This piece by Ed Yong at the Atlantic is kind of terrifying. This country is just not prepared for the hell we are about to go through with this pandemic. And the people on the front lines who are tasked with getting us through it are already burned out and pushed to their limits:
In the months since March, many Americans have habituated to the horrors of the pandemic. They process the election’s ramifications. They plan for the holidays. But health-care workers do not have the luxury of looking away: They’re facing a third pandemic surge that is bigger and broader than the previous two. In the U.S., states now report more people in the hospital with COVID-19 than at any other point this year—and 40 percent more than just two weeks ago.
Emergency rooms are starting to fill again with COVID-19 patients. Utah, where Nathan Hatton is a pulmonary specialist at the University of Utah Hospital, is currently reporting 2,500 confirmed cases a day, roughly four times its summer peak. Hatton says that his intensive-care unit is housing twice as many patients as it normally does. His shifts usually last 12 to 24 hours, but can stretch to 36. “There are times I’ll come in in the morning, see patients, work that night, work all the next day, and then go home,” he told me. I asked him how many such shifts he has had to do. “Too many,” he said.
Hospitals have put their pandemic plans into action, adding more beds and creating makeshift COVID-19 wards. But in the hardest-hit areas, there are simply not enough doctors, nurses, and other specialists to staff those beds. Some health-care workers told me that COVID-19 patients are the sickest people they’ve ever cared for: They require twice as much attention as a typical intensive-care-unit patient, for three times the normal length of stay. “It was doable over the summer, but now it’s just too much,” says Whitney Neville, a nurse based in Iowa. “Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” I asked her how much slack the system has left. “There is none,” she said.
The entire state of Iowa is now out of staffed beds, Eli Perencevich, an infectious-disease doctor at the University of Iowa, told me. Worse is coming. Iowa is accumulating more than 3,600 confirmed cases every day; relative to its population, that’s more than twice the rate Arizona experienced during its summer peak, “when their system was near collapse,” Perencevich said. With only lax policies in place, those cases will continue to rise. Hospitalizations lag behind cases by about two weeks; by Thanksgiving, today’s soaring cases will be overwhelming hospitals that already cannot cope. “The wave hasn’t even crashed down on us yet,” Perencevich said. “It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.”
In the imminent future, patients will start to die because there simply aren’t enough people to care for them. Doctors and nurses will burn out. The most precious resource the U.S. health-care system has in the struggle against COVID-19 isn’t some miracle drug. It’s the expertise of its health-care workers—and they are exhausted.
He notes that there have been many improvements in testing and care for COVID patients than there was in the spring but the numbers are so daunting that those improvements will not be able to stop the rising death count.
Intensive-care units are called that for a reason. A typical patient with a severe case of COVID-19 will have a tube connecting their airways to a ventilator, which must be monitored by a respiratory therapist. If their kidneys shut down, they might be on 24-hour dialysis. Every day, they’ll need to be flipped onto their stomach, and then onto their back again—a process that requires six or seven people. They’ll have several tubes going into their heart and blood vessels, administering eight to 12 drugs—sedatives, pain medications, blood thinners, antibiotics, and more. All of these must be carefully adjusted, sometimes minute to minute, by an ICU nurse. None of these drugs is for treating COVID-19 itself. “That’s just to keep them alive,” Neville, the Iowa nurse, said. An ICU nurse can typically care for two people at a time, but a single COVID-19 patient can consume their full attention. Those patients remain in the ICU for three times the length of the usual stay.
Nurses and doctors are also falling sick themselves. “The winter is traditionally a very stressful time in health care, and everyone gets taken down at some point,” says Saskia Popescu, an infection preventionist at George Mason University, who is based in Arizona. The third COVID-19 surge has intensified this seasonal cycle, as health-care workers catch the virus, often from outside the hospital. “Our unplanned time off is double what it was last October,” says Allison Suttle of Sanford Health, a health system operating in South Dakota, North Dakota, and Minnesota. Many hospitals have staff on triple backup: While off their shifts, they should expect to get called in if a colleague and their first substitute and the substitute’s substitute are all sick. At least 1,375 U.S. health-care workers have died from COVID-19.
The first two surges were concentrated in specific parts of the country, so beleaguered hospitals could call for help from states that weren’t besieged. “People were coming to us in our hour of need,” says Madad, from NYC Health + Hospitals, “but now the entire nation is on fire.” No one has reinforcements to send. There are travel nurses who aren’t tied to specific health systems, but the hardest-hit rural hospitals are struggling to attract them away from wealthier, urban centers. “Everyone is tapping into the same pool, and people don’t want to work in Fargo, North Dakota, for the holidays,” Suttle says. North Dakota Governor Doug Burgum recently said that nurses who are positive for COVID-19 but symptom-free can return to work in COVID-19 units. “That’s just a big red flag of just how serious it is,” Suttle says. (The North Dakota Nurses Association has rejected the policy.)
Short-staffed hospitals could transfer their patients—but to where? “A lot of smaller hospitals don’t have ventilators or staff trained to take care of someone in critical condition,” says Renae Moch, the director of Bismarck-Burleigh Public Health, North Dakota. “They’re looking to larger hospitals,” but those are also full.
Making matters worse, patients with other medical problems are sicker than usual, several doctors told me. During the earlier surges, hospitals canceled elective surgeries and pulled in doctors from outpatient clinics. People with heart problems, cancers, strokes, and other diseases found it harder to get medical help, and some sat on their illness for fear of contracting COVID-19 at the hospital. Now health-care workers are facing an influx of unusually sick people at a time when COVID-19 has consumed their attention and their facilities. “We’re still catching up on all of that,” says Choo, the Oregon physician. “Even the simplest patients aren’t simple.”
We practice sophisticated medicine in America but it’s only as good s the people who administer it. And we’re running them into the ground. On top of that Trump is out there saying they’re all a bunch of greedheads who are inflating the numbers in order to make more money.
It’s a recipe for disaster this winter.
For more information on how the pandemic is being spread, read “This overlooked variable is key to the pandemic.” It’s fascinating. This pandemic is different than others and our approach to containing it needs to be different as well.