How U.S. Hospitals Are Too Small For Covid-19

Tracy Fine lay on a stretcher in the corridor of the emergency room for 13 hours with intolerable pain with lesions on her face and scalp.

The hospital bed in Madison, Wisconsin was full of Covid-19 patients around her. Her nurse was so rushed that she couldn’t remember her condition, and the staff took time to bring her painkillers and food.

In a small rural hospital in Missouri, Shain Zundel’s severe headache was found to be a brain abscess. His condition usually required surgery within a few hours, but he was forced to wait a day while doctors struggled to find a bed with a neurosurgeon — eventually in Iowa. At a hospital 375 miles away.

From New Mexico to Minnesota to Florida, hospitals are flooded with a record number of Covid patients. Small hospital staff had to repeatedly ask large medical centers to accept another and another patient, but many large hospitals severely restricted the transfers they accepted and their own. The hall and ward are overflowing.

In the spring, the pandemic focused primarily on hit areas like New York and offered lessons to hospitals in other states in anticipation of the spread of the virus. However, despite months of planning, many of the country’s hospital systems are now plagued by a tremendous swell of patients, a lack of available beds, and a growing shortage of nurses and doctors. .. Some hospitals had to reject forwarding requests in the event of an emergency treatment or emergency.

In addition, rising infection rates for nurses and other frontline workers have doubled the burden on standing patients.

With pandemics continuing to hit cities and rural areas across the country, with a total of 13 million cases so far this year, hospitals across the country are endless. Public health experts also warn that holidays could accelerate the pace of infections, which are already changing rapidly, and further increase the demand for hospital beds and medical care.

A record number of Americans — 90,000 — Currently hospitalized at Covid, And a new case was climbing to Almost 200,000 every day.

Dr. Michael Osterholm, a member of President-elect Joseph R. Biden’s Covid-19 Advisory Board, said the healthcare system is “on the verge of collapse.” With a podcast this month.

Dr. Osterholm did not understand how dire the situation was for the general public, saying, “When people are dying, they sit in the waiting room chairs of the emergency room for 10 hours to secure a bed. You may only respond if you can’t find a bed, and they die. “

When Fine went to UW Health’s college hospital in Madison, she found the doctor overwhelmed and distracted there. “They just parked me in the hallway because I didn’t have a place to go,” said Fine, 61, who was finally found to have a severe bout of shingles that threatened her eyes. Said.

She missed an annual health checkup and shingles vaccination due to a pandemic.

As he entered the temporary room with the curtains that separate the beds, Fine saw the confusion around him. The nurse didn’t know who she was and asked if she had a hard time walking or if she heard a grunt in her ear. “I was completely absorbed in her,” Fine recalled, but the staff added, “I was kind, compassionate, and did my best in a terrifying situation.”

Hospital workers I submitted a petition It appeared in the Wisconsin Journal as a two-page ad last Sunday, asking state residents to help prevent further spread of the virus.

“Without immediate changes, our hospital will be full to treat anyone infected with the virus or any other illness or injury,” they warned. “Soon you or your loved one may need us, but regardless of Covid-19, cancer, heart disease or other urgent conditions, we need the life-saving medical care you need. As a healthcare provider, we are afraid that it will become a reality. “

UW Health declined to comment directly on Fine’s experience, but acknowledged the tension caused by the pandemic. Dr. Jeff Pothoff, Group’s Chief Quality Officer, said patients sometimes boarded emergency rooms even before the new coronavirus surged, but now the occupancy is “ultra-high.”

“We’re starting something we’ve never been to before,” UW Health said, including including primary care and attending family doctors to treat critically ill patients in hospitals. “It works, but it’s not great,” he said.

Hospitals in St. Louis have been hit particularly hard in recent weeks, said Dr. Alexander Garza, chief community health officer at SSM Health, a Catholic hospital group. He is also responsible for the regional task force for viruses. Last month, SSM Health discharged about 50 patients who could not be treated immediately.

And nurses, already one of the most vulnerable groups to infection, are adding more and more time to the shift.

Hospitals relocate nurses from pediatrics to adult intensive care units, doubling patients in one room and requiring nurses who usually treat two critically ill patients at a time to cover three or more He said.

“If you can’t spend a lot of time and resources on them, obviously they aren’t getting the best care,” Dr. Garza said.

