January 6, 2022

'A crisis within the crisis': The omicron surge is starting to overwhelm hospitals

Daily Briefing

    Covid-19 cases driven by the omicron variant are hitting record levels in the United States, and while evidence suggests omicron causes less severe cases of Covid-19, many hospitals are still overwhelmed with patients, in part because of staff shortages.

    The omicron surge: 4 ways to help your overwhelmed workforce

    Omicron continues to spread throughout the U.S.

    On Monday, the United States reported 1,082,549 new Covid-19 cases, according to data from Johns Hopkins University—more than double the daily case count officially reported in any other country at any point in the pandemic, according to Bloomberg.

    The previous milestone outside the U.S. was over 414,000 reported cases in a single day, which occurred in India in May during the country's delta surge.

    According to NPR, the reported case load likely was skewed by reporting delays over the holidays and includes tests that occurred over the weekend. As of Monday, the seven-day average for new U.S. Covid-19 cases sits at 480,273 per day, NPR reports.

    According to CDC estimates, omicron accounted for 95% of all Covid-19 cases that were diagnosed during the week ending in Jan. 1. By comparison, omicron accounted for just 38% of new cases during the week ending in Dec. 18, 2021.

    Hospitalizations are rising as well, with 112,941 Americans hospitalized with Covid-19, according to data from HHS. About 26% of ICU beds in the United States are occupied by Covid-19 patients.

    Omicron's symptoms appear to be less severe than those of other variants

    The wave of hospitalizations largely reflects the sheer number of people infected with the omicron variant, some of whom have developed severe symptoms. However, data continues to suggest that, on the whole, people infected with omicron are less likely to develop severe Covid-19 than those infected with other variants.

    In a government report from Britain, people infected with omicron were found to be half as likely to require hospital care and a third as likely to require ED hospitalization as those infected with delta.

    The United States reported 1,688 new Covid-19 deaths on Monday, down from a record 4,442 deaths in January 2021.

    One reason why omicron may cause less severe disease could be that, based on preliminary laboratory findings, it doesn't appear to attack the lungs as aggressively as other variants do, the New York Times reports. Rather, omicron tends to replicate primarily in the nose and throat, meaning patients are less likely to have trouble breathing or need a ventilator.

    However, while early data is encouraging, Natalie Dean, a biostatistician at Emory University, said it's still too early to draw firm conclusions on how severe omicron is.

    And even if omicron does cause less severe disease, its high transmissibility still means hospitalizations are going to increase, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.

    "We have got to be careful about that, because, even if you have a less of a percentage of severity, when you have multi-multi-multi-fold more people getting infected, the net amount is you're still going to get a lot of people that are going to be needing hospitalization," Fauci said. "And that's the reason why we're concerned about stressing and straining the hospital system."

    'We're in a crisis within the crisis'

    In areas where omicron has surged in recent weeks, hospitalizations are hitting record numbers, slamming already-strained hospitals.

    For example, New York has reported a record-high number of Covid-19 hospitalizations. Maryland declared a state of emergency on Tuesday with 3,057 Covid-19 hospitalizations—an increase of more than 500% in the past seven weeks, the Associated Press reports.

    Hospitals are especially struggling to deal with the surge of patients because many of their own staff are also out sick. For example, Ohio has reported record numbers of Covid-19 hospitalizations every day since Dec. 26, according to the Cleveland Plain Dealer—and at the same time, Cleveland Clinic reported that more than 2,700 employees called out sick on one day last week.

    "Our hospitals are struggling to deal with the numbers of sick people coming to them," said Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems. "As of yesterday afternoon, more than 600 people were waiting in emergency departments for their turn to be admitted to a hospital bed. In fact, our emergency departments are as busy as they have ever been."

    "We're in truly crushed mode," said Gabe Kelen, director of the Johns Hopkins University School of Medicine's ED.

    "We're in a crisis within the crisis," said Carlos Aviles, a pharmacy technician at Temple University Hospital. "We weren't ready for the first wave of Covid, and we're dealing with a dam with a lot of cracks and leaks right now. If this dam bursts through, how many lives are we going to lose?"

    The surges are leading many hospitals to consider delaying elective procedures to free up resources.

    "We're never going to crowd out strokes, and we're never going to crowd out heart attacks," said Ed Jimenez, CEO of the University of Florida Health Shands. "But if this keeps going the way it's going, we're going to have hospitals that have to start considering slowing down their planned admissions."

    Many patients are visiting EDs for other reasons and are later testing positive for Covid-19, the Times reports. At NYU Langone, roughly 65% of patients admitted with Covid-19 were originally hospitalized for another reason. Similarly, just under half of Covid-19 admissions at NewYork-Presbyterian were the same, the Times reports.

    However, even patients who were incidentally found to have Covid-19 still need to isolate, presenting a challenge for hospital staff.

    "You still need to put them in isolation," said Carlos del Rio, an infectious disease specialist at the Emory University School of Medicine. "You still need to treat them as patients who could potentially transmit Covid in the hospital. And when you have less staff, then you really have a problem." (Hong, Bloomberg, 1/4; Sullivan, The Hill, 1/4; Treisman, NPR, 1/4; Reed, Axios, 1/4; Witte, Associated Press, 1/4; Anthes/Ghorayshi, New York Times, 1/5; Leonhardt, New York Times, 1/5; Gantz/Whelan, Philadelphia Inquirer, 1/3)

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