Hospitals Are in Serious Trouble

[Nevilledog]

Link to tweet

Tweet text:

Megan Ranney MD MPH 🗽
@meganranney
"Here, then, is the most important difference about this surge: It comes on the back of all the prior ones."

A powerful piece on why hospitals are bleeding out under the strain of #omicron.

https://theatlantic.com/health/archive/2022/01/omicron-mild-hospital-strain-health-care-workers/621193/… @edyong209

Hospitals Are in Serious Trouble
Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.
theatlantic.com
2:50 PM · Jan 7, 2022

https://www.theatlantic.com/health/archive/2022/01/omicron-mild-hospital-strain-health-care-workers/621193/

No paywall
https://archive.fo/xNmeK

When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me.

In this surge, COVID-19 hospitalizations rose slowly at first, from about 40,000 nationally in early November to 65,000 on Christmas. But with the super-transmissible Delta variant joined by the even-more-transmissible Omicron, the hospitalization count has shot up to 110,000 in the two weeks since then. “The volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before,” Kit Delgado, an emergency physician in Pennsylvania, told me. Health-care workers in 11 different states echoed what he said: Already, this surge is pushing their hospitals to the edge. And this is just the beginning. Hospitalizations always lag behind cases by about two weeks, so we’re only starting to see the effects of daily case counts that have tripled in the past 14 days (and are almost certainly underestimates). By the end of the month, according to the CDC’s forecasts, COVID will be sending at least 24,700 and up to 53,700 Americans to the hospital every single day.

This surge is, in many ways, distinct from the ones before. About 62 percent of Americans are fully vaccinated, and are still mostly protected against the coronavirus’s worst effects. When people do become severely ill, health-care workers have a better sense of what to expect and what to do. Omicron itself seems to be less severe than previous variants, and many of the people now testing positive don’t require hospitalization. But such cases threaten to obscure this surge’s true cost.
Omicron is so contagious that it is still flooding hospitals with sick people. And America’s continued inability to control the coronavirus has deflated its health-care system, which can no longer offer the same number of patients the same level of care. Health-care workers have quit their jobs in droves; of those who have stayed, many now can’t work, because they have Omicron breakthrough infections. “In the last two years, I’ve never known as many colleagues who have COVID as I do now,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. “The staffing crisis is the worst it has been through the pandemic.”

This is why any comparisons between past and present hospitalization numbers are misleading: January 2021’s numbers would crush January 2022’s system because the workforce has been so diminished. Some institutions are now being overwhelmed by a fraction of their earlier patient loads. “I hope no one you know or love gets COVID or needs an emergency room right now, because there’s no room,” Janelle Thomas, an ICU nurse in Maryland, told me.

*snip*

[Autumn]

1. Some people want everything open and politicians are eager to appease. There is no will

or courage to do what must be done.

[SoonerPride]

3. What must be done?

This is now endemic.

It is not ever going away.

This is the new reality.

[Autumn]

12. Then someone must lead us through this new reality. Who will it be depends on who will

step up with solutions tht work. The same old business as usual is not going to cut it.

[Drunken Irishman]

27. The same old business as usual is going to have to cut it.

Especially when the Supreme Court rules that Biden's vaccine mandate is unconstitutional, which they will based on the hearings today.

The only thing we can do is continue to encourage those who haven't been vaccinated to get vaccinated/boosters and to wear masks when outside.

But there is no realistic option to shut down every time there's a surge.

[Calculating]

24. Exactly

Do we close everything forever? That's how long COVID will be with us.

[Alpeduez21]

2. Our hospital in a rural VA county

said. Don't come unless you're gonna die. Like choking, stroke, heart attack. Broken bones, lacerations, stomach pains, etc go to a farther away ER or wait for urgent care to open. Pretty freaking scary. I may shut down my business, which is mobile, so I don't have to drive and risk needing hospitalization.

[mwooldri]

10. Not much better in rural NC either.

Last night, ambulances were queuing to drop off patients. The hospital has been on and off diverting patients. The hospital could theoretically open a floor for Covid patients but they have no staff to do so. The lab is under strain as the techs are sick and those who are working are pulling extra shifts. The people who draw blood are absent as they're sick - leaving it to the nurses to do it all. And staff talk about taking "travelling" positions (short term positions elsewhere) for obscene amounts of pay (a person who draws blood and who's on a travel contract easily do more than $30 an hour, before overtime).

