American Hospitals Are in Serious Trouble

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ASPartOfMe
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08 Jan 2022, 7:58 pm

Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.

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When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me.

In this surge, COVID-19 hospitalizations rose slowly at first, from about 40,000 nationally in early November to 65,000 on Christmas. But with the super-transmissible Delta variant joined by the even-more-transmissible Omicron, the hospitalization count has shot up to 110,000 in the two weeks since then. “The volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before,” Kit Delgado, an emergency physician in Pennsylvania, told me. Health-care workers in 11 different states echoed what he said: Already, this surge is pushing their hospitals to the edge. And this is just the beginning. Hospitalizations always lag behind cases by about two weeks, so we’re only starting to see the effects of daily case counts that have tripled in the past 14 days (and are almost certainly underestimates).

Omicron is so contagious that it is still flooding hospitals with sick people. And America’s continued inability to control the coronavirus has deflated its health-care system, which can no longer offer the same number of patients the same level of care. Health-care workers have quit their jobs in droves; of those who have stayed, many now can’t work, because they have Omicron breakthrough infections. “In the last two years, I’ve never known as many colleagues who have COVID as I do now,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. “The staffing crisis is the worst it has been through the pandemic.” This is why any comparisons between past and present hospitalization numbers are misleading: Some institutions are now being overwhelmed by a fraction of their earlier patient loads. “I hope no one you know or love gets COVID or needs an emergency room right now, because there’s no room,” Janelle Thomas, an ICU nurse in Maryland, told me.

Here, then, is the most important difference about this surge: It comes on the back of all the prior ones COVID’s burden is additive. It isn’t reflected just in the number of occupied hospital beds, but also in the faltering resolve and thinning ranks of the people who attend those beds

The patients now entering American hospitals are a little different from those who were hospitalized in prior surges. As the Financial Times’ John Burn-Murdoch has reported, the number of hospitalized COVID patients has risen in step with new cases, but the number needing a ventilator has barely moved.

In the U.S., many health-care workers told me that they’re already seeing that effect: COVID patients are being discharged more easily. Fewer are critically ill, and even those who are seem to be doing better. But others said that their experiences haven’t changed, perhaps because they serve communities that are highly unvaccinated or because they’re still dealing with a lot of Delta cases. Milder illness “is not what we’re seeing,” said Howard Jarvis, an emergency physician in Missouri. “We’re still seeing a lot of people sick enough to be in the ICU.” Thomas told me that her hospital had just seven COVID patients a month ago, and is now up to 129, who are taking up almost half of its beds. Every day, about 10 patients are waiting in the ER already hooked up to a ventilator but unable to enter the ICU, which is full.

During this surge, record numbers of children are also being hospitalized with COVID. Sarah Combs, a pediatric emergency physician in Washington, D.C., told me that during the height of Delta’s first surge, her hospital cared for 23 children with COVID; on Tuesday, it had 53. Children fare much better against the coronavirus than adults, and even severely ill ones have a good chance of recovery. But the number of such patients is high, and Combs and Sathya both said they worry about long COVID and other long-term complications.

The youngest patients are not necessarily being hospitalized for the disease—Sathya said that most of the kids he sees come to the hospital for other problems—but many of them are: Combs told me that 94 percent of her patients are hospitalized for respiratory symptoms. Among adults, the picture is even clearer: Every nurse and doctor I asked said that the majority of their COVID patients were admitted because of COVID, not simply with COVID. some vaccinated people, are there because milder COVID symptoms exacerbated their chronic health conditions to a dangerous degree. “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time,” said Vineet Arora, a hospitalist in Illinois. “Some of it is for COVID, and some is with COVID, but it’s all COVID. At the end of the day, it doesn’t really matter.”

Omicron’s main threat is its extreme contagiousness. It might be less of a threat to individual people but it’s disastrous for the health-care system that those individuals will ultimately need.

Other countries have had easier experiences with Omicron. But with America’s population being older than South Africa’s, and less vaccinated or boosted than the U.K.’s or Denmark’s, “it’s a mistake to think that we’ll see the same degree of decoupling between cases and hospitalizations that they did,” James Lawler, an infectious-disease physician in Nebraska, told me. “I’d have thought we’d have learned that lesson with Delta,” which sent hospitalizations through the roof in the U.S. but not in the U.K.

The health-care workforce, which was short-staffed before the pandemic, has been decimated over the past two years. As I reported in November, waves of health-care workers have quit their jobs (or their entire profession) because of moral distress, exhaustion, poor treatment by their hospitals or patients, or some combination of those. These losses leave the remaining health-care workers with fewer trusted colleagues who speak in the same shorthand, less expertise to draw from, and more work.

