Hospitals throughout New York City are reporting thousands of available beds—but front-line health care workers are struggling to find space for patients as the omicron surge drives Covid-19 hospitalizations to record levels.
Despite being the epicenter of the omicron surge where the variant hit early and has since pushed hospitals to the brink, New York City hospitals recently reported that roughly 20% of the city's hospital beds are currently available.
According state data, about 6,100 of the total 12,000 hospitalized patients have Covid-19 as of Sunday—a figure not seen since May 2020. Among those patients, roughly 750 were in intensive care units.
And while hospitals are self-reporting bed availability, health care workers on the front lines have said the claims do not reflect their realities. In fact, some workers have said public data does not match the hospitals' internal systems that track real-time capacity.
For instance, Benny Mathew, an ED nurse at Montefiore Medical Center's Moses campus in North Central Bronx and a board member of the New York State Nurses Association, said some patients were waiting for up to two days before they could be admitted.
"It is so crowded, to get from one bed to the next we have to move the stretchers," Mathew said.
Notably, Mathew said the ED last Wednesday had 32 patients waiting for beds, and two patients waiting for a bed in the ICU—but the hospital's self-reported data suggested the Moses campus was at 75% capacity at the time, with over 200 open beds.
This disconnect seemingly stems from the data collection process—specifically, the way public data is consolidated and what time hospitals record their numbers. In addition, public datasets seemingly combine adult and children's hospitals and do not specify availability by bed type, even though workers say these beds are not always interchangeable. As a result, the state often gets an inaccurate picture, according to workers.
And while hospital workers largely agreed that today's Covid patients are less sick than those in previous coronavirus waves, they noted that the rising number of hospitalizations and workforce shortages are creating the "perfect storm."
According to HHS data, the number of nationwide Covid-19 hospitalizations as of Sunday was 142,388—up from last winter's peak of 142,315 reported on Jan. 14. In addition, the seven-day average for daily hospitalizations was 132,086—reflecting an 83% increase from two weeks ago.
Hospitalization totals include "incidental" Covid-19 cases, where individuals contract the virus after being admitted for unrelated conditions—but there is no data to distinguish the number of people in that category, the New York Times reports.
The surge, largely driven by people under the age of 60, has overwhelmed hospitals around the nation.
Currently, health experts believe hospitalizations are one of the most reliable ways to measure the state of the pandemic. In fact, Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said it was "much more relevant to focus on the hospitalizations."
However, experts also caution the situation has not yet peaked, as hospitalizations typically lag case counts by about two weeks. (Kaufman, Modern Healthcare/Crain's New York Business, 1/10; Astor et al., New York Times, 1/10)
The omicron surge is representing a true staffing crisis situation for employers across the country, and health care providers are among the hardest hit. No one wants to think about what happens when the essential workers can’t work—and that’s what is happening now.
The emergency plans many states are putting in place are unquestionably needed in order to maintain continuity of care during the surge but are also agonizing to consider. Even setting aside the potential challenges to patient safety caused by staff working while infected, the impact on the workforce will be intense.
Health care workers have been fighting the pandemic for nearly two years now, and fatigue and burnout were problematic even before omicron. It remains to be seen what the long-term impact will be of calling staff in to work while testing positive, but I am concerned this will represent a breaking point. Staff are exhausted and under pressure to continue to maintain efficiency in the face of illness, patient and family anger, and lack of childcare. Where the early days of the pandemic brought 7 p.m. balcony applause in communities and meal offerings from employers, providers are now having to continue with all of the same challenges, and little of the same support. Staff may also face significant moral distress from potentially exposing patients or colleagues to the virus.
At minimum, leaders should do what they can to offer support to staff, knowing the weight these decisions put on their shoulders.
We are in a crisis point—and sometimes there are no good choices in a crisis. The health care industry, and states putting these policies in place, believe they are making the best decisions they are able to make given the surge, and the early data indicating that the omicron variant is milder, especially in vaccinated individuals. However, I would not be surprised to see more and more clinicians making their own choices coming out of the surge—choices that may take them out of the direct care workforce entirely.
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