An ER doctor on hospitals’ struggle with the omicron wave – Grid News

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An ER doctor on hospitals’ struggle with the omicron wave

Hospitals across the United States are being stretched to their limits — again — as the omicron variant rips through the country.

The average daily number of new infections broke the 700,000 mark this month for the first time since the pandemic began, and experts are warning that the surge has not yet peaked. While a smaller percentage of people with omicron get severely ill compared with previous variants, the sheer size of the omicron wave threatens to overwhelm an already struggling healthcare system.

Over 132,500 Americans are hospitalized with covid-19, surpassing last January’s record-setting peak. Many states, including Illinois, Michigan, Pennsylvania and New Jersey, have also set covid-19 hospitalization records. Hospitals in 600 U.S. counties — roughly 25 percent — were at full capacity as of Monday, with facilities in another 476 counties at imminent risk of exceeding capacity. The crush of omicron patients could jeopardize the care of non-covid patients who need treatment.

Standing to meet this surge is a healthcare workforce weary from the accumulated toll of the past two years, and thinned out from job departures and their own omicron infections. Grid spoke with Megan Ranney, an emergency room physician and academic dean at the School of Public Health at Brown University in Rhode Island, about what she’s seeing in her hospital — and how she and her colleagues are preparing for the coming weeks.

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This interview has been edited for length and clarity.

Grid: What’s it like in your emergency room right now, and how does it compare with past surges?

Megan Ranney: This surge both feels very much the same and awfully different from the prior surges.

Even though omicron is a different variant, by the time people get sick with covid, it’s the same. It’s about lung disease, blood clots, kidney trouble, low oxygen. A lot of the covid patients that end up getting hospitalized go to the intensive care unit and fill up our hospital beds for days and days, if not weeks. So that part of it is the same.

What’s different now is that in prior surges of covid, the hospital was otherwise largely empty. We managed to get a lot of the other stuff out, temporarily, so that we had space for covid patients. We also had alternative care sites, things like field hospitals, where we could care for sick covid patients. Now, none of those things are true. We’re dealing with two years of delayed care, lack of preventive care, lack of doctor visits, lack of preventive surgeries — that’s hitting our emergency departments and our hospitals.

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We’re also dealing with staffing shortages that existed prior to this omicron surge but have only been worsened as people get infected themselves. Now, thank God, my staff are not getting seriously ill thanks to the vaccines, but it is impacting our ability to provide care. I’ve gotten three text messages today about illnesses in my own physician group. We’re all scrambling to cover each other’s shifts.

The overwhelm of the hospital system and the ICU is actually worse than I saw it even at the height of last winter. But again, there’s that difference that we, as providers, are safe now, thanks to the vaccines. Most of those who I’m admitting for covid are there because they’re unvaccinated.

G: There have been indications that omicron causes milder illness. Is that something you’ve noticed?

MR: At the moment, I have no idea which type of covid [my patients] are infected with. I can’t do a bedside test for which variant it is. But with that caveat, the patients I’m caring for don’t seem significantly different from throughout the pandemic.

On a population basis, a greater percentage of folks have mild illness, and certainly I’m hearing that anecdotally. But the reality is in the emergency department, folks we’re seeing look the same. They’re still quite sick, and there’s just so many more people who are getting sick with omicron, more than enough to fill up our hospital.

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G: How close to full capacity are you right now?

MR: Our hospitals across the state are all operating somewhere between 90 and 116 percent capacity. And that doesn’t count the number of patients sitting in the waiting room of the emergency department.

I have a colleague who works in another emergency department who had a patient come in who’d been having chest pain for a couple of days and ended up having a cardiac arrest while waiting to be cared for. The physician couldn’t find an intensive care unit bed to transfer the patient to anywhere within an hour’s radius. Had this patient been taken care of earlier, they may not have had a cardiac arrest. Instead, my colleague spent all this time trying to get the best next step for this patient — time my colleague could have spent taking care of other patients.

That patient didn’t have covid. But the reason that the ED was full and the reason there were no staff and the reason there are no beds anywhere was partly because of covid. And I feel like it just encapsulates the whole mess that the system is in right now and the degree to which everyone is getting hurt by this problem.

G: How are you and your colleagues dealing with this additional strain on the system, nearly two years into the pandemic?


MR: It is tough. We’ve been in this marathon for two years now, and people are exhausted. I think folks are more fragile than they’ve been since the beginning. Burnout is higher, but also that sense of moral injury, of not being able to provide care to patients the way we want to, is higher now than I’ve seen it at any point. Just like the rest of the country, we’ve had enough of covid, but we don’t get the choice to say we’ve had enough. Patients keep coming through our doors.

For now, we’re just putting our head down and powering through — because at the end of the day, we’re there for the patients, so we’re not going to not show up. But it’s taking a huge mental and emotional toll.

