Virus threat diminishes, but US hospitals are still full

CNN
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At Massachusetts General Hospital in downtown Boston, the halls of the emergency department are lined with dozens of patients waiting for a room upstairs.

“Imagine spending days and nights in the hallway under fluorescent lights in the ER next to a trauma room while [patients] have heart failure, kidney failure or pneumonia,” said Dr. Melissa Mattison, physician and chief of hospital medicine at Mass General, who is a founding member of Mass General Brigham.

“Everyone is doing their best, but where do they go to the bathroom? How do they take a shower if they want to clean themselves? How do they eat? There is no privacy. It’s just, it’s awful. It’s absolutely awful.

As of Friday, about 87% of all available hospital beds in the state are usedand capacity constraints have eased little despite a dramatic decline in the number of people being treated for respiratory illnesses.

“Every day our emergency room has a backlog of 25 to 100 patients waiting for a bed upstairs. So if today that number was 25, and two weeks ago it was 100 – yes, that’s better, but there’s still a long queue,” Mattison said. “Maybe patients aren’t crammed as much as sardines in the ER when you only have 35 patients waiting versus 75. But that’s still not great.”

The winter triple threat of influenza, Covid-19 and RSV is easing in the United States and, like Massachusetts, most states are now reporting low or minimal levels of overall respiratory disease activity.

Nationally, ER visits for respiratory viruses are one-third of what they were a month ago, federal government says data show. Flu hospitalizations are almost as low as they have been all season since October. Hospitalizations for Covid-19 – the last of the three viruses to trend downwards – have been falling for the past few weeks, and only 4% of hospital beds nationwide are being used by Covid-19 patients.

That’s a stark change from January 2022, when Covid-19 patients filled most hospital beds amid Omicron’s first surge. But hospitals are still about as full as they’ve ever been during the pandemic — at least three-quarters of available beds across the country have been used for all of 2022 — and it doesn’t seem likely to change anytime soon.

Hospitals faced capacity and resource challenges long before the pandemic hit, experts say, largely because those admitted are sicker than they were before.

“It’s been an ongoing trend for the past decade that there is greater patient acuity inside hospitals,” said Nancy Foster, vice president for quality and patient safety at the ‘American Hospital Association. “So what you see is this group of incredibly sick people inside hospitals. If you’re a doctor, nurse, respiratory therapist, pharmacist, or any other healthcare professional working inside the hospital, that means it’s still a difficult puzzle you’re trying to solve to help that patient.

At Mass General, an emergency department boarding school program — which outlines plans to cover patients waiting for a bed — was well established years before the pandemic hit, Mattison said.

Hospitals began reporting capacity data to the federal government in 2020 as part of a pandemic requirement, so there is no federal data to compare to pre-pandemic years.

But Mattison was quick to say his hospital is now 99% full, as it was in 2019 and years before the pandemic. Yet, she says, “how long is this waiting list, and who is on this waiting list? This is something that is not reflected in this metric.

Overall, the mix of patients in hospitals is similar to what it was before the pandemic, said Aaron Wesolowski, vice president of policy research, analysis and strategy at the American Hospital Association.

As the share of Covid-19 patients declines, it may be “a breath of less stress” for healthcare providers who have felt frustrated with the lack of tools available to help people like them. wanted him so desperately at the start of the pandemic, Foster said.

In fact, for most categories of care — with infectious diseases as a notable exception — the number of people seen in hospitalizations and emergency departments in 2022 was lower than in 2019, Wesolowski said, citing data from Strata, a healthcare data system. analysis company.

Experts say a mix of complicating factors have been exacerbated during the pandemic, straining resources more than ever.

“The length of stay is longer because people need more acute care. Due to workforce pressures, there are not as many people who can be treated at one time in a hospital setting,” Wesolowski said. “So I think both things can be true.”

Samuel Scarpino, director of AI and life sciences at Northeastern University, says it’s a “perfect storm” of issues: Covid-19 and the ongoing infection control measures hospitals must maintain in place, a backlog of other patients with delayed need for acute care and workforce burnout three years into a pandemic.

The biggest risk factor in the equation is still Covid-19, he says, not because a new variant will necessarily lead to more hospitalizations, but because unpredictability forces hospitals to leave more beds open. as a buffer just in case.

“The biggest risk is almost certainly the uncertainty associated with what’s to come,” said Scarpino, who previously served as vice president of the Rockefeller Foundation’s Pandemic Prevention Institute.

Foster of the American Hospital Association says the pandemic emergency declaration granted a number of flexibilities — such as telehealth — that helped more patients have options for care outside of hospitals.

The federal government has continually renewed the declaration of emergency since January 2020, but it is likely to expire in May.

Without it, says Foster, hospitals would likely be even fuller than they already are — especially as alternative care options outside of the hospital could become more limited again.

“Part of the reason why we have the type of hospital capacity that we have now is that we have a number of flexibilities that have been granted to hospitals by [the Centers for Medicare and Medicaid Services] and other federal and state agencies during Covid that are used for a wide variety of patients,” she said. “If these were to disappear overnight, we would struggle to care for the current level of patients.”