By Joel Achenbach, Karin Brulliard, Brittany Shammas and Jacqueline Dupree,
Hospitals in many regions of the country — the Upper Midwest, the Mountain West, the Southwest and the heart of Appalachia — are seeing record levels of patients suffering from covid-19, the disease caused by the novel coronavirus.
More than 42,000 people were hospitalized nationally with the virus Monday, a figure that is steadily climbing toward the midsummer peak caused by massive outbreaks in the Sun Belt. In the places hit the hardest, this is nudging hospitals toward the nightmare scenario of rationing care.
The country is not there yet, but the recent rise in confirmed coronavirus infections — which set a single-day record Saturday of more than 83,000 — is an ominous leading indicator of an imminent surge of patients into hospitals. The pattern of this pandemic has been clear: Infections go up, hospitalization rates follow in a few weeks, and then deaths spike.
The medical community vividly remembers the crisis in New York hospitals in the spring and the catastrophe in northern Italy, where the oldest patients were left untreated so that doctors could try to save younger patients. In Utah, the president of that state’s hospital association, Greg Bell, has warned that within two weeks, the hospitals may have to start rationing care among the most seriously ill patients in intensive care units.
El Paso reached 100 percent hospital capacity Sunday and is setting up field hospitals to handle the overflow of patients. University Medical Center in the Texas city has established a mobile unit in its parking lot to hold covid-19 patients who are almost ready to go home. Officials are hoping to transfer non-covid-19 patients to Children’s Hospital next door. The hospital has 198 covid-19 patients; during the July surge, the maximum was 64.
State officials have dispatched 100 nurses and five doctors to the hospital to help, but the hospital has asked for 45 more nurses, said Joel Hendryx, the chief medical officer.
“Our doctors and nurses have been doing this for over seven months, so talk about covid fatigue,” he said.
The border city, which has seen an explosive outbreak in the past few weeks, reported 1,443 new infections Monday — more than double the cases reported Sunday in more-populous New York. County Judge Ricardo Samaniego on Sunday imposed a 10 p.m. curfew, with exceptions for work or emergencies. Violators will face a fine of $500.
Forty-one states and Puerto Rico have more hospitalized covid-19 patients now than at the end of September, and 22 of those states have seen increases in excess of 50 percent, according to health data analyzed by The Washington Post.
“The data is just going up on hospitalizations, and we are going to run into trouble — it looks like almost inevitably,” Ross McKinney, chief scientific officer of the Association of American Medical Colleges, said Monday.
Rural America is particularly vulnerable. In the entire state of North Dakota, only 25 intensive care unit beds remained staffed and available Monday in the 11 hospitals that have ICUs, according to state data.
Even hospital officials in places not yet in a full-blown crisis are looking with concern at the national trends, worried about a potential drain of experienced nurses who may be lured to other parts of the country to help combat outbreaks.
“WE’RE HEADED IN THE WRONG DIRECTION,” declared a two-page advertisement Sunday in the Tulsa World newspaper, placed by Saint Francis Health System, which operates seven hospitals across Oklahoma. The ad featured a graph that showed the number of coronavirus patients soaring in recent weeks. “We were doing better when we were in this together,” the ad said.
The goal was to prod the public to follow practices such as mask-wearing to limit viral spread, according to Jake Henry Jr., president and chief executive of Saint Francis.
“What we’re seeing is not sustainable,” Henry said Monday.
He said exhausted medical workers get discouraged when they see people in public who are not wearing masks. The city of Tulsa has a mask ordinance — signs are posted outside businesses reminding customers — but suburban jurisdictions do not, nor does the state.
“We’d just like to get everybody going in the same direction,” Henry said.
The pandemic, and President Trump’s handling of it, have emerged as the defining issues of the presidential race, and polling suggests that the crisis is a major drag on the president’s prospects for a second term. Hospitalizations are rising sharply in three electoral battleground states: Michigan, Pennsylvania and Wisconsin. In Milwaukee, a field hospital has been established at the state fairgrounds to treat overflow covid-19 patients.
Ohio, a traditional bellwether state in presidential elections, joins the other three battlegrounds on a list of the 10 states with the greatest increases in covid-19 hospitalizations since Sept. 30, according to The Post’s data.
Ohio set a new high Monday for hospitalizations since the start of the pandemic. Seven other states Monday also set records: Iowa, Kentucky, Minnesota, New Mexico, South Dakota, West Virginia and Wisconsin. Montana tied its record.
In West Virginia, Clay Marsh, an intensive-care physician who serves as the state’s coronavirus czar, said many people who postponed elective surgeries in the spring, during the initial outbreak, are now taking up some of the hospital capacity. Officials are closely watching the high rate of new infections and know that at some point it might be necessary to stop doing elective surgeries and other procedures that are not urgent, Marsh said.
A midsummer spike in infections affected mainly younger adults, but much of the recent surge has been in older people, Marsh said. He said he believes there has been a gradual spread from younger people to their elders, including community spread in houses of worship and in nursing homes.
“We’re seeing that covid positivity is moving toward an older population, and we have a very vulnerable older population,” Marsh said. “That’s the population we’ve always been very nervous about.”
In Michigan, hospitalizations have jumped 80 percent in recent weeks, causing particular concern in the more rural parts of the state, where some hospitals “are being inundated with patients,” said Gary Roth, chief medical officer for the Michigan Health and Hospital Association.
“Are we getting concerned regarding the increasing numbers, the surging of patients coming into the hospitals? Absolutely,” he said.
At hospitals across the state, the greatest worry is about health-care workers who have only just begun to recover from the stress of the first coronavirus surge.
“One thing that we’ve noticed, particularly in the areas that got hit hard by covid, is it caused a lot of scar tissue for our health-care workers,” said David Wood, chief medical officer at Beaumont Health in southeast Michigan, where hospitals neared capacity during the spring. “Seeing the amount of death in such a short period of time, by what seemed like an entity that we had no defenses against, has made it more difficult to get the health-care workers necessary to want to come back and be back in that same position.”
At University of Utah Health in Salt Lake City, the hospital had about 20 covid-19 patients at the end of August. The numbers started rising three to four weeks ago, with 52 covid-19 patients Monday, said Russell Vinik, chief medical operations officer.
The hospital is mostly using existing staffing, and the workers are overtaxed, Vinik said. Nurses are on mandatory on call, and a third team has been added to staff a surge intensive care unit that opened two weeks ago.
“This is doable for a short period of time, but for a long period of time, it really wears down our staff,” Vinik said. “They are physically and emotionally exhausted.”
He lamented that mask-wearing “is still not as compliant as we’d like, particularly outside Salt Lake County. We have big families in Utah, and big family gatherings, and what we’ve seen is the majority of the transmission comes from household gatherings. That’s a culture that needs to change, to make some sacrifices.”
The fall surge nationally has been propelled by colder weather, the reopening of schools and colleges, the broad migration indoors, patchy-at-best adherence to mask-wearing and other public health guidelines, and the general chaos and confusion of the national response.
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