G: Have the newly authorized antiviral pills been making a difference? Have you been able to access them?

MR: Not yet. We have a few hundred sets of doses across my entire state, and the access to them is incredibly limited. One of the challenges that we face in the emergency department is that by the time folks get to us, it is often beyond the window where they would be eligible for these medications. Paxlovid [the Pfizer antiviral pill] is most effective if it is started a few days after onset of symptoms, and that’s often not when people are coming to the emergency department. I’m hoping that we’ll see it make a big difference going forward, but I’ve yet to see it have a huge impact just because the supply is so limited right now.

G: How is this surge impacting the non-covid care that people normally get from hospitals?

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MR: We don’t have nursing staff. We don’t have beds. The only way right now that we can make space in our hospital for the patients both with covid and with other medical problems is by stopping some of the other services that we normally provide. For the past couple weeks since, we’ve stopped all overnight elective surgeries. These are not cosmetic surgeries. These are things like hip replacements. We’ve also recently stopped all nonemergency surgeries; that includes surgeries for cancer, aortic and heart problems. And that’s going to have a knock-on effect. We’re going to see those patients ending up in the emergency department down the road because they’re not getting their surgeries.

We’re also seeing an increase in patients coming in with severe depression or suicidal thoughts, patients coming in with opioid overdoses or alcohol-related problems. But only emergencies are being treated right now, which means down the road, more folks are going to have psychiatric emergencies because they’re not getting the care they need. There is just this horrible negative feedback cycle that’s going on throughout the healthcare system. I’m very worried that we’re going to get through omicron and there’s going to be all this other stuff that comes back to haunt us.


G: We’re still likely a couple weeks at least from the peak of this omicron surge. How are you preparing?

MR: We’re all-hands-on-deck right now. We’re pulling in people who normally spend less time clinically into more time clinically. We are desperately trying to get traveling nurses and other support staff. We’ve been working with our governor to try to mobilize the National Guard to help support us in nonclinical duties, like helping to transport patients from one side of the hospital to another. That doesn’t require a medical degree, but we need somebody to push the stretcher. We’re really working on all fronts to try to set up those systems.

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But one of the things that’s equally important is to think about what happens next. We’ll hopefully be through this surge soon. How are we setting things up so that, if and when there is another surge, we’re not back in this situation again? What do we have to do today so we don’t end up back in this exact same spot again three months or six months from now? How many times do we have to keep doing the same thing over and over again before we realize that it’s not working to pretend that we don’t have to fix the system?

G: What should we be doing now to better prepare the system for what will inevitably come next?

MR: It’s a variety of things. We need to invest in training more support staff, including certified nursing assistants, medical assistants, certainly nurses and other highly skilled healthcare workers, but also folks that serve the basic functions of a hospital or clinic. Investing in training them, retaining them and keeping them in healthcare. We need to help folks who show up for bedside care day after day, both financially and emotionally.

We need to think about how to make more telehealth available, particularly for behavioral health patients. How do we fix the supply chains so that my psychiatric patients aren’t running out of medications because they can’t fill them at the pharmacy? How do we set up a public health infrastructure that can be flexible so that when there is another surge, they know how to set up those testing systems quickly, how to divert patients away from the emergency department?

This is not going to be the last time we go through a national disaster like this. We’re facing wildfires, climate change, and there are certainly other infectious diseases out there. How do we set up a system of emergency and disaster preparedness that’s ready?

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G: What can people do now to help alleviate some of the strain on hospitals?

MR: A few things. If you are someone with chronic conditions, please don’t skip your preventive care visits. Do keep seeing your specialists or your primary care. Stay on your medications. Doctors’ offices are taking every precaution possible, so I encourage people to not skip those normal parts of care just because of covid.

If you’re not vaccinated, get vaccinated. If you’re not boosted, get boosted. Yes, omicron can break through the vaccines, but the illness is much milder for those of us who are vaccinated and boosted. That does a huge amount to alleviate stress on the system.

Please don’t come to the emergency department if you’re not super sick or you just need a test. We are not a testing facility, we are there to take care of emergencies. Call your doctor to figure out if you really need to come to the ED before you show up.

The last thing is I ask folks to be kind. Every healthcare worker who’s out there is doing their best right now, and there is a lot of anger against us, whether from folks who bought into the disinformation campaigns or just from people who are exhausted and sick and tired. And one of the huge things you can do is to be nice. I think we are all feeling quite hopeless and frustrated right now. And so the biggest thing that I’m trying to communicate to people is to not give up hope.

  • Jonathan Lambert
    Jonathan Lambert

    Public Health Reporter

    Jonathan Lambert is a public health reporter for Grid focused on how science, policy and the environment shape our collective well-being.

TOPICS

COVID-19