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(new thread) COVID-19 Hospitalizations Are Surging.

November 10, 2020 04:25PM
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COVID-19 Hospitalizations Are Surging. Where Are Hospitals Reaching Capacity?
Surging hospitalizations are straining health care systems around the United States.

[www.npr.org]

Throughout the U.S., hospitals and health care workers are tracking the skyrocketing number of new coronavirus cases in their communities and bracing for a flood of patients to come in the wake of those infections. Already, seriously ill COVID-19 patients are starting to fill up hospital beds at unsustainable rates.

U.S. hospitalizations overall have nearly doubled since late September. As of Tuesday, 59,275 COVID-19 patients were hospitalized around the country, nearly on par with the highs of the midsummer and spring surges.



"We have legitimate reason to be very, very concerned about our health system at a national level," says Lauren Sauer, an assistant professor of emergency medicine at Johns Hopkins University who studies hospital surge capacity.

The spring and summer waves of COVID-19 hospitalizations were concentrated largely in a handful of cities in the Northeast and parts of the South.

With the virus now surging across the country, experts warn that the impact of this next wave of hospitalizations will be even more devastating and protracted.

"I fear that we're going to have multiple epicenters," says Dr. Mahshid Abir, an emergency physician at the University of Michigan and researcher at the Rand Corp. who has developed a model that helps hospitals manage surge capacity.

If that happens, Abir warns that there won't be flexibility to shuffle around resources to the places in need because everywhere will be overwhelmed.

The impact varies state by state with certain areas showing much more rapid increases in hospitalizations. As of Monday, hospitalizations are now rising in 47 states, according to data collected by The COVID Tracking Project, and 22 states are seeing their highest numbers of COVID-19 hospitalizations since the pandemic began.

Where are hospitals at risk of maxing out?

With the numbers growing nearly everywhere, the key question for hospital leaders and policymakers is, when is a community on the brink of having more patients than it can handle?

In parts of the Midwest and the West, hospitals are already brushing up against their capacity to deliver care. Some are struggling to find room for patients, even in large urban hospitals that have more beds.

But the surge in hospitalizations is not evenly spread — and hospitals' capacity for weathering case surges varies greatly.

One way to gauge the growing stress on a health care system is by tracking the share of hospital beds occupied by COVID-19 patients.

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The federal department of Health and Human Services tracks and publishes this data at the state (but not the local) level. Several experts NPR spoke to say that, though imperfect, this is one of the best metrics communities have to work with.



Though there's not a fixed threshold that applies to all hospitals, generally speaking, once COVID-19 hospitalizations exceed 10% of all available beds, that signals an increasing risk that the health care system could soon be overwhelmed, explains Sauer.

"We start to pay attention above 5%," says Sauer. "Above that, 10% is where we think, 'Perhaps we have to start enacting surge strategies and crisis standards of care in some places.'"

Crisis standards of care is a broad term for how to prioritize medical treatment when resources are scarce. In the most extreme cases, that can lead to rationing of care based on a patient's chance of survival.

The latest data from HHS shows that in 18 states — mostly in the Midwest — COVID-19 hospitalizations have already climbed above 10%.

Six states are over 15%, including North Dakota and South Dakota, which are now over 20%.

Hospital capacity is flexible ... until it's not

The percentage of hospital beds taken up by COVID-19 patients does not tell a complete story about hospital capacity, says Sauer, but it's a starting point.

Hospital capacity is not so much a static number, but an ever-shifting balance of resources. "It's space, staff and stuff, and you need all three, and if you don't have one, it doesn't matter if you have the other two," says Abir.

The level of COVID-19 hospitalizations that would be a crisis in one place might not be in another. Still, a growing share of beds occupied by COVID-19 patients can be a strong signal that the health care system is headed for trouble.

COVID-19 patients can be more labor intensive because health care workers have to follow intricate protocols around personal protective equipment and infection control. And some of the patients take up ICU space.

"When the numbers go up like that, particularly for critical care, that strains the system pretty significantly," says Abir. "This is a scarce resource. Critical care nurses are scarce. Ventilators are scarce. Respiratory therapists are scarce."

