Tracey Fine lay on a stretcher in an emergency room hallway for 13 hours in excruciating pain, with lesions on her face and scalp.
All around her, Covid-19 patients filled beds in a Madison, Wisconsin hospital. Her nurse was so tormented that she could not remember Ms. Fine’s condition and the staff were slow to bring her pain medication or food.
At a small rural hospital in Missouri, Shain Zundel’s severe headache was found to be a brain abscess. His condition would normally have required surgery within a few hours, but he had to wait a day while doctors struggled to find a neurosurgeon and a bed – eventually at an Iowa hospital 375 miles away.
From New Mexico to Minnesota to Florida, hospitals are teeming with record numbers of Covid patients. Smaller hospital staff have repeatedly had to ask larger medical centers to accept one more patient, just one more, but many of the larger hospitals have severely restricted the transfers they will accept as their own halls and wards are overcrowded.
In the spring, the pandemic mainly focused in hard-hit areas like New York, where hospitals in other states were given classes to anticipate the spread of the virus. Despite months of planning, many of the country’s hospital systems are now overcrowded with a staggering number of patients, no available beds, and an increasing shortage of nurses and doctors. Every day, some hospitals had to refuse transfer requests for patients who need urgent care or arrive in an emergency.
And rising infection rates among nurses and other frontline workers have doubled the patient burden for those standing.
There’s no end in sight for the country’s hospitals as the pandemic has continued to hit cities and rural areas across the country, with a total of 13 million cases this year. And public health experts warn that the holidays could accelerate the already rapid pace of infection and keep increasing demand for hospital beds and medical care.
Health systems “are on the verge of rupture,” said Dr. Michael Osterholm, member of the Covid-19 Advisory Board of President-Elect Joseph R. Biden in a podcast this month.
The public doesn’t know how bad the situation is, said Dr. Osterholm, and can only answer, “When people die, they sit on chairs in waiting rooms in emergency rooms for 10 hours to get a bed and they can’t find one and then they die. “
When Ms. Fine went to UW Health University Hospital in Madison, she found doctors there overwhelmed and distracted. “They only parked me in a hallway because I ran out of space,” said Ms. Fine, 61, who eventually had a severe bout of shingles that threatened her eyes.
She had missed her annual check-up or a shingles vaccination because of the pandemic.
Ms. Fine was let into a makeshift room with curtains between the beds and watched the chaos around her. One nurse didn’t know who she was and asked if she was having trouble walking or heard a rush in her ears. She “was just utterly amazed,” recalled Ms. Fine, although she added that the staff were “friendly, caring and doing their best in terrible conditions.”
Workers in the hospital issued a plea published in a two-page ad in the Wisconsin State Journal last Sunday asking citizens to prevent the virus from spreading further.
“Without change immediately, our hospitals will be too full to treat everyone with the virus and those with other illnesses or injuries,” they warned. “Soon, you or someone you love may need us, but we won’t be able to provide the life-saving care you need, be it for Covid-19, cancer, heart disease or other urgent medical conditions. As a health care provider we are afraid that this will become a reality. “
UW Health declined to comment directly on Ms. Fine’s experience, but acknowledged the pressures created by the pandemic. While the patients were sometimes housed in the emergency room before the new coronavirus surge, the occupancy is now “super high,” said Dr. Jeff Pothof, the Group’s chief quality officer.
UW Health “is starting to do things it hasn’t done before,” he said, including recruiting general practitioners and general practitioners to work in the hospital and treat critically ill patients. “It works, but it’s not great,” he said.
Hospitals in St. Louis have been particularly hard hit in the past few weeks, said Dr. Alexander Garza, the chief health officer of SSM Health, a Catholic hospital group that also heads the task force on the virus in the region. Last month, SSM Health turned away about 50 patients who could not receive immediate care.
And nurses – already one of the most infected groups – are adding more hours to their shift.
Hospitals are assigning nurses from adult pediatric intensive care units, doubling the number of patients in a single room, and requiring nurses who normally care for two critically ill patients at the same time to insure three or more, he said.
“If you don’t have that much time and resources devoted to them, they are obviously not being optimally looked after,” said Dr. Garza.
Consuelo Vargas, a Chicago emergency room nurse, says patients spend days in emergency rooms because the I.C.U. are full. The lack of care has a cascading effect. It “leads to an increase in patient falls, which leads to pressure ulcers, which leads to delays in patient care,” she said.