Omicron has turned this bad situation into a dire one. Its ability to infect even vaccinated people means that “the numbers of staff who are sick are astronomical compared to previous surges,” Joseph Falise, a nurse manager in Miami, told me. Even though vaccinated health-care workers are mostly protected from severe symptoms, they still can’t work lest they pass the virus to more vulnerable patients. “There are evenings where we have whole sections of beds that are closed because we don’t have staff,” said Ranney, the Rhode Island emergency physician.

Every part of the health-care system has been affected, diminishing the quality of care for all. A lack of pharmacists and outpatient clinicians makes it harder for people to get tests, vaccines, and even medications; as a result, more patients are ending up in the hospital with chronic-disease flare-ups. There aren’t enough paramedics, making it more difficult for people to get to the hospital at all. Lab technicians are falling ill, which means that COVID-test results (and medical-test results in general) are taking longer to come back. Respiratory therapists are in short supply, making it harder to ventilate patients who need oxygen. Facilities that provide post-acute care are being hammered, which means that many groups of patients—those who need long-term care, dialysis, or care for addiction or mental-health problems—cannot be discharged from hospitals, because there’s nowhere to send them.

These conditions are deepening the already profound exhaustion that health-care workers are feeling.

Public support is also faltering. “We once had parades and people hanging up signs; professional sports teams used to do Zooms with us and send us lunches,” Falise told me. “The pandemic hasn’t really become any different, but those things are gone.” Health-care workers now experience indifference at best or antagonism at worst. And more than ever, they are struggling with the jarring disconnect between their jobs and their communities. At work, they see the inescapable reality of the pandemic. Everywhere else—on TV and social media, during commutes and grocery runs—they see people living the fantasy that it is over. The rest of the country seems hell-bent on returning to normal, but their choices mean that health-care workers cannot.

As a result, “there’s an enormous loss of empathy among health-care workers,” Swaminathan said. “People have hit a tipping point,” and the number of colleagues who’ve talked about retiring or switching careers “has grown dramatically in the last couple of months.”
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In the coming weeks, these problems will show up acutely, as the health-care system scrambles to accommodate a wave of people sick with COVID. But the ensuing stress and strain will linger long after The danger of COVID, to individual Americans, has gone far past the risk that any one infection might pose, because the coronavirus has now plunged the entire health-care system into a state of chronic decay.

When Swaminathan’s friends asked what they should be doing about Omicron, he advised them about boosters and masks, but also about wearing a seat belt and avoiding ladders. “You don’t want to be injured now,” he told me. “Any need to go to the emergency department is going to be a problem.” This is the bind that Americans, including vaccinated ones, now face. Even if they’re unconcerned about COVID or at low personal risk from it, they can still spread a variant that could ultimately affect them should they need medical care for anything.

From outside the system, it can be hard to see these problems. “I don’t think people will realize what’s happening until we fall off that cliff—until you call 911 and no one comes, or you need that emergency surgery and we can’t do it,” Swaminathan said. The system hasn’t yet careened over:

Hospitals often canceled nonemergency surgeries during past surges, but many of those patients are now even sicker, and their care can’t be deferred any longer. This makes it harder for COVID teams to pull in staff from other parts of a hospital, which are themselves heaving with patients.

Newer solutions are limited, too. So, almost unbelievably, the near-term fate of the health-care system once again hinges on flattening the curve—on slowing the spread of the most transmissible variant yet, in a matter of days rather than weeks.

Ranney fears that once hospitalizations start falling, policy makers and the public will assume that the health-care system is safe, and do nothing to address the staffing shortages, burnout, exploitative working conditions, and just-in-time supply chains that pushed said system to the brink. And even if the flood of COVID patients slows, health-care workers will still have to deal with the fallout—cases of long COVID, or people who sat on severe illnesses and didn’t go to hospital during the surge.

There’s a plausible future in which most of the U.S. enjoys a carefree spring, oblivious to the frayed state of the system they rely on to protect their health, and only realizing what has happened when they knock on its door and get no answer. This is the cost of two years spent prematurely pushing for a return to normal—the lack of a normal to return to.

Bolding=mine


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23 Jan 2022, 10:16 am

I honestly don't feel any sympathy for hospitals. They were paid off and given hush money. They were colluding with George Soros and Anthony Fauci back in 2020: inflating Covid numbers (where someone Covid-positive who got hit by a train was classified as a Covid death), hiring crisis actors to pose as patients, and renting empty refrigerator trucks to stage on their premises, for the alleged Covid death bodies, to create fear porn for the liberal media. The hospitals' own morgues were relatively full, but that doesn't create the extreme fear porn the liberal media wanted.

