Winter COVID-19 wave poses threat to nation’s hospitals

Coronavirus hospitalizations are rising in the United States as a wave builds ahead of winter, threatening to overwhelm hospitals in some areas. 

Several major European countries currently have even worse outbreaks than the U.S., but former Food and Drug Administration Commissioner Scott Gottlieb warned Wednesday that the U.S. is on a trajectory to match them in about three weeks. 

Already, hospitals in some areas of the U.S. are showing strain given the ever-mounting rise in cases and hospitalizations, which are not showing any signs of slowing down. 

In El Paso, Texas, authorities are setting up a field hospital at the convention center to help deal with the surge in hospitalizations. In Utah, the head of the state hospital association told The Salt Lake Tribune that hospitals are on a trajectory to soon have to start rationing care.

“Our hospitals cannot keep up with Utah’s infection rate,” Gov. Gary Herbert (R) tweeted Thursday. “You deserve to understand the dire situation we face.” 

Kootenai Health, a hospital in Idaho, warned in a statement last week that it was 99 percent full, and that many hospitals in the area were not accepting patients to be transferred because they are also at capacity. 

“Hospital capacity is going to be a paramount concern,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. While hospital treatment for coronavirus has improved since the early days of the pandemic, with new drugs available like remdesivir and dexamethasone, and improved knowledge among doctors, once capacity is overwhelmed, that is no longer true. 

“When hospital capacity is compromised, we know that care will decline,” Adalja said.

Hospitalizations nationally have risen to about 45,000 people, up from around 30,000 at the beginning of the month. Those numbers are still rising, according to the COVID Tracking Project. 

France and Germany announced partial lockdowns on Wednesday, a sign of the worsening situation there.

Such drastic measures are not expected on a national level in the United States, though experts expect many states and localities will have to implement at least targeted measures like closing bars and indoor dining as the situation worsens. 

The surge occurs just days ahead of Election Day, as President Trump continues to downplay the virus. He has mocked the idea of wearing a mask, and said that more testing makes the country look bad by identifying more cases, while calling to “open our country.”

White House chief of staff Mark Meadows even said “we’re not going to control the pandemic” on CNN on Sunday. 

Democratic nominee Joe Biden is pushing for the federal government to take a much more active role in ramping up testing, calling for governors to impose mask mandates and publishing “evidence-based national guidance” on when businesses should open or close based on infection rates in the area. 

Many experts are calling for mask mandates at a minimum, and say closing places like bars and indoor dining can also help. 

“Bars and indoor dining are probably one of our riskier places,” said Jodie Guest, an epidemiologist at Emory University, adding that household gatherings should also generally be kept below 10 people. 

As hospitals fill up, they are urging people in the community to take precautions like mask-wearing, washing hands and avoiding crowded places to slow the spread of the virus. 

Elizabeth Middleton, a pulmonologist with the University of Utah hospital system, said “it’s kind of like a kick in the teeth” when people do not wear masks. 

She said the hospital has had to set up surge ICU capacity to deal with the influx of patients, and while they are not overwhelming capacity yet, “of course I’m worried we’re gonna get there.”

“It’s like being in a washing machine. You jump in, everything is spinning, and then you come out just haggard,” she said. 

Carrie Kroll, a vice president at the Texas Hospital Association, said hospitals in El Paso and the western part of the state are being strained most right now, but “it’s not just going to be in that area for much longer.”

Hospitals are doing “innovative things” to try to get by at the moment, Kroll said, like moving some adult non-COVID patients into a children’s hospital in El Paso to free up space at other facilities. 

“We are aware that certainly at some point you could get to the point where there’s so many patients that you start to bridge that capacity issue. We’re just sort of unwilling to throw in the towel,” she said. 

One bright spot is that personal protective equipment shortages that plagued hospitals in the early days of the pandemic have significantly declined. “Thankfully that hasn’t been an issue,” Kroll said. 

While Europe has now seen a surge in cases, with its current outbreak surpassing the United States, the U.S. still has some of the worst numbers in the world for cases and deaths, and remains significantly ahead of Europe in cumulative per capita deaths. 

In fact, the U.S. is 11th in the world for coronavirus deaths per capita, according to data from Johns Hopkins University. 

While Europe and the U.S. are both seeing renewed surges now, some countries have been able to keep the virus suppressed, most notably South Korea, with an extensive testing system, and New Zealand, with a quick lockdown that helped cut off transmission and allowed reopening. 

“We’re about maybe three weeks behind Europe, maybe a month at the most, so we’re on a trajectory to look a lot like Europe as we enter the month of November,” Gottlieb said on CNBC. “So I think things are going to get worse.”