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Struggling to handle record numbers of COVID-19 patients, hundreds of intensive care units across the country are running out of space and supplies and are scrambling to hire temporary mobile nurses at a breakneck pace. Many facilities are grouped to the south and west.
An Associated Press analysis of federal hospital data shows that since November, the share of US hospitals near breaking point has doubled. More than 40% of Americans now live in areas with limited critical care space, with only 15% of beds still available.
The intensive care units are the ultimate defense for the sickest patients, patients in the process of suffocation or facing organ failure. Nurses who work in the most stressed ICUs, changing IV bags and monitoring patients on breathing machines, are exhausted.
“You can’t push great people forever. Right? I mean, it’s just not possible, ”said Houston Methodist CEO Dr Marc Boom, one of many hospital leaders hoping the number of critically ill COVID-19 patients has started. to cap. Worryingly, there are an average of 20,000 new cases a day in Texas, which has the third highest death toll in the country and more than 13,000 people hospitalized with symptoms related to COVID-19.
According to data from the COVID Tracking Project through Thursday, hospitalizations are still high in the west and south, with more than 80,000 hospitalized patients currently living with COVID-19 in those areas. The number of cases reported in the United States since the start of the pandemic has exceeded 25 million on Sunday, according to Johns Hopkins University.
Encouragingly, hospitalizations appear to have leveled off or are trending down in all regions. It is not known whether the easing will continue with the emergence of more contagious versions of the virus and problems with vaccine deployment.
In New Mexico, a burgeoning hospital system brought in 300 temporary nurses from out of state, at a cost of millions of dollars, to deal with overwhelming intensive care patients, who were treated in hospitals. intervention rooms and operating theaters converted.
“It has been horrible,” said Dr. Jason Mitchell, Chief Medical Officer of Presbyterian Health Services in Albuquerque. He is comforted that the hospital never activated its life-saving rationing plan, which would have required a triage team to rank patients with numerical scores based on who was least likely to survive.
“It’s a relief we never had to,” Mitchell said. “It sounds scary because it’s scary.”
In Los Angeles, Cedars-Sinai Medical Center has experienced a shortage of take-out oxygen tanks, which means some patients who might otherwise return home have been kept longer, taking necessary beds. But the biggest problem is the competition with other hospitals for itinerant nurses.
“Initially, when COVID peaks hit one part of the country at a time, mobile nurses were able to travel to more severely affected areas. Now that most of the country is booming at the same time, “hospitals are paying twice and thrice what they would normally pay for temporary mobile nurses,” said Dr. Jeff Smith, COO of the hospital.
The Houston Methodist Hospital recently paid retention bonuses of $ 8,000 to prevent staff nurses from signing up with agencies that would send them to other hot spots. The wages of itinerant nurses can be as high as $ 6,000 per week, an enticement which may benefit a nurse, but which may appear to be poaching for hospital executives who watch nurses leave.
“There are a lot of these agencies that charge absolutely ridiculous amounts of money to get nurses into intensive care,” Boom said. “They go to California, which is in the middle of a wave, but they poach critical care nurses there, send them to Texas, where they charge disproportionate amounts to fill the loopholes in Texas, a lot of which is created because whether nurses from Texas went to Florida or back to California. “
Space is another issue. Augusta University Medical Center in Augusta, Georgia, treats adult intensive care patients under the age of 30 at children’s hospital. Recovery rooms now accommodate intensive care patients, and if things get worse, other areas – operating rooms and endoscopy centers – will be the next areas converted for intensive care.
To prevent rural hospitals from sending more patients to Augusta, the hospital is using telemedicine to help manage these patients for as long as possible in their local hospitals.
“It’s a model that I believe will not only survive the pandemic, but thrive after the pandemic,” said Dr Phillip Coule, Chief Medical Officer at Augusta Hospital.
Hospitals are imploring their communities to wear masks and limit gatherings.
“There just hasn’t been a lot of respect for the disease, which is disappointing,” said Dr. William Smith, chief medical officer at Cullman Regional Medical Center in Cullman, Alabama. He sees that changing now with more people personally knowing someone who has passed away.
“It took a lot of people,” he said of the virus, adding that the toll – 144 people in six months in a county of 84,000 people – “opened their eyes to the randomness of this situation”.
The Alabama hospital’s ICU has been overflowing for six weeks, with 16 patients infected with the virus on ventilators at a hospital that a year ago had only 10 breathing machines. “You can see the stress on people’s faces and in their body language. It’s just a lot of stuff to haul, ”Smith said.
“The very fatigue of our staff can affect the quality of care. I was encouraged by our ability to keep the quality of care at a high level, ”said Smith. “You feel in a very precarious situation where mistakes can arise, but luckily we’ve managed to stay on top of things.”
Hospitals say they maintain high standards for patient care, but experts say surges are compromising many normal medical practices. Overwhelmed hospitals could be forced to mobilize makeshift intensive care units and staff them with no intensive care experience. They may lack the sedatives, antibiotics, intravenous drip, or other supplies they rely on to keep patients calm and comfortable while on ventilators.
“It’s really intimidating and mentally taxing. You do what you believe is the best practice, ”said Kiersten Henry, nurse at MedStar Montgomery Medical Center in Olney, Maryland, and member of the board of directors of the American Association of Critical-Care Nurses.
In Oklahoma City, OU Medicine chief medical officer Dr Cameron Mantor said while vaccines show promise, hope still looks low as critical care cases continue to rise. The number of COVID-19-related hospitalizations at OU Medicine has risen from more than 100 per day in recent weeks to 98 on Wednesday, Mantor said.
“What stresses everyone out,” Mantor said, “is watching week after week after week the faucet is not turned off, not knowing there is a pause, not seeing the proverbial light at the end of the tunnel. “
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Associated Press writers Marion Renault in Rochester, Minnesota, Nomaan Merchant in Houston, and Ken Miller in Oklahoma City contributed.
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The Associated Press’s Department of Health and Science receives support from the Department of Science Education at the Howard Hughes Medical Institute. The AP is solely responsible for all content.
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