It was all meant to make the Covid situation look worse than it really was. At the same time, the lootings and the arsons in May 2020 "didn't raise the case counts, despite the close physical contact the criminals engaged in" :roll:.


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24 Jan 2022, 5:11 am

Aspie1 wrote:
I honestly don't feel any sympathy for hospitals. They were paid off and given hush money. They were colluding with George Soros and Anthony Fauci back in 2020: inflating Covid numbers (where someone Covid-positive who got hit by a train was classified as a Covid death), hiring crisis actors to pose as patients, and renting empty refrigerator trucks to stage on their premises, for the alleged Covid death bodies, to create fear porn for the liberal media. The hospitals' own morgues were relatively full, but that doesn't create the extreme fear porn the liberal media wanted.

It was all meant to make the Covid situation look worse than it really was. At the same time, the lootings and the arsons in May 2020 "didn't raise the case counts, despite the close physical contact the criminals engaged in" :roll:.


You're still going deep for the conspiracy theories in this one, aren't you?

I do not believe that crisis actors are a real thing. The empty refrigerator trucks were failed predictions - and I, for one, was relieved on that account. The activities in May 2020 helped provide data to clarify the point that transmission outdoors wasn't as likely as been projected, and recommendations changed accordingly. We can't know what we don't yet know, there is nothing nefarious about that reality. They were calling it the NOVEL coronavirus for a reason. Better to be over-prepared than under-prepared, IMHO. No conspiracy needed.


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Aspie1
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24 Jan 2022, 6:51 am

DW_a_mom wrote:
You're still going deep for the conspiracy theories in this one, aren't you?
Of course! :D

DW_a_mom wrote:
The activities in May 2020 helped provide data to clarify the point that transmission outdoors wasn't as likely as been projected, and recommendations changed accordingly.
Or did they? The destruction of America in May 2020 helped the Democrats' agenda, while the Lake of the Ozarks party and the Sturgis motorcycle rally, both done outdoors, did not. That's the only reason why the former was celebrated, while the latter were vilified. Because money talks, and BS walks.

I feel absolutely no compassion or sympathy for hospitals nowadays. They used to trash people for wanting to meet with a friend or keep their small business open, and push staged images of hallways filled with patient beds, while receiving millions of dollars from George Soros for doing so. Now that the sponsorship dried up, the shoe is on the other foot, like many workers getting the pink slip for not being vaccinated. So all I feel now is schadenfreude.



Last edited by Aspie1 on 24 Jan 2022, 7:02 am, edited 1 time in total.

kraftiekortie
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24 Jan 2022, 7:02 am

There were FULL refrigerator trucks in NYC from March to May, 2020. We had about 20,000 deaths in three months from March to June, 2020…mostly during March and April.

I know a person who was shot dead, and had to wait a month to be cremated.

Scamdemic? Hell no!! !!



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26 Feb 2022, 8:11 pm

Haha, hospital trouble ? No hospital trouble here. Our farm burg's hospital isn't in trouble, it's just plain gone.
Just before covid hit it closed abruptly due to financial shenanigans by the new and out of state owners.


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27 Feb 2022, 6:18 am

Apart from covid, most hospitals are now owned by huge mega corporations who make money off health care.

The real problem, even before covid, was the poor pay and working conditions for nurses and other staff. Add covid, and the result is even more people getting out of nursing.

Without nurses and staff, you don’t have a hospital. It’s not the doctors who are going to do the work.


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27 Feb 2022, 8:32 am

blazingstar wrote:
The real problem, even before covid, was the poor pay and working conditions for nurses and other staff. Add covid, and the result is even more people getting out of nursing.


BINGO!

:arrow: Note Date of source given after quote & how long before C19 it is.

Quote:
Nevertheless, work stress and burnout remain significant concerns in nursing, affecting both individuals and organizations. For the individual nurse, regardless of whether stress is perceived positively or negatively, the neuroendocrine response yields physiologic reactions that may ultimately contribute to illness.1 In the health care organization, work stress may contribute to absenteeism and turnover, both of which detract from the quality of care.9 Hospitals in particular are facing a workforce crisis. The demand for acute care services is increasing concurrently with changing career expectations among potential health care workers and growing dissatisfaction among existing hospital staff.19 By turning toxic work environments into healthy workplaces, researchers and nurse leaders believe that improvements can be realized in recruitment and retention of nurses, job satisfaction for all health care staff, and patient outcomes—particularly those related patient safety.20


From:
Patient Safety and Quality: An Evidence-Based Handbook for Nurses.
Hughes RG, editor.
Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.
Chapter 26 Work Stress and Burnout Among Nurses: Role of the Work Environment and Working Conditions
Bonnie M. Jennings.
https://www.ncbi.nlm.nih.gov/books/NBK2668/


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