Delta Forces Hospitals Across U.S. to Ration Scarce ICU Beds
(Bloomberg) -- Hospitals across the U.S. are parceling out beds for Covid patients, hunting for doctors and nurses as the delta variant sweeps coast to coast.
The disease is outstripping any mitigation measures. In a few states, the unvaccinated are entering intensive care at rates matching the winter wave. The vaccinated are coming to realize that a sweet summer of release may have been a fantasy, as they again calculate the risks of working, seeing relatives and circulating in society.
Delta’s march began in the U.S. in the Ozarks and South, in states and regions with low vaccination rates. But the surge has shown that even the best vaccinated areas still don’t have enough immunity against the easy-spreading variant.
In Texas, where only half the population is vaccinated, Governor Greg Abbott on Monday asked hospitals to postpone surgeries and ordered the heath department to seek help from doctors and nurses from other states. The governor, a Republican, didn’t lift his order banning government entities from requiring masks and social distancing.
Many experts believe the delta wave will crest without last year’s mortality: The vaccinated can get infected but are vastly less likely to die. Hospitalizations in highly vaccinated areas are increasing relatively slowly. Still, those waves are just beginning, and infections can take weeks to send people to the ICU.
In any case, it’s clear the pandemic isn’t done with America, and decidedly so in places where residents have shunned shots or resisted the renewal of mask mandates and other public-health measures.
In Washington state, cases in the Benton-Franklin Health District started rising almost a month ago, and there are no signs of slowing, said Malvina Goodwin, an employee with the agency. The district is hiring people so it can add lanes to the community testing site; about 800 people a day are coming.
In Benton County, 51% of the population has received at least one dose and 42% in Franklin County, compared with about 65% statewide, according to the CDC. About half of all ICU beds in Benton are in use by Covid-19 patients, up about 7 percentage points in the past week. That’s a level similar to Mississippi’s.
Across the country, officials reported alarmingly small numbers of open intensive-care beds. In at least one state, they could be counted with fingers: Eight, Arkansas Governor Asa Hutchinson announced. “We saw the largest single-day increase in hospitalizations and have eclipsed our previous high of COVID hospitalizations,” he wrote in a tweet.
Health workers in Texas and nearby states have struggled with a lack of intensive-care beds, said Rhiana Ireland, an emergency-room doctor who is herself struggling with what she believes is a breakthrough case.
Ireland described spending hours unsuccessfully trying to find a bed for a 22-year-old southeast Texas patient, hunting as far away as Colorado, North Dakota and Montana. All she could provide him was oxygen and steroids because her hospital lacks remdesivir or monoclonal antibodies.
“I know what he needs, but I can’t do it,” she said.
Ireland said she and her colleagues are not only exhausted, but frustrated by knowing that vaccines could have headed off the new surge. “It feels like this is worse” than December, Ireland said as she coughed and struggled to breathe, using an inhaler.
Nationwide, hospital utilization is expected to rise further in coming weeks, according to projections from the University of Washington’s Institute for Health Metrics and Evaluation, and there are already too few people to care for patients.
“There is a significant nursing shortage,” said Carlos Javier Cardenas, a doctor who is chairman of the board of DHR Health in Texas’s Rio Grande Valley. “Our first round of Covid decimated the ability of us to staff appropriately and adequately across the country. We’re feeling it in south Texas just like they’re feeling it in Louisiana.”
States including Louisiana, Mississippi and Florida -- where the surge started -- are cautionary tales.
In Florida, adult intensive-care unit occupancy has soared to 5,804; that’s a more than seven-fold increase just since mid-July, with some hospitals converting conference rooms and cafeterias into patient areas. Florida has an overall vaccination rate close to the national average, though some counties resemble the laggard Deep South.
The U.S. was bound to see an increase in cases among vaccinated people and communities, with delta spreading via increased travel and large gatherings, said Bertha Hidalgo, associate professor in the epidemiology department at the University of Alabama at Birmingham.
Truly stopping transmission would require about 90% vaccination, impossible to achieve, because children under 12 aren’t eligible for a shot, said Ajay Sethi, an associate professor of population health sciences at the University of Wisconsin.
The delta variant is exposing the limits of the vaccines. While they’re extremely good at preventing serious illness and death, they are less good at preventing infection. People who have been immunized and infected may spread the virus, and most places in the U.S. no longer require masks.
Even so, this wave shouldn’t be as dire as previous ones, thanks to the vaccines, said Robert Kim-Farley, a professor of epidemiology and community health sciences at the University of California at Los Angeles.
“Although we may see cases occurring, we’re not going to see the same level of hospitalizations or deaths that occurred at the time of the viral tsunami, with back-to-back holidays” last Thanksgiving and Christmas, he said.
Some of the most vulnerable people are now more protected. About 90% of Americans 65 and older have received at least one shot, according to CDC data.
Models show the surge should peak in the third week of August and deaths will start declining later in September, said Ali Mokdad, a professor with the Institute for Health Metrics and Evaluation. By then, more people should receive protection whether through vaccination or natural infection.
“Like a fire runs out of wood, you run out of people to infect,” he said.
There is still plenty of fuel.
“We are seeing sometimes entire families come in,” said Cardenas. “You know, a lot of our families in South Texas are multi-generational households.”
Most patients are under 50, he said, and most haven’t gotten their shots.”
“The take-home message, is for god’s sake please get vaccinated,” Cardenas said. “Do it for yourself, do it for your neighbor, do it for your abuela, your abuelito, your tio and your tia, your whole family, all the people who you love and care about.”
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