[GB_RN]

14. The VA Hospital Here In Durham...

May have to start taking civilian patients to help take the load off of Duke and other regional hospitals.


I’m taking grad classes at Duke. A doc in my class who works at the VA told me that.

[AllyCat]

22. We've lost dozens of nurses because we get no incentive pay to come in

for regular shifts or extra shifts. They all leave to go travel making $thousands a week. Sometimes, our own/their old employer HIRES them back at that rate of pay.

[CrispyQ]

4. And one of our justices on the highest court of the land is questioning the efficacy of vaccines. nt

JFC.

[PortTack]

17. Unfortunately, it's more than one, roberts, goesick, and thomas have openly verbalized their

Feelings!

[Farmer-Rick]

18. 95 percent of hospitalized Covid patients are unvaccinated

And yeah the vaccinated are getting more breakthrough cases. You now have about a 4 to 5 percent chance of getting a breakthrough infection if you are vaccinated. I'll take those odds.

[NowISeetheLight]

34. Especially since you won't be that sick anyway

With a breakthrough infection you still stand a much less chance of ending up hospitalized and very ill. Great odds.

[madville]

38. With Omicron it's 50-70 percent of hospitalization are unvaccinated

Depending which study/report you read. There are large health providers reporting it is now 50/50 vaxxed vs. unvaxxed being admitted to their hospitals.

[Farmer-Rick]

40. I don't think that is accurate.

Can you provide a recent link. It may have been a bad estimate. Now that the real numbers are in, it's not showing that. It's still showing 95 percent of COVID patients are unvaccinated.

The UK just published a report on vaccinated vs unvaccinated hospitalized Covid patients and it shows about 95 percent are unvaccinated. And the UK is swamped with the new variant.

https://www.democraticunderground.com/100216225902

[madville]

41. Here you go, very recent study

51% of hospitalized Omicron patients in this study were vaccinated. It still is good to be vaccinated of course, it should improve outcomes.

https://www.medrxiv.org/content/10.1101/2021.12.30.21268560v2.full-text



Excerpt:
We next analyzed Omicron vaccine breakthrough cases (Table 1, Table 2). We found 675 of the 1313 total Omicron patients (51.4%) for whom we have whole genome sequence data met the CDC definition of vaccine breakthrough cases

Compared to either Alpha or Delta patients, a significantly greater percentage of patients with breakthrough cases was caused by the Omicron VOC (51.4% compared to 3.2% and 24.3% for Alpha and Delta VOCs, respectively)

[Farmer-Rick]

42. Thanks for that link

Last edited Sat Jan 8, 2022, 08:28 PM - Edit history (1)

I'll be curious what the peer review finds. It is a small sample.
I assume their vaccinated sample was representative of the general population and Not just Texas.

A couple of issues I hope a peer review will clarify. They claimed that when the vaccine was given did not correlate to when a person is infected yet in this small sample population those boosted were infected at about a 10 percent rate vs about 50 percent without booster. If time of vaccine did not correlate with infection dates why would a booster affect it?

It may just be due to sample size or just fewer boosted people during that time.

"We next analyzed Omicron vaccine breakthrough cases (Table 1, Table 2). We found 675 of the 1313 total Omicron patients (51.4%) for whom we have whole genome sequence data met the CDC definition of vaccine breakthrough cases." This means that if infected with omicron, you have a 50/50 chance of having been vaccinated...though not boosted. I expect this to change though as peer review evaluate the study sampling.

Just a warning don't interpret this to mean that if you are fully vaccinated you have a 51.4 percent chance of being infected by Omicron. Not even unvaccinated people have a 51.4 percent chance of catching COVID.

According to NY infection rates: "Breakthrough infections soared by relative standards through December, with 149.5 of 100,000 fully vaccinated New Yorkers getting infected the week of Dec. 20." That's about a 0.15 percent infection rate for fully vaccinated for that time.

"That compares with a rate of 28.3 breakthrough infections per 100,000 the week of Dec. 6. Unvaccinated New Yorkers are still more than six times as likely to get infected, with a 940.7 daily infection rate per 100,000 residents the week of Dec. 20. That's still a more than a four-fold increase from their risk of infection the week of Dec. 6."

