Hospitals worry rising case counts will push them past breaking point

Hospitals increasingly are worried that a growing number of COVID-19 cases in several states will push them beyond their breaking point, even before the omicron strain really hits U.S. shores hard. 

Already dealing with depleted workforces, hospitals are juggling a continuing flood of patients infected with the still-dominant delta strain, along with more patients seeking attention for worsening conditions after delaying care earlier in the pandemic. 

Several states, particularly in the Northeast and Midwest, have called for support in recent days to alleviate the demand already pummeling hospitals ahead of the holiday season and any potential major spread of the omicron variant. 

Some public health experts worry that omicron could only make things worse, even in an optimistic scenario where the new variant doesn’t lead to deadly cases. 

“Some of our hospitals are already at breaking points, so anything additional on top of them will only make it worse,” said Leana Wen, an emergency physician and public health professor at George Washington University. 

Fourteen states report their overall inpatient bed capacity has surpassed 80 percent as of Monday, with Rhode Island, Maryland, Michigan and Massachusetts topping the list. More than half of states say their intensive care units are more than 80 percent full, according to Health and Human Services data. 

Nationwide, hospitalizations are climbing, with the seven-day average for daily hospitalizations approaching 66,000 as of Sunday in a 23 percent increase from two weeks earlier, according to data from The New York Times.  

Still, hospitals in some hot spots face even greater admission surges. Indiana’s largest hospital system requested help from the National Guard last week for most of its locations as hospitalizations for COVID-19 and non-COVID-19 patients “reach all-time highs” and demand “has never been greater.” 

“Managing those surges alongside all of the other incredibly vital reasons that patients come to the hospital — that’s what makes this moment different than earlier in the pandemic and every bit as challenging as all the other moments in the pandemic,” said Akin Demehin, the American Hospital Association’s (AHA) director of policy. 

Leaders in Minnesota hospitals took out a full-page newspaper ad on Sunday warning that they are “heartbroken” and “overwhelmed” as their beds fill to capacity during a COVID-19 surge.

New Hampshire and Maine officials also announced the National Guard’s deployment last week to assist with its overwhelmed hospitals. Massachusetts instructed its hospitals to further reduce elective procedures amid a “critical staffing shortage,” and Maryland directed its hospitals to update their emergency plans and maximize hospital bed capacity. 

Bob Atlas, president and CEO of the Maryland Hospital Association, said the state is trying to “avert a real crisis” as 85 percent of its inpatient beds are in use.  

“We’re already maxed out in terms of available space,” he said. “More importantly … staffing is strained to almost the breaking point. Most of our hospitals are keeping their capacity open with agency or travel personnel, which is extremely costly.” 

“We need everybody to help with this,” he said. “Particularly with Christmas, New Year’s coming up, the risks of overwhelming our hospital system a couple weeks later are really very real if people are not careful.”

Hospitals are not yet dealing with significant admissions related to the omicron strain, as the Centers for Disease Control and Prevention (CDC) estimates 99.9 percent of COVID-19 cases nationwide can be traced to the delta variant.   

It’s unclear if and how the omicron strain could affect the demand on hospitals. Preliminary data suggests that the omicron strain may cause less severe illness but could be more transmissible than the delta strain. 

“If omicron is both more contagious and more virulent, it would quickly overwhelm hospitals,” said Nancy Foster, the AHA’s vice president of quality and patient safety policy.  

“If it’s more contagious and not as virulent, it may fill hospitals … if it becomes widespread across the community,” she added.

Despite this data indicating a possibly less severe disease, Wen, of George Washington University, noted that a more contagious variant could ultimately lead to more infections and thus hospitalizations.  

“Just by sheer numbers, we could still end up having a large number of individuals getting severely ill and needing hospital care … even if it is a milder disease,” she said.  

But David Dowdy, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, said the omicron strain likely won’t overtake the delta variant in the next three to four weeks before the worst of the flu season.

“What we may see is kind of a prolonged, flattened peak, as opposed to a huge spike, which, again, on a national level would be a good thing,” he said. “The problem is that that prolonged peak may be hiding big spikes happening in certain cities, certain counties, one after the other.” 

Early data has indicated that the two-dose COVID-19 vaccines induce a lower antibody response to the omicron strain compared to previous variants, suggesting that more fully vaccinated and previously infected people could get infected.

But there’s a growing body of evidence supporting that booster doses provide significantly more protection against the strain. A quarter of the U.S. population has received a booster dose, CDC data shows, while 60 percent are fully vaccinated.

Although vaccines are expected to have waning immunity over time, with more people getting boosted and more vaccinations overall this winter, Dowdy said he doesn’t expect hospitalizations to reach last winter’s surge levels.

“It’s still uncertain how things are going to play out, but chances are, it’s not going to be as bad as last year,” Dowdy said. “So that uncertainty is not a reason to panic.”