Hospitals are confronting new and alarming levels of strain amid a surge of coronaviruspatients, with nearly 100,000 hospitalized nationwide Tuesday. Now, even with the hope that vaccines will arrive soon, health-care workers who are already stretched thin are bracing for an unprecedented wave of illness.
Good news arrived for medical staff on Tuesday, when a federal advisory panel recommended that an estimated 21 million health-care workers should be given the first doses of a coronavirus vaccine because the vaccine initially will be in extremely short supply after it is cleared by federal regulators. About 3 million residents of long-term-care facilities also should receive top priority, according to the Advisory Committee on Immunization Practices. A vaccine, which could be authorized for distribution by the end of the month, would finally provide much-needed protection for the elderly, who are at highest risk of death if they are infected, and medical staff because of their exposure to the virus and their critical role in keeping the nation’s hospitals and clinics functioning.
Until then, an influx of new covid-19 patients could lead to hard decisions in the worst-hit hospitals about how to allocate medical resources and care.
Tom Moore, an infectious-disease doctor in Wichita, said cases had been rising steadily throughout the summer because of outbreaks at meatpacking plants. But over the past few days, the number of positive cases has reached shocking levels. Now, his hospital is “maxed out,” Moore said, and it has stopped taking transfers from rural areas that routinely sent their most critically ill patients to the city. Earlier this year, Moore was managing 40 to 50 patients at a time. Today, that number is closer to 90.
The burden has become increasingly visible. Moore described a nurse in the intensive care unit breaking down crying on a recent day. Other workers are burned out.
“We’re all at our breaking points,” he said. “It’s unmanageable.”
And local officials, he said, estimate that the number of hospitalizations will double in the next few weeks. In Sedgwick County, Kan., where Wichita is located, nearly 15,000 people tested positive for the virus in November, according to Washington Post data.
“We are doing our best, and people are rising to the occasion, but it becomes difficult to do your job the way that you want to do it, the way you’re trained to do it” when the numbers are this high, Moore said.
Sixteen states and Puerto Rico reported record numbers of hospitalizations on Tuesday, and four states tied with their highest days. Arizona, California, Maine, New Hampshire, Pennsylvania and West Virginia each reported more than a 25 percent increase in the average number of hospitalizations compared with one week ago.
If the number of cases and hospitalizations continues to swell, hospitals may be forced to offer less care to those with numerous co-morbidities in favor of treating others with a better chance of surviving, said Janis M. Orlowsky, the chief health-care officer of the Association of American Medical Colleges.
New York City operated under crisis standards of care for a short period during the first wave of the pandemic there in April, but the idea of adopting them in many places across the United States simultaneously may be unprecedented, Orlowsky said.
Whether crisis standards of care are officially invoked, the extreme strain on medical staff will inevitably lead to reduced-quality care for all patients, said Jean Ross, the co-president of National Nurses United, which represents more than 170,000 nurses in 20 states. She said many nurses across the country were already spread thin before the pandemic arrived, which she blamed on hospital administrators who are ultimately driven by financial interests.
“People aren’t listening. We are going to be overrun. We are. And that’s depressing,” she said. “And at some point your mind and your body give out. When you can’t humanly work anymore, some will fall by the wayside, and some maybe already have. If I have more people assigned to me than I can safely take care of as a nurse, somebody’s going to get short shrift. That’s just common sense.”
Orlowsky cited some hospitals in Utah that continue to expand their intensive-care beds into other parts of the hospital and employ doctors and other staff members who lack training in critical care for those patients.
“Every CEO I talk to says ‘personnel, personnel, personnel,’ ” she said. “The nurses are exhausted. The doctors are exhausted. Can I get through the next 60 days with my staff, with my tired, overworked, mentally and physically exhausted staff?’”
On Monday, New York state’s Department of Health ordered what Gov. Andrew M. Cuomo (D) called “emergency hospital measures” to prepare the state for an anticipated surge of admissions in the coming weeks. That includes preparing to increase bed capacity by 50 percent; identifying retired nurses and doctors who could be called back to augment staff; preparing to open and staff emergency field hospitals; and confirming the availability of equipment and supplies in stockpiles.
Hospital systems were also directed to begin balancing patient loads across their facilities. Erie County hospitals were ordered to suspend elective surgeries to create more space for coronavirus patients.
“We must adapt to this reality and have a plan in place that specifically addresses the challenges that come with it,” Cuomo said.
In California, Gov. Gavin Newsom (D) warned that the state’s ICUs were already two-thirds full and could reach 112 percent capacity by mid-December.
In Ohio, hospitalizations have surged 200 percent since Nov. 1, said RJ Sontag, the president of the Emergency Medicine Residents’ Association. Sontag, a physician who works for Mid-Ohio Emergency Services, said his hospital has been receiving patients from other hospitals that have run out of room.
He said it is only a matter of time before his hospital is full, too.
“It’s an absolutely tragedy, and it’s getting harder and harder to cope,” he said. “As the months drag on, it’s becoming more and more difficult to realize you are the last person your patient is going to see before they go on a ventilator and that some of them are not going to wake up.”
This week, Rhode Island became the latest state to begin sending patients to a temporary field hospital because of rising demand for beds, as residents received an emergency alert on their phones warning them that hospitals were full.
Meanwhile, the White House on Tuesday stepped up its pressure on the Food and Drug Administration to quickly authorize Pfizer’s coronavirus vaccine. White House Chief of Staff Mark Meadows summoned FDA Commissioner Stephen Hahn to a meeting and demanded an explanation for why the agency was not moving faster on clearing the vaccine, according to a senior administration official who spoke on the condition of anonymity because he was not authorized to address the issue.
Hahn, in a statement issued before the meeting, said: “We want to move quickly because this is a national emergency, but we will make sure that our scientists take the time they need to make an appropriate decision. It is our job to get this right and make the correct decision regarding vaccine safety and efficacy.”
The recommendations from the Advisory Committee on Immunization Practices will be sent to CDC Director Robert Redfield, who also informs Health and Human Services Secretary Alex Azar. If the recommendations are approved, they will become official Centers for Disease Control and Prevention recommendations on immunization in the United States and provide official guidance to state officials, who are trying to meet a Friday deadline for vaccine distribution planning.
The decision on the highest-priority groups is known as Phase 1a. Residents and employees of long-term-care facilities were prioritized because they account for nearly 40 percent of covid-19 deaths. Health-care workers are on the front lines of the pandemic.
The committee voted 13 to 1 to prioritize the two groups. Helen Talbot, an associate professor of medicine at Vanderbilt University, was the sole dissenting vote. Unease over the recommendations centered on the inclusion of long-term-care residents, with several panel members saying there was insufficient vaccine safety and efficacy data to support immunizing that population right away.
Talbot said safety monitoring of people who have received the shots in these settings is inadequate.
“We hope it works, and we hope it’s safe,” she said of the vaccine.
Other members said they were reassured by the support of the recommendation from specialists in geriatric medicine.
Even as hospitalizations rise, President Trump and first lady Melania Trump plan to throw more than two dozen large, indoor holiday parties during December, according to White House officials with knowledge of the planning.
“Masks will be required and available, social distancing encouraged while on the White House grounds, and hand sanitizer stations throughout the State Floor,” said Stephanie Grisham, a spokeswoman for the first lady. “Guests will enjoy food individually plated by chefs at plexiglass-protected food stations. All passed beverages will be covered. All service staff will wear masks and gloves to comply with food safety guidelines. Attending the parties will be a very personal choice.”
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Ariana Eunjung Cha, Lenny Bernstein, Lena H. Sun and Jose A. Del Real