{"id":13027,"date":"2022-01-13T08:40:17","date_gmt":"2022-01-13T16:40:17","guid":{"rendered":"https:\/\/worldcampaign.net\/?p=13027"},"modified":"2022-01-13T08:40:17","modified_gmt":"2022-01-13T16:40:17","slug":"covid-hospitalization-numbers-are-as-bad-as-they-look-the-atlantic","status":"publish","type":"post","link":"https:\/\/worldcampaign.net\/?p=13027","title":{"rendered":"“COVID-Hospitalization Numbers Are as Bad as They Look”, The Atlantic"},"content":{"rendered":"

By Ed Yong<\/a>, January 12, 2022<\/p>\n

Many supposedly \u201cincidental\u201d infections aren\u2019t really incidental, and cannot be dismissed.<\/p>\n

More Americans are now hospitalized<\/a> with COVID-19 than at any previous point in the pandemic<\/a>. The current count\u2014147,062\u2014has doubled since Christmas, and is set to rise even more steeply<\/a>, all while Omicron takes record numbers of health-care workers off the front lines with breakthrough infections. For hospitals<\/a>, the math of this surge is simple: Fewer staff and more patients mean worse care. Around the United States, people with all kinds of medical emergencies are now waiting hours, if not days, for help.<\/p>\n

Some reporters and pundits<\/a> have claimed that this picture is overly pessimistic because the hospitalization numbers include people who are simply hospitalized with <\/em>COVID, rather than for <\/em>COVID\u2014\u201cincidental\u201d patients who just happen to test positive while being treated for something else. In some places, the proportion of such cases seems high. UC San Francisco recently said a third of its COVID patients<\/a> \u201care admitted for other reasons,\u201d while the Jackson Health System in Florida put that proportion at half<\/a>. In New York State<\/a>, COVID \u201cwas not included as one of the reasons for admission\u201d for 43 percent of the hospitalized people who have tested positive.<\/p>\n

But the \u201cwith COVID\u201d hospitalization numbers are more complicated than they first seem. Many people on that side of the ledger are still in the hospital because of the coronavirus, which has both caused and exacerbated chronic conditions. And more important, these nuances don\u2019t alter the real, urgent, and enormous crisis unfolding in American hospitals<\/a>. Whether patients are admitted with or for COVID, they\u2019re still being admitted in record volumes that hospitals are struggling to care for. \u201cThe truth is, we\u2019re still in the emergency phase of the pandemic, and everyone who is downplaying that should probably take a tour of a hospital before they do,\u201d Jeremy Faust, an emergency physician at Brigham and Women\u2019s Hospital, in Massachusetts, told me.<\/p>\n

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Some COVID-positive patients are unquestionably hospitalized for COVID<\/em>: They are mostly unvaccinated, have classic respiratory problems, and require supplemental oxygen. Omicron might be less<\/a> severe<\/a> than<\/a> Delta, but that doesn\u2019t make it mild. \u201cIf a virus that causes less severe lung disease affects an extraordinarily large proportion of the population, you\u2019ll still get a lot of them in the hospital with severe lung disease,\u201d Sara Murray, a hospitalist at UC San Francisco, told me. The proportion of such patients varies around the country: In areas where Omicron has taken off, it\u2019s lower than in previous surges, but it remains high in communities that still have a lot of Delta infections or low vaccination rates, as The Washington Post <\/em>has reported<\/a>. At the University of Nebraska Medical Center, \u201cthe vast majority of our COVID-positive cases are at the hospital for reasons related to their COVID infection,\u201d James Lawler, an infectious-disease physician, told me.<\/p>\n

At the other extreme, there are patients whose COVID infection is truly incidental. They might have gone to an emergency room with a broken limb or a ruptured appendix, only to realize when they got tested that they also have asymptomatic COVID. Many health-care workers told me that they\u2019ve treated such patients\u2014but rarely. \u201cIt happens, but it\u2019s not a big proportion,\u201d Craig Spencer, an emergency physician at Columbia University Medical Center, told me.<\/p>\n

The problem with splitting people into these two rough categories is that a lot of patients, including those with chronic illnesses, don\u2019t fit neatly into either. COVID isn\u2019t just a respiratory disease; it also affects other organ systems. It can make a weak heart beat erratically, turn a manageable case of diabetes into a severe one, or weaken a frail person to the point where they fall and break something. \u201cIf you\u2019re on the margin of coming into the hospital, COVID tips you over,\u201d Vineet Arora, a hospitalist at the University of Chicago Medicine, told me. In such cases, COVID might not be listed as a reason for admission, but the patient wouldn\u2019t have been admitted were it not for COVID. (Some people might have chronic conditions only because of an earlier COVID infection<\/em>, which can increase the risk of diabetes<\/a>, heart problems, and other long-term complications<\/a>.) \u201cThese incidental infections are not so incidental for people with chronic conditions,\u201d Faust said. \u201cWhether they live to see the age of 60 or 90 depends on things just like this.\u201d<\/p>\n

Colds and other viral infections can also land people in the hospital by pushing their chronic diseases over the edge. \u201cBut we don\u2019t generally see such infections happening to such massive swaths of the population at once,\u201d Murray said. Omicron (helped along by Delta) is doing what other respiratory viruses do, but with enough speed and <\/em>ferocity to overwhelm the health-care system. As Arora put it to me recently, \u201cWe have a lot of chronically ill people in the U.S., and it\u2019s like all of those people are now coming into the hospital at the same time.\u201d<\/p>\n

