COVID-related hospitalizations in US hit record high: Gunshots

A medical worker puts on a mask before entering a negative pressure room with a COVID-19 patient in the intensive care unit at UMass Memorial Medical Center in Worcester, Massachusetts, last week.

Joseph Prezioso / AFP via Getty Images

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Joseph Prezioso / AFP via Getty Images

A medical worker puts on a mask before entering a negative pressure room with a COVID-19 patient in the intensive care unit at UMass Memorial Medical Center in Worcester, Massachusetts, last week.

Joseph Prezioso / AFP via Getty Images

The omicron-induced surge has skyrocketed COVID-19-related hospitalizations in the United States, reaching a new pandemic high this week with 145,982 hospital patients.

This exceeds the previous record recorded in January of last year, according to data tracked by the Department of Health and Social Services, from more than 5,400 hospitals nationwide.

COVID patients now occupy around 30% of intensive care beds nationwide, and COVID pediatric hospitalizations are also at the highest rate in the pandemic.

The record numbers are a sign of how quickly the omicron variant has spread across the country. Overall, infections are also at record levels, with the United States recording an average of more than 700,000 new cases per day.

And researchers and health workers are warning that overcrowded conditions could lead to an increase in preventable deaths, as clinicians struggle to provide the level of care they would normally have.

“Things are looking bleak and considerably worse in many ways than just a year ago,” said Dr. Doug White, an intensive care physician in the University of Pittsburgh School of Medicine.

Warnings of a crisis from state leaders and hospitals

Hospitals are under stress across the country from Maryland to Missouri where the number of people hospitalized with COVID-19 has exceeded or is approaching previous highs. State and hospital leaders and healthcare workers are issuing some of the pandemic’s most dire warnings.

“We are closer to a crisis situation than ever before,” said Dr John Lynch of UW Medicine in Seattle at a recent press briefing.

In Maryland, Governor Larry Hogan, who declared a state of emergency, said last week that the coming weeks would be “the most difficult time in the entire pandemic.”

Arizona healthcare workers are warning state leaders the healthcare system is on the verge of “collapsing.”

“We have had more events where people have cardiac arrests, or decompensate and get very sick and even die in waiting rooms,” Dr Bradley Dreifuss, an emergency physician from Tucson, Ariz., told reporters Friday.

Governors across the country are mobilizing members of the National Guard to bolster besieged hospitals, including in Ohio.

“The hospital is packed to the brim,” said Dr Kristin Englund, infectious disease physician at the Cleveland Clinic. “Our intensive care units are full, our regular hospital beds are full, and much of it is COVID.”

Overcrowded conditions lead to worse outcomes

The medical consequences of this latest wave could affect any American who needs medical attention, whether it’s for COVID-19 or another acute illness or injury, as research shows that when hospital admissions reach crisis levels , more patients are dying.

“When hospitals are overcrowded, everyone suffers,” White says.

Prior to the omicron coup, many US hospitals were already faltering over strong demand for patients infected with the delta variant, as well as patients seeking care due to treatment that had been postponed earlier in the pandemic. In addition, the shortage of health workers had reached critical levels. And now a large number of doctors, nurses and other healthcare workers are also testing positive and missing, just as they are most needed.

Following patterns seen in other countries, there are early signs in the United States that omicron is causing less severe disease than the delta variant. Some hospitals are finding that fewer patients need intensive care or mechanical ventilation – a welcome sign.

“But the problem is that [omicron is] if communicable, the number of cases is going to be so high, ”says Dr. Sameer Kadri, infectious disease and critical care specialist at the National Institutes of Health Clinical Center.

The extreme contagiousness of Omicron, when associated with a depleted healthcare workforce leaves hospitals unable to provide the same level of care to patients as they normally would.

Kadri and his colleagues studied previous outbreaks and found that one in four deaths from COVID-19 was potentially caused by overpopulation. In the most overwhelmed hospitals – where the demand for ventilators and other resource-intensive care was highest – the risk of death for COVID-19 patients doubled.

“What surprised me was the magnitude of the impact,” says Kadri, lead author of the study published last fall. “There are fewer eyes, fewer hands, and for those patients who require high-precision care, that could mean the difference between life and death.”

“There is rationing every day at the moment”

Much of this breakdown in care takes place out of sight for most Americans, but front-line physicians like Dr White of Pittsburgh see deadly consequences every day.

“We got a call from an out-of-state hospital with a patient who had acute kidney failure and needed dialysis to replace kidney function in order to survive,” White said. “We had no beds.”

No other hospital either. “This patient died in the hospital that didn’t have that kind of basic therapy that we give patients all the time – dialysis,” he says.

“These are very real, real-life examples of patients who are currently dying in high quality US hospitals because they cannot be transferred to higher levels of care,” he adds. “And the same thing happens for patients with acute heart attacks or acute strokes.”

State agencies and hospitals have protocols for what to do when patient demand threatens to exceed hospital capacity.

These protocols, called “Crisis Care Standards”, help triage patients and guide decisions about who receives care and who does not in disasters, epidemics, or large numbers. of victims. Crisis standards can help determine how to allocate equipment such as ventilators or drugs such as monoclonal antibodies and activate systems to transfer patients between hospitals in states or regions. In the current wave, some hospitals have activated their crisis plans, including those in Maryland.

White says more health officials need to follow suit and admit that much of America’s healthcare system is already functioning in de facto crisis mode, whether or not they officially made that statement.

“There is a huge disconnect between what is real and what is in the public consciousness, and what, in my opinion, many state governments are ready to recognize,” he says. “The simple reality is that there is daily rationing right now in American medicine.”

This rationing occurs in many ways and may not be obvious to the public, but the consequences are very real: one nurse forced to care for more patients per shift than is safe; canceled or delayed procedures and surgeries; and life-saving care that is simply not available to those in need.

COVID patients aren’t the only ones suffering

Some epidemiologists predict that the total number of cases will peak this month. However, hospitalizations for COVID-19 tend to drag infections by around two weeks, meaning hospitals need to prepare for more patients in the weeks to come, even after infections have peaked and started. to lower.

Surges affect all kinds of patients, not just those with coronavirus. One study found a significant increase in overall mortality when patients were admitted during COVID-19 outbreaks.

For 30 of the most serious conditions – stroke, heart attack, gastrointestinal bleeding – mortality increased by almost 1% in outbreaks at the start of the pandemic. That’s the equivalent of one in every 100 additional patients dying under these conditions, if the hospital did not cope with an influx of patients, says Dr Amber Sabbatini, assistant professor of emergency medicine at the University of Washington.

“It’s a substantial increase,” she said. “If the units are stressed by COVID patients, they can reach a patient with heart failure or a septic patient less quickly. “

While the study could not determine why these patients died, Sabbatini says the exhaustion of healthcare workers who care for patients day in and day out – often without sufficient help or with new staff who do not is unfamiliar – can inevitably affect care.

“The impacts on the staff who take care of these patients, this cognitive burden, this emotional burden is very high,” she says. “So there are these subtle, difficult-to-test factors that could explain why patients are receiving poorer quality of care or not performing as well as they are. [normally] would like.”

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