Ledes from the Land of Enchantment

Omicron variant brings hospitals to the breaking point

Joseph Prezioso / AFP via Getty Images

A medical worker and a COVID patient in the intensive care unit at UMass Memorial Medical Center in Worcester, Massachusetts, where beds were scarce, Jan. 4.

In Chicago, patients are treated in hospital corridors and on office chairs.

In Farmington, New Mexico, military reinforcements were deployed in civilian hospitals from San Diego, over 700 miles away.

And emergency operations were canceled in Paterson, New Jersey. Gallbladder Disease That Usually Needs Removal? Try antibiotics first. A broken bone that you normally go under the knife for? Let’s put you in a cast and crutches to see how you fare.

“You don’t really have to rely on crisis management standards to meet crisis management standards,” said Anand Swaminathan, assistant professor of emergency medicine at Paterson’s St. Joseph’s University Medical Center. “At the moment it is an enormous challenge to care for as many patients as possible.”

This is America in the Omicron wave. U.S. hospitals and their staff are currently being tested in new and challenging ways that are different from previous spikes in the pandemic, medical workers across the country told BuzzFeed News. Patients who could normally be admitted for observation are sent home to keep beds free. Others wait 10 hours or more in the emergency room to be seen before they may give up and leave completely.

Reaching your limit is a deceptively slow process, but little by little Swaminathan said that his hospital and others are losing the things they need to keep going effectively. “This collapse is not going to be like an Armageddon. It won’t all happen at once, ”he said. “It’ll be pretty quiet and people won’t notice until they call 911 and no one comes.”

As Omicron spreads, COVID cases are rising to record levels in all 50 states. However, given the relative mildness of the variant for most people, especially those who have been vaccinated, Anthony Fauci and others have said that it is now more important to pay more attention to hospital admission data than total case numbers. But that too is alarming. More than 147,000 people are currently in US hospitals with COVID – more than ever before during the pandemic. CDC director Rochelle Walensky said Wednesday that the seven-day average of hospital admissions had increased 33% from the previous week to about 19,800 per day.

Peter Aldhous / BuzzFeed News / via the Department of Health and Social Affairs

Importantly, these numbers also include people with a random case of COVID, which means they were treated for something else and were positive for the virus as well. This may sound less worrying, but it can be deceiving. COVID can exacerbate the underlying health problems of some people, and most importantly, the net impact on hospitals is the same: more patients occupy more beds and require special isolation and safety protocols to avoid infecting others.

While new studies show Omicron is less severe and requires about 70% shorter hospital stays on average than Delta, the incredibly communicable variant is still spreading like wildfire, including among children admitted to hospitals with COVID at record rates. “The risk of hospitalization remains low, especially for people who are up to date on their COVID vaccines,” Walensky said on Wednesday. “However, the staggering increase in cases – over 1 million new cases per day – has resulted in high numbers of hospital admissions.”

While more and more medical staff are self-testing positive and sidelined, their colleagues – at least those who have not yet given up their jobs completely because of burnout – are making an effort to treat the drowning patients in emergency rooms with COVID, yes, but also for any other illness or traumatic injury.

So the cruel irony is that what appears to be the mildest common variant of the coronavirus is at risk of toppling the U.S. hospital system.

“If you previously had an acute life-threatening medical problem and you went to an emergency room in America, you had a promise that it would be dealt with quickly,” said Gabe Gao, an ambulance in St. Luke’s Hospital in New Bedford, Massachusetts. “I don’t think we can keep that promise right now.”

Jay Reeves / AP

A man enters the emergency room at UAB Hospital in Birmingham, Alabama on January 5, 2022. The emergency room is overwhelmed, in addition to the normal health problems faced by COVID-19 patients.

Not every hospital is currently facing a crisis. Some, who have previously experienced huge waves, are holding on to being stable – for now. “In the first wave, I had 400 patients with COVID, now we have 100,” said Aaron Glatt, chairman of the medical department at Mount Sinai South Nassau on Long Island, New York. “We have better treatments, we have a better understanding of the virus, but at the same time I had 10 patients with COVID two months ago.”

