More Americans are currently hospitalized with Covid-19 than at any previous point in the pandemic, a grim milestone indicating that the coronavirus pandemic is not slowing down in the U.S.
On July 22, 59,628 people in the United States were in the hospital after testing positive for the new coronavirus, according to the Covid Monitoring Project; That total exceeded the previous daily high of 59,539 on April 15, when the New York City area was the epicenter of the outbreak in the United States.
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Christina Animashaun / Vox
Covid-19 has migrated across the country to many more regions in the three months between those peaks. Hospitalizations were overwhelmingly concentrated in the Northeast in the spring, but now more than half of Covid-19 hospitalized patients (35,624) are in the South. The West has also seen the number of patients hospitalized with Covid-19 double since April, while the Northeast now accounts for less than 5,000 of the nearly 60,000 current hospitalizations.
“The hospitalization number is the best indicator of where we are,” Eric Topol, professor of molecular medicine and director of the Scripps Research Translational Institute, told Vox. “We are going to reach new heights in the pandemic that we have not seen before. Not that what we saw before wasn’t horrible enough. “
Growth has been fueled by accelerated spread in Arizona, California, Florida, Georgia, and Texas in particular. On April 15, when New York City hospitals were about to be overrun with Covid-19 patients, Texas had about 1,500 patients hospitalized with the disease. Today, more than 10,000 Texans are hospitalized with Covid-19.
Some areas are reaching an unfortunate turning point of hospitals stretched to full capacity, struggling to find beds in other Covid-19 patient facilities. Miami-Dade County reported this week that the number of patients needing ICU care had exceeded the number of beds available in the ICU. More than 50 hospitals across the state say they do not have beds available in the ICU.
The Texas Medical Center in Houston has already filled its usual non-pandemic ICU unit and has been forced to rely on its plans to increase capacity to handle patient load. Earlier this month, 10 of the 12 hospitals in the Rio Grande Valley reported that they were fully booked and that they needed to start transferring patients to hospitals in other parts of the state.
This, unfortunately, was to be expected. Almost all states currently experiencing an increase in new cases and hospitalizations began to relax their social distancing restrictions in May and June before complying with the government’s reopening guidelines of having sufficiently reduced the spread of the virus and adequately increasing its test and trace. New cases began to increase and hospitalizations continued a few weeks after that. Now deaths are rising again, reversing a steady decline that had started in early May.
Four million Americans have had confirmed cases of Covid-19. More than 143,000 of them have died. With hospitalizations reaching the new peak and several states still reporting thousands of new cases per day, experts say a difficult August and fall awaits us.
“We still have 91 to 92 percent of people who are still vulnerable, who have not been infected,” Topol said. “And that just shows how many more people can be injured. Obviously, many will not get sick as much, but many will. ”
The new hospitalization record, and the unsustainable pressure it is exerting on the healthcare system, is also a reminder of the importance of states implementing and applying measures such as mandatory face masks, and that the federal government solve testing problems. and contact tracking. . “It should be a bulletin of all the points to really take this into account because otherwise there is no limit to where this could go,” Topol said.
Hospitals are running out of staff, supplies and beds for patients with Covid-19
Hospitals in hot spots across the country are expanding and even maximizing their staff, equipment and beds, and doctors warn that the worst-case scenario of hospital resources overflowing is on the horizon if their states don’t get a better coronavirus control.
“With Covid, many times people who are not sick enough are still forced to back off, and unfortunately they can really get sick because we focus our efforts on people on the verge of death.” A doctor from the Banner Health system emergency room in the Phoenix metropolitan area, who asked not to be identified for fear of retaliation from his employer, told Vox recently.
Other doctors in Arizona, where 85 percent of hospital beds across the state were in use on Thursday, have said the shortage of resources means they will soon ration medical care, as doctors in Italy did.
“The fear is that we are going to have to start sharing fans, or we are going to have to start saying, ‘You give yourself a breather, you don’t.’ I would be very surprised if in a couple of weeks we didn’t have to do that,” says Murtaza Akhter, an emergency medicine physician at Valleywise Health Medical Center in Phoenix.
The rampant transmission of the virus in Arizona and the resulting pressure on hospitals are particularly irritating to some emergency rooms and ICU staff, who say they have to make on-the-go decisions that make them uncomfortable.
