/Covid-19 Surge Strains Hospitals Once Again

Covid-19 Surge Strains Hospitals Once Again

Hospitals across the nation face an even bigger capacity problem from the resurgent spread of Covid-19 than they did during the virus’s earlier surges this year, pandemic preparedness experts said, as the number of U.S. hospitalizations hit a new high Wednesday.

The number of hospitalized Covid-19 patients reached 65,368, according to the Covid Tracking Project, passing the record set Tuesday for the highest number of hospitalizations since April. A spring surge in the Northeast pushed hospitalizations near 60,000. Hospitalizations hit a nearly identical peak again in late July, as the pandemic’s grip spread across the South and West.

Epidemiologists said the record is likely to be swiftly replaced by another as Covid-19 cases soar nationally. “We already know this is going to go far north,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

The U.S. set single-day records for coronavirus cases three of the last seven days, reaching about 136,000 Tuesday, Johns Hopkins University data show.

Demand for health-care workers is of heightened concern in the latest surge, said hospital and disaster-response officials. Cases are more geographically widespread, reaching more remote regions than the spring and summer. Federal and private pools of health-care workers typically draw from one state to help another.

New hospitalizations usually follow new cases by a few weeks. More widespread testing is finding more people with the virus, but that cannot fully account for surging cases, epidemiologists said.

More young people are among those newly infected, and they are less likely to need hospital care than the elderly. But as infections rise among the young, so does transmission to high-risk older co-workers and family, said Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins Covid-19 Testing Insights Initiative. “It doesn’t stay in one age group,” Dr. Nuzzo said.

Pandemic fatigue is fueling transmission as people frustrated with months of restrictions have started to gather, public health officials said. “What we are finding is the disease is being spread in gatherings; family gatherings, weddings, holidays, and is being spread by people who know each other,” said Randall W. Williams, director of the Missouri Department of Health and Senior Services.

Geographic Spread

North-central parts of the country have some of the highest Covid-19 hospitalization rates.

Covid-19 hospitalizations per 1 million population

“Lives are at stake,” said Eric Toner, an expert in health-care disaster preparedness at the Johns Hopkins Center for Health Security, who urged public-health precautions, such as masks. “When hospitals cannot accommodate all the patients, people die.”

Despite improved treatments, hospitals have only so much capacity, doctors and health-care experts said. Overrun hospitals in New York in the spring scrambled to find ventilators and enough staff. Swamped hospitals in Arizona and California in the summer struggled to find nurses and frantically sought to transfer patients to hospitals with more capacity.

“The medical system can only save so many people, and fortunately, things ebbed before things really got out of hand” during the spring and summer surges, said Charles Branas, chairman of epidemiology at the Columbia University Mailman School of Public Health. “There is a capacity limit here.”

That limit is pronounced for patients who need the skilled staff and equipment of hospital intensive-care units. “That’s where there’s a resource bottleneck to be concerned about,” Dr. Branas said.

The pandemic’s impact on patients and hospitals will vary widely because of regional differences in health-care services, said Molly Jeffery, scientific director of emergency medicine research at the Mayo Clinic.

“This has not been a single pandemic,” Dr. Jeffery said. “This hospital system across the country looks totally different.”

Hospitals outside metro areas have fewer intensive-care beds per 10,000 people, on average, an April analysis by the Kaiser Family Foundation found.

The challenge of meeting the pandemic’s demand in rural parts of the U.S. is particularly acute. More rural residents, on average, are at risk of severe Covid-19 because of age and health conditions than those living in metropolitan areas, researchers reported in June in the Journal of Rural Health. Local rural hospitals are often the nation’s smallest, with limited staff.

A medical staff member working in the intensive-care unit in a Houston hospital on Sunday.



Photo:

Go Nakamura/Bloomberg News

North Dakota Gov. Doug Burgum, a Republican, said Monday that health-care workers with Covid-19 but no symptoms would be able to continue working, but only with coronavirus patients, under an amended state order and Centers for Disease Control and Prevention guidelines for crisis staffing.

In Harlowton, Mont., the 25-bed Wheatland Memorial Hospital has no intensive-care unit and it largely functions as the local nursing home.

The hospital is located in Wheatland County, where the population of about 2,100 has seen an uptick in Covid-19 cases since October, with 76 reported through Monday, Johns Hopkins University data show.

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Montana, where Covid-19 cases and hospitalizations per 100,000 people in October were among the highest in the U.S., ranks among states with the fewest ICU beds per 100,000 people, according to data from the Covid Tracking Project and federal agencies.

To prevent inadvertent spread of the virus to its vulnerable long-term patients, Wheatland Memorial locked the door to its emergency room, said Joan Marie McMahon, the hospital’s chief of staff. “We basically have a doorbell out there.” Hospital staff meet arrivals at the door to first screen them for infections and ensure anyone who enters wears a mask.

Concerned about rising cases statewide, the hospital converted its ambulance bay to a temporary eight-bed unit for patients, she said.

Wheatland Memorial carefully accepts referrals from Billings Clinic about 90 miles away to help the larger hospital make room for the most critical patients and minimize exposure to the virus.

Rural hospitals aren’t equipped for the sickest patients and must send them to larger hospitals, which are now also grappling with the surge.

In the Billings Clinic’s 290-bed flagship hospital, the ICU was at 167% occupancy Tuesday and its emergency room wasn’t accepting ambulances, a spokesman said.

Bridget Brennan, chief of emergency medicine for the Benefis Medical Group in Great Falls, Mont., talks with doctors each morning at the state’s other larger hospitals for an update on where beds are available, she said. Benefis Hospital staff closely track beds within their hospital campuses, seeking openings. “We call it a tetris game,” Dr. Brennan said.

The sustained surge will soon outmatch the state’s health-care system, she said: “The majority of people are not going to be sick enough to be in the hospital, but the number who are, all at once, is going to overwhelm what we have available here.”

Health experts say having a vaccine is just one front in a two-front battle against Covid-19. The other is effective treatments for those who are already sick with the disease. WSJ breaks down the three most promising types in development. Photo Illustration: Jacob Reynolds/WSJ.

and Tom McGinty contributed to this article.

Write to Melanie Evans at Melanie.Evans@wsj.com

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