The Worst-Case Scenario Is Here—Hospitals Are Overwhelmed

A month ago, in early November, hospitalizations passed 60,000—and kept climbing, quickly. On Wednesday, the country tore past a nauseating virus record. For the first time since the pandemic began, more than 100,000 people were hospitalized with COVID-19 in the United States, nearly double the record highs seen during the spring and summer surges.

The pandemic nightmare scenario—the buckling of hospital and health-care systems nationwide—has arrived. Several lines of evidence are now sending us the same message: Hospitals are becoming overwhelmed, causing them to restrict whom they admit and leading more Americans to needlessly die.

The current rise in hospitalizations began in late September, and for weeks now hospitals have faced unprecedented demand for medical care. The number of hospitalized patients has increased nearly every day : Since November 1, the number of people hospitalized with COVID-19 has doubled; since October 1, it has tripled.

Throughout that time, health-care workers have worried that hospitals would soon be overwhelmed. “The health-care system in Iowa is going to collapse, no question,” an infectious-disease doctor told my colleague Ed Yong early last month. The following week, a critical-care doctor in Nebraska warned, “The assumption we will always have a hospital bed for [you] is a false one.”

These catastrophes seem to be coming to pass—not just in Iowa and Nebraska, but all across the country. A national breakdown in hospital care is now starkly apparent in the coronavirus data.

It is clearest in a single simple statistic, recently observed by Ashish Jha, the dean of the Brown University School of Public Health. For weeks, the number of people hospitalized with COVID-19 had been about 3.5 percent of the number of cases reported a week earlier. But, he noticed, that relationship has broken down. A smaller and smaller proportion of cases is appearing in hospitalization totals.

“This is a real thing. It’s not an artifact. It’s not data problems,” Jha told us.

Why would this number change? As hospitals run out of beds, they could be forced to alter the standards for what kinds of patients are admitted with COVID-19. The average American admitted to the hospital with COVID-19 today is probably more acutely ill than someone admitted with COVID-19 in the late summer. This isn’t because doctors or nurses are acting out of cruelty or malice, but simply because they are running out of hospital beds and must tighten the criteria on who can be admitted.

Many states have reported that their hospitals are running out of room and restricting which patients can be admitted. In South Dakota, a network of 37 hospitals reported sending more than 150 people home with oxygen tanks to keep beds open for even sicker patients. A hospital in Amarillo, Texas, reported that COVID-19 patients are waiting in the emergency room for beds to become available. Some patients in Laredo, Texas, were sent to hospitals in San Antonio—until that city stopped accepting transfers. Elsewhere in Texas, patients were sent to Oklahoma, but hospitals there have also tightened their admission criteria.

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