In Utah, where the share of hospitalized COVID-19 patients is about 8%, state health officials have already warned that hospitals may soon be forced to ration care because of limited ICU space.

There is no "magic number" to indicate when a health care system may be overwhelmed, says Eugene Litvak, who is CEO of the Institute for Healthcare Optimization and helps advise hospitals on how to manage their capacity. But hospitals must be alert to rapid increases in patient load.

"Even a 10% increase can be quite dangerous," says Litvak. "If you are a hospital that's half empty, you can tolerate it." But U.S. hospitals generally run close to capacity, Litvak says, with above 90% of beds already full — especially toward the end of the week.

"Imagine that 10% of extremely sick patients on top of that," he says. "What are your options? You can not admit ambulances and patients with non-COVID medical needs, or you have to cancel your elective surgeries."

In the spring, some states ordered that most elective surgeries come to a halt so that hospitals had room for COVID-19 patients, but Litvak says this leads to all kinds of collateral damage because patients don't get the care they need and hospitals lose money and lay off staff.

State data may miss local hot spots

Statewide COVID-19 hospitalization metrics mask huge variations within a state. Certain health care systems or metro areas may be in crisis.

"It's very valuable information, but a state average can be misleading," says Ali Mokdad with the Institute for Health Metrics and Evaluation at the University of Washington, which projects that many states will face big problems with hospital capacity this winter. "It doesn't tell you where in the states it's happening."

Big urban centers may be much better equipped to absorb a rush of patients than smaller towns.

In New York City, Mount Sinai Health System was able to more than double its bed capacity during the spring surge. Other communities don't have the ability to ramp up capacity so quickly.

"Especially the states that don't have major cities with major hospitals, you see a lot of stress on them," Mokdad says.

But it's hard for researchers and health leaders to get a clear picture of what's happening regionally without good data, he adds. NPR has reported that the federal government does not share this local data, although it does collect it daily.

Some states publish their own hospital data sets. Texas, which shares the data in detail, provides a striking example. Statewide, COVID-19 hospitalizations have reached about 11%. Meanwhile, El Paso is above 40%, which has pushed the health care system to the brink.


Ultimately, it's difficult to know the true capacity for a region because many hospitals still don't coordinate well, says Dr. Christina Cutter, an emergency physician at the University of Michigan who collaborated on the Rand model with Abir.

"It's really hard to make sure you're leveraging all the resources and that one hospital is not overburdened compared to another hospital, and that may have unintended loss of life as a consequence," Cutter says.

Dire consequences of overfilled hospitals

During the height of Arizona's summer surge, COVID-19 patients filled nearly half of all beds in the state.

"When 50% of our hospital is doing COVID, it means the hospital is overloaded. It means that other services in that hospital are being delayed," says Mokdad. "The hospital becomes a nightmare."

Health care workers are pushed to their limits and are required to treat more patients at the same time. Hospitals can construct makeshift field hospitals to add to their capacity, but those can be logistically challenging and still require health care workers to staff the beds.

In Wisconsin, COVID-19 patients account for 17% of all hospitalizations, and many hospitals are warning that they are at or near capacity.

The Marshfield Clinic Health System, which runs nine hospitals in primarily rural parts of the state, is expecting its share of COVID-19 patients to double, if not more, by the end of the month.

"That will push us well beyond our staffing levels," says Dr. William Melms, chief medical officer at Marshfield. "We can always make more space, but creating the manpower to take care of our patients is the dilemma."

During earlier surges, many hospitals relied on bringing in hundreds or even thousands of out-of-state health care workers for backup, but Melms says that is not happening this time.

"We are on an island out here," he says.

An increase in COVID-19 hospitalizations statewide is also associated with higher mortality, according to a recent study that analyzed the relationship between COVID-19 hospitalizations and deaths.

"It's an indicator that you're going to have more deaths from COVID as you see the numbers inch up in the hospital," says Pinar Karaca-Mandic, professor and academic director of the Medical Industry Leadership Institute at the University of Minnesota.

