Welcome back. I hope you had a terrific Christmas holiday. The nation’s big newspapers are breathlessly reporting about record Covid-19 case numbers in certain states, but that’s not the problem to watch. No, the problem to watch is how hospitals are coping with patients from the Omicron wave, their own preexisting staffing shortages, and their own staff catching Omicron and needing to stay home. Also, the Washington Post would now like to assure you that catching Covid-19 is not a character defect or a sign that you have poor judgment.
‘Three Days after Christmas, Here Comes the Next Wave’
“The highly transmissible Omicron variant is sending daily caseloads in parts of the United States soaring to levels higher than last winter’s pandemic peak,” warns the New York Times. “Delaware, Hawaii, Massachusetts, New Jersey, New York and Puerto Rico are among the areas that have reported more coronavirus cases in the past week than in any other seven-day period, data show.”
(What, none of those states are being accused of an “experiment in human sacrifice” as Georgia was?)
As this newsletter has emphasized with metronomic and perhaps maddening regularity, the big worry is not the number of Covid-19 cases — even though they’ve increased 83 percent in the past two weeks. A skyrocketing case rate was baked in the cake as soon as the super-duper-contagious variant of Omicron replaced the “merely” super-contagious variant of Delta. No, the smaller but still significant worries are that the number of hospitalized for Covid-19 has increased 8 percent over the past two weeks, to a bit over 71,000, and the daily number of new deaths from Covid-19 are up 3 percent, to the still-pretty-darn-high 1,328. (Remember earlier this month, when the U.S. passed 800,000 deaths, and the threshold was seen as a grim milestone? On Worldometers, the U.S. just passed 837,000 deaths. When you’re adding 1,200 to 1,300 new deaths per day, you reach those threshold numerals with depressing regularity. Not only have more Americans died of Covid-19 during the Biden presidency than during the Trump presidency, when this pandemic is done, those figures won’t even be close. Put another way, we will have lost more Americans to this virus after the vaccines arrived than we did before vaccines were available.)
Nationwide, the typical hospital isn’t overwhelmed. According to the U.S. Department of Health and Human Services, as of this morning, 71.8 percent of the nation’s hospital beds are in use, and less than 10 percent of those patients are being treated for Covid-19. A bit more than 75 percent of the nation’s ICU beds are in use, and more than 21 percent of the patients in those ICU beds are being treated for Covid-19. (Keep in mind that the gathering of official statistics tends to get a little spotty around a big holiday such as Christmas.)
But we just had arguably the biggest holiday of the year, with families traveling across the country, gathering around the Christmas tree and dinner table, and with Covid-19 tests exceptionally hard to find in many parts of the country. Chances are good that a lot of families spread Omicron when they passed the gravy boat during Christmas dinner, and while that probably won’t be much of an issue for the kids or mom and dad, that may well turn into an issue for grandma and grandpa and great-uncle Phil or great-aunt Edna. Hospitals know the post-Christmas waves are likely to be bigger than the pre-Christmas waves:
“So, we absolutely expect to see a post-holiday surge, much like we did last year and after Thanksgiving,” says Dr. Amy Edwards, a pediatric infectious disease specialist at University Hospitals.
“You know, three days after Christmas, here comes the next wave,” says Mindy Siler, an emergency department nurse with University Hospitals.
“We are dreading January with every fiber of our being. We talk about it at work all the time,” Edwards said.
Doctors and staff laying it out for 3News like they have been for nearly two years, telling us they’re just tired.
“For two years we’ve been begging people to take care so as not to burn us out,” Edwards said.
The question isn’t just how many beds a hospital has but also how many healthy staffers it has — much more challenging when so many of their own personnel are catching Covid-19 and forced to quarantine for a week or so. The CDC is concluding that if the health-care worker feels up to it, patients are better served by getting health-care workers back to work faster:
The CDC is shortening the recommended isolation time for health care workers who test positive for COVID-19 from 10 days to seven days, as long as they don’t have symptoms. The decision was motivated in part by health officials’ concerns that infections from the more transmissible Omicron variant could worsen staffing shortages at hospitals nationwide.
In its guidance, the CDC says infected workers who are asymptomatic can return to work after seven days with a negative test. It added that employers could further reduce the isolation period if there are staffing shortages.