That's at the most a 1 percent infection rate for unvaccinated during that time.

https://www.google.com/amp/s/www.nbcnewyork.com/news/coronavirus/ny-covid-hospitalizations-top-2021-surge-levels-as-omicron-drives-95-of-cases/3476250/%3famp

I still stand by the studies I was able to find that you have anywhere between 1 to 5 percent chance of getting infected with omicron if you are fully vaccinated and boosted at any time to date.

[WhiskeyGrinder]

5. And we'll just keep going on business as usual, as with other surges, because Capital must be

appeased.

[leftstreet]

6. So decades of for profit consolidation, mergers, closures...

nevermind

[sarcasmo]

7. ICU beds 91 percent full here in Wisconsin.

[JanMichael]

8. The last paragraph, last sentence, sums it up well.

"There’s a plausible future in which most of the U.S. enjoys a carefree spring, oblivious to the frayed state of the system they rely on to protect their health, and only realizing what has happened when they knock on its door and get no answer. This is the cost of two years spent prematurely pushing for a return to normal—the lack of a normal to return to."

The people constantly trying to get EVERYONE go back to 2019 are helping form this layered disaster.

Here's looking to 2028.

[Drunken Irishman]

28. If you're vaccinated, with boosters, you should be able to live your life.

This entire crisis is caused by the unvaccinated. We continue to have a pandemic of the unvaccinated. I spent an entire year locked away in my house in 2020. My mother spent the whole last year of her life away from family because we were told to do the good thing and stay home. She missed St. Patrick's Day dinner, the 4th of July, Thanksgiving, birthdays - and would have missed Christmas if she wasn't dying in a hospital from cancer that she didn't even know she had at the start of 2020. It was a miserable year for her but she stayed indoors because she wanted to do the right thing.

Well I'm tired of being told to do the right thing and then told we need to stay inside again for another year despite doing the right thing.

I am going to live my life. I've already gone to concerts, movies, football games, restaurants and that isn't going to change. I am vaccinated. I am boosted. I wear a mask.

That's about all you can ask of me now.

[JanMichael]

29. The issue isn't one person. It is systems

Just don't get an accident going out because you might not get fast help in the emergency room or in the hospital.

That's going to be the new reality. Has nothing to do with your desire to go out. Or me being vaccinated too. I have a booster and whatever other shots there are I will gladly take as they become available. And I mask up all the time too.

You may want to live your life but there's a lot about life thay isn't going to go doing what you wanted to do.

But hey that cat's out of the bag, go pop a beer.

[Drunken Irishman]

33. And the alternative is people losing their livelihoods because of lockdowns.

People who count on people going out and dining or going to a concert or a bar or to even just run errands. The other side of the coin about locking yourself in beyond just going out for essentials is that millions of people will be negatively impacted by such logic. They will lose their job, fail to be able to pay rent or their mortgage and be out on the streets because of it.

There is no silver bullet but at the end of the day, we're entering year three of this pandemic and clearly it's not going to end. So we have to come to grips with how we're going to coexist with this virus.

The best way is to continue to push for vaccines but even that is limited. The next best way is to take as much precaution as you can and go live your life because this isn't just going to go away.

[Docreed2003]

9. K&R...wish I could recommend this more strongly

This is article is a must read. It captures perfectly the struggle those of us in healthcare are facing daily. This is affecting hospitals of all shapes and sizes and will for the foreseeable future. The system is breaking.

[monkeyman1]

11. guess what- Scotus is now " supreme dead weight of the pandemic" ???

[bucolic_frolic]

13. Thanks for the warning.

[paleotn]

15. Time to implement rationing of healthcare.

No vax at this late date and you come in with a covid case, no treatment. That's no joke. I'm serious. I do not want to see innocent people die due to others complete stupidity. If these nutters believe so strongly in personal responsibility, than let them be responsible for their own stupid actions.

[PortTack]

16. And yet at the time of the writing of this piece, SCOTUS is poised to go against any kind of

Vaccine mandates!

Political hacks in robes that care nothing for democracy or the ppl that live in this country!

