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How this new covid hospitalization surge is different (and worse)

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Illinois

Illinois hospitals running short on inpatient beds are increasingly housing patients in their emergency rooms, creating a situation some doctors say threatens the quality of care.

As of Sunday night, the most recent state data available, Chicago hospitals had 239 people waiting in beds in ERs for space elsewhere in the hospital to open up — the highest level ever measured during the pandemic. An additional 220 people were waiting in ERs in hospitals in suburban Cook County, and with more still in the regions covering DuPage and Kane counties (50), Lake and McHenry counties (39) and Will and Kankakee (27). […]

The Tribune has previously reported how this fifth pandemic surge came at a perilous time for Illinois hospitals, as they struggled with fewer workers trying to care for more people. The vast majority of those patients weren’t seeking treatment for COVID-19 and were often sicker from delaying needed care earlier in the pandemic.

* This surge is different and worse. It’s stressing our entire healthcare system and more people are winding up in the hospital for other reasons. Here’s Ed Yong at The Atlantic…

“We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time,” said Vineet Arora, [Dean for Medical Education of the University of Chicago Biological Sciences Division]. “Some of it is for COVID, and some is with COVID, but it’s all COVID. At the end of the day, it doesn’t really matter.” (COVID patients also need to be isolated, which increases the burden on hospitals regardless of the severity of patients’ symptoms.) […]

Every part of the health-care system has been affected, diminishing the quality of care for all patients. A lack of pharmacists and outpatient clinicians makes it harder for people to get tests, vaccines, and even medications; as a result, more patients are ending up in the hospital with chronic-disease flare-ups. There aren’t enough ambulance drivers, making it more difficult for people to get to the hospital at all. Lab technicians are falling ill, which means that COVID-test results (and medical-test results in general) are taking longer to come back. Respiratory therapists are in short supply, making it harder to ventilate patients who need oxygen. Facilities that provide post-acute care are being hammered, which means that many groups of patients—those who need long-term care, dialysis, or care for addiction or mental-health problems—cannot be discharged from hospitals, because there’s nowhere to send them. […]

Brunson works in a cardiac ICU, not a COVID-focused one, but her team is still inundated with people who got COVID in a prior surge and “are now coming in with heart failure” because of their earlier infection, she said. “COVID isn’t done for them, even though they’re testing negative.” Hospitals aren’t facing just Omicron, but also the cumulative consequences of every previous variant in every previous surge.

The final graf…

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.

posted by Rich Miller
Friday, Jan 7, 22 @ 11:19 am

Comments

=This is a failure at all levels from Republicans to the CDC and Fauci moving the goalposts so many times=

Failures yes, but I wouldn’t necessarily say that these groups and individuals moved the goalposts, science did. But messaging and expectations could have been set better as well as our reaction to those changes. But that also means that we need to do a better job of listening and following. Part of the reasons that the goalposts move is because we ignore what science is telling us to do.

Comment by Pundent Friday, Jan 7, 22 @ 11:52 am
Another backup in the healthcare system due to COVID. It’s not just beds, it’s preparing for possible bed use or ORs at hospitals for other than COVID issues (or related to COVID issues due to long haul effects). Shots.Mask.Distance (banned punctuation) Failures to do so just exacerbate the breakdowns we are experiencing in our healthcare systems.

From Politico https://www.politico.com/news/2022/01/07/covid-testing-staff-shortage-526701?nname=illinois-playbook&nid=00000150-1596-d4ac-a1d4-179e288b0000&nrid=00000159-b728-d0fa-a1db-f73b1ade0001&nlid=639163

Mara Aspinall, an adviser to the Rockefeller Foundation and member of OraSure Technologies’ board of directors, agreed that the supply chain for labs has benefited from extensive government investment, but noted lab staff are dealing with more than Covid test volumes.

“People are going back to doctors’ offices,” Aspinall said. “They’re having biopsies and mammograms and physicals and blood tests. So the challenge that the labs have today is they have an enormous number of Covid tests. But in addition, they have general tests that they didn’t have a year ago when so many doctors’ offices were closed.”

