COVID-19 has brought health care system to ‘the brink of failure,’ doctors say

A physical therapist at a hospital in Madison, Wis. (Daniel Acker/Reuters)

The U.S. recorded more than 1 million cases of COVID-19 in the last seven days, Johns Hopkins University data shows, which is more than any other week since the pandemic began. There are 80,000 people currently hospitalized with COVID-19 and over 15,000 of these individuals are currently in intensive care units (ICUs) with nearly 5,000 on ventilators. These numbers are prodigious and make it clear to experts in the medical field that catastrophe in the health care world is not imminent — it has arrived.

“The health care system is overwhelmed and it is on the brink of failure,” says Dr. Kevin Doerschug, medical director of the University of Iowa’s medical intensive care unit. It’s an emergency that concerns not only shortages of staff and supplies, but of space. Based on data from COVID Exit Strategy, at least 30 states are using 70 percent or more of their hospital beds as of this week, and 29 are reporting ICUs with 25 percent capacity or less. Hospitals in Colorado, New Mexico, Indiana and North Dakota have reported either being on the verge of running out of beds or are already there.

“I’m not going to put them back out on the sidewalk”

In Iowa, where the COVID-19 positivity rate is now 50 percent — the fourth highest in the U.S. — the ICUs are listed as 80 percent full. Doerschug, who sees patients daily at the University of Iowa, suspects that it’s even worse. “Southeastern Iowa is full,” he tells Yahoo Life. “We’ve had institutions trying to transfer patients here and they say that we’re the 14th hospital they’ve called.” Doerschug says his 26-bed ICU was expanded to 36 beds on Monday, but reached capacity soon after. “We had one open bed this morning.”

Dr. Thomas Benzoni, an emergency medicine physician in Des Moines, agrees the scenario many feared would come is here. “When you see hospitals saying that they’re at capacity, that means that they have exceeded their capacity,” Benzoni tells Yahoo Life. “They’re in crisis mode.” One of the ways hospitals are coping is by increasing what’s called “ER boarding,” meaning holding patients in emergency rooms to wait for a bed.

But this isn’t a great solution either. “When you’ve determined that this patient needs to be admitted, where are you going to send them?” asks Benzoni. “I’m not going to put them back out on the sidewalk, they have to be somewhere. But there aren’t any inpatient beds for them yet because we are at or beyond capacity, so they sit in my ER.” Because the ER is staffed with nurses who are trained in emergency medicine, not intensive care, Benzoni says that “the problem becomes very complex.”

Doerschug adds that hospitals that exceed capacity have to ask medical staff to take on more risks. “When hospitals are stretched beyond their capacity, things can get more dangerous,” he notes. “It can be very nerve-wracking for a nurse that’s never been in an ICU to then be expected to take care of very complex, very sick patients. That anxiety itself can be dangerous. When you’re anxious, mistakes will happen. And the more overwhelmed the system is, the more likely those mistakes are to happen.”

“It’s scary. It’s … what happens next?”

Iowa is far from the only state in which hospitals are scrambling to keep up with the rising need for beds. A similar scene is playing out in Wisconsin, where more than 70 percent of hospital beds are full. In an attempt to prepare for more cases, Wisconsin officials have set up an alternative-care facility at an exhibition center outside Milwaukee called Wisconsin State Fair Park, where 23 patients are currently being treated.

Oguzhan Alagoz, a professor at the University of Wisconsin-Madison who models the spread of infectious disease, says that in the wake of a spike in infections, hospitalizations will follow. While some have suggested that the lag time between COVID-19 cases rising and hospitalizations is 12 days, Alagoz believes the impact may come sooner. “My guess is it could be between five days to 10 days,” he posits.

Although his state is being hit particularly hard, Alagoz is most worried about North and South Dakota, two of the places where the virus has taken off. In South Dakota, ICUs are 83 percent full and averaging 1,400 new cases a day. Deb Fischer-Clemens, president of the South Dakota Nurses Association in Sioux Falls, is hopeful that they will find a way to keep treating patients, but she’s concerned. “We still have some levers to pull,” she believes, “But it’s scary. It’s…what happens next?”

Fischer-Clemens says that hospitals have had to get creative by “eliminating all surgeries” for a few days to free up nurses or open up makeshift ICUs in areas that were previously closed. But she worries that many health care workers are reaching a breaking point. “One of the concerning things I hear is, ‘How much longer can we keep doing this?’” says Fischer-Clemens. “It’s not just nurses, it’s the respiratory therapist, it’s the social workers, it’s the housekeepers, it’s everybody in the hospital that is on the frontlines.”

“The crisis starts now”

In Illinois, hospitals remain under 70 percent capacity — but with more than 600,000 cases in the state, doctors have already had to make adjustments. For example, one of the largest health systems in Illinois is canceling elective surgeries this week, Dr. Vineet Arora, a hospitalist at the University of Chicago Medicine and founder of IMPACT (Illinois Medical Professionals Action Collaborative Team) discloses, which is important to call out because that means people can’t get the care they need. Several hospitals in Chicago reportedly delayed elective surgeries this week, surgeries that Arora argues are often, unlike the designation implies, medically necessary.

“The last thing that you want is for somebody to die in the community because they were too afraid to come to the hospital or unable to get the care they need,” says Arora. “That’s why the crisis starts now because you have to turn away some patients, some patients get afraid and don’t come and then also you’ve got this onslaught of COVID patients that you’re trying to care for the best that you can with the staff that you have.”

Doerschug expresses a similar sentiment. “I think the hospital system nationwide is on the verge of collapse,” he says. “That may be immediate, or it may be six months from now … but people need to realize it’s not just COVID, every other medical problem is going to be challenged.”

Like the other health care workers Yahoo Life spoke with, he wishes that more of the public understood the cost of not taking precautions seriously. “What do we need to do right now? We need to wear a mask. We need to social distance. We need to avoid large gatherings, even on Thanksgiving,” Doerschug implores. “As sad as that makes me, that’s what we need to do to protect our health care system and each other.”

http://www.yahoo.com/

For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.