Shortage of medics crippling hospitals
Arkansas among worst-hit states
The rapidly escalating surge in coronavirus infections across the U.S. has caused a shortage of nurses and other front-line workers in virus hot spots that can no longer keep up with the flood of unvaccinated patients and are losing staff members to burnout and lucrative out-of-state temporary gigs.
Florida, Arkansas and Louisiana all have more people hospitalized with covid-19 than at any other point in the pandemic, and nursing staffs are badly strained.
In Florida, virus cases have filled so many hospital beds that ambulance services and fire departments are straining to respond to emergencies. Some patients wait inside ambulances for up to an hour before hospitals in St. Petersburg, Fla., can admit them — a process that usually takes about 15 minutes, Pinellas County Administrator Barry Burton said.
One person who suffered a heart attack was turned away from six hospitals before finding an emergency room in New Orleans that could take him in, said Joe Kanter, Louisiana’s chief
public health officer.
“It’s a real dire situation,” Kanter said. “There’s just not enough qualified staff in the state right now to care for all these patients.”
Health workers in Texas and nearby states have struggled with a lack of intensive-care beds, said Rhiana Ireland, an emergency-room doctor who is herself struggling with what she believes is a breakthrough case.
Ireland described spending hours unsuccessfully trying to find a bed for a 22-year-old southeast Texas patient, hunting as far away as Colorado, North Dakota and Montana. All she could provide him was oxygen and steroids because her hospital lacks remdesivir or monoclonal antibodies.
“I know what he needs, but I can’t do it,” she said.
Ireland said she and her colleagues are not only exhausted, but frustrated by knowing that vaccines could have headed off the new surge. “It feels like this is worse” than December, Ireland said.
In Florida, adult intensive-care unit occupancy has soared to 5,804; that’s a more than sevenfold increase just since mid-July, with some hospitals converting conference rooms and cafeterias into patient areas.
Nationwide, hospital utilization is expected to rise further in coming weeks, according to projections from the University of Washington’s Institute for Health Metrics and Evaluation, and there are already too few people to care for patients.
‘JUST TAPPED OUT’
Michelle Thomas, a registered nurse and a manager of the emergency department at a Tucson, Ariz., hospital, resigned three weeks ago after hitting a wall.
“There was never a time that we could just kind of take a breath,” Thomas said Tuesday. “I hit that point … I can’t do this anymore. I’m so just tapped out.”
She helped other nurses cope with being alone in rooms with dying patients and holding mobile phones so family members could say their final goodbyes.
“It’s like incredibly taxing and traumatizing,” said Thomas, who is unsure if she will ever return to nursing.
Miami’s Jackson Memorial Health System, Florida’s largest medical provider, has been losing nurses to staffing agencies, other hospitals and pandemic burnout, Executive Vice President Julie Staub said. The hospital’s CEO says nurses are leaving for jobs in other states at double and triple the salary.
Staub said system hospitals have started paying retention bonuses to nurses who agree to stay for a set period. To cover shortages, nurses who agree to work extra are getting the typical time-anda-half for overtime plus $500 per additional 12-hour shift. Even with that, the hospital sometimes still has to turn to agencies to fill openings.
“You are seeing folks chase the dollars,” Staub said. “If they have the flexibility to pick up and go somewhere else and live for a week, months, whatever and make more money, it is a very enticing thing to do. I think every health care system is facing that.”
Nearly 70% of Florida hospitals are expecting critical staffing shortages in the next week, according to the Florida Hospital Association.
116,000 NEW CASES A DAY
The U.S. is averaging more than 116,000 new coronavirus infections a day and about 50,000 hospitalizations, levels not experienced since the winter surge. Unlike other points in the pandemic, hospitals now have more noncovid patients for everything from car accidents to surgeries that were postponed during the outbreak.
That has put even more burden on nurses who were already fatigued after dealing with constant death among patients and illnesses in their ranks.
“Anecdotally, I’m seeing more and more nurses say, ‘I’m leaving, I’ve had enough,’” said Gerard Brogan, director of nursing practice with National Nurses United, an umbrella organization of nurses unions across the U.S. “‘The risk to me and my family is just too much.’”
Hawaii is seeing more new daily virus cases than ever.
In a Honolulu hospital’s emergency department, patients have had to wait for beds for more than 24 hours on gurneys in a curtained-off section because there’s not enough staff to open more beds, nurse Patrick Switzer said.
“Somebody who’s been sitting in the emergency room for 30 hours is miserable,” he said.
He described being “in this constant state of anxiety, knowing that you don’t have the tools that you need to take care of your patients because we’re stretched so thin.”
Covid-19 hospitalizations have now surpassed the pandemic’s worst previous surge in Florida, with no signs of letting up, setting a record of 13,600 on Monday, according to the Department of Health and Human Services. More than 2,800 required intensive care.
At the height of last year’s summer surge, there were more than 10,170 covid-19 hospitalizations.
At Westside Regional Medical Center in Plantation, Fla., the number of covid-19 patients has doubled each week for the past month, wearing down the already short staff, said Penny Ceasar, who handles admissions there.