Comment by Anon221 Friday, Jan 7, 22 @ 11:58 am
I think the last link might be broken. It just point to a blank page.

Comment by TheInvisibleMan Friday, Jan 7, 22 @ 12:01 pm
Just yesterday, I had a 85 year old family member in Atlanta GA wait about 5 hours for an ambulance after she fell and broke multiple bones. A few months ago, I had a double vax family member unable to get needed monoclonal therapy when he had Covid because the facility was full of people who didn’t get vaccinated. I don’t have any patience for the anti-vaxers and Covid-deniers who only think about themselves. They are seriously hurting others.

Comment by City Guy Friday, Jan 7, 22 @ 12:06 pm
I had blood work done over the holidays. All routine stuff. But I can attest to the delays. It took 2+ weeks to get back results that are usually delivered in a couple of days. The labs are a supply chain pinch point. The whole system has been stretched and for more urgent testing that is going to bring real consequences. So when I hear that this continues to be “no big deal” it makes my blood boil.

Comment by Pundent Friday, Jan 7, 22 @ 12:08 pm
And now we are starting to see hospitals use space not normally used for medical care.

“HSHS St. Joseph’s Hospital in Highland announced Friday that its PrimeCare clinic would see patients for unscheduled, non-emergency care in the hospital’s Sullivan Conference Room between 9 a.m. and 5 p.m. starting Tuesday. Those patients used to go into the emergency room to register to see a PrimeCare clinic provider.”

Read more at: https://www.bnd.com/article257127862.html#storylink=cpy

Comment by DownSouth Friday, Jan 7, 22 @ 12:11 pm
The IDPH website lets you look at the “reopening” metrics over the entire period of the pandemic. If you look at the ICU bed availability stats for the various hospital regions you can get a real sense of the fact that for the last several months hospital ICUs have been incredibly stressed, especially in our under served rural areas and now we’re at a point where they’re full and there’s also no where to transfer to.

Check in on your friends that work in in-patient care. Odds are pretty good that they need to hear a friendly voice. The idea that we can just have another emergency pop up hospital that can address this crisis is a fantasy because even if there are beds and space available, physicians and nurses are not going to appear as if by magic to be able to staff them.

It’s easy for us to look at numbers and not realize that every single COVID-19 death in a hospital setting is a patient that a care team watched deteriorate until no intervention would be able to allow that patient, that person to continue to live their life. That for each of those numbers there is a family involved and that every day these care teams, these physicians and nurses, have been repeating this process like a Groundhogs Day from Hell where the only thing that changes is the patient and their family.

We have experienced a collective trauma, and we have forced some of the worse trauma to be felt by certain sectors our our economy the most. Our society is going to have to change to address how teachers, physicians, nurses, public employees, and “essential workers” at grocery stores, restaurants, and movie theaters have been treated throughout this pandemic.

We have made some of the most critical components of our society into the bag holders for our failures and I am getting the impression that they do not like it anymore.

Comment by Candy Dogood Friday, Jan 7, 22 @ 12:14 pm
I am so glad that my dad and stepmother are retired from their medical practices so they don’t have to put up with this mess.

Comment by Huh? Friday, Jan 7, 22 @ 12:15 pm
I remember when some on the far right boisterously claiming the ACA would create ‘death panels’. Now we’re seeing something similar playing out in real time and they’re gleefully cheering it on.

Comment by Cubs in '16 Friday, Jan 7, 22 @ 12:20 pm
How does this square with what the officials from the Illinois Hospital Association said earlier about being able to expand capacity like an accordion?

Comment by Bell Curve Friday, Jan 7, 22 @ 12:31 pm
Bell Curve, the comments are still accurate. People are still being cared for.

Comment by Rich Miller Friday, Jan 7, 22 @ 12:35 pm
I am delighted this is finally being reported. ERs have had to deal with this housing of patients for well over the past month. The person I know who works and ER has been saying this is a problem since November. When I asked about moving from ER to in hospital care, the response was the hospital floors can say they are full, but an ER due to EMTLA can’t. If all hospitals are on by-pass emergency personnel will pick which one they will take a patient to. ER docs have to then treat incoming as well as those housed and the staffing is not being increased. They are burning out and getting sick which is now creating a crisis in getting staff to cover shifts. It is bad thanks to all who want to ignore this virus.

