With a record number of patients with COVID-19, hundreds of intensive care units in the country are running out of space and supplies and competing to hire temporary nurses on increasing trips. Many of the facilities are grouped in the South and West regions.
An Associated Press analysis of federal hospital data shows that since November, the proportion of US hospitals near the breaking point has doubled. More than 40% of Americans now live in areas that are running out of ICU space, with only 15% of beds still available.
Intensive care units are the ultimate defense for the sickest, patients who are almost suffocating or experiencing organ failure. Nurses who work in the most stressed ICUs, exchanging intravenous bags and monitoring patients on respiratory devices, are exhausted.
“You can’t push big people around forever. Right? I mean, it just isn’t possible, ”said Houston Methodist CEO Dr. Marc Boom, who is among many hospital leaders who hope that the number of critically ill COVID-19 patients has begun to stabilize. It is worrying that there are an average of 20,000 new cases per day in Texas, which has the third highest death count in the country and more than 13,000 people hospitalized with symptoms related to COVID-19.
According to data until Thursday from the COVID Tracking Project, hospitalizations are still high in the West and South, with more than 80,000 current COVID-19 hospital patients in these regions. Encouragingly, hospitalizations appear to have stagnated or are declining in all regions. It is not clear whether flexibilization will continue with the emergence of more contagious versions of the virus and obstacles in the distribution of vaccines.
In New Mexico, an emerging hospital system brought in 300 temporary nurses from out of state, at a cost of millions of dollars, to deal with patients who overflowed from ICUs, who were treated in converted procedure rooms and operating rooms.
“It’s been awful,” said Dr. Jason Mitchell, medical director at Presbyterian Healthcare Services in Albuquerque. He is pleased that the hospital has never activated its essential care rationing plan, which would require a screening team to rank patients with numerical scores based on who was least likely to survive.
“It’s a relief that we never really did that,” said Mitchell. “It looks scary because it is scary.”
In Los Angeles, Cedars-Sinai Medical Center experienced a shortage of oxygen tanks to take home, which means that some patients who could go home have been kept longer, occupying the necessary beds. But the biggest problem is competing with other hospitals for itinerant nurses.
“Initially, when the COVID outbreaks reached one part of the country at a time, itinerant nurses were able to go to the most severely affected areas. Now, with almost the entire country growing at the same time, ”hospitals are paying two or three times what they would normally pay for temporary traveling nurses, said Dr. Jeff Smith, director of operations for the hospital.
Houston Methodist Hospital recently paid a $ 8,000 withholding bonus to prevent nurses from hiring agencies that would send them to other critical points. Paying nurses on the go can reach $ 6,000 a week, an attraction that may benefit a nurse, but it may look like poaching to hospital executives watching the nurses depart.
“There are many of these agencies that are charging absolutely ridiculous sums of money to place nurses in the ICU,” said Boom. “They go to California, which is in the middle of an outbreak, but they steal some nurses from the ICU there, send them to Texas, where they charge excessive amounts to fill the gaps in Texas, many of which are created because nurses in Texas went to Florida or back to California. “
Space is another problem. The Augusta University Medical Center in Augusta, Georgia, is treating adult ICU patients, under the age of 30, at the children’s hospital. The recovery rooms now have ICU patients and, if things get worse, other areas – operating rooms and endoscopy centers – will be the next areas converted to 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 at its local hospitals.
“It is a model that I believe will not only survive the pandemic, but will flourish after the pandemic,” said Dr. Phillip Coule, chief medical officer at the Augusta hospital.
Hospitals are begging their communities to wear masks and limit meetings.
“There just wasn’t much respect for the disease, which is disappointing,” said Dr. William Smith, medical director at the Cullman Regional Medical Center in Cullman, Alabama. He sees that changing now, with more people personally meeting someone who has died.
“A lot of people were needed,” he said of the virus, adding that the death toll – 144 people in six months in an 84,000-county county – “opened his eyes to the randomness of it.”
The Alabama hospital’s ICU has been full for six weeks, with 16 virus patients on ventilators in a hospital that a year ago had only 10 breathing machines. “You can see the stress on people’s faces and their body language. It’s a lot for people to carry, ”said Smith.
“Only the tiredness of our team can affect the quality of care. I am encouraged that we have managed to maintain the high quality of care, ”said Smith. “You feel like you’re in a very precarious situation, where mistakes can occur, but luckily we managed to keep up with things.”
Hospitals say they maintain high standards of patient care, but experts say the outbreaks undermine many normal medical practices. Overburdened hospitals may be forced to mobilize makeshift ICUs and equip them with staff without any intensive care experience. They may run out of sedatives, antibiotics, intravenous or other supplies they depend on to keep patients calm and comfortable during ventilators.
“It is really scary and mentally draining. You are doing what you believe is best practice, ”said Kiersten Henry, a nurse at MedStar Montgomery Medical Center in Olney, Maryland, and director of the American Association of Critical-Care Nurses.
In Oklahoma City, OU Medicine’s medical director, Dr. Cameron Mantor, said that although the vaccines are promising, hope still looks weak as UTI cases continue to rise. The number of COVID-19 hospitalizations in OU Medicine has dropped from more than 100 a day in the past few weeks to 98 on Wednesday, said Mantor.
“What is stressing everyone,” said Mantor, “is to look week after week after week, the tap is not being turned off, not knowing that there is a break, 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 Department of Health and Science receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.