These patients whose problems were exacerbated by COVID are often misleadingly bundled together with the smaller group whose medical problems are truly unrelated to COVID. In fairness, there\u2019s no easy way to tell, for example, whether a COVID-positive person\u2019s heart attack was triggered by their infection or whether it would have happened anyway. But health problems don\u2019t line up to afflict patients one at a time. They intersect, overlap, and feed off one another. The entire for-COVID-or-with-COVID debate hinges on a false binary. \u201cThe health-care system is in crisis and on the verge of collapse,\u201d Spencer said. \u201cIt doesn\u2019t matter whether it\u2019s with or for. It\u2019s a pure deluge of numbers.\u201d<\/p>\n

Even the truly incidental cases increase the strain. COVID-positive people must be kept apart from other patients, which complicates hospitals\u2019 ability to use the beds they have. These patients need to be monitored in case their infection progresses into something more severe. If they start dying for unrelated reasons, their family won\u2019t be allowed into their room. The health-care workers who treat them need to wear full personal protective equipment. If they need follow-up care, they can\u2019t be discharged to a nursing home or similar facility. They\u2019re taking up space and attention when hospitals are short on both. \u201cIf you\u2019re 90 percent full and you suddenly have 10 percent more patients, I don\u2019t care if it\u2019s half COVID, all COVID, incidental COVID\u2014it just matters that you\u2019re full,\u201d Faust said.<\/p>\n

In the short time since Omicron was discovered, the popular narrative about the variant has calcified around the idea that it is milder. That is true for individuals<\/em>, and in comparison with Delta<\/em>, but the variant certainly isn\u2019t mild for unvaccinated people, for those who could develop long COVID from a supposedly \u201cmild\u201d infection<\/a>, and especially not for the health-care system as a whole. The hospitalization debate illustrates how wishful thinking about the new variant, and America\u2019s continued failure to consider the pandemic at both the personal and societal scales<\/a>, is obscuring the danger of the current surge.<\/p>\n

Instead of overselling our plight, official hospitalization data might actually be underestimating <\/em>it. The number of staffed hospital beds, as tracked by the Department of Health and Human Services, is subject to the whims of individual hospitals, which can choose how to count the number of beds that their staff could reasonably oversee. Many health-care workers have told me that over the course of the pandemic, they have been pushed to care for more patients than they can safely handle, and that the pressure is getting worse as more of them are falling sick with COVID themselves.<\/p>\n

Capacity data also tend to be out-of-date by at least a week<\/a>. Take Maryland as an example: As Faust recently wrote, HHS currently estimates<\/a> that only 87 percent of the state\u2019s hospital beds are occupied. But a model that he co-created, which projects that number forward based on the previous week\u2019s cases, suggests that’s not right\u2014and that every county in the state is now above capacity. The experiences of Maryland\u2019s health-care workers<\/a> support Faust\u2019s conclusions. Last week, a Maryland nurse told me that her emergency department regularly has 10 patients on ventilators waiting for a bed in the overcrowded ICU. A critical-care physician said that patients with heart attacks and other emergencies might wait 24 to 36 hours before seeing a doctor. It is difficult to reconcile these firsthand accounts with the notion that 13 percent of the state\u2019s beds are still free.<\/p>\n

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COVID data have always been mushy, lagging, and incomplete. No single metric can account for the number of patients, how sick they are, what their care demands, how many health-care workers are around to help them, or how close those workers are to their breaking point. We have no straightforward way to measure exactly how stressed the health-care system is.<\/p>\n

But we can ask health-care workers what they\u2019re experiencing. I\u2019ve asked dozens over the past three months, and heard from hundreds more. And what they\u2019ve said, almost unanimously, is that they\u2019re exhausted, demoralized, overwhelmed, and working in a system that cannot handle the strain it is being asked to shoulder. Debating how many patients are in the hospital with COVID or for COVID distracts from the most important question of the moment: As Anne Sosin, a public-health practitioner at Dartmouth College, wrote to me on Twitter<\/a>, \u201cWhat is or will be too much for our health systems and workforce to bear?\u201d The U.S. is about to learn the answer the hard way.<\/p>\n

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The Atlantic\u2019s COVID-19 coverage is supported by grants from the Chan Zuckerberg Initiative and the Robert Wood Johnson Foundation.<\/p>\n<\/section>\n<\/div>\n

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Ed Yong<\/a> is a staff writer at The Atlantic<\/em>, where he covers science.<\/div>\n
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By Ed Yong, January 12, 2022 Many supposedly \u201cincidental\u201d infections aren\u2019t really incidental, and cannot be dismissed. More Americans are now hospitalized with COVID-19 than at any previous point in the pandemic. The current count\u2014147,062\u2014has doubled since Christmas, and is set to rise even more steeply, all while Omicron takes record numbers of health-care workers […]<\/p>\n","protected":false},"author":1001004,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[53],"tags":[],"_links":{"self":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13027"}],"collection":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/users\/1001004"}],"replies":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=13027"}],"version-history":[{"count":1,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13027\/revisions"}],"predecessor-version":[{"id":13028,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/13027\/revisions\/13028"}],"wp:attachment":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=13027"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=13027"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=13027"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}