The nation's hospitals under siege
The rapidly spreading Omicron variant appears less virulent, but hospitalizations rise with the total case count
The surge in COVID-19 cases from the Omicron variant is threatening to overwhelm the U.S. health care system. While the unvaccinated account for most new COVID-19 hospitalizations, even people who’ve gotten their shots are getting severely ill if they are frail, elderly or suffer from diabetes, lung disease, dementia or other co-morbid conditions.
This latest hospitalization surge, like the two previous surges, is taking its greatest toll on poor, working class and minority communities. Rural areas are especially vulnerable, particularly in states where Republican leaders are actively spreading disinformation about vaccine safety and efficacy.
As the New York Times reported on Christmas Day, “low vaccination rates are still heavily concentrated in rural areas and the South, with Louisiana, Mississippi, Georgia, Arkansas and Alabama near the bottom. Those states have recorded around half of their population as fully vaccinated.”
Yet no area of the country is immune, not when just 62% of the nation is fully vaccinated and only 73% have received their first shot. Those levels are at least 10 percentage points below the vaccination rates achieved in every country in Western Europe and Northeast Asia (excluding North Korea).
So it came as no surprise on New Year’s Eve when the government reported more than a fifth of nation’s occupied intensive care unit beds contained COVID-19 patients. Overall, 78% of ICU beds are currently in use, which is comparable to the rates seen during the Delta surge last summer and during the peak of the first Covid surge a year ago.
ICU capacity again under strain
However, I noticed an interesting phenomenon when I disaggregated the numbers on the Johns Hopkins University COVID-19 tracking website (which I consider the most accessible source of such information in the country). The total number of Covid cases in ICU beds last week remains far below that original peak – just 18,133 patients on average versus 29,170 a year ago.
Staffed ICU beds on the decline
What happened? It turns out the nation’s 6,000 hospitals have 11,000 fewer staffed ICU beds today compared to January 2021. That number fell steadily over the past year, even as the number of ICU beds occupied by non-COVID patients ticked up slightly (44,322 beds occupied last week compared to 42,193 a year ago).
One can easily surmise what’s going on by reading recent headlines. There’s burnout and distress among hospital staff members, making it more difficult to replace critical staff — nurses in particular — who quit. There is the ongoing financial stress on fee-for-service dependent hospitals, which are still losing revenue from the COVID-related decline in discretionary tests, procedures and surgeries.
And there is an inexplicably high rate of non-vaccinated personnel at hospitals. It turns out people who work in hospitals reflect the general population; are just as likely to dwell in the rightwing fever swamps of Fox News and social media; and are just as likely to rebel against government vaccine mandates.
In early November, the Centers for Medicare and Medicaid Services required any provider receiving federal funds vaccinate their entire staffs. It set a deadline of January 4, 2022, i.e., tomorrow.
Disease in the courts
Don’t hold your breath. In rapid fashion, 24 states sued to void the mandate. In late November a Louisiana federal court issued an injunction prohibiting enforcement anywhere in the country, including in the states that hadn’t sued.
In mid-December the New Orleans-based Fifth Circuit Court of Appeals, where 12 of 17 judges were appointed by Republicans including five by Donald Trump, voided that nationwide injunction. But the court left it intact in the states that brought the suit pending their appeal to the U.S. Supreme Court, which is slated for oral arguments later this week.
Health care institutions, and the people they normally care for, are paying the price for this resistance. Last week, the Cleveland Clinic had 4% of its staff out on sick leave due to Covid. Illinois Gov. J.B. Pritzker over the weekend issued a plea for hospitals to postpone non-emergency surgeries. The federal government has dispatched emergency personnel to Arizona and New Mexico to deal with the surge in hospitalized Covid-19 patients.
The Omicron variant, while more contagious, appears to be less virulent, especially for people who have been fully vaccinated. But as long as the total number of cases continues to mount, the number of people requiring hospitalization will rise right along with it. As Dr. Anthony Fauci told Face the Nation on Sunday, “that’s the reason why we’re concerned about stressing and straining the hospital system.”