Consuelo Vargas, a nurse in the Chicago emergency room, says patients will stay in the emergency room for days because the ICU is full. The shortage of nurses has a chain effect. “It leads to increased patient falls, which leads to bedsores, which leads to delayed patient care,” she said.

There is basically a shortage of personnel, beds and protective equipment available.so Press conference held by the National Nurses UnitedThe union, Vargas, said he did not yet have enough protective equipment like the N95 mask and had to buy it himself.

Several hospitals have participated in sounding alarms: Insufficient supply of test kits, masks and gloves.

Dr. Osterholm said the country never completely caught up with the previous shortage. “We just hit the wall from a PPE perspective,” he said.

Even if hospitals in some cities appear to have ample physical space, or can quickly build new units or set up field hospitals, staff shortages offset the benefits of expansion.

“Beds don’t care for people. People do care for people,” said Dr. Mark Harrison, CEO of Intermountain Healthcare, a vast system of hospitals and clinics based in Salt Lake City. I did.

At any point in the last few weeks, a quarter of Intermountain nurses have been out. I was infected with the virus because I was ill, quarantined, or cared for my family. Nursing students have been given temporary licenses from the states to fill the gap, and the hospital system is struggling to catch travel nurses who are in high demand and costly to hire in many states.

To relieve pressure on large hospitals, Intermountain maintains more patients in smaller centers and is remotely monitored by large hospital specialists who consult with local doctors via remote links.

Small hospitals are under great stress. “We don’t have an intensive care unit. We don’t do surgery here. Covid’s case,” said Tony Keane, chief executive officer of Sullivan County Memorial Hospital, a 25-bed licensed regional hospital in Milan, Missouri. It puts a heavy burden on our abilities. “

His small hospital usually has less than half a dozen patients on a busy day, but now it has the potential to treat twice as many. About a quarter of the hospital’s 100 employees, including Keane, have been infected with the virus since March.

“It’s a daily and hourly struggle to make sure the hospital has enough staff,” he said. Hospital nurses, who typically work in 12-hour shifts three times a week, make five to six shifts a week.

“We are here ourselves,” Keane said. “We don’t have a large system to send us money.” The hospital used federal Covid aid to invest in a medical gas line so that it could oxygenate patients. ..

Most sick patients still have to be transferred, but larger hospitals 35 miles away are flooded with their own large numbers of Covid patients, reducing staff levels.

Even if local hospitals are discussing how to deal with the overall surge in hospitalization weekly, if not daily, few can afford the ever-growing number of areas. Many people reduce or stop offering selective surgery and procedures.

Nancy Foster, Vice President of Quality and Patient Safety Policy at the American Hospital Association, said: “We are concerned about the surge we are seeing right now. Patients in need of special treatment can usually be sent to nearby urban areas, but” in many cases these referrals The center is full or almost full, “she said.

Mr. Zundel’s case was a matter of life and death. He had a debilitating headache and “couldn’t work at all,” he said. A large hospital nearby was flooded with patients, so his wife, Tessa, took him to a small hospital in the countryside of Missouri for immediate medical attention. Doctors there realized he had a brain abscess, but couldn’t quickly find a medical center to treat him.

“He was dying,” his wife said. Some hospitals had beds, but no neurosurgeons were available. The staff was trying to find a place to have surgery all day long.

“They just called until they found a solution,” she said. “They didn’t give up.”

The 48-year-old Zundel was finally taken to the University of Iowa Hospital and Clinic, where neurosurgeon Dr. Matthew Howard performed surgery.

But Iowa is also keeping patients away, Dr. Howard said. “In the early days of the crisis, we were hit by PPE limits. Now the problem is that the beds are full,” he said.

Dr. Dixie Harris, Intermountain’s critical care specialist, volunteered in New York City during a pandemic last spring. Doctors can now better treat the virus and predict the course of the disease, she said.

However, they are also very thinly stretched and take care of Covid patients in addition to normal patients. “Almost no one is on a real vacation,” she said. “People are really tired.”

And re-hospitalization or the prolonged health problems of Covid’s “long-haul carriers” exacerbated the enhanced regimen for health care. “Not only do we see the tsunami coming, but the reverse wave comes,” Dr. Harris said.

Some healthcare professionals say they feel abandoned. Leslie McCamy, a nurse in Bismarck, North Dakota and a member of the National Nurses United, said: “Nurses have been screaming for months that this is a problem and we are not really rescued.

“We work overtime. We do a few different jobs,” she said. “We really feel that tension.”