U.S. hospitals are stretched way too thin
In excruciating pain with lesions on her face and scalp, Tracey Fine lay for 13 hours on a gurney in an emergency room hallway.
All around her, COVID-19 patients filled the beds of a hospital in Madison, Wis. Her nurse was so harried that she could not remember Fine’s condition, and the staff was slow to bring her pain medicine or food.
In a small rural hospital in Missouri, Shain Zundel’s severe headache turned out to be a brain abscess. His condition would typically have required an operation within a few hours, but he was forced to wait a day while doctors struggled to find a neurosurgeon and a bed — finally, at a hospital 375 miles away in Iowa.
From New Mexico to Minnesota to Florida, hospitals are teeming with record numbers of COVID patients. Staff members at smaller hospitals have had to beg larger medical centers repeatedly to take one more, just one more patient, but many of the bigger hospitals have sharply limited the transfers they will accept, their own halls and wards overflowing.
In the spring, the pandemic was concentrated mainly in hard-hit regions like New York, which offered lessons to hospitals in other states anticipating the spread of the virus. Despite months of planning, though, many of the nation’s hospital systems are now slammed with a staggering swell of patients, no available beds and widening shortages of nurses and doctors. On any single day, some hospitals have had to turn away transfer requests for patients needing urgent care or incoming emergencies.
And rising infection rates among nurses and other front-line workers have doubled the patient load on those left standing.
There is no end in sight for the nation’s hospitals as the pandemic continues to hammer cities and rural areas across the country, totaling 13 million cases so far this year. And public health experts warn that the holidays may speed the already fast-moving pace of infection, driving the demand for hospital beds and medical care ever higher.
A record number of Americans — 90,000 — are now hospitalized with COVID, and new cases had been climbing to nearly 200,000 daily.
Health care systems “are verging on the edge of breaking,” Dr. Michael Osterholm, a member of President-elect Joe Biden’s COVID-19 advisory council, said in a podcast this month.
The public does not realize how dire the situation is, Osterholm said, and may respond only “when people are dying, sitting in chairs in waiting rooms in emergency rooms for 10 hours to get a bed, and they can’t find one, and then they die.”
When Fine went to UW Health’s University Hospital in Madison, she found doctors there overwhelmed and distracted. “They just parked me in a hallway because there was no place for me to go,” said Fine, 61, who was eventually found to have a severe bout of shingles that threatened her eyes.
She had missed her annual checkup or a shingles vaccination because of the pandemic.
Admitted to a makeshift room with curtains separating the beds, Fine watched the chaos around her. A nurse did not know who she was, asking if she had trouble walking or heard whooshing in her ears. She “was just completely frazzled,” Fine recalled, though she added that staff members were “kind and caring and did their best under horrifying conditions.”
Workers at the hospital issued a plea Nov. 22, published as a two-page ad in The Wisconsin State Journal, asking state residents to help prevent further spread of the virus.
“Without immediate change, our hospitals will be too full to treat all of those with the virus and those with other illnesses or injuries,” they warned. “Soon you or someone you love may need us, but we won’t be able to provide the lifesaving care you need, whether for COVID-19, cancer, heart disease or other urgent conditions. As health care providers, we are terrified of that becoming reality.”
UW Health declined to comment directly on Fine’s experience but acknowledged the strains the pandemic has imposed. While patients were sometimes boarded in the emergency room even before the new coronavirus surge, occupancy is now “superhigh,” said Dr. Jeff Pothof, the group’s chief quality officer.
UW Health is “starting to do things it hasn’t done before,” he said, including enlisting primary care and family doctors to work in the hospital treating seriously ill patients. “It works, but it’s not great,” he said.
Hospitals in St. Louis have been particularly hardhit in recent weeks, said Dr. Alexander Garza, chief community health officer for SSM Health, a Catholic hospital group, who also serves as head of the area task force on the virus. Over the last month, SSM Health turned away about 50 patients whom it could not immediately care for.
And nurses — already one of the groups most vulnerable to infection — are adding more hours to their shifts.
Hospitals are reassigning nurses to adult intensive care units from pediatric ones, doubling up patients in a single room, and asking nurses, who typically care for two critically ill patients at a time, to cover three or more, he said.
“If you’re not able to dedicate as much time and resources to them, obviously they’re not getting optimal care,” Garza said.
Consuelo Vargas, an emergency room nurse in Chicago, said patients linger for days in emergency rooms because ICUs are full. The nursing shortage has a cascading effect. It “leads to an increase in patient falls; this leads to bedsores; this leads to delays in patient care,” she said.
Personnel, available beds and protective equipment are fundamentally scarce. At a news conference held by National Nurses United, a union, Vargas said there was still not enough protective equipment like N95 masks, forcing her to buy her own.
Some hospitals have joined in sounding the alarm: Supplies of testing kits, masks and gloves are running low.
The country never quite caught up from the earlier shortages, Osterholm said. “We’re just going to run into a wall in terms of PPE,” he said, referring to personal protective equipment.
Even if hospitals in some cities appear to have enough physical space or can quickly build new units or set up field hospitals, staff shortages offset any benefit of expansion.
“Beds don’t take care of people; people take care of people,” said Dr. Marc Harrison, chief executive of Intermountain Healthcare, a sprawling system of hospitals and clinics based in Salt Lake City.