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The spike caused by omicrons has rocketed COVID-19 hospital admissions in the US, hitting a new pandemic high this week with 145,982 hospitalized patients.
This beats the previous high, which was recorded in January last year, according to data from the Ministry of Health and Social Welfare from more than 5,400 hospitals in the country.
Patients with COVID now occupy about 30% of the intensive care beds in the country, and pediatric COVID hospital stays also have the highest rate of the pandemic.
The record-breaking numbers are a sign of how quickly the Omicron variant has spread across the country. Overall, infections are also at record levels, with the US recording an average of more than 700,000 new cases per day.
And researchers and health workers warn that the cramped conditions could lead to an increase in preventable deaths as clinicians struggle to provide the level of care they normally would.
“Things are looking grim in many ways and a lot worse than they were a year ago,” says Dr. Doug White, an Critical Care Physician at the University of Pittsburgh School of Medicine.
State and hospital leaders warned of a crisis
Hospitals across the country are stressed, from Maryland to Missouri, where the number of people hospitalized with COVID-19 has exceeded or is nearing previous highs. State and hospital leaders, as well as health care workers, are issuing some of the worst warnings of the pandemic.
“We are closer than ever to a crisis situation,” said Dr. John Lynch of UW Medicine in Seattle at a recent press conference.
In Maryland, Governor Larry Hogan, who declared a state of emergency, said last week that the coming weeks will be “the most challenging time of the entire pandemic.”
Arizona health workers warn heads of state that the health system is on the verge of “collapse.”
“We have had more events where people go into cardiac arrest or decompensate and get very sick and even die in the waiting rooms.” Dr. Bradley Dreifuss, an emergency doctor in Tucson, Arizona, told reporters on Friday.
Governors are mobilizing National Guard members across the country to strengthen beleaguered hospitals, including in Ohio.
“The hospital is full to the brim,” said Dr. Kristin Englund, an infectious disease doctor at Cleveland Clinic. “Our intensive care units are full, our regular hospital beds are full, and a lot of it is COVID.”
Overcrowded conditions lead to poorer results
The medical repercussions of this recent surge could hit any American in need of medical care, be it because of COVID-19 or some other acute illness or injury, as research shows that more patients die when hospital admissions reach crisis levels.
“When hospitals are overloaded, everyone suffers,” says White.
Before the Omicron strike, many U.S. hospitals were already coming under strong demand from patients infected with the Delta variant as well as from patients seeking care because of treatment that was postponed earlier in the pandemic. In addition, the shortage of skilled workers in the health sector has reached a level of crisis. And now, many doctors, nurses, and other health care workers are also testing positive and missing work just like they are most needed.
After samples in other countries, there are first indications in the USA that Omicron causes less serious illnesses than the Delta variant. Some hospitals are finding fewer patients need intensive care or mechanical ventilation – a welcome sign.
“But the problem is that [omicron is] so transmissible, the sheer number of cases will be so high, ”says Dr. Sameer Kadri, an infectious disease and critical care medicine specialist at the National Institutes of Health Clinical Center.
The extreme contagiousness of Omicron in connection with exhausted health care workers mean that hospitals are unable to provide patients with the same standard of care as they normally would.
Kadri and colleagues examined previous climbs and found that one in four COVID-19 deaths may have been caused by the overcrowding. In the most overwhelmed hospitals – where the demand for ventilators and other resource-intensive supplies was greatest – the risk of death for COVID-19 patients doubled.
“What surprised me was the sheer magnitude of the effects,” says Kadri, lead author of the study published in the fall. “There are fewer eyes, fewer hands, and for these patients in need of high-precision care, it can mean the difference between life and death.”
“At the moment there is rationing every day”
Much of these mishaps in care happen out of sight for most Americans, but frontline doctors like Dr. Pittsburgh White see deadly consequences every day.
“We got a call from an overseas hospital with a patient who had acute kidney failure and was on dialysis to replace kidney function in order to survive,” says White. “We didn’t have any beds.”
No other hospital either. “This patient died in the hospital that didn’t have the type of basic therapy that we offer patients all the time – dialysis,” he says.
“These are the very real, concrete examples of patients dying right now in high quality American hospitals because they cannot be upgraded,” he adds. “And the same thing happens with patients with acute myocardial infarction or acute stroke.”
Government agencies and hospitals have protocols of what to do when patient demand threatens to exceed hospital capacity.
These protocols, known as “Emergency Management Standards,” help triage patients and guide decisions about who will and who will not be treated in the event of a disaster, epidemic, or mass casualty event. The crisis standards can help determine the allocation of devices such as ventilators or drugs such as monoclonal antibodies and the activation of systems to transfer patients between hospitals within states or regions. In the current flood, some hospitals have activated their contingency plans, including in Maryland.
White says more health officials need to follow suit, admitting that much of the U.S. healthcare system is already in de facto Crisis mode, regardless of whether they officially made this declaration or not.
“There is a big gap between reality and what is in the public consciousness and what I think many state governments are willing to acknowledge,” he says. “The simple reality is that rationing is happening every day in American medicine these days.”
This rationing happens in many ways and may not be obvious to the public, but the consequences are very real: a single nurse has to care for more patients per shift than is safe; canceled or delayed procedures and operations; and life saving care that is simply not available to some who need it.
It’s not just COVID patients who suffer
Some epidemiologists predict that the total number of cases will peak this month. However, hospitalizations for COVID-19 tend to lag infections by about two weeks, which means hospitals will need to be prepared for more patients in the coming weeks, even as infections peak and begin to decline.
Surges affect all types of patients, not just those with coronavirus. One study found a significant increase in all-cause mortality when patients were admitted during a COVID-19 surge.
For 30 of the most serious illnesses – stroke, heart attack, gastrointestinal bleeding – mortality during the pandemic rose by almost 1% at the beginning of the pandemic. That equates to an additional patient in 100 with these conditions who will die if the hospital didn’t have to deal with a flood of patients, says Dr. Amber Sabbatini, Assistant Professor of Emergency Medicine at the University of Washington.
“That is a significant increase,” she says. “When units are stressed by COVID patients, they may not reach a heart failure patient or a septic patient in a timely manner.”
While the study failed to pinpoint exactly why these patients died, Sabbatini says the exhaustion of health workers who care for patients day in and day out – often without enough help or with new staff who are unfamiliar – inevitably compromises care can.
“The impact on the staff who care for these patients, this cognitive burden, this emotional burden is very high,” she says. “So there are these subtle, difficult-to-test factors that could contribute to why patients may receive poorer quality of care or not as good outcomes as they do.” [normally] would.”