Hospitals are getting crushed, but hope remains

The case counts are sky-high, but omicron is causing less severe illness than before. Hospitals are close to being overwhelmed, yet hospitalization rates are lower than earlier in the pandemic, and fewer of those admitted to hospitals are in intensive care or need lifesaving respiratory assistance. Can it be that a less severe variant is nonetheless leading to turmoil in the health care system?

Yes, it can, thanks largely to the sheer size of the wave. The Centers for Disease Control and Prevention reported Sunday that nationwide hospital admissions of patients with confirmed COVID-19 rose to 4.45 per 100,000 people, compared with 1.53 in early November, before omicron. Of 2,224 counties in the United States that have hospital beds, an estimated 644 are projected to be at capacity and an additional 619 are at high risk of reaching their limits in the next 10 days on present trends, according to the COVID-19 Hospital Capacity Circuit Breaker Dashboard, created by Jeremy Faust, Bill Hanage and Benjy Renton. Republican Gov. Larry Hogan declared a state of emergency in part to help Maryland hospitals cope with the surge. New Jersey, New York, Ohio and Maryland are among the states with the highest rates of COVID-19 hospitalization per 100,000 residents. At 111 patients per 100,000 residents, Washington, D.C., has the highest rate in the country.

The unvaccinated are driving the surge. New York state reported that in the last week of December, as omicron took hold, daily new hospital admissions of unvaccinated people soared to 58 per 100,000 residents, compared with only 4.6 for the fully vaccinated. Similar reports have come from around the country. In Louisiana, 80 percent of the hospital admissions were not fully vaccinated; in Connecticut, 71.2 percent. The stress on hospitals is not only for beds. Health care workers are exhausted after two years of relentless pressure. They are quitting at an unprecedented rate; 1 in 5 U.S. hospitals are reporting critical staffing shortages. In many places, the hospital crisis may have knock-on effects, too, meaning that people with other health care needs will be forced to wait, if they can.

Not everyone is being admitted for COVID-19 alone — a large portion of these patients are being admitted for other maladies that have been aggravated by the virus. Both situations count as COVID-19 cases. In the day-today unfolding of the crisis, hospitals are seeing a marked shift to less severe illness for patients in emergency departments. One hospital official told us that while last winter 80 percent or so of those testing positive in the ER were admitted, now only about 20 percent or 25 percent are, and of those, a smaller share than before are admitted for COVID-19 alone. The big difference is vaccination: In areas with higher uptake, disease is less severe. A study from the Houston Methodist health care system found that omicron patients’ median length of stay was 2.8 days, compared with 5.4 for the delta variant.

Vaccines, masks, testing and improved ventilation will all help ease the pressure on hospitals. It is in everyone’s interest to take advantage of the tools at hand.