Intended for healthcare professionals


Covid-19: US hospitals are overwhelmed as cases rise at “alarming rate”

BMJ 2021; 374 doi: (Published 23 August 2021) Cite this as: BMJ 2021;374:n2092

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  1. Janice Hopkins Tanne
  1. New York

The representative body of more than 5000 hospitals in the US has appealed to the federal government to release more than $48bn (£35.1bn; €40.9bn) to help them cope with a 43% increase in covid-19 hospital admissions over the past two weeks, which are especially affecting poorly vaccinated southern states.

Richard Pollack, president of the American Hospital Association, outlined the worsening situation in a letter to Xavier Becerra, secretary of health and human services.1 He wrote, “The emergence of new covid-19 cases and associated hospitalizations is now accelerating at an alarming rate. For the week ending August 9, cases increased in 44 states and the District of Columbia.

“Cases increased in more than half of these states by 30% or more in just one week—a staggering escalation in the spread of covid-19. Hospitalization rates have followed suit, increasing week-over-week in almost every state and DC, with 10 states and DC seeing increases of 50% or more . . .

“There was an average of over 15 000 daily adult intensive care unit (ICU) covid-19 patients, an increase of 33% from just the week prior. Twenty states and DC have ICU occupancy rates of 75% or more, with 11 states over 80% or more . . . Their resources—human, infrastructure, and financials—are being stretched to the brink.”

Pollack added that hospitals were trying to cope by postponing non-urgent operations or transferring patients to other hospitals. Some have set up overflow beds in hospital hallways, offices, cafeterias, and parking lot tents.

Younger patients

As infections with the delta variant increase, now causing more than 90% of new covid cases, a shortage of nurses “imperils patients,” said the New York Times. It added that the pandemic, in the 18 months since it appeared, had “stretched the nation’s nurses as never before, testing their skills and stamina as desperately ill patients with a poorly understood malady flooded emergency rooms.” More than 1200 nurses have died from the virus, and many others have retired or left the profession.2

Texas, the second largest state by population with more than 29 million residents, is facing a shortage of nurses as the delta variant spreads among younger, unvaccinated people. Vaccination rates are low, 96% of the state’s ICU beds are full, and the state health department has hired out-of-state healthcare workers to assist and has requested more mortuary trailers from the Federal Emergency Management Agency.3 The state has an average of 17 000 new cases a day—second only to Florida, which has more than 23 000 new cases a day.

Joseph Chang, chief medical officer for the Parkland Health and Hospital System, a 983 bed academic hospital in Dallas, Texas, told the Public Broadcasting System of a “dire shortage” of staff and said that the system was “about 450 full time equivalence of nurses down from our optimal staffing levels.” It has had to transfer some patients away from the hospital.

He added that Parkland was seeing unvaccinated patients who thought that they would not get sick because they were young and healthy. “In the hospital there are more 40 year olds now than 70 year olds,” said Chang.

“When you get sick with covid, and you are in my hospital, I have exactly zero treatments for you that can kill this virus. Zero,” he explained. “Nothing we have discovered in the last 18 months of dealing with covid-19 can kill this virus. Only your immune system can . . . I’m going to support your immune system as best I can. Your body is going to have to fight it yourself. What you have got to do is prevent yourself from getting it in the first place: And that is the vaccine.”

Texas children are returning to school, mostly unmasked, although those under age 12 cannot be vaccinated. The state’s Republican governor, Greg Abbott, has tried to prevent local authorities from requiring masks to be worn. Steve Adler, Democrat mayor of the state capital, Austin, which tried to make masks mandatory, said, “We know the best way, and really the only way, out of this long term is for people to get vaccinated, so we are doing everything we can to get more and more people vaccinated.”4

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