[bingohbangoh]

Are they really overwhelming hospitals?

This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%. [0]

If we look at Israel, which has a very high vaccination rate, we see that they're supposedly running out of hospital space. [1] But the article linked doesn't say _anything about their actual numbers atm_ and points to a fiscal problem rather than a manpower problem.

There was a recent Science Magazine article that states that 13% of the hospitalized-and-vaccinated group are under 60. That amounts to 39 people in a country of 9 million. [2]

I've asked this before both here and elsewhere: If these vaccines aren't "good enough," what is? At what point does this become "zero COVID" in that "nobody can ever die from this disease again?"

[0]: this may have changed -- things are changing quickly -- so I'd be curious if you have any recent (<1 week old) information on this.

[1]: https://www.haaretz.com/israel-news/israel-s-public-hospital...

[2]: https://www.sciencemag.org/news/2021/08/grim-warning-israel-... -- and I took this from Louis Rossmann's video https://www.youtube.com/watch?v=mYtfT7HsJq0

[dragonwriter]

> Are they really overwhelming hospitals?

Yes.

> This keeps being repeated but most hospitals operate at about 80% capacity as-is.

They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity.

> Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%

In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0]

[0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...

[zeku]

There are NO ICU beds in Tennessee.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

[ekianjo]

> there are significant areas over 95% ICU capacity

It's not like there is any large ICU capacity anywhere anyway.

[erhk]

Those patients simply go somewhere else and cause more strain. We on hacker knews should known the pain of cascade failures more than other platforms.

[dham]

Is every hospital getting overwhelmed though? I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I'm getting fake news?

[dragonwriter]

> Is every hospital getting overwhelmed though?

In the country? No. In large areas? Yes.

> I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I’m getting fake news?

There are vaccine requirements being adopted some places, and there are departures related to it. But if you are seeing news suggesting that that is the major source of capacity strain (or even the major source of COVID-related causes of people departing healthcare jobs), it is, at least, distorted news.

[bingohbangoh]

I'll throw in a anecdote: my family in nearby hospitals are *not* being mandated to get vaccinated.

This is precisely because there is high demand for registered nurses and other medical staff at the moment.

[qwerty456127]

> This is precisely because there is high demand

Ok. At least somebody can exercise reason when necessary.

By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.

[bingohbangoh]

> what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay?

I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.

[qwerty456127]

Not all Europe. Some countries governments are stubbornly against this and only accept a positive PCR test taken during the actual sickness.

[SamBam]

> To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it.

This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.

A vaccine is nothing more than exposing the immune system to the antigens. If their immune systems are already geared up to fight Covid, they will simply respond to the vaccine as another Covid infection and fight it accordingly.

As for whether there is any benefit, there absolutely is. Multiple exposure events greatly increase the storage of the antibodies in the memory cells of the immune system. This is why most vaccines require at least two shots, and why the CDC is now recommending a third booster shot for some people.

Plenty of studies show that the immunity of people who are vaccinated is stronger than those who were infected naturally (e.g. [1]), and that the immunity of people who have had Covid is significantly more robust after subsequent vaccination (e.g. [2], [3]).

1. https://www.biorxiv.org/content/10.1101/2021.04.15.440089v2....

2. https://apnews.com/article/science-health-coronavirus-pandem... ("The survivors who never got vaccinated had a significantly higher risk of reinfection than those who were fully vaccinated, even though most had their first bout of COVID-19 just six to nine months ago.")

3. https://www.medrxiv.org/content/10.1101/2021.04.25.21256049v...

[logicchains]

Yet data from Israel suggests that the vaccinated are six times more likely to get delta than people with natural immunity: https://www.israelnationalnews.com/News/News.aspx/309762.

>This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.

There's nothing unscientific about it; it's been known for a while now that some vaccines like the flu vaccine are inferior to natural immunity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870374/

[sumnuyungi]

Do you have a non-paywall link to that article or a link to the actual data? The article should list sources.

[xadhominemx]

Have you tried Google?

[KaiserPro]

India: yes.

The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed.

Belgium was overwhelmed.

The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=...]

filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff.

if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer.

The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless

[qwerty456127]

> you could go one more cycle of exponential growth, doubling every n weeks/days

I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't.

Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

[KaiserPro]

> Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.

Correct!

but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action.

We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag.

I really hope that you are correct about asymptomatic. but we can't be sure, yet.

[starik36]

> At what point does this become "zero COVID"

In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zeala...

It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.

