Advances in Covid-19 treatment have shortened hospital stays, easing capacity strains. But doctors and health experts say the profits are not enough to sustain hospitalizations, especially in the country’s out-of-pocket pockets, which have smaller hospitals and fewer medical professionals.
Nationally, the spring influx of Covid-1
Treatment for the disease remains limited, and too many long-stay patients can still overwhelm available doctors and nurses and swamp emergency and intensive care units, they say.
These risks are greater now, as fatigue from restrictions in public life complicates efforts to stop the infection. The virus also reaches less populated regions of the United States, where many hospitals are smaller and more remote. Coinciding with the latest high tide, the country has entered the flu season, which usually fills hospital beds every year.
“It’s just a numbers game,” said Dixie Harris, a Utah intensive care physician who is anxiously calculating how long the beds in Salt Lake City Hospital will remain.
Dr. Harris saw firsthand the effects of overcrowded hospitals when he volunteered in New York in April. “You don’t want to be in an intensive care unit without enough breastfeeding,” she said. “When you don’t have good medical care, it’s harder to survive.”
Hospitalization growth is worrying, but does not fully reflect the risk to hospitals and patients from the latest wave, health officials and experts said in response to disasters.
“Several things are not obvious in terms of national numbers alone,” said Eric Toner, a senior scientist at the Johns Hopkins Health Security Center. The latest wave is spreading to a wider geographical area, he said.
The locations, which were flooded with Covid-19 in the spring, were concentrated in several places, mostly in New York, Dr. Toner said. As patients are now flowing into hospitals in many states, there are fewer unaffected areas that can send relief, such as temporary nurses and doctors.
Hospitals in New York and New Jersey account for nearly half – 45% of hospitalizations in the United States and areas at the peak of the spring tide, according to data from the Covid Tracking Project. The second wave was concentrated in California, Florida and Texas, where 49% of hospitalizations were in late July. Approximately the same percentage is now distributed in nine states: Texas, California, Illinois, Florida, Georgia, Indiana, Ohio, Wisconsin and Tennessee.
“It’s much harder when everyone is in pain at the same time,” said Jonathan Green, a readiness and response officer at the U.S. Department of Health and Human Services. “There are a limited number of resources.”
Mr. Green directs some health workers deployed to provide federal disaster relief. During the pandemic, many such personnel have already been sent more than once to help with Covid-19 emergencies, he said.
The cases are also increasing in the rural areas of the country. The total number of sick patients in Covid-19 is smaller, but so is the number of hospitals in remote areas, Mr Green said. Without another hospital nearby, more outside help is needed.
At Red Lodge, Mont., The local 10-bed hospital is often overcrowded, putting patients with overcrowding in beds that are typically used for those in need of temporary follow-up, said Kelly Evans, the hospital’s chief executive officer, clinic Beartooth Billings.
Red Lodge is one of 14 small hospitals owned or contracted by the Billings Clinic. Small hospitals, about 470 miles apart, typically transfer sick patients to Billings Clinic’s leading hospital in Billings, Mont.
But as coronavirus cases increase in the state, the leading 290-bed hospital sends patients with Covid-19 to Beartooth, which also continues to care for local patients. As employment in the region grows, Beartooth and other hospitals swap staff to fill the emergency shortage when health workers quarantine after exposure to the virus.
Beartooth had a radiology technician to cover the emergency room around the clock after two other technicians needed quarantine, Ms. Evans said. Doctors will meet quickly to consider treatment options for trauma patients without diagnostic imaging before temporary help arrives from another hospital, she said.
Beartooth briefly sent nurses to Billings, but could not afford to go on without them. “It’s tight,” Ms. Evans said. “It’s completely tight. We all need to take a deep breath and say, “We can do this today.” ”
So far, Beartooth has not seen flu patients, but the seasonal virus usually fills some hospital beds each year. “He’s holding me back at night,” Ms. Evans said. “I don’t know how long it’s been sustainable.”
Last year, the flu sent about 400,000 people to American hospitals at the Center for Disease Control and Prevention, called the moderate season. Officials fear the flu virus overlapping with Covid-19 could mean little relief for hospitals in the coming months.
“It’s a sign of things to come,” said Jim Murphy, Montana’s administrator in the Department of Communicable Diseases and Laboratory Services at Montana’s Department of Public Health and Human Services.
HCA Healthcare Inc., one of the country’s largest hospital systems, has seen an increase in its intensive care unit capacity as the Nashville-based company uses data analysis to monitor the care of critically ill patients and use a ventilator, the CEO said. Sam Hazen told analysts earlier this month. “This creates a shorter length of stay for the patient and ultimately a much better result,” he said.
The new treatments, although limited, have also helped improve care and shorten hospital stays for patients with Covid-19. These gains and the growing number of infections among young people – who are least likely to die if infected – may have helped reduce mortality, according to epidemiologists, although measuring that percentage is a challenge.
Steroids and remdezivir are “great weapons in Covid 19’s arsenal” and have shortened hospital stays, said Ryan Milke, a spokesman for El Paso University Medical Center.
But the benefits of improved care and shorter hospital stays can be overwhelming if people relax health precautions, he said.
A month ago, the University Medical Center had 30 patients with Covid-19. There were 206 on Thursday, many in tents serving as makeshift intensive care units in a city that has seen a steady rise in coronavirus cases for weeks, he said.
“It’s fatigue,” Mr Mielke said. “Efforts to soften, such as staying away from groups, are starting to be put aside and people want to see their friends, they want to go to a restaurant. People do not wear masks. “
Officials said most of the new cases involved people under the age of 30, but they were spreading the infection to more vulnerable groups.
New Covid-19 cases have been steadily rising for a month in El Paso, the sixth largest city in Texas, and hospital administrators have warned that facilities are approaching capacity. In the past two weeks, El Paso County has registered an average of 942 new cases a day – the most in Texas – up from an average of 137 in September. Deaths, which usually lag behind new cases by a few weeks, remain single digits. The region turned to the state for help as Covid’s patients filled more than a third of their hospital beds.
Other hospitals in El Paso treating coronavirus patients have added tents. But some patients are transported to hospitals in cities hundreds of miles away, such as Dallas and San Antonio. The Texas Department of Emergency Management is sending medical equipment and personnel to turn the Center for Conventions and Performing Arts in El Paso into a temporary hospital with up to 100 beds. The state has also helped hospitals with extra beds and more than 900 medical workers.
“The alternative care area and medical support units will reduce the workload of hospitals in El Paso as we limit the spread of Covid-19 in the region,” Governor Greg Abbott said in a news release.
Write to Melanie Evans at Melanie.Evans@wsj.com and Elizabeth Findell at Elizabeth.Findell@wsj.com