Comment by illinifan Friday, Jan 7, 22 @ 12:38 pm
I was scheduled for spinal fusion on January 19 at Springfield Memorial. The surgeon’s office called yesterday to tell me Memorial has paused elective surgeries. I’m tentatively scheduled two days later at St. John’s. Do I believe that will happen either? No. I agree with City Guy except I would use words that would get me banned. I shouldn’t have to endure continuing pain just because someone else wants their so-called “freedom “.

Comment by FormerGOPer Friday, Jan 7, 22 @ 12:53 pm
=== Illinois Hospital Association said earlier about being able to expand capacity like an accordion? ===

Everything is a theory until it is put into practice. Being able to expand capacity at the same time that every other hospital system in every other state is also being required to expand capacity would require a reallocation of certain resources and trying to identify new pools of resources that are not currently being utilized. In addition to either letting people who are not currently licensed to practice medicine pick up a provisional licenses based off of past a license or having a fraction of the requirements, or putting medical students to work, hospitals could require specialists in areas like dermatology to begin working as a hospitalist and providing direct patient care to in patient hospital patients.

The expansion, while theoretically possible, is not necessarily going to be a smooth or quick process and some specialists would just quit rather than run in patient service for COVID-19 patients. They literally spent years of their lives training to develop skills and abilities so that they wouldn’t have to be a hospitalist.

Other states that have done things like fast track giving licenses to practice medicine to people who used to be able to practice without doing much review. Wisconsin had to strip a medical licenses from a radiologist that was doing tele-medicine in the state who had been imprisoned for his part in running a multimillionaire dollar prostitution ring.

The kinds of things required to prompt a sudden expansion tend to have negative impacts on patient care.

Comment by Candy Dogood Friday, Jan 7, 22 @ 1:01 pm
===When I asked about moving from ER to in hospital care, the response was the hospital floors can say they are full, but an ER due to EMTLA can’t. ===

In this case expanding capacity means tents. They can follow up with IEMA and get some tents when they run out of hallways, exam rooms, and other spaces to re-purpose.

Tents.

Comment by Candy Dogood Friday, Jan 7, 22 @ 1:09 pm
This, from the article:

==he advised them about boosters and masks, but also about wearing a seat belt and avoiding ladders. “You don’t want to be injured now,” he told me. “Any need to go to the emergency department is going to be a problem.” ===

So those exercising their freedumb are only hurting themselves?

Comment by Jibba Friday, Jan 7, 22 @ 1:25 pm
Candy Dogood, all the tents in world are useless if you don’t have the staff to assist people. That is what is happening. Nurses are quitting or sick. Doctors are walking away or sick. Staff are being asked to reassign from what they are trained to do, to do other jobs but many of those are declining the offer. You need staff to clean, deliver food, monitor meds and more of those don’t exist. This is what an overwhelmed health care system looks like. Patients out the door and staff having to figure out who is the most critical (the heart attack or the person gasping for air).

Comment by illinifan Friday, Jan 7, 22 @ 1:29 pm
HSHS said today on a press call that 80% of everyone in the hospital with COVID is unvaccinated. And the few vaccinated folks that show up are discharged in half the time.

I really don’t know why I write that anymore - it won’t change anyone’s mind it seems. And I was on the other end of a phone call recently about a doctor I could call if I wanted to get ivermectin. I fear the person I was talking too is going to be very sick in a few days.

Comment by Cool Papa Bell Friday, Jan 7, 22 @ 2:18 pm
=I really don’t know why I write that anymore - it won’t change anyone’s mind it seems.=

Because it bears repeating. Again, and again, and again. To counter Joe Rogan, Aaron Rogers, and every whackpot on Facebook providing a steady stream of misinformation. To support our overworked health care workers, kids under 5, the immunocompromised.

People are going to continue to believe what they want to believe. But we do have a moral obligation to do whatever we can to prevent them from doing so at our collective peril.

Comment by Pundent Friday, Jan 7, 22 @ 2:40 pm