Some hospitals are running out of health care workers. Here's what could happen next
Posted November 11, 2020 12:27 p.m. EST
CNN — Imagine going to a hospital so overwhelmed, doctors and nurses with Covid-19 are allowed to keep working.
Or having a heart attack and getting rushed to a hospital, only to learn there's not enough emergency care for you.
These scenarios have already turned into reality. The US has more people hospitalized with Covid-19 this week than at any other point in the pandemic.
"The difference between what's happening now versus what happened before is that the virus is everywhere now," emergency medicine physician Dr. Leana Wen said.
"Before, there were just a few hot spots across the country. There were health care workers who could volunteer and go between different states," she said.
"But when the virus is so widespread, we could very well ... run out of health care workers, which means that patient care is going to suffer. And we will be at breaking point in our hospitals."
This current onslaught of fall Covid-19 cases is the result of more indoor socializing, reopened schools and people flouting safety precautions due to pandemic fatigue, health experts say.
Nationwide, 61,964 patients were hospitalized with Covid-19 on Tuesday, according to the Covid Tracking Project. That's the highest number since this pandemic began.
"We're already seeing our hospitals at breaking point in some parts of the country. And that means it doesn't just affect patients with coronavirus," Wen said.
"It also means that elective surgeries are being put off for things like hip replacements, for cancer surgery or heart surgery in some cases."
And the crisis is expected to get worse. The US had a record-high 136,325 new Covid-19 cases reported Tuesday, according to Johns Hopkins University.
And massive surges in new infections lead to more hospitalizations and deaths in the following weeks.
"Unfortunately, I think the statement about 'new record' is going to be repeated over and over again," said Dr. Ashish Jha, dean of the Brown University School of Public Health.
"We have more infections now than we've had certainly since the beginning of the pandemic. And I expect that those numbers will continue to climb. Hospitalizations are going to continue to climb."
When hospitals can't take any more patients
In Idaho, some patients needing hysterectomies or joint replacements will have to wait.
"We've already been making decisions about not taking pediatric admissions and closing our pediatric floor to save on bed space and staffing," said Dr. Joshua Kern, vice president of medical affairs for St. Luke's Magic Valley, Jerome and Wood River medical centers.
"We're saying no to elective procedures that require an overnight stay."
Idaho was one of 17 states that had a record-high number of patients hospitalized with Covid-19 on Monday, according to the Covid Tracking Project.
"We have gotten to the point where we haven't turned patients away but we've been required to transfer them to one of our sister hospitals in Boise, where they do have some capacity," Kern said from Twin Falls, about two hours southeast of the capital.
"Basically when we get to the point where the hospital is full -- based on the staffing capacity that we have available -- then we'll say no to any additional patients. So that'll be patients in our own ER that we'll then have to transfer to Boise via ambulance or helicopter or fixed-wing plane."
Even patients who don't have coronavirus are suffering from the pandemic.
"We have a big backlog in hysterectomies ... knee replacements, hip replacements -- anything that can be put off," he said.
"Is it optimal? Never. If somebody needs a spine surgery or a hysterectomy, it's borderline whether it's truly elective. But we're so crunched for staff, we have to make those decisions."
A doctor who volunteered in NYC won't travel now
When Covid-19 crippled New York City earlier this year, thousands of volunteers from across the US came to help.
Dr. Tomas Diaz, an emergency room doctor from San Francisco, spent a month volunteering at a New York hospital during the spring surge.
But now, Diaz is staying put in California.
"I'd be concerned about leaving at a time when I might be needed here, at my current home," Diaz said.
San Francisco is faring much better than many cities -- possibly because of an early mask mandate and shelter-in-place order, he said.
But the situation could change at any moment.
"These are unprecedented times for all of us," Diaz said.
"We're seeing the effects of it, in terms of folks ... not being able to have visitors in the hospital, (being) isolated from their loved ones in the hospital, and potentially dying as well."
And he's seeing young people get hospitalized with Covid-19, too.
"I have had patients who are young -- like 30s and 40s, otherwise healthy -- who are just completely knocked out by Covid and need to stay in the hospital with low oxygen saturations," he said.
When a heart attack patient can't get quick care
In Utah, hospitals "are really at the brink of not being able to take any more people ... particularly in our intensive care units," Gov. Gary Herbert said.