Specifically, Karaca-Mandic's research found that a 1% increase of COVID-19 patients in a state's ICU beds will lead to about 2.8 additional deaths in the next seven days.

She says a statewide level of 20% COVID-19 hospitalizations may not look all that alarming, but that number doesn't capture the constraints on the health care system in adding more ICU beds.

"That's not very flexible," she says. "It requires a lot of planning. It requires a lot of investments. So the more you fill up the ICU, the impact is going to be larger."

SubjectAuthorViewsPosted

  (new thread) COVID-19 Hospitalizations Are Surging.

zn161November 10, 2020 04:25PM

  Ain't no surprise here is it ?

waterfield20November 10, 2020 04:56PM

  agreed (nm)

zn8November 10, 2020 06:39PM

  It's going to just have to take it's course

NewMexicoRam23November 11, 2020 10:35AM

  Re: It's going to just have to take it's course

waterfield19November 11, 2020 11:06AM

  I don't think that's what he meant at all....

JamesJM19November 11, 2020 11:09AM

  Re: I don't think that's what he meant at all....

waterfield18November 11, 2020 11:24AM

  The suicides aren't the virus

NewMexicoRam19November 11, 2020 12:33PM

  Re: The suicides aren't the virus

waterfield18November 11, 2020 02:46PM

  there is no evidence of some "suicide" binge

zn21November 11, 2020 04:59PM

  no it's not, zn....

JamesJM25November 11, 2020 05:15PM

  there are studies demonstrating no rise in suicides

zn21November 11, 2020 08:06PM

  Yes, right, zn

NewMexicoRam18November 11, 2020 06:28PM

  Re: Yes, right, zn

zn12November 11, 2020 08:11PM

  I'm speaking about COVID cases and deaths

NewMexicoRam11November 12, 2020 08:14AM

  Re: Yes, right, zn

waterfield16November 11, 2020 08:14PM

  I ask the other side

NewMexicoRam15November 12, 2020 03:00AM

  Re: I ask the other side

waterfield14November 12, 2020 08:20AM

  Many suicides come from economic concerns

NewMexicoRam14November 12, 2020 08:55AM

  This is almost impossible to discuss...

JamesJM14November 12, 2020 09:02AM

  Re: This is almost impossible to discuss...

zn22November 12, 2020 09:55AM

  Re: This is almost impossible to discuss...

JamesJM16November 12, 2020 11:27AM

  Re: This is almost impossible to discuss...

zn18November 12, 2020 11:54AM

  It ain't me...

JamesJM14November 12, 2020 12:06PM

  Re: It ain't me...

ramBRO14November 12, 2020 12:21PM

  Re: It ain't me...

JamesJM10November 12, 2020 12:25PM

  Re: It ain't me...

ramBRO15November 12, 2020 02:36PM

  Re: It ain't me...

zn16November 13, 2020 04:55AM

  An interesting point here is...

JamesJM14November 12, 2020 12:39PM

  Re: An interesting point here is...

zn10November 12, 2020 12:59PM

  Correlation vs Causation vs Coincidence

waterfield20November 12, 2020 02:42PM

  Good reply...

JamesJM9November 12, 2020 02:57PM

  sigh

zn14November 12, 2020 01:08PM

  No, that's double speak....

JamesJM13November 12, 2020 01:10PM

  Re: No, that's double speak....

zn11November 12, 2020 01:26PM

  You're doing it every post you make...

JamesJM10November 12, 2020 01:27PM

  Re: You're doing it every post you make...

zn15November 12, 2020 01:33PM

  You're deluded. (nm)

JamesJM6November 12, 2020 01:34PM

  more of the same

zn10November 12, 2020 01:41PM

  I could say the same...

JamesJM11November 12, 2020 01:42PM

  Re: I could say the same...

zn12November 12, 2020 01:48PM

  What?!?!?!? No one is arguing for lockdowns?!?!?!

