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With a second winter pandemic approaching, there are promising signs that the worst delta surge is over, but in America’s hospitals – which are already understaffed and overworked by the COVID-19 summer flood – the relief could be short-lived . lived.
Many look to a tough spell of colder months, with the risk of a potentially bad flu season, an influx of patients trying to catch up on late treatments, and an exhausted workforce with little, if any, time to break away from this latest wave of Coronavirus infections.
“It’s like a perfect storm, isn’t it? High volume, high sharpness and few staff,” says emergency doctor Dr. Gregg Miller, Chief Medical Officer of the Vituity Health Care Group. “Winters are already tough for hospitals and emergency rooms.”
And while some of the leading COVID-19 models suggest the U.S. will be spared another major coronavirus onslaught during the holiday season, recent history has shown hospitals that nothing is predictable about this virus.
“We have to be prepared for the fact that we always have some people infected with COVID in our hospitals and that we need acute care,” says Dr. Amy Williams, executive dean of the Mayo Clinic Practice.
A big flu epidemic?
The dreaded “thread wave” of influenza and coronavirus did not occur last winter, likely in part due to the social distancing and masking people have undertaken in response to the coronavirus.
However, some experts fear that last year’s remarkably mild flu season has now set the stage for a big recovery in the months ahead as fewer people have built up immunity.
“It could be really bad, and it could be really bad at a time when our hospitals are still pretty full of COVID-19,” says Dr. Mark Roberts, director of the Public Health Dynamics Laboratory at the University of Pittsburgh.
In recent flu seasons – not counting last year – there have been an average of around 300,000 to 400,000 hospital admissions for influenza, he says. Two recent studies by Roberts and his colleagues suggest that this season could bring an additional 100,000 to 400,000 flu hospital admissions. Research into previous flu seasons has estimated that there were between 18,000 and 96,000 intensive care stays related to the flu, depending on the time of year.
Flu season is difficult to predict, and it is possible that these worst-case scenarios will not occur, but that depends on the prevailing flu and people’s behavior.
“There is quite a chessboard in the United States to contain COVID, so that depends on how much influenza you see and how many people get the flu vaccine,” says Roberts.
Also, COVID is not going away entirely, even with optimistic predictions.
Models from the CDC and others show that there could be a steady decline in cases nationally, but there may very well be enough viruses to fuel regional outbreaks and keep some hospitals busy.
“I still expect some climbs,” says Stephen Kissler, a research fellow at Harvard TH Chan School of Public Health. “I think we’re not quite out of the woods yet.”
The combination of even a mild to moderate flu season and the holdover from this current COVID-19 wave is likely to drain valuable resources in the intensive care unit, says Dr. Greg Martin, President of the Society of Critical Care Medicine.
“The delta climb isn’t going away as quickly as anyone would like, and that long tail creates a lot of uncertainty and fear,” he says.
Catching up on the need for long-term care
Patients have a tendency to show up sicker in hospital as early as the winter, and this could be especially true this year after the massive disruptions in access to health care caused by COVID-19 resulted in a backlog in delayed care.
Some patients were forced to postpone much-needed surgeries and inpatient treatments while others dropped out of routine doctor appointments that may have had a growing health problem before it got too serious, says Gregg Miller of Vituity.
“We’re already dealing with a baseline of sicker patients, so what happens when it’s colder and people slip and fall? he says.
Many hospitals have tried to avoid shutting down much-needed medical procedures for other types of patients during this recent wave of COVID-19, but this has not necessarily been possible in some severely affected states.
In Washington state, the MultiCare health system was “very, very full before the Delta Wave started and really drove our cases up,” said Dr. Michael Myint, Chief Public Health Physician at MultiCare.
Myint anticipates that given the current demands of COVID-19, they will be working on deferred care in their hospitals for a while.
“We are still at the level we achieved last winter and the last breathing season,” he says.
After a sharp rise in the number of COVID-19 patients, the healthcare workforce is stagnating, with many parts of the country facing major staff shortages at the same time.
“The crisis we are currently experiencing in this country is the inability to provide the right staff to patients in need of care, ”says Dr. Omar Lateef, CEO of Rush University Medical Center in Chicago.
This loss of health care providers is particularly pronounced in the nursing sector, and many hospitals are competing fiercely for the same limited pool of travel nurses to fill the gaps. There are also concerns that COVID-19 vaccine mandates could further undermine the workforce, although Lateef says that’s not causing their staffing issues.
“It really depends on supply and demand, “he says.” And the difference from previous years is that we’re going to have this increase in patient numbers at the national level, while at about the same time we’re going to have a decrease in health care providers. ”
It’s not just a numbers problem either. Hospitals “see an exodus” of their most experienced healthcare workers, says Dr. Thomas McGinn, executive vice president of medical companies for CommonSpirit Health, a nationwide healthcare system.
“Instead of retiring in a year or two, they are retiring now,” he says. “A lot of these seasoned people teach the younger people when they come in, so there’s this tension of losing older people and losing those who would train on the job.”
And that couldn’t come at a worse time. With all the factors getting worse, health care workers fear the coming onslaught of patients this winter.
“People are tired in healthcare and there is a burnout that we have not seen in this country [before]”says Lateef.” This in combination with the expected higher volumes in winter creates the conditions for even more burnout in the future and even more personnel problems. “