US hospitals struggle with staffing shortages and Omicron outbreaks
On her fourth day of Covid symptoms, Ruth woke up in the worst pain of her life. It felt like her joints were filled with broken glass; she couldn’t walk, couldn’t move. “It was worse than childbirth,” she said.
When friends texted to check on her, she couldn’t hold the phone or move her fingers to write back. Her doctor called in medication, and it took Ruth 40 minutes to shuffle to the pharmacy half a block away.
Ruth – who did not want her full name used – is certain that if she weren’t vaccinated and boosted, she would be in the intensive care unit or worse right now. But while she’s recovering from this “mild” case, she’s unable to work even as cases surge in her region.
Ruth is an emergency nurse in Washington DC. Her case of breakthrough Covid shows what may happen when the more contagious variant hits health workers all over the country – and the pressures Omicron will put on a US health system already groaning under the weight of the pandemic. In this wave, it’s not a shortage of beds but a shortage of qualified workers to care for people in those beds that is raising alarm bells.
“What do you do when you have a tidal wave coming at you in a little paddle boat?” Ruth asked. “There’s going to be a huge uptick. Our entire waiting room is going to be all Covidpositive.”
In Washington DC the infection curve looks like a straight line up. On Saturday, the city nearly tripled its previous record-high number of cases. At least two of Ruth’s colleagues were already out sick with Covid.
In a matter of weeks, Omicron has become the dominant variant in the United States. It accounts for 73% of sequenced cases, six times higher than last week. As the holidays approach, officials and experts warn of an unmanageable crush of patients and potentially catastrophic staffing shortages.
“This is a big concern,” said Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials. “This is a highly contagious variant, and we really think it could cause significant issues with the workforce.”
Omicron is spreading like wildfire and slamming into hospitals, and “there’s no question that this is going to be on us, really in the next week or so”, Plescia said.
Others agreed. “There’s no question” that Omicron outbreaks among healthcare workers are “significantly diminishing the workforce”, said Georges Benjamin, executive director of the American Public Health Association. “It has profound implications for our ability to not just take care of people with Covid but [also] the other diseases that are out there.”
The American Nurses Association is urging US officials to declare the nursing shortage a national crisis, and the American College of Emergency Physicians has expressed concerns the short
age will affect patient care.
Makers of monoclonal antibodies also delivered crushing news recently: most of them – including the one the US heavily invested in – don’t work well against Omicron. The only one that does is in short supply, and the last available shipment just went out. Without widespread medications to prevent hospitalization and death, health systems may face more stress.
Even before Omicron, the situation was growingdire as hospitals grappled with a Thanksgiving surge in cases.
Nearly two years into the coronavirus outbreak, nurses, doctors, specialists and other key health workers are exhausted. In April, 55% of front-line health workers reported feeling burned out. They frequently face harassment and frustration at work.
“It’s really horrible,” Ruth said. “I got into medicine to take care of people, and people are just angry at me all the time.” The day she was infected, there were 150 people in the waiting room, facing a nine- or 10-hour wait time.
Recently, a child came into her hospital with a broken arm. An orthopedic surgeon was ready to operate, but there were no nurses available to assist in the procedure. The child had to wait for 10 hours.
Yet Ruth knows she’s not ready to go back yet; it still hurts to move, and her thinking is foggy, even if she’s not contagious anymore. “I cannot provide appropriate care for my patients,” she said. Just getting up to tidy her apartment made her oxygen drop to 91%.
She had Covid before, early in the pandemic, and it wiped her out for a week and a half. She had to wear a cardiac monitor for two weeks because of heart complications. She was eager to get vaccinated, and received her first shot on the first day vaccines were available in the US. Those vaccines cut her illness short and kept her out of the hospital.
Omicron is a particular threat because it is effective at overcoming protection against infection among those who have been vaccinated or survived previous cases of Covid – which means even vaccinated health workers may need to isolate after a positive test or take time off to recover from the illness.
“Health systems are going to have to plan for that,” Benjamin said – a calculation that is especially fraught during the holiday season.
Hospital administrators may need to bring back retired workers, even for a short period of time, and “rethink some of the services that they’re delivering”, Benjamin said. “They’re probably going to have to put off a lot more discretionary procedures. But there are some services that we just can’t continue to put off.”
The national guard may also be deployed in areas with overwhelmed health systems.
Health workers who become sick need time to recover. But it’s possible the public health guidance will change for those who experience mild or no symptoms.
“We’re kind of waiting for some guidance from CDC and others on whether we could bring some further flexibility into some of the current isolation and quarantine and other guidance,” Plescia said. “Perhaps, particularly with healthcare workers because they’re wearing pretty significant PPE, maybe they could return to work in five days rather than 10.” In previous surges, even nurses who tested positive were asked to continue working with Covid patients if they were able.
In March 2020, in the face of many unknowns about treating the virus and massive testing delays, we were encouraged to stay home and flatten the curve. But Benjamin doubts that will happen again.
“We’ve got to figure out how to flatten the curve a little differently,” Benjamin said. He recommends instituting rules requiring proof of vaccination in public places – essentially making it “more difficult for people not to be vaccinated”.
Everyone needs to be vaccinated and boosted, Ruth warned. “It’s not a matter of ‘if’ at this point. It’s a matter of when. And how well do you want to be protected against it?”