How hospitals are preparing for a surge in COVID patients: 'Things will get worse before they get better'

Korin Miller
·9 min read
HOUSTON, TX - NOVEMBER 26: (EDITORIAL USE ONLY) Dr. Joseph Varon hugs and comforts a patient in the COVID-19 intensive care unit (ICU) during Thanksgiving at the United Memorial Medical Center on November 26, 2020 in Houston, Texas. According to reports, Texas has reached over 1,220,000 cases, including over 21,500 deaths.  (Photo by Go Nakamura/Getty Images)
Dr. Joseph Varon hugs and comforts a patient in the COVID-19 intensive care unit during Thanksgiving at the United Memorial Medical Center in Houston. (Photo by Go Nakamura/Getty Images)

Despite warnings from public health experts not to travel or visit with extended family for Thanksgiving, plenty of people did just that. Now state officials, doctors and hospitals across the country are anticipating a surge in COVID-19 patients, and they’re trying to prepare as best as they can.

Rhode Island sent out a statewide emergency alert to residents this week, saying that its hospitals are “at capacity” due to COVID-19. “Help the frontline by staying home as much as possible for the next two weeks,” the alert said, per the Associated Press. The state has launched a program called Rhode Island on Pause, with new restrictions. “These reductions are key to stemming Rhode Island’s recent increase in cases and hospitalizations over the winter months,” the state says online.

In New York, Gov. Andrew Cuomo gave a press conference on Monday, detailing the state’s new strategy for dealing with hospital capacity. Cuomo said that, if hospitals in the state become overwhelmed, he may issue regional shutdowns. Cuomo also asked hospital systems to identify retired doctors and nurses who may be able to help with staff shortages.

California Gov. Gavin Newsom also warned on Monday in a virtual press conference that hospitals may be close to capacity by Christmas if COVID-19 cases continue to climb in the state. “If these trends continue, California will need to take drastic action,” he said, warning of more strict restrictions and full stay-at-home orders.

But hospital systems and doctors on the frontlines are making preparations on their own for an anticipated surge.

Every doctor and hospital system is approaching the pandemic and expected surge a little differently. But, no matter where they’re located, many say that they feel somewhat prepared for another wave of cases.

Akron, Ohio

Dr. Richard Watkins, an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University, tells Yahoo Life that his hospital system “has plans in place on how to handle a surge, in terms of logistics related to staffing and where patients will go.”

On a personal level, Watkins says, he’s “just trying to be careful about using personal protective equipment and only going out when absolutely necessary, mainly to the grocery store and gas station.”

Birmingham, Ala.

“We are definitely seeing an increased number of patients who are COVID-positive and requiring hospital admission because of complications,” Dr. Sarah Nafziger, co-chair of the University of Alabama at Birmingham’s Emergency Management Committee and professor of medicine in the school’s Department of Emergency Medicine, tells Yahoo Life. As a result, she says, her hospital has had to “dedicate more resources” to caring for COVID-19 patients. “Units that might be used for patients who have other types of disease processes, we’re converting those into COVID units,” she says.

Staffing is also an issue, Nafziger says. “We had a surge in late July and early August and did not have a significant number of staffers who were infected,” she says. “But with this surge, we’re seeing more and more employees who are infected as well.” (Nafziger says those infections seem to be ones that staffers are getting in the community, not at work.) As a result, Nafziger says, “staffing has been impacted.”

Nafziger says she knew back in February that the pandemic would last a long time. “In my mind, I accepted early on that this would be something we would have to deal with for 12 to 18 months,” she says. “I’m not surprised that we’re still in the thick of things.” Now, Nafziger says, she’s trying to get rest, proper nutrition and time with her family during her downtime, so that she can focus when she’s at work.

There is some positive news, though: Nafziger says her hospital is gearing up to administer vaccines to people. “Working through that has been invigorating for us and gives us hope,” she says. “We see the end in sight.”

New Jersey

“We have begun to see a steady increase in the number of patients hospitalized at our facilities with COVID,” Dr. Christopher Freer, senior vice president for emergency and hospitalist medicine at RWJBarnabas Health, tells Yahoo Life. But, he says, this was “predicted, and our facilities are well prepared to handle the influx.”

Freer says his hospital system has been “stockpiling” personal protective equipment and medications. “We have developed a redistribution plan for staffing and have contracted for additional nurses, and we have increased testing capacity, enabling us to rapidly diagnose those with COVID and separate them from other patients,” he says.

Freer says that his hospital group is “very hopeful” that its preparations, along with “communitywide distribution of successful COVID vaccines,” will help “lessen the severity of illness and decrease new COVID infections and hospitalizations.”