The hospital has converted overflow areas to accommodate the rise in admissions. Some staff members have fallen ill with covid-19.
“It’s just hard. We’re just tired. I just want this thing over,” Ceasar said.
TEXAS SEEKS HELP
Texas Gov. Greg Abbott appealed for out-of-state help to fight the third wave of the coronavirus while two more of the state’s largest school districts announced mask mandates in defiance of the governor.
The Republican governor has directed the Texas Department of State Health Services to use staffing agencies to find additional medical staff from beyond the state’s borders as the delta-variant wave began to overwhelm its present staffing resources. He also has sent a letter to the Texas Hospital Association to request that hospitals postpone all elective medical procedures voluntarily.
Abbott’s request Monday was made as Harris Health System and Lyndon B. Johnson Hospital in Houston added nearly 2,000 square feet of medical tents to accommodate its overflow. Private hospitals in the county already were requiring their staffs to be vaccinated against the coronavirus.
Last week, Houston area officials said the wave of delta variant infections so strained the area’s hospitals that some patients had to be transferred out of the city, with one being sent to North Dakota.
Meantime, the Dallas and Austin school districts announced Monday that they would require students and staff members to wear masks. The Houston school district already announced a mask mandate for its students and staff members later this week if its board approves.
Abbott also directed the state health department and the Texas Division of Emergency Management to open additional covid-19 antibody infusion centers to treat patients not needing hospital care and expand vaccine availability to the state’s underserved communities. He also announced about $267 million in emergency Supplemental Nutrition Assistance Program food benefits for August. That was on top of the $3.9 billion in benefits previously allocated since April 2020.
The governor’s actions fall short of lifting his emergency order banning county and local government entities from requiring the wearing of masks and social distancing to lower the covid-19 risk. Abbott has said repeatedly that Texans have the information and intelligence to make their own decisions on what steps to take to protect their health and the health of those around them.
Also Monday, Dallas County Judge Clay Jenkins filed a lawsuit asking a judge to strike down Abbott’s mask-mandate ban.
The state’s rolling twoweek daily average of new covid-19 cases has increased by 165% to 8,533, according to Johns Hopkins University research data. About 45% of the state’s population has been vaccinated against the coronavirus, according to the U.S. Centers for Disease Control and Prevention.
FAUCI ON MANDATES
Anthony Fauci, the top U.S. infectious-disease expert, said state and local governments should require teachers to get vaccinated.
As back-to-school season approaches and the delta variant surges across the U.S., Fauci acknowledged that his position might anger some people who’ve resisted vaccination mandates for teachers.
“Yeah, I’m going to upset some people on this, but I think we should,” he said Tuesday in an interview with MSNBC. “This is very serious business. You would wish that people would see why it’s so important to get vaccinated.”
But Fauci, director of the National Institute of Allergy and Infectious Diseases, said there wouldn’t be federal mandates for teacher vaccinations. Local mandates “for schools, for teachers, for universities, for colleges” would be appropriate, he said.
“I’m sorry, I mean I know people must like to have their individual freedom and not be told to do something, but I think we’re in such a serious situation now, that under certain circumstances, mandates should be done,” he said.
Full Food and Drug Administration approval could help empower governors, local officials and businesses to institute vaccine mandates without fear of legal repercussions, Fauci said.
“If you want to work in an organization, you have to be vaccinated: I think we’re going see a lot more of that,” Fauci said.
CDC VACCINE REPORT
For adults, the benefits of the three coronavirus vaccines authorized in the United States outweigh the risks of serious side effects, which remain rare, according to a new report from the CDC.
The Pfizer-BioNTech and Moderna vaccines have been linked to inflammation of the heart muscle, known as myocarditis, and the Johnson & Johnson vaccine may increase the risk of a rare blood-clotting disorder and a neurological condition known as Guillain-Barre syndrome. All of the conditions can be serious but remain uncommon.
These small risks are exceeded by the benefits of the vaccines, which provide powerful protection against disease and death, experts concluded.
The paper is based on data reported to the federal Vaccine Adverse Events Reporting System. The database contains unverified reports, but researchers confirmed many of the cases used in their calculations, which were initially presented at a July meeting of the CDC’s vaccine advisory group.
As of June 30, roughly 12.6 million doses of the Johnson & Johnson vaccine had been given to U.S. adults. As of that date, there had been 100 reports of Guillain-Barre, which can cause muscle weakness and paralysis, a rate of 7.8 cases per 1 million doses.
As of July 8, there had also been 38 reports of the clotting disorder following the Johnson & Johnson vaccine. The overall rate of the clotting disorder is 3 cases per 1 million doses.
By the end of June, there had also been 497 reports of myocarditis after the second dose of either the Pfizer or the Moderna vaccines, a rate of 3.5 cases per 1 million doses.
Information for this article was contributed by Terry Spencer, Jennifer Sinco Kelleher, Andrew Selsky, Freida Frisaro, Kelli Kennedy, Melinda Deslatte and Terry Wallace of The Associated Press; by Jennifer Jacobs, Angelica LaVito, Jonathan Levin and Francesca Maglioneof Bloomberg News (TNS); and by Emily Anthes of The New York Times.