Michael Daignault, an emergency doctor at Providence St. Joseph Medical Center in Burbank, Calif., Said he was so shocked by the flood of cases in his area last winter that he thought the present moment was more manageable. Patients used to stay in the intensive care unit for weeks or months, but now it’s different. “The majority of the patients who are admitted have a less serious illness. The average length of stay has decreased, ”he said. “It’s a quick turnaround. We are able to deal with it. “

But both Daignault and Glatt said they still experienced staff shortages as hospital workers contracted the virus. They also found that they live in states with relatively high vaccination rates. For example, New York has nearly 20 percent more people fully vaccinated than Missouri, where total hospital admissions are now above their worst previous levels.

“The Missouri hospitals have slammed,” said Dave Dillon, spokesman for the Missouri Hospital Association. “Hospitals delay the treatment of non-emergencies, accommodate patients of all kinds due to a lack of space in emergency rooms and face considerable challenges for the workforce.”

“I don’t know what else to tell you. These are very difficult times, ”he said.

In Idaho, the lowest vaccination state where fewer than half the population is fully vaccinated, the rise in omicron could be disastrous. Many hospitals there have only recently withdrawn from crisis standards of care after a staggering spike in Delta cases in September. Susie Keller, CEO of the Idaho Medical Association, said its members have barely caught their breath from the trauma and are now looking at the likely prospect of another wave. “You just feel completely besieged,” she said. “It’s a different thing to everything else.”

Keller pleaded with those in her state who had not received a vaccine to do so so that they would not be placed on a hospital bed that could go to someone else who has had a vaccination and is being treated for COVID or something just for medical purposes Finding help is in short supply. “This is absolutely unfair and a very sad situation,” she said. “My heart really goes out to the people who try to do the right thing and end up in a hospital where the resources are not available for circumstances beyond their control.”

Steven Senne / AP

A nurse leaves an isolation room where a patient recovered from COVID at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, Jan. 3.

There is evidence that some places affected by Omicron early on have seen the worst spikes in infections, although prior hospital admissions tended to delay case numbers by about two weeks.

But other states haven’t peaked at Omicron yet, including Arizona, where Marjorie Bessel, chief clinical officer at Banner Health, headquartered in Phoenix, which employs over 50,000 people across the American West, pleaded in a news conference on Tuesday Have patience with the employees for the coming days and weeks. More employees are calling in sick, she said, which means patients have longer waiting times than normal.

“We are busy in our clinics, we are busy with our urgent care, we are busy in our emergency rooms and we are busy in our hospitals,” said Bessel. “We also understand that we are not yet at the peak of the Omicron variant.”

In an effort to reduce the total number of sick people who are sick at any point, the CDC announced just before Christmas that if they tested negative, asymptomatic medical staff could return to work in seven days instead of 10 days. Medical staff who have received their booster vaccinations no longer have to go into quarantine themselves after high-risk exposure.

A Manhattan emergency doctor, who asked not to be called to speak freely about conditions at his hospital, said this change to CDC policy reduced the shortage of care at his facility, but noted that doctors always do still frequently performed nursing tasks, such as administering IVs or discharging patients.

“There are obviously concerns,” he added. “I think there is still no good evidence of how long you have been contagious, and I think it’s a rule made out of understandable necessity because otherwise we wouldn’t have enough medical staff, but on an individual level it is difficult to expect the idea. “and possibly infect other employees.”

Across the city in Brooklyn, another emergency doctor who was not allowed to speak to the media said that in addition to her own work, she too had to do more tasks that would normally be carried out by a nurse. She has only been a working doctor for a year and a half, but the shortage of staff overwhelms her more than ever. “Sometimes it’s just so busy that you don’t even have time to think about it or have emotions,” she said, “but after the shift is over, it kind of hits you, that wave of exhaustion.”

Gao, the Massachusetts doctor, said he had noticed classic burnout symptoms in himself and other colleagues. When he comes to work on a Monday morning and sees 35 or 40 admitted patients moving into beds in the emergency room and another 20 to 30 in the waiting room, he knows he has another tough week ahead of him. It takes some mental and physical resilience to work in the emergency room, but he worries that he has already broken down on it.

“It’s horrible. It’s horrible. It’s the moral harm of all of this,” Gao said. “Health care shouldn’t work on the backs of beleaguered rescue workers trying to find the smallest nook and cranny that anyone can fit Health care for this person should not hang by a thread because of these efforts. “

Peter Aldhous and Dan Vergano contributed to this story.

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