January 3, 2022

The omicron surge: How hospitals are coping

Daily Briefing

    The daily average of new Covid-19 cases last week surpassed 400,000 for the first time in the pandemic, driven by a combination of the omicron and delta variants. Now hospitalizations are rising too, hitting hospitals already strained by staff shortages.

    How to prepare your workforce for omicron: 4 key strategies

      Covid-19 cases continue to rise

      According to the New York Times, over the past week there were more than 401,200 new Covid-19 cases per day in the United States, triple the rate of two weeks ago.

      In an op-ed for the Washington Post, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, and Ezekiel Emanuel, vice provost for global initiatives at the Perelman School of Medicine at the University of Pennsylvania, argued "[t]he current omicron surge represents one of the greatest public health challenges not only of the pandemic but also of our lifetime."

      They argued that Covid-19 cases are likely being undercounted because of a lack of testing.

      "Most positive cases picked up by over-the-counter rapid tests are unlikely to be reported," Osterholm and Emanuel wrote. "And bottlenecks created by heightened demand for PCR testing means many cases will go untested and unreported."

      As a result, "the inadequacy and unavailability of reliable testing means that data on omicron cases in the United States is incomplete and will be unreliable for several weeks," they wrote.

      However, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, noted that many new Covid-19 cases are either mild or asymptomatic, especially among those who have been vaccinated and boosted. As such, he argued that a better measure of the epidemic's severity is hospitalizations—which are also rising, but more slowly than cases.

      According to the Times, hospitalizations rose over the past week to 92,300, a 33% increase. Deaths averaged 1,249 daily, a 4% decrease.

      Fauci added that it's important to remember "hospitalizations and deaths are lagging indicators. However, the pattern and disparity between cases and hospitalization strongly suggest that there will be a lower hospitalization-to-case ratio when the situation becomes clear."

      While vaccines are providing protection, Fauci said, "I'm still very concerned about the tens of millions of people who are not vaccinated at all because even though many of them are going to get asymptomatic and mildly symptomatic, a fair number of them are going to get severe disease."

      How hospitals are responding

      Even though hospitalizations are increasing at a slower rate than cases, they're still surging to record numbers in some areas of the country. For instance, the Maryland Hospital Association said the number of hospitalized patients in the state had surpassed the previous peak from last winter.

      "We believe that the next four to six weeks are really going to be a terrible point in this crisis, and it's potentially going to be the worst part of the whole two-year fight," Maryland Gov. Larry Hogan (R) said.

      As a result of surging cases and hospitalizations, many hospitals are implementing new rules to slow the spread of the virus, and others are delaying care.

      For example, Mayo Clinic announced that all visitors and patients will be required to wear surgical masks when entering the hospital.

      "Single-layer cloth masks, neck gaiters and bandanas are commonly worn, for example, and do not provide optimal protection to help ensure the health and safety of all," the Clinic said in a statement.

      Mayo Clinic hospitals will offer medical-grade masks to patients and visitors who don't have one, and those with unacceptable masks will be required to wear either a surgical, N95, or KN95 mask.

      Meanwhile, Mount Sinai Health System said in an internal memo it will stop scheduling elective and non-emergency procedures to free resources for Covid-19 patients.

      The stoppage will take place "for the next few weeks," Viki LoPachin, Mount Sinai's SVP and CMO, said in the memo. Rehab and transitional care services at some sites will also be paused, and the health system will be recruiting additional per diem help, the memo said.

      Hospitals facing major staffing shortages

      The surges in Covid-19 patients come as many hospitals are facing significant staffing shortages.

      On Tuesday, Marjorie Bessel, chief clinical officer for Banner Health, said staff at the health system is stretched thin, and some hospitals are exceeding capacity.

      "We expect that volumes will continue to increase through the beginning of next year before peaking in mid-January," Bessel said. "Currently, Covid patients account for 40% of our ICU patients. Nearly 90% of those Covid ICU patients are unvaccinated."

      This has led many hospitals to look to temporary health professionals to fill staffing gaps. According to a recent report from AMN Healthcare, a health care staffing company, 75% of hospitals and other health care facilities are looking for "temporary allied health care professionals," and 96% have reported using one of those professionals in the past 12 months.

      Covid-19 case surges amid staffing shortages are also straining an already stressed workforce. "You feel like, 'What am I doing here?'" Nguyet Nguyen, a pulmonary critical care specialist at Barnes-Jewish Hospital, said. "I'm working as hard as I can and still all of these people are dying."

      "Most of the people who come to the ICU are still unvaccinated, and they did not have to be where they ended up being," Nguyen added. "So it's very frustrating for us to deal with that on a day to day basis."

      "We're tired," Tiffany Osborn, a professor of surgery and emergency medicine, said. "We see so much needless suffering." (DeBarros/Hookway, Wall Street Journal, 12/30/21; Devereaux, Modern Healthcare, 12/30/21; Kaufman, Crain's New York Business/Modern Healthcare, 12/30/21; Hamilton, "Shots," NPR, 12/31/21; Kolata/Kambhampaty, New York Times, 1/3; Fabiano, ABC15, 12/28/21; Japsen, Forbes, 12/29/21; Bean, Becker's Hospital Review, 12/29/21; Osterholm/Emanuel, Washington Post, 12/30/21)

      Access our resources to kickstart workforce recovery

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