“Send people with Covid home with oxygen tanks because we don’t have the resources for them? This is something I have never done before in my life, ”says Akhter. “This is Crazy. And this is going to be even worse in a couple of weeks. So far we are trying to stay firm, but how long will it last?
The psychological cost, he says, is also severe.
“Getting out of a shift and saying ‘I’m losing hope’ is a dangerous place to be,” he says. “I don’t want to feel this way. And that’s because despite the horrible numbers, despite the fact that I’m still getting Covid cases [in the ER]Despite what we’ve been saying to the media from the front line, I drive home from work and literally see many people gathering together and at the grocery store without wearing masks. “
Texas hospitals say they are in better shape with personal protective equipment now than they were in March and April, but that could change as the crisis worsens. Roberta Schwartz, executive vice president of Houston Methodist, says her facilities have sometimes struggled to get gowns and sanitizing wipes. John Henderson, who represents a trade association for rural hospitals in the state, says he recently “received a couple of SOS calls.”
Staffing is a universal problem at critical points. Houston Methodist has already brought in nurses from other states and has asked their administrative staff with nursing certifications to start doing medical work again. Nurses are also asked to work longer and work night shifts.
Rural hospitals in Texas are not yet running out of beds, but they are running out of staff. These facilities can typically have five patients in a given unit, and hospitals have cared for them accordingly. But now there can be up to 20 patients.
“You are working with all the nurses as much as you can work with them and you are still not meeting the need,” says Henderson.
It is unclear where more staff could come from. The state has already sent around 2,300 volunteers to the Rio Grande Valley, one of the most affected areas in the state.
“Other areas request the support of the workforce,” says Henderson. “But there isn’t much more in terms of resources to send.”
Another concern is the fans. Rural Texas hospitals typically transferred their critically ill patients, the type that could be on a ventilator for days, to a larger hospital in the city. But because urban hospitals are already saturated with Covid-19 patients, there is nowhere for rural hospitals to send their patients. Instead, they are forced to support those patients, making their beds fill up even faster.
And while current coronavirus patients are younger than those seen in the spring, Henderson says that their hospitals don’t have enough nasal oxygen connections that are used to help those patients breathe on their own and prevent them from getting high. a respirator.
“They have proven effective, but everyone is trying to do it,” he says.
The Regional Medical Center in Imperial County, one of the largest Covid-19 hot spots in California right now, has already faced its worst-case scenario. Recently, the hospital saw its available fans drop to one.
Adolphe Edward, the hospital’s CEO, convened a makeshift committee to screen patients who currently use ventilators so they could prioritize if another patient in need comes through their door. They checked the lung capacity of the patients and considered whether they could risk removing one or two of them from the ventilator if necessary.
Fortunately, Edward discovered an alternative solution. He called another nearby hospital and asked if they had fans available. They had two, which they sent to El Centro. For now, the machines are still there, though Edward says he and the other hospital have kept in constant contact in case the fans need to be transferred again.
Daily deaths are rising again, but are still well below the previous peak.
While Covid-19’s daily hospitalizations hit a record on July 22, another key metric, daily deaths, 1,126, was still less than half of its May 7 peak of 2,742, according to the Covid Monitoring Project. However, the trend is ominous as daily deaths steadily decreased in mid-June and then began to increase again in early July.
On Thursday, Florida reported a new record number of deaths in a single day of 173. Texas reached its own respective record on Wednesday, with 193 deaths.
Given that many Covid-19 deaths to date have occurred among people who were hospitalized for weeks before succumbing, experts say they expect deaths to continue to rise in the coming days and weeks. However, they say fewer hospitalized people may end up dying in this summer stage of the pandemic compared to spring.
“Hospitalizations will undoubtedly be associated with more deaths or chronic diseases, but I hope the deaths are not as pronounced as in March and April,” Topol said. “And maybe that is because they are younger, sick and going to get ahead. Maybe it’s also because the treatments are improving, not just the drugs, but the whole approach. “
In general, he says, “the hope is that the relationship between hospitalizations and deaths is not as close as it was, but we have to watch this closely because that is the optimistic view.”
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