NewMexicoRam14November 12, 2020 01:40PM

  gee I posted that 4 or 5 times and you just now caught it

zn17November 12, 2020 01:52PM

  Wow, zn

NewMexicoRam16November 12, 2020 03:14PM

  Re: Wow, zn

zn17November 12, 2020 07:59PM

  Re: Yes, right, zn

zn11November 12, 2020 03:31AM

  Let me give you another statistic

NewMexicoRam16November 12, 2020 04:30AM

  Re: Let me give you another statistic

zn10November 12, 2020 09:47AM

  C'mon, zn

NewMexicoRam10November 12, 2020 11:05AM

  Re: C'mon, zn

zn10November 12, 2020 11:10AM

  Zn, your last statement isn't even medically scientific

NewMexicoRam14November 12, 2020 01:03PM

  hunh?

zn8November 12, 2020 01:40PM

  Read more of JAMA

NewMexicoRam11November 12, 2020 01:42PM

  not some articles you agree with out of tons, consensus

zn10November 12, 2020 01:51PM

  So you have read ALL the JAMA articles on covid

PHDram12November 12, 2020 06:58PM

  what is the international scientific consensus

zn10November 12, 2020 07:57PM

  Working for the Fire Dept, I know there is collateral damage.

Ramgator14November 12, 2020 05:48AM

  I'm with you

NewMexicoRam10November 12, 2020 06:24AM

  I DO understand that it IS a concern.

Ramgator10November 12, 2020 06:59AM

  Of course.

NewMexicoRam13November 12, 2020 08:08AM

  and what you have there

zn14November 12, 2020 10:03AM

  Sorry but the media has done a CRAPPY job of toning down the hysteria.

Ramgator9November 12, 2020 10:39AM

  who is talking about "the media"

zn13November 12, 2020 11:17AM

  Re: who is talking about "the media"

ramBRO15November 12, 2020 11:59AM

  Negative!

Ramgator10November 12, 2020 01:58PM

  wait sorry

zn12November 12, 2020 02:16PM

  My reply was not about YOU!

Ramgator10November 12, 2020 02:04PM

  Re: My reply was not about YOU!

zn8November 12, 2020 02:21PM

  It has been up and down all year.

Ramgator5November 12, 2020 02:59PM

  Re: It has been up and down all year.

zn7November 12, 2020 03:02PM

  Problem with Florida is it is LOADED with people! Orlando...

Ramgator10November 12, 2020 03:08PM

  And ZN and Rambro....

Ramgator11November 12, 2020 03:13PM

  Re: And ZN and Rambro....

ramBRO13November 12, 2020 05:15PM

  Re: And ZN and Rambro....

zn10November 13, 2020 04:59AM

  that doesn;t matter

zn13November 12, 2020 08:10PM

  Re: that doesn;t matter

zn18November 12, 2020 08:22PM

  Masks, shutdowns, isolation... oh my...

Atlantic Ram19November 11, 2020 04:20PM

  Re: Masks, shutdowns, isolation... oh my...

zn17November 11, 2020 04:55PM

  No, it wouldn't

NewMexicoRam17November 11, 2020 06:25PM

  Good news on the subject

waterfield20November 11, 2020 03:03PM

  Re: Good news on the subject

zn18November 11, 2020 05:00PM

  pro/con lockdown talk in the news

zn18November 13, 2020 05:54AM

  ""no appetite" "

waterfield19November 13, 2020 07:04AM

  hard to say

zn14November 13, 2020 08:12AM

  I'm sure we all have differing opinions on that..

sstrams11November 13, 2020 09:52AM

  Re: I'm sure we all have differing opinions on that..

waterfield14November 13, 2020 10:53AM

  a sports writer on getting the virus

zn12November 13, 2020 04:37PM

  health workers getting dangerously overworked in the new virus surge

zn18November 13, 2020 06:41PM

  Re: (new thread) COVID-19 Hospitalizations Are Surging.

canadaram22November 20, 2020 12:01PM

  what I heard about Canada

zn11November 20, 2020 12:11PM

  Re: what I heard about Canada

canadaram9November 20, 2020 01:51PM