Personnel, available beds and protective equipment are generally scarce. At a National Nurses United Press ConferenceMs. Vargas, a union, said there was still not enough protective gear like N95 masks, which forced her to buy her own.
Some hospitals have sounded the alarm together: The supplies of test kits, masks and gloves are running out.
The country has never fully caught up with the previous bottlenecks, said Dr. Osterholm. “We’re only going to bump into a wall regarding P.P.E.,” he said.
Even if hospitals in some cities have ample physical space or can quickly build new units or set up field hospitals, the staff shortage offsets the benefits of expansion.
“Beds don’t care about people; people care about people,” said Dr. Marc Harrison, executive director of Intermountain Healthcare, a sprawling system of hospitals and clinics in Salt Lake City.
At any point in the past few weeks, a quarter of Intermountain’s nurses had been absent – sick, quarantined, or caring for a virus-infected family member. Nursing students have been granted temporary licenses by the state to fill in the loopholes, and the hospital system is trying hard to stick with travel nurses, who are in high demand and expensive to hire in many states.
To ease the burden on the large hospitals, Intermountain is keeping more patients in its smaller centers, which are remotely monitored by specialists from the larger hospitals who consult with local doctors via remote connections.
Smaller hospitals are under considerable stress. “We don’t have intensive care units,” said Tony Keene, executive director of Sullivan County Memorial Hospital, a rural 25-bed hospital in Milan, MO. “We do not perform any operations or the like here. If we have Covid cases, this puts a lot of strain on our skills.”
His tiny hospital doesn’t usually have more than half a dozen patients in a busy day, but can now treat twice as many. About a quarter of the hospital’s 100 employees, including Mr Keene, have contracted the virus since March.
“It is sometimes a daily and hourly struggle to make sure we have adequate staff in the hospital,” he said. The hospital nurses, who typically work three 12-hour shifts a week, do up to five or six shifts each week.
“We’re out here alone,” said Mr. Keene. “We don’t have a bigger system that pumps money into us or something.” With the help of Covid, the hospital invested in medical gas lines so that patients could receive oxygen.
The sickest patients have yet to be referred, but the larger hospital 35 miles away is full of its own large volume of Covid patients and is reducing staffing levels.
Even if hospitals in a community talk weekly, if not daily, about how to deal with general admission spikes, few have room in areas where the number continues to grow. Many have reduced or even discontinued the provision of elective operations and procedures.
“We’re all concerned about the waves we’re seeing now,” said Nancy Foster, vice president of quality and patient safety for the American Hospital Association. Patients who usually need special medical attention can be sent to a nearby city area, but “these referral centers are often full or almost full,” she said.
Mr. Zundel’s case was a matter of life or death. He had a debilitating headache and “was unable to function at all,” he said. A major nearby hospital was flooded with patients, and his wife, Tessa, took him to a small hospital in rural Missouri to be seen quickly. Doctors there realized that he had a brain abscess but could not immediately find a medical center to treat him.
“He was dying,” said his wife. Some hospitals had beds but no neurosurgeon available. The staff spent an entire day trying to find a place to operate on.
“They just kept talking on the phone until they found a solution,” she said. “You haven’t given up.”
Mr. Zundel, 48, was eventually flown to the University of Iowa hospitals and clinics, where Dr. Matthew Howard, a neurosurgeon, performed an operation.
But Iowa is also turning down patients, said Dr. Howard. “At the beginning of the crisis, we were told by restrictions in P.P.E. Now the problem is that the beds are full, ”he said.
Dr. Dixie Harris, an intensive care specialist at Intermountain, volunteered in New York City during the height of the pandemic last spring. Doctors are now better able to treat the virus and predict disease progression, she said.
But they are also very thin and take care of Covid patients in addition to their regular patients. “Almost no one has had a real vacation,” she said. “People are really tired.”
And readmissions or the ongoing health problems of long-distance Covid drivers have tightened the intensified medical care regime. “Not only do we see the tsunami coming, we also have this back wave,” said Dr. Harris.
Some healthcare workers feel abandoned. “Nurses have been shouting for months that this is a problem and we really haven’t been saved,” said Leslie McKamey, a nurse in Bismarck, N.D. and a member of National Nurses United.
“We work overtime. We work in different professions,” she said. “We really feel the strain.”