[Evolve Dammit]

21. Yes. That will help. sarcasm...We are in serious trouble.

[PortTack]

36. Sarcasm???? NO dead serious

[Evolve Dammit]

39. Not you, my first sentence

[Solly Mack]

19. K&R

[yaesu]

20. Imma thinking we could have a very bad supply disruption, food, fuel, shortage, worse than before

anything dependent on labor, just a gut feeling its coming.

[Farmer-Rick]

23. The health care system was pretty broken even before the pandemic

At least in rural TN the health care was atrocious.

When my uncle was in ICU after open heart surgery, he was on blood thinners and kept bleeding out a lot. I went in one night to check on him and he was dozing in and out saying his bandages were soaked through with blood and no one would change them. I pulled his sheet down and his bed was flooded. It was as if he was sitting in a pool.

Of course I grabbed the first nurse......and only nurse in a 12 patient ICU ward......Me with absolutely no medical training, helped the nurse staunch the flow of blood and stayed all night to ensure it did not happen again.

I literally had my hands in his blood, in his chest, trying to slow the bleeding. One nurse in an ICU unit. This is what a for profit hospital looks like. This is what capitalism turns good hospitals into. Nursing staff cut so short that it is dangerous. Patients sitting in pools of blood for hours because there is no support staff anymore. This was a premier heart specialist hospital with a medical college across the street. Just recently bought out by a huge conglomerate.

Capitalism destroys everything it touches.

It must be really awful now.

[questionseverything]

30. Capitalism is fine for designer jeans and shoes 👠

For things like healthcare, food and a decent roof over your head we ( the government) needs to make sure there’s a basic standard

[area51]

32. This.

"This is what a for profit hospital looks like."

The drive for profits means patients get shafted.

[struggle4progress]

25. Oregon issues hospital crisis care standards

By: Associated Press (AP)
Posted at 12:27 PM, Jan 07, 2022 and last updated 2:27 PM, Jan 07, 2022

PORTLAND, Ore. — Oregon health authorities have published new interim guidelines for hospitals to follow if a surge of COVID-19 patients forces them to activate crisis standards of care.

The policy will be used to help decide which patients get urgent, life-saving care if there aren't enough hospital beds, staff or critical medical equipment. The standards are based on similar guidelines developed in Arizona, Massachusetts and Washington amid the pandemic ...

https://www.kivitv.com/news/oregon-issues-hospital-crisis-care-standards-as-covid-surges

[struggle4progress]

26. U Maryland Hospitals in Prince George's Declare Emergency

By Sophia Barnes
Published January 1, 2022 • Updated on January 1, 2022 at 4:01 pm

University of Maryland Capital Region Health says it's moving three Prince George’s health centers to crisis standards of care amid rising COVID-19 cases and staffing shortages.

UM Capital Region Medical Center, UM Bowie Health Center and the Emergency Department at UM Laurel Medical Center declared a hospital emergency ...

https://www.nbcwashington.com/news/coronavirus/um-hospitals-in-prince-georges-declare-emergency-employ-crisis-standards-of-care/2924396/

[DallasNE]

31. And The Sad Part

Is that some of this could have been avoided. First was the greedy drug companies that would not waive their patent rights so foreign manufacturers could produce the vaccine so poor countries had virtually no protection, allowing the virus to run wild. That was compounded in America because of the misinformation from the Trump administration, social media and Fox News. By then the virus started to mutate, rendering the vaccinations much less effective. And here we are today. In stores there are still only around 10-15% of customers in stores wearing masks. Mask mandates need to be brought back. The next 10 days will be critical because hospitalizations should be peaking and the rate of infection should be starting to show signs of topping out. But they may not either. Nobody really knows what this virus is capable of.

[al bupp]

35. The hospital where my wife works in Holyoke, MA is now in Code Black

Meaning resources, such as beds, nurses, PAs, doctors and support staff are are at a critically low levels and all non-emergency and outpatient procedures be deferred with very few exceptions, w/ all available resources being directed to emergency and intensive care departments.

[ProfessorGAC]

37. Here In Illinois...

...ICU bed availability is under 10% in all 11 regions. All 11 regions were over 20% a month ago.
95% of ICU admissions are unvaxxed. No shock.

[Quixote1818]

43. If it goes like South Africa, this should be short lived and then we may be to the endemic stage

of Covid after that. If they can just hold up for another month, things should improve dramatically. At least that is what the studies are saying.