Dr. James McDeavitt, senior vice president and dean of clinical affairs at the Baylor College of Medicine, works with several Houston-area hospitals on their COVID-19 response plans. Right now, he tells Yahoo Life, “we feel like we’ve been there, done that.”

The hospitals McDeavitt works with developed surge plans, as well as plans to open up auxiliary intensive care units, when the area went through a spike in cases in July. “We haven’t had to reinvent that wheel,” he says. Baylor has also done a lot of work around the redeployment of medical professionals. “We said a long time ago that we didn’t want physicians taking care of patients in a capacity that they didn’t feel comfortable with,” he says. “So, we figured out who felt comfortable working as an ER doctor and put training programs into place for those doctors.” Now, he says, doctors who are interested in working in an ICU setting can get training refreshers in areas such as how to operate a ventilator.

Until now, McDeavitt says, COVID-19 hospitalizations have been “manageable.” However, he adds, that could change. “It’s become my job to worry,” he says. The Houston area recently had more than 3,000 new cases and, McDeavitt says, “if we see 2,000 to 3,000 new cases per day, day in and day out, then we will get overwhelmed.”

HOUSTON, TX - NOVEMBER 29:  (EDITORIAL USE ONLY) Medical staffers gather for a briefing at a nursing station in the COVID-19 intensive care unit (ICU) at the United Memorial Medical Center on November 29, 2020 in Houston, Texas. Texas reports more than 1.2 million positive cases of Covid-19, and more than 21,800 deaths.  (Photo by Go Nakamura/Getty Images)
Medical staffers gather for a briefing at a nursing station in the COVID-19 intensive care unit at the United Memorial Medical Center in Houston on Monday. (Photo by Go Nakamura/Getty Images)

Los Angeles

Hospital administrators at Los Angeles’s Cedars-Sinai Medical Center say they feel prepared. “We have been refining our COVID-19 plans in anticipation of a surge based on what we learned over the last nine months of the pandemic,” Bryan Croft, senior vice president of operations at Cedars-Sinai, tells Yahoo Life. “We are scaling up our bed capacity and staffing, and identifying additional supplies of personal protective equipment for our health care workers. Cedars-Sinai is safe to visit, and we are working tirelessly to ensure that all patients receive the care they need for COVID-19 and other medical conditions.”

Fellow Los Angeles medical center UCLA Health says in a statement to Yahoo Life that hospital administrators are “carefully monitoring COVID-19 testing and hospitalization data, staffing plans and equipment and supplies to ensure safe, high-quality care while maintaining preparedness for additional coronavirus cases.” The group also added that it is “in regular contact with county public health officials and hospitals throughout the region.”

“If needed, capacity could be gradually increased to a total of more than 1,100 inpatient beds, including 453 ICU beds — for example, by adding beds to single inpatient rooms and converting other rooms to provide ICU-level care,” UCLA Health said, noting that the hospital group is “well prepared” in the event of a “significant increase” in the volume of hospitalized COVID-19 patients.

Erik Wexler, chief executive of the Providence Southern California health system, tells Yahoo Life that his organization “began drafting surge plans early last year before the coronavirus hit our shores.” Each hospital came up with possibilities for dealing with surges, from using outdoor tents to converting cafeterias into patient spaces.

“We face this new surge with the benefit of experience, better understanding [of] the virus and the knowledge of the more successful therapeutic treatments and medications,” Wexler says. “I hope I’m not being over-optimistic in saying cases will wind down significantly in the summer months. At that point, we will have the ability to safely care for the comparatively fewer cases and better control the spread.”


Dr. Amesh Adalja is a senior scholar at the Johns Hopkins Center for Health Security who works at several Pittsburgh-area hospitals. He wrote on Twitter Monday that, during a recent shift at a hospital, he saw “patient after patient” with COVID-19, adding, “It’s not sustainable for community hospitals.”

Adalja tells Yahoo Life that the hospitals he works for are “all closely looking at the number of patients in the hospital and ICU, and what percentage of those are COVID-positive patients.” They’re also tracking nonemergency surgeries and “determining what type of resources are needed” for those procedures, while “making decisions on a day-to-day basis of local dynamics.” If too many resources are needed for COVID-19 patients, he says, then elective surgeries may need to be delayed.

While his hospitals have field hospital contingency plans, Adalja says that they’re “not quite there yet” in terms of actually needing to use them. “Hopefully, we never will get to that,” he says.

But, despite the increase in COVID-19 patients, Adalja says things are “business as usual” for him — at the moment. However, he adds, “it’s just going to intensify and become much more unpleasant at work,” he says. “Things will get worse before they get better.”

For the latest coronavirus news and updates, follow along at According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.

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