The sight of so many full vaccinated health-care workers catching the virus and needing to stay home for a week really calls into question the value of New York state’s policy of firing unvaccinated health-care workers. Wouldn’t all of those workers come in handy right about now?
Hospitals and state governments can work around the shortages, but it costs them — and ultimately, the taxpayers:
Iowa is expected to spend more than $9 million to place 100 out-of-state nurses and respiratory therapists at the state’s larger health care facilities for six weeks of the latest spike of COVID-19 hospitalizations.
The state agreed early this month to pay a Kansas company $220 per hour for the nurses it supplies, with the expectation that the nurses will work 20 hours of overtime each week at the rate of $330 per hour, said Sarah Ekstrand, an Iowa Department of Public Health spokesperson.
And just because most hospitals aren’t overwhelmed nationwide doesn’t mean that some hospitals aren’t running out of room. Hospitals are at or near capacity and transferring patients in Indiana, Maryland, Massachusetts, Washington State, West Virginia, and probably elsewhere by the time you read this.
And in a bunch of places, circumstances are probably going to get worse before they get better:
Boston hospitals are on an “unsustainable” path as COVID-19 cases, driven by the extremely contagious omicron variant, skyrocket across the region, warns a local emergency medicine doctor.
“I think all public officials should use this data to look and see where they can expand hospital capacity and where they can stop the spread of the virus,” said Jeremy Faust, an emergency physician at Brigham and Women’s Hospital who’s helping track hospital capacity for different states and counties.
Several Massachusetts counties are at risk of exceeding normal hospital capacity, and Suffolk County over the holiday weekend was in the “unsustainable” category, according to Faust.
One might think that part of the problem is emergency-room visits by patients with relatively mild cases of Covid-19 who could safely recover at home. But at least in one hospital in Vermont, the problem is the opposite — patients are showing up at the hospital in much more serious condition than they realize and needing immediate and serious care:
One of the complications faced by the emergency department has been a change in the basic pattern of patient arrivals caused by the effect of the SARS-CoV2 virus in people’s lungs.
“The thing that’s interesting about COVID — interesting medically, not necessarily in a good way — is how sick patients can be before they seek care. It’s a bit unlike anything I’ve seen before,” said [Dr. Christopher Fore, chief quality officer for Concord Hospital].
He said people regularly show up at the emergency room in their own cars even though they have oxygen saturation levels, a key measure of lung health, far below the normal level of 95 percent — so far that they would normally have to be transported in an ambulance. “You’ll see patients literally walk into the waiting room with saturations in the 60s and 70s, which is something in my entire career I have never seen. That forces us to spring into action in a way we’ve not had to before.”
In response Concord Hospital has changed the way it handles triage, the process of sorting through patients as they first arrive to determine who needs what care and how quickly, adding a physician to the mix from the very start. Even so, ER backups have been common.
Quite a few hospitals enacted suspensions of regularly scheduled “elective” surgeries or other procedures during this wave of Covid-19 cases — which has its own deleterious effects on people’s health. Some of those “elective” surgeries include procedures to treat cancer and herniated discs.
And for every patient who dies from non-Covid causes, their families are left wondering if care was delayed because of the influx of Covid patients:
Dale Weeks’ family believes he was an indirect victim of the COVID-19 pandemic.
The retired Iowa school superintendent died in late November, nearly a month after he was diagnosed with sepsis, a dangerous, blood-borne infection unrelated to the coronavirus.
His daughters think he might have survived if he’d been admitted immediately to a large medical center, where he could have received advanced testing and prompt surgery.
But he stayed for 15 days at Newton’s relatively small hospital because the bigger facilities said they couldn’t spare a bed for him, his family says. Iowa’s short-staffed hospitals have been jammed for months with patients, including people severely sickened by COVID-19.
There’s never a good time to need to go to the hospital. But you really want to avoid needing the hospital for the next six weeks or so.
ADDENDUM: Headline in the Washington Post this morning: “Thousands who ‘followed the rules’ are about to get covid. They shouldn’t be ashamed.”
First, we don’t even capitalize “Covid” anymore? I needed shock treatment before I stopped writing ‘COVID-19’ on every reference.
Second . . . that’s what we’ve been insisting for a very, very long time. Unsurprisingly, the national media had much less interest in emphasizing this point when southern red states had high rates of Covid-19 infection, but they’re trumpeting it now that northern blue states have high rates of Covid-19 infection.