"We just don't have rooms that have got doctors and nurses that can provide the health care."
Utah mother Laurie Terry learned that the hard way. And she doesn't even have coronavirus.
Terry recently suffered a heart attack and needed special equipment in a hospital's intensive care unit. But a doctor told her family there weren't enough hospital resources available due to the pandemic.
Eventually, Terry got to a hospital with an opening and the specialized care she needed. But her sister said her condition has grown worse.
6 hours to the closest available ICU bed
While big cities took the brunt of previous outbreaks, Covid-19 cases are now exploding in rural parts of the country.
"Surges in rural areas are especially concerning since many rural hospitals have less capacity to expand the ability to care for patients and fewer resources to fall back on," said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association.
Kansas Gov. Laura Kelly said hospital capacity is now a major concern in both rural and urban parts of the state.
She recalled a recent example in rural Kearny County, where the closest available ICU bed was in Kansas City -- six hours away by car.
"We must (work) to flatten the curve," the governor said. "We know how to mitigate the spread of the virus. We know that masks work."
Some doctors and nurses with Covid-19 can keep working
In North Dakota, the staffing shortage is so bad that asymptomatic health care workers infected with coronavirus can work in Covid-19 units of medical facilities.
"Our hospitals are under enormous pressure now," Gov. Doug Burgum said when announcing the change Monday.
Some hospitals have already hired traveling nurses and suspended elective surgeries. But staffing "continues to be a challenge amid heavy patient counts," Burgum's office said.
Health care workers infected with coronavirus can keep working in Covid-19 units "so long as they remain asymptomatic and additional precautions are taken as recommended by the US Centers for Disease Control and Prevention and the North Dakota Department of Health to protect the worker and the community," the governor's office said.
Such precautions include taking the health care worker's temperature daily and wearing a face mask.
Retired health care workers are asked to help
"Many nurses are coming out of retirement to deal with this issue," said Gerard Brogan, director of nursing practice for National Nurses United, the largest union of registered nurses in the US.
Like many states, Wisconsin is grappling with both an onslaught of Covid-19 patients and a heavily strained health care system.
"The number of staff out due to illness or quarantine is also a factor in our staffing needs," said Laura Hieb, chief nursing officer at Bellin Health Systems in Green Bay.
So Bellin has asked retired health care workers to return.
"They are helping in some of our high-need areas like testing sites, follow-up phone calls and data entry. Some have worked in clinical areas, but due to age and other factors, most are not working on the front lines," she said.
The health care system has redeployed or rehired more than 200 people, Hieb said. They include retirees as well as "a good number of Bellin College faculty and students helping in low-level jobs."
Hieb said there's a key difference between this fall Covid-19 surge and previous surges: "The volume of inpatients is greater than last time."
Doctors plead for personal responsibility
For many months, Americans have heard "we must flatten the curve so as to not overwhelm the hospitals," Brogan said.
Yet here we are again: Hospitals are at or near capacity, starting to divert patients and delaying certain surgeries. Why?
"I think it's pretty simple: People will not behave themselves," Brogan said.
"There's a whole lot of people who think this is a 'plandemic.' They don't believe the science," he said.
"There's this myth among the youth that they can't get Covid. People aren't social distancing. People aren't wearing masks. It's a misinformation campaign that's exacerbating this pandemic."
Dr. Emily Spivak, who's been treating Covid-19 patients in Salt Lake City, said it's "super frustrating" that many people won't take simple steps to help -- such as physical distancing, mask wearing and hand washing.
"I don't see an end. No one's doing anything to stop what's happening," she said.
"It's kind of like people just are going out and living their lives not realizing that they are exhausting our health care system."
It's important to remember health care workers are "really putting their lives and their safety at risk," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
Many have lost their lives. More than 1,700 health care workers in the US have died from Covid-19, National Nurses United reported in late September.
It's a tragedy not just for their loved ones and colleagues but also for patients who relied on their care.
And exhausted nurses working 12-hour shifts are sometimes caring for twice as many patients as they normally would, Brogan said.
For those who don't think they'll be personally affected by this crisis, don't count on your luck lasting, he said.
"Do not overwhelm the system. If you do not have a close relative or a loved one or someone in your neighborhood who's suffered from Covid, you will in the future unless you adhere to these basic public health measures," Brogan said.
"It's a little sacrifice now for the greater gain for all."