The Cleveland Clinic in Weston, Florida, on Jan. 11 was treating 80 COVID-19 patients — a tenfold increase since late December. Nearly half of those admitted were for other medical reasons.
The extremely infectious omicron variant drove the hospital to increase its capacity from 206 beds to 250 patients. The hospital was experiencing severe staff shortages, while nurses and other caregivers were suffering from COVID. This led to an increase in cases.
Dr. Scott Ross, chief physician, stated that the challenge lies in finding safe space to treat all COVID patients and keeping staff members safe.
“It’s not a PPE issue,” he said, referring to personal protective equipment like masks, “nor an oxygen issue, nor a ventilator issue. It’s a volume issue and making sure we have enough beds and caregivers for patients.”
Nationally, COVID hospitalizations and cases are at their highest highest levelsSince the pandemic started. However, unlike previous COVID spikes, many COVID patients are coming to the hospital for different reasons. The infections are exacerbating some medical conditions and making it harder to reduce COVID’s spread within hospital walls, especially as patients show up at earlier, more infectious stages of the disease.
Although the omicron variant generally produces milder cases, adding the sheer number of these “incidental” hospitalizations to COVID-caused hospitalizations could be a tipping point for a health care system that is reeling as the battle against the pandemic continues. In addition to the rising COVID rates in the community, hospital staffers are also experiencing an increase in their rates. This causes them to call out sick more frequently and adds stress to an already overwhelmed system.
13 hospitals across the country have confirmed that it is difficult to care for patients infected with other diseases and require different protocols.
Dr. Robert JansenGrady Health System’s chief medical officer in Atlanta, Dr. Jeremy Grady, said that the local infection rate was unprecedented. Grady Memorial Hospital saw a dramatic increase in COVID patients from 18 to 259 on Dec. 1.
Roughly 80% to 90% of those patients either have COVID as their primary diagnosis or have a health condition — such as sickle cell disease or heart failure — that has been exacerbated by COVID, Jansen said.
Although fewer of their patients have developed pneumonia caused by COVID than during the major spikes early last year, Grady’s leaders are grappling with high numbers of health care workers out with COVID. Jansen stated that 100 nurses and 50 other staff members were out at one point last week.
In one of New Jersey’s largest hospital systems, Atlantic Health System, where about half the COVID patients came in for other reasons, not all of those with incidental COVID can be shifted into the COVID wards, CEO Brian Gragnolati said. They require specialized services for their other conditions. Hospital staffers take extra precautions such as wearing higher-level PPE when treating patients with COVID in areas like a cardiac wings.
At Miami’s Jackson Memorial Hospital, where about half the COVID patients are there primarily for other health reasons, all patients admitted for COVID — whether they have symptoms or not — are treated in a part of the hospital reserved for COVID patients, said Dr. Hany Atallah, chief medical officer.
Regardless of whether patients are admitted for or with COVID, the patients still tax the hospital’s ability to operate, said Dr. Alex Garza, incident commander of the St. Louis Metropolitan Pandemic Task Force, a collaboration of the area’s largest health care systems. He estimated that 80% to 90% of patients in the region’s hospitals are there because of COVID.
In Weston, Florida, the Cleveland Clinic is also having a hard time discharging COVID patients to nursing homes or rehabilitation facilities because many places aren’t able to handle more COVID patients, Ross said. Ross said that the hospital is having trouble sending patients home because they are concerned about putting their loved ones at risk.
All this means there’s a reason that hospitals are telling people to stay away from the ER unless it’s truly an emergency, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston.
The sheer number of patients who are showing up and don’t know they have COVID during this surge is frightening, Faust said. As more incidental cases pour into hospitals, they pose a greater risk to staffers and other hospital patients because they are typically at a more contagious stage of the disease — before symptoms begin, Faust said. People were hospitalized in the middle and late stages of COVID waves in previous years.
In Faust’s analysis of federal data, Jan. 7 showed the second-highest number of “hospital onset” COVID cases since the pandemic began, behind only an October 2020 outlier, he said. But this data accounts for only people who were in the hospital for 14 days before testing positive for COVID, Faust said, so it’s likely an undercount.
A KHN investigative series revealed multiple gaps in government oversight in holding hospitals accountable for high rates of COVID patients who didn’t have the diagnosis when they were admitted, including that federal reporting systems don’t publicly note COVID caught in individual hospitals.
“People in the hospital are vulnerable for many reasons,” said Dr. Manoj JainA Memphis-based infectious disease specialist. “All of their existing underlying illnesses with multiple medical conditions — all of that puts them at much greater risk.”
Garza said that the ER is a potential risk zone given the current number of cases. Garza advised that patients wear high quality masks such a KN95 or an N95 respirator. According to The Washington PostThe Centers for Disease Control and Prevention are currently weighing whether to recommend that all Americans update their masks during the omicron surge.
“It’s physics and math,” Garza said. “If you’ve got a lot of people concentrated in one area and a high viral load, the probability of you being exposed to something like that if you’re not wearing adequate protection are much higher.”
If patients can’t tolerate an N95 for an entire day, Faust urges them to wear upgraded masks whenever they come into contact with hospital staffers, visitors or other patients.
Dr. Dallas Holladay, an emergency medicine physician for Oregon’s Samaritan Health Services system, said that because of nursing shortages, more patients are being grouped together in hospital rooms. This increases their risk of infection.
Dr. Abraar KaranStanford’s infectious diseases fellow, Dr. John Appel, believes that all health-care workers should be required by law to wear N95s in every patient interaction.
He recommended that patients request that their providers wear N95 masks, as there are no mandates for staffers to use a higher-quality mask.
“Why should we be putting the onus on patients to protect themselves from health care workers when health care workers are not even going to be doing that?” he asked. “It’s so backwards.”
Some hospital workers may not know they are getting sick — and infectious. Even if they know, some states include Rhode Island CaliforniaBecause of staff shortages, health care workers who are asymptomatic may be called back into work.
Faust would like to see a greater testing capacity for health workers and other staff members.
Karan said that regular testing is encouraged at Stanford and that staff members have access to the tests. But that’s an exception to the rule: Jain said some hospitals have resisted routine staff testing — both for the lab resource drain and the possible results.
“Hospitals don’t want to know,” he said. “We just don’t have the staff.”