With 114,000 people hospitalized for COVID-19 in the United States, according to the COVID Tracking Project, intensive care units are struggling to accommodate patients whether or not they have the coronavirus.
As part of the pandemic, which in the U.S. has caused more than 17 million COVID-19 cases and more than 312,000 deaths from the virus, health care systems (and exhausted medical workers) are reaching maximum capacity in ICUs. According to the New York Times, which analyzed recent data by the Department of Health and Human Services, 10 percent of Americans live near facilities with completely full ICU beds or those where less than 5 percent of beds are free.
California, for example, with more than 1.7 million positive COVID-19 cases, 15,000 hospitalizations and 3,200 people in the ICU, has reached zero percent availability for ICU beds, forcing doctors to treat patients in non-ICU settings, according to the Los Angeles Times. “We’re getting crushed,” Dr. Brad Spellberg, the chief medical officer at LAC-USC Medical Center, said on Friday. “We’ve had to scramble. Can we move this patient here? Can we move this patient there? It isn’t just COVID patients. It’s car accidents, and heart attacks and victims of violence.”
And in late November, Colorado Gov. Jared Polis issued an executive order for hospitals and emergency rooms to transfer patients and stop admitting new ones, in response to the pandemic. Back then, reported the Associated Press, the state had 1,500 confirmed COVID-19 hospitalizations, a number that’s ballooned to more than 17,000, per the state’s Department of Public Health & Environment.
But it’s the accounts from both medical professionals and patients’ families that best illustrate how the pandemic has overwhelmed health care systems.
“We have ZERO available ICU beds at my hospital today,” tweeted Katie Capano, a nurse practitioner at Johns Hopkins in Baltimore, where more than 246,000 people have tested positive for COVID-19, close to 1,700 people are hospitalized for the illness and 400 are in intensive care, per the Maryland Department of Health. And Dr. Matthew Klee of Mercy Hospital in Coon Rapids, Minn., told the Star-Tribune, “There’s no beds anywhere. It’s become like a game of chess over the entire state.” Minnesota has more than 380,000 cumulative positive cases, more than 20,000 cumulative hospitalizations and 4,000 cumulative ICU hospitalizations.
“Capacity is a finite resource, whether or not it’s for COVID-19 patients,” Dr. Lisa Maragakis, the senior director of infection prevention at the Johns Hopkins Health System, tells Yahoo Life, adding, “As COVID-19 sweeps through the country, people are still unfortunately requiring care for heart attacks, strokes and cancer, so our hospitals are usually quite full in in this country.”
“You hear about hospitals having to open up new physical spaces and add beds in order to care for patients, but that’s only part of the equation,” she says. “The real scarce resource are the doctors, the nurses and the respiratory therapists … and at any given time, [medical workers] are either isolating, recovering [from COVID-19] or in quarantine.”
To prepare for such emergencies, Maragakis says hospitals and public health leaders develop “surge plans,” such as canceling nonurgent surgeries, hiring more health care staff and sharing medical resources — for example, transferring patients to nearby hospitals with available beds. According to Yahoo medical contributor Dr. Dara Kass, they can also include converting every spare inch of hospital space, such as recovery rooms or PICUs (pediatric intensive care units), into ICUs. And hospitals that reach capacity limits use alert systems to communicate with EMS workers so that ambulances can divert incoming patients elsewhere.
Difficult decisions about which patients should be prioritized are guided by the “Crisis standards of care,” which, according to the American Medical Association, deviate from the principle that a physician “shall, while caring for a patient, regard responsibility to the patient as paramount” during public health emergencies like pandemics. As the AMA states, “This commitment of fidelity to the individual patient is counterbalanced by the need to protect the welfare of a population of patients … and to be prudent stewards of limited societal resources entrusted to them.”
So what does this mean for patients with COVID-19 or other medical emergencies? Kass says people should not worry about being turned down for medical care. “If you come to an emergency department, you will be taken care of,” she tells Yahoo Life, adding that physicians are legally required to treat any and all patients. “But that doesn’t mean there are resources,” she explains. So a heart attack patient might be transferred to another facility with more appropriate resources or treated on site with alternative methods, what she calls “resource-strapped care.”
Although Kass says people generally cannot anticipate future medical needs, everyone should understand the ICU limitations in their region and the surrounding area. “If you’re having surgery and you’re worried about it being canceled, it might behoove you to understand what’s happening at different hospitals or choose a different one,” she explains.
She points to a trickle-down effect of the pandemic: “If the ICUs are full [with COVID-19 patients], the ER becomes the ICU,” adding, “We won’t shut the doors, but we’re bursting at the seams.”
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