[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.