adult patients that present with milder COVID have illnesses that are complicated by “their chronic health conditions…”


The key driver of Omicron is its highly contagious nature and although milder generally the absolute number of those needing hospitalization is “enough to saturate the system” as it stands depleted today.


Making the ability to service patients worse is that health-care workers are quitting-from the accumulated stress/burnout. Those hospital workers wanting to stay on the job are sometimes limited by having their own breakthrough COVID infections. The volume of patients are lower than last January but the staffing levels are much lower. “Before the sickest ICU patient would get two nurses, and now there’s four patients for every nurse.” On some nights due to COVID breakthrough infections, Dr. Ranney (ER physician in RI) notes “there are evenings where we have whole sections of beds that are closed because we don’t have staff.”


The staffing issue extends beyond nursing as there are shortages in pharmacy, in laboratory and in respiratory therapy. Meanwhile “healthcare workers now experience indifference at best or antagonism at worst…[there’s] a jarring disconnect between their jobs and their communities.” Society at large too is beaten down by the persistence of COVID and just want to move on.


The issue of a failing hospital system is largely invisible to the public. They won’t know “until they need medical care and can’t get it.” Swaminathan adds “I don’t think people will realize what’s happening until we fall off the cliff-until you call 911 and no one comes, or you need that emergency surgery and we can’t do it.”


A number of fixes from military staffers to newer drugs are coming into the solution set but they too are limited. Ultimately, once again, we need to reduce demand by flattening the curve. There is some hope that Omicron may suddenly wane as it has elsewhere. While experts would welcome that, they worry that there will be less incentive then to reinvigorate the depleted health-care system in America.