US hospitals are preparing for the worst-case scenario as Covid-19 surges again
The latest Covid-19 surge is forcing US hospitals to take drastic measures — setting up temporary facilities or preparing to transport patients to other cities and states — to avoid being overrun.
The number of Americans currently hospitalized with Covid-19 has risen by 12,000 over the last month, reaching 41,753 on October 25, according to the Covid Tracking Project. Some hospitals are drawing up plans to ration care if they have more patients than beds, the kind of worst-case scenario they’d been hoping to avoid.
Case numbers are still rising too: The US is now averaging nearly 69,000 new Covid-19 cases every day, higher than the previous peak in July. Hospitalizations lag behind cases, because it takes time for a person to become ill enough to require hospitalization‚ and so that number is likely to keep going up as well.
Deaths are already ticking up, with the US now averaging more than 800 every day, and they usually follow the same trends as cases and hospitalizations with a slightly longer lag. (Fortunately, hospitals have figured out how to better treat Covid-19, which is leading to lower mortality rates. But still, more patients in the hospital will inevitably mean more deaths.)
And the scary feature of this new wave is that cases and hospitalizations are climbing everywhere. In previous waves, cases were ebbing in one part of the country while they spiked somewhere else. But now, the entire country is experiencing a surge at the same time.
Every state except Hawaii, Delaware, and Louisiana (and Washington, DC) saw their case numbers rise over the last two weeks, according to Covid Exit Strategy. More than 40 states have a higher number of people hospitalized with Covid-19 now than they did 14 days ago.
Public health experts have long expected that cases would increase during the winter months, when social distancing becomes more difficult and the colder weather makes it easier for the coronavirus to spread. But this new data shows the difficult days are already here.
And hospitals are feeling the strain, just as they did in previous surges. The weekend brought numerous reports of hospitals taking emergency measures in order to handle the influx of Covid-19 patients. According to Covid Exit Strategy, 20 states have more than 70 percent of their ICU currently occupied; that remaining capacity could quickly shrink if the current trends continue. In some cities, hospitals have already reached their capacity.
Here are just a few examples of hospitals being pushed to the brink in the pandemic’s third wave.
El Paso, Texas, is setting up a field hospital and ordering a mandatory curfew
El Paso County has issued a mandatory curfew, from 10 pm to 5 am, after hospitalizations surged by 300 percent in less than three weeks. A recent University of Texas study projected a 96 percent likelihood that the area would have more ICU patients than beds by November 8 and a 85 percent probability that all of the hospital beds would be filled.
Several other regions in the state — around Amarillo, Lubbock, Wichita Falls, Abilene, Dallas/Fort Worth, and Odessa — also have better than even odds of exceeding their ICU capacity in the next two weeks. Statewide, the number of currently hospitalized Covid-19 patients has risen from 3,190 on October 1 to 5,206 on October 25.
“We are at a crisis stage,” El Paso County Judge Ricardo Samaniego said this weekend, according to CBS News.
A field hospital is being set up at the El Paso Convention and Performing Arts Center, initially with 50 beds but the capacity to add 50 more. More than 1,000 state and federal health workers have moved into the county in recent days to try to provide more support. As Vox has previously reported, one problem hospitals experience during Covid surges is staffing; sometimes, they may have open beds, but not enough nurses and doctors to take care of the patients.
Hospitals are also preparing to airlift patients from the El Paso area to other parts of Texas with more available beds. Gov. Greg Abbott has raised the possibility of opening a military hospital to civilians.
“Hospitals are reaching a point where they have expanded, within their existing brick and mortar, as much as they can,” the University Medical Center in El Paso said in a statement.
Utah hospitals are preparing to ration medical care for Covid-19 patients
Covid-19 has exploded in Utah over the last two months. On September 1, the state was averaging less than 400 new cases every day; as of October 25, the average number of daily new cases had nearly reached 1,500. Hospitalizations have followed the same trend, with the number of currently hospitalized Covid-19 patients more than doubling from 145 to 313 over the same period.