[DanielR31D]

This is untrue. In New Zealand we locked down a reasonable amount for the information we have on the case. With the current lockdown, there was a single case with no known link to the border which had traveled around the country while infectious. Knowing just this and that every case in managed isolation (iirc) was is the Delta variant, we went into lockdown. Also, '5 lockdown' is misrepresentive. We can see on this page https://covid19.govt.nz/alert-levels-and-updates/history-of-... that while some lockdowns were very restrictive, country wide, and long (2.5 months), most were short and regional (with other regions maybe going to lvl 2 alert)

[starik36]

How is that untrue. There were three Alert Level 3 and two Alert Level 4 instances.

> short and regional

Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.

[xadhominemx]

Definitely not more disruptive in New Zealand over the entire course of the pandemic and also we have suffered 600,000 fatalities as a result of the virus.

[dcolkitt]

I'm virtually certain that the pandemic disrupted everyday life in NZ more than it did in Florida. Now more people died, but Florida demonstrates that even at the height of the pre-vaccine pandemic it's perfectly possible to live a lockdown free life post-Covid without society collapsing.

[mbesto]

Here ya go in Texas:

https://www.texastribune.org/2021/08/10/coronavirus-texas-ho...

As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%.

https://covid-texas.csullender.com/

So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.

[cogman10]

So, the anecdotal evidence would be to visit /r/medicine and /r/nursing on reddit.

It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients.

Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.

[bingohbangoh]

I know many nurses and doctors who work at hospitals in and around the NYC tristate area -- they all say capacity is well under the normal rates for them.

Note: last April (2020), they said it had exploded due to COVID-19.

[cogman10]

Yeah, the main difference appears to be states that have high vaccine participation and states that don't.

[sreque]

This is just your bias showing, nothing more. COVID has been shown to be seasonal and to hit different parts of the world at different times of the year. Southern states appear to get hardest hit in the summer, while the colder Northern states are harder-hit in the winter.

Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.

[bingohbangoh]

So what is there to say about Israel or Gibraltar?

Both have very high hospitalization rates. Both also have very high vaccination rates.

[cogman10]

IDK, hard to say what's going on there.

In the worst case, it may just been that the vaccine effectiveness wanes over time.

[spookthesunset]

What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

Positive covid tests require a hell of a lot more hospital overhead to deal with, even if they don’t have symptoms and are in for something else. It could very well be the case that this is a self made problem. We very well could be artificially overloading hospitals because we dictate that every positive test, regardless of symptoms, invokes massive overhead.

And again, every article I read never clarifies this. In fact many conflate “people with covid but there for something else” and “people sick with covid”.

I am fully inclined to believe that this hospital shortage is a self inflicted problem. If this was literally a hospital full of people choking on their own ooze, the media would be all over it like moths to a flame.

[cogman10]

> What is a covid patient? One that tested positive and is in the hospital for something else? Or one that is actually sick from covid? Because absolutely none of these articles I read clarify that tidbit and it is very important.

The stories on the reddits I suggested are all pretty much the same. Patient comes in struggling to breath, tests positive for covid, ends up with blood clots or pneumonia which pushes them into the ICU.

Here's just one of many stories of burnout [1]

[1] https://www.reddit.com/r/nursing/comments/p9ps06/the_burn_ou...

[spookthesunset]

Those are anecdotes not data.

[cogman10]

Clearly.

> So, the anecdotal evidence would be...

I'm not trying to represent it as anything other than that.

[kxyvr]

Yes. Unquestionably.

Here are a few different articles from around the gulf coast states that speak to this:

https://www.khou.com/article/news/health/coronavirus/houston...

https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-...

Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full?

On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal.

In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses.

As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then.

Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete.

Some questions that may help with any personal investigation:

1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be.

2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.

[aero142]

From what you are hearing, are staffing levels the same as pre-covid, and how much is reduced staff vs increased COVID patients contributing?

[kxyvr]

That, I don't know. Since we've been together, prior to COVID, I never recall her mentioning they had trouble getting nurses. If there was a particularly busy night, the nurse manager had a number of nurses on-call who would then come in to staff beds. Now, that's impossible. They're not there. On top of that, the nursing staff calls out sick far more often now than before.

Are these difficulties because there are fewer nurses on the market, the existing staff are burned out, there are better opportunities to work locums, or some other factor? Not sure. Mostly, it's to say that there was never a conversation between us on the lack of nurses prior to COVID.

As far as physicians, also not sure. I will say that demand was consistent prior to COVID, but now demand for both temporary and permanent positions is extremely high. They won't stop calling. Something to understand here is that the supply of new critical care physicians takes a very long time to ramp up, four years of medical school, four years of residency, and two years of fellowship. They're not easy to replace.

