COVID surge overwhelms U.S. hospitals, causing fear of rations

The U.S. healthcare system has once again buckled under the weight of the COVID-19 surge, filling over 100,000 beds nationwide, and in some states “Crisis standards for care— A plan for last resort to distribute medical care during catastrophic events.

This idea is a disturbing sign of how the Delta variant cut through a wide area of ​​the country. It primarily sickens unvaccinated people and puts a strain on already depleted health care workers.

In the last few weeks, more than 10 states, from the southeast to the northwestern Pacific, have reached the highest hospitalizations for the Pandemic COVID-19. And the United States continues to have an average of more than 160,000 new coronavirus cases per day.

Many hospitals are “state-of-the-art”

“Given the level of our surge, we are in a very dangerous place,” he says. Dr. Bruce Siegel, President of America’s Essential Hospitals, an industry association representing hundreds of public hospitals.

“We are about to enter a critical standard of care. We hope we don’t reach that point, but that can happen very easily,” says Siegel. This is basically a roadmap for how to divide medical care in a fair way when resources are scarce.

There are national guidelines for crisis standards, but actual plans may vary by state, region, or agency. Declaring a crisis standard does not necessarily mean that the patient is completely denied care, but it gives the hospital flexibility as to who to prioritize and provides physicians with legal protection. increase.

For example, certain patients who are unlikely to survive may not be able to get a bed in the intensive care unit. Nurses may be required to treat far more patients than is usually considered safe. Patients may usually have to be discharged before returning home, and some patients who are usually hospitalized for inpatient care may have to be rejected.

Arizona needed to rejuvenate its plans early in the pandemic. And some states were on the verge of doing so last winter. These plans include A “scoring” system that assesses a patient’s viability It is based on the function of the brain, heart, kidneys or other major organs.

And even if the state slightly circumvents this worst-case scenario, doctors in the affected areas are in a way that bitterly reminds us of last winter, when the United States peaked with more than 120,000 hospitalizations. Says that serious stress on the patient inevitably affects the care of the patient

“Worse than ever”

The nurse was overwhelmed. Patients in the ICU are admitted to the emergency room. A doctor scrutinizing the state for the last bed. These are scenes that the emergency physician Kenneth Krel did not expect to deal with in late 2021 after the highly effective vaccine for COVID-19 became widely available.

“It’s getting worse than ever, and it looks like there’s no end at this point,” said Krel, who helps run the ICU in eastern Idaho. “Therefore, we never offer the usual standard treatments.”

In Idaho, Republican Governor Brad Little has called on National Guard and federal health workers to help understaffed hospital logistics and staffing to avoid critical activation of care standards.

Once crisis standards are in place, doctors will begin to make decisions about “who will receive the quickest treatment by viability,” with the goal of “saving the most lives,” Krel said. say. This applies equally to COVID-19 and non-COVID-19 patients, he says.

“There are major drawbacks,” says Krel. “We panic in the state. People will decide they can’t take care of it.”

As in the early days of the pandemic, an important limited resource is not a ventilator or physical space, but a trained healthcare professional. In fact, many hospitals have even fewer nurses, respiratory therapists, and doctors than they were on staff during the surge last winter.

“The staffing crisis is the worst ever,” said Essential Hospitals of the Siegel of America. There are hundreds of vacancies in the healthcare system that cannot be filled even if you pay the highest wages because “people aren’t there anymore”.

What’s more, many hospitals haven’t been disappointed after the COVID-19 surge last winter. They have been busy because so many patients were coming to delay treatment, he says.

In Alabama, Republican Governor Kay Ivy State of emergency This is due to a surge in serious COVID-19 cases last month. “Currently, it has a huge impact on all healthcare and is fragmented,” he said. Dr. Arna Arora, President of the Alabama Medical Association.

“Everyone is a short nurse,” says Arora. “EMS response times are much slower. Patients have to wait longer in the ER.”

“A decision from the ground up” on the horizon

He says it is important to have such a plan in place, even if the hospital does not need to activate the crisis management protocol. Dr. Eric TonerHe is a senior scholar at the Johns Hopkins Health Security Center and has assisted in designing guidance on state and healthcare system crisis standards.

“In the absence of declarations and plans, only doctors and nurses are left to make decisions that undermine these guts,” says Toner.

Toner says everything needs to be done to avoid a transition to crisis standards, but he is currently in a state of “chaos” in many places and the kind of kind needed to keep this worst-case scenario away. I am worried that I am having a hard time making adjustments.

“Even outside the state, individual doctors are trying to call other hospitals to transfer patients, but that shouldn’t happen,” he says. “We don’t have a good balance of patients between hospitals. We don’t share resources properly.”

In New Mexico, the surge has created a waiting list for ICUs, and state health officials need to immediately adopt critical standard treatment if the infection trajectory simply remains the same, rather than rising. I warn you that it may be.

Last winter experience helped some hospitals prepare

However, at least some hospitals in the state feel more equipped to deal with surges than last winter.

Dr. Jason MitchellPresbyterian, chief medical officer of Presbyterian, New Mexico’s largest medical system, has extensive experience managing COVID-19 pressure last year, so “optimistic” hospitals do not need to implement crisis plans. It states.

“We were able to overcome this stage of the pandemic and still maintain that standard of care,” he says. “That is, people work harder and work longer.”

Other states may also be taking breaks. According to the latest modeling According to the Institute for Health Metrics at the University of Washington, some of the hardest-hit states may have peaked in hospitalizations and cases, especially in parts of the South, such as Florida and Texas.

However, in many other parts of the country, hospitalizations may continue to increase, with the United States projected to peak at around 116,000 in hospitals by mid-September, researchers say. ..

According to the model, ICU capacity is exposed to “extreme stress” in states such as Tennessee, Kentucky, Indiana, Hawaii, Georgia, Delaware, and Wisconsin.

ArimokudadA member of the University of Washington team, says it’s understandable that some hospitals in the United States are currently struggling.Many Americans have not yet been vaccinated and the Delta variant has changed the dynamics of the United States

“No one expected a surge in the summer. We expected a surge in the winter,” says Mokudad. “And, including most hospitals, we all said,’Get ready for the winter for the flu and COVID.’ Well, it hit us before that. “

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