‘At capacity’: COVID-19 patients push US hospitals to brink

A hospital in Idaho is 99% full and warning that it may have to transfer coronavirus patients to hospitals in Seattle and Portland, Oregon. Medical centres in Kansas City, Missouri, turned away ambulances on a recent day because they had no room for more patients. And in West Allis, just outside Milwaukee, an emergency field hospital erected on the grounds of the Wisconsin State Fair admitted its first virus patient this week.

More than 41,000 people are currently hospitalised with the coronavirus in the United States, a 40% rise in the past month, and cooler weather that pushes more people indoors is threatening to expand the outbreak still more. At least 14 states saw more people hospitalised for the virus on a day in the past week than on any other day in the pandemic, according to the COVID Tracking Project. Seven more states are nearing their peaks.

The nation has seen more people hospitalized at earlier points — during an onslaught of cases in New York City in April and in the Sun Belt in July — but the sharply rising numbers now are deeply worrisome, in part, because they are testing the limits of smaller hospital systems.

Patients are now spread more broadly across the country, with troubling hot spots from North Dakota to Kentucky. More people than ever are falling critically ill in rural areas, particularly in the Midwest and the Mountain West, where they must rely on hospitals that may have only a handful of beds. And experts worry that the growing numbers in need of hospital care will only get worse if cases continue to mount.

“I don’t really see any signs that things are slowing down and that concerns me a lot,” said Caitlin M Rivers, an epidemiologist at Johns Hopkins University. “It has to be our starting premise that it’s not going to slow down unless we force it to slow down.”

Even as hospitalisations and known cases of the virus have grown, daily deaths across the country have remained fairly steady at around 760 in recent days. But some experts fear that the rate of deaths is beginning to rise again. Upticks in deaths usually lag behind rises in cases and hospitalizations because of the time it takes for the virus to progress.

For families around the country, the mounting hospitalisations were frightening — and personal. Among the thousands of patients, there was a retired Air Force lieutenant colonel who had trouble catching her breath in Missouri, grandparents being treated in separate hospitals in Utah and a beloved uncle whose niece said he had been on a ventilator for five weeks in Wisconsin.

Amy Stadler, the niece, sat in a black minivan outside of the Milwaukee Brewers’ stadium this week as she waited for a nurse to swab her nose. She said relatives had collected messages for her uncle — who is gravely ill — to be shared if his condition were to grow even more dire. Stadler, 49, said she sent hers: “That I love him, and that it’s OK to go.”

In recent days, Stadler, who works as a teaching assistant, began coughing and registered a fever. “I’m careful, but there’s a lot of people that aren’t,” she said softly from behind her face mask as she waited for her test.

The signs of a crunch for hospital space were painfully clear across several states.

“Make no mistake about this, this is an urgent crisis,” Gov. Tony Evers of Wisconsin said Thursday of the state’s outbreak.

In months past, field hospitals have opened in several cities, including Seattle and New York. Some closed after seeing only small numbers of patients, or none at all. But in Wisconsin, the health secretary-designee, Andrea Palm, said hospital officials had sounded an “urgent call” as more and more patients arrived at their doors.

The 530-bed field hospital in West Allis, she said, is the state’s “ultimate insurance policy.” The hospital was built inside the Exposition Centre, a brick building the size of three football fields where the fair, in most years, is a widely attended event. Inside the hospital, hundreds of white cubicles are lined up one after the next, each with little more than a bed, a waste bin and a curtain for privacy.

In Utah, officials sounded frustrated Thursday as they issued urgent pleas.

“Our health care system is at capacity, our health care providers are overwhelmed and exhausted, our public health system is stressed,” said Dr Angela Dunn, the state epidemiologist.

“I don’t know what to do anymore,” Dunn added. “I’m really not trying to scare anyone, I’m just trying to inform you of what’s going on.”

Gov. Gary Herbert said the state was preparing to open a field hospital of its own at an exposition centre south of Salt Lake City. One out of five patients in intensive care units across the state are COVID-19 patients, he said.

In separate hospitals in Utah — about 20 miles apart — Rebecca Hannett’s grandmother, a 79-year-old retired bus driver, is feeling better, but her grandfather, who is 85, is not, Hannett said. The isolation and separation of being hospitalized with COVID-19 has added to their struggle with the illness.

“My grandma called us yesterday because she’s worried about our grandpa,” Hannett, 22, said. “He’s kind of decided that if this is the end, this is the end. And my grandmother is just worried that they won’t be able to say their goodbyes to each other.”

In some rural parts of the nation, hospital officials are having to act “almost like air traffic control,” moving around patients to open up beds, said Dr David Basel, a vice president at the Avera Medical Group, which is based in South Dakota and runs about three dozen hospitals in the Midwest.

“Our regional hospitals are all running at or near capacity on a daily basis,” Basel said.

One in four of the patients now being admitted to the group’s hospitals are COVID-19 patients, Basel said, a proportion that could rise if the infection rate remains high. As more patients arrive from rural parts of the region, he said, he feared that hospitals might have to cancel cancer screenings, back operations and other nonemergency procedures to make room.

As the pandemic wears on, hospital officials said they were most worried about a shortage in workers, rather than physical supplies. Unlike when the virus was largely concentrated in New York and the Northeast, when medical workers arrived to assist from across the country, the virus is now more widespread, meaning there are few nurses or doctors arriving to help.

“It feels more like a slog that we’re getting through, rather than something we can rally together and defeat rapidly,” said Nancy Foster, a vice president at the American Hospital Association. “There are not as many folks who can leave their community to help out in another one because they’re struggling to keep up in their own community.”

Karina Brown, a nurse, has been helping to treat virus patients at the Aurora Sinai Medical Centre in Milwaukee since the pandemic began. Even though she felt prepared for the influx of patients, it was still a shock when they came.

“We had a plan, but once you really saw it and it was go time, that’s kind of different,” Brown said.

Now she is assigned to more patients and they are, on average, much sicker, meaning she has to monitor and care for them more often. She and other nurses have also become, in many cases, one of the few connections between patients and relatives who are not allowed to visit. It has brought her closer to her patients, but also makes it more painful if they succumb to the illness.

“We’re their person while they’re here,” Brown said. “Because they’re all alone.”

She added: “You get to know people, and you have to sit at the bedside with them and hold their hand because their family might not be able to come.”

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