As a final side note, whether they do or not, they would all like to quit. They're burned out. This has gone on too long. The families dealing with end of life care are often abusive. Virtually all of their patients are unvaccinated, which means that this is preventable. They're frustrated that their professional opinion has very little impact on the public discussion of COVID, especially when they deal with the issue so intimately and they spent a good portion of their life dedicated to understanding and treating the issues behind illness.

[kolanos]

> More than 260 hospitals and health systems furloughed workers in the last year, and many others implemented layoffs.

[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...

[spookthesunset]

Those articles never define what “covid hospitalization” means. Is it people in the hospital because of covid or is it people that test positive for covid and are there for something else? There is a big difference between the two. Covid positive test results probably invoke a lot of extra overhead even if the patient has no symptoms and this could be a self made problem.

[kxyvr]

If someone is COVID positive, then they are likely contagious even if they have no symptoms. This means that they must be isolated from the other patients that do not have COVID or else there is a high risk of infection spreading to other patients. In places like the ICU, where all of the patients are critically ill, any additional infection will likely kill them.

Isolation from other patients means that they need other rooms and other nurses. It is not safe to have a nurse go from a clean room to a COVID room repeatedly if they don't have enough PPE to fully gown between rooms. Otherwise, there is cross contamination. Currently, there is not enough PPE. If a hospital has the staff, they will also isolate the physicians to either COVID or non-COVID wards to prevent cross contamination. Often, they do not have the physicians, so there is a time cost to constantly changing PPE. Time spent changing PPE means time not taking care of patients.

When a patient dies in a COVID room, the room must be cleaned. This takes time and staff. Failure to do so can also lead to increased infections.

To be clear, infections that spread in the hospital are very well studied. It's the reason why hospitals have very strict rules about things like hand hygiene. It's one of those inspections that can cost a hospital a lot of money.

That's a long way to say, it's not a self made problem. A patient that comes in for something like a heart stent who is also COVID positive is far more work than one who does not have COVID. I do not know if these news articles are referring to these cases as COVID hospitalizations. In some sense, it doesn't impact the broader issue: In a good number of states, hospitals are effectively full. The reason behind this issue is unvaccinated people catching COVID.

[spookthesunset]

It is a self made problem. Imagine if we tested people for every infectious disease and put them into crazy protocol-land even if they don’t have symptoms. Nothing would ever get done!

We need to accept that vaccines exist and work. It shouldn’t matter if the dude in the hospital has a positive covid test because everybody in that room can be vaccinated if they want to.

This mass testing created a bunch more problems than it solved.

[kxyvr]

No. It is not.

The difference between COVID and something like cancer is that cancer is not highly contagious. COVID is. Further, it's contagious and deadly. That's why it requires special care. COVID is also not the only disease where these kind of precautions are taken. Another one is TB. Now, there are other diseases that are contagious, but not right now. For example, syphilis is both contagious and deadly. However, you're not going to catch syphilis when you're sitting next to someone who is positive. With COVID, you potentially will. That's why they have to test for it in the hospital.

Now, I will agree that vaccines exist and work. In the sense that there are people who choose to refuse vaccination, I will also agree it is a self made problem. However, this affects everyone to a high degree and not just the vaccinated.

Case in point, my wife and I are vaccinated. If she gets COVID, she most assuredly won't die, but she can't work in the ICU. She would risk getting her patients infected even though she is vaccinated. That means the hospital loses a physician in short supply. They're going to test you in the hospital because they can't afford you getting their staff sick.

This also affects you. You're vaccinated. However, say you're appendix bursts, you may or may not be able to get into the ER before you become septic. Yes, the ER will triage based on need. However, if there's no beds there's no beds and you will not be seen.

However, to reiterate, the hospital will always test you for diseases that they believe will affect their staff. You come in with respiratory symptoms. You're getting a COVID test. Having surgery? They'll test you for HIV. It's a protection issue. COVID is a pain because airborne infections are hard to contain.

[spookthesunset]

Stop counting cases. We already know covid is endemic and isn’t going away. Why continue to test every patient for it? What purpose does it serve? Anybody that wants to be protected can be with a simple vaccine.

[zeku]

Here is the Tennessee reporting. NO ICU beds.

https://www.tennessean.com/story/news/health/2021/08/19/tenn...

[JamesSwift]

Anecdotal, but an acquaintance here in Florida had to wait over 14 hours to get an emergency appendectomy (and over 12 hours to get from check-in to a bed in the ER) recently, due to both COVID protocols as well as COVID workload.

[Calavar]

Total bed usage is a very poor metric for this.

The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in.

Source: I am a physician.