With some hospitals already forced to activate their emergency surge capacity plans, hospital officials have started drawing up criteria for how to ration care if they have more patients than beds available.
It could literally become a matter of choosing which patients live and which patients die. From the Salt Lake Tribune:
Greg Bell, president of the Utah Hospital Association, said administrators of the state’s hospitals confronted Gov. Gary Herbert on Thursday with a grim list: Criteria they propose doctors should use if they are forced to decide which patients can stay in overcrowded intensive care units.
Under the criteria, which would require Herbert’s approval, patients who are getting worse despite receiving intensive care would be moved out first. In the event that two patients’ conditions are equal, the young get priority over the old, since older patients are more likely to die.
“We told him, ‘It looks like we’re going to have to request those be activated if this trend continues,’” Bell recounted, “‘and we see no reason why it won’t.’”
Utah hospitals are also facing the same staffing problems seen elsewhere: Though the state created plans to establish a field hospital at an expo center, medical leaders are warning that they don’t have the doctors or nurses available to staff those new beds. Health care workers have described feeling overwhelmed throughout the Covid-19 crisis and now they are being asked to do even more, months into the pandemic.
“Hundreds and hundreds of nurses are not able to work as they were [before] because of their own disease or infection in the family, or they’re moms and dads with school issues,” Bell told the Tribune. “Some are worn out, some are on leave because they’ve been doing this for seven months.”
Idaho hospitals are planning to send patients out of state as beds fill up
Idaho has set a record for Covid-19 hospitalizations over the weekend with 259 people currently hospitalized, up from 135 at the beginning of October. The state is also averaging almost twice as many new cases as it was a few weeks ago, meaning more hospitalizations are likely coming.
Hospitals might need to send patients to hospitals in other states as their beds fill up, an enormous logistical challenge for the facilities and an emotional one for families that may be separated from their loved ones by hundreds of miles.
At least one hospital in northern Idaho has already planned for such a contingency. Kootenai Health in Coeur d’Alene reported at the end of last week that it had reached 99 percent capacity. The health system will send patients to Portland, Oregon, or Seattle, Washington, if its numbers continue to rise, because nearby hospitals are experiencing the same surge and don’t have room to take extra patients.
Another hospital, Saint Luke’s Magic Valley in Twin Falls, has announced it will start transferring children who require hospitalization to hospitals in the state capital of Boise in order to keep more beds available for Covid-19 patients.
The surge in Covid hospitalizations is going to be worse before it gets better
There are more stories like this across the country:
- Wisconsin has set up a field hospital on the state fairgrounds near Milwaukee. (Covid-19 hospitalizations in the state have doubled since the start of the month.)
- Hospitals in Kansas City, Missouri, are reportedly turning away ambulances because they don’t have any beds available, and urban hospitals warn they may not be able to accept overflow patients from rural areas. (Hospitalizations in Missouri reached a new record last week.)
- Oklahoma City hospitals are activating their surge capacity plans to add more beds, call in extra staff, and possibly reduce non-Covid services. (Oklahoma is yet another state to see a record number of Covid-19 hospitalizations in the last few days.)
With cases rising, hospitalizations will follow and deaths after them. It’s an established pattern. This will get worse before it gets better.
But we can try to lighten the burden for hospitals and their staff. As Vox explained at the beginning of the pandemic, the goal of social distancing is to suppress Covid-19’s spread so that hospitals don’t become overwhelmed. It also buys time for hospitals to put their surge capacity and staffing plans in place.
It won’t be easy. The federal government isn’t going to provide more resources to hospitals for the foreseeable future, with hopes for another Covid-19 relief package before January fading. Some state and local governments continue to resist mask mandates (even in these stressed areas like Idaho) and other social distancing restrictions.
Wearing a mask and keeping our distance is something each of us can do on our own to reduce Covid-19’s spread and slow down on the rapid growth in hospitalizations. There is no time to waste.