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Keith Bishop/Getty Photographs Keith Bishop/Getty Illustrations or photos Thousands and thousands of persons are testing positive with COVID-19 in the U.S. each 7 days and the Food and drug administration warns that most Individuals will get the virus at some place. With increasing evidence that …
Dr. Anthony Fauci, director of the Nationwide Institute of Allergy and Infectious Illnesses and chief health care adviser to the president, and Dr. Rochelle Walensky, director of the Facilities for Ailment Command and Avoidance, testify at a Senate committee hearing about the federal response to …
A medical worker puts on a mask before entering a negative pressure room with a COVID-19 patient in the ICU ward at UMass Memorial Medical Center in Worcester, Mass., last week.
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A medical worker puts on a mask before entering a negative pressure room with a COVID-19 patient in the ICU ward at UMass Memorial Medical Center in Worcester, Mass., last week.
Joseph Prezioso/AFP via Getty Images
The omicron-driven surge has sent COVID-19 hospitalizations skyrocketing across the U.S., reaching a new pandemic high this week with 145,982 patients hospitalized.
This exceeds the previous high recorded in January last year, according to data tracked by the Department of Health and Human Services, from more than 5,400 hospitals in the country.
Patients with COVID now fill about 30{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} of ICU beds in the nation and pediatric COVID hospitalizations are also at the highest rate of the pandemic.
The record-breaking numbers are a sign of just how quickly the omicron variant has swept across the country. Overall, infections are also at record levels, with the U.S. averaging more than 700,000 new cases a day.
And researchers and health workers warn that the crowded conditions could be leading to a rise in avoidable deaths, as clinicians struggle to provide the level of care they would normally.
“Things are looking grim and substantially worse in many ways than even just a year ago,” says Dr. Doug White, a critical care physician at the University of Pittsburgh School of Medicine.
Hospitals are stressed all over the country, from Maryland to Missouri, where the number of people in the hospital with COVID-19 have exceeded or are nearing previous highs. State and hospital leaders and health care workers are issuing some of the more dire warnings of the pandemic.
“We are closer to a crisis situation than we ever have been,” said Dr. John Lynch at UW Medicine in Seattle at a recent press briefing.
In Maryland, Gov. Larry Hogan, who has declared a state of emergency, said last week that the coming weeks will be the “most challenging time of the entire pandemic.”
Health care workers in Arizona are warning state leaders that the health care system is on the verge of “collapse.”
“We’ve had more events where people are having cardiac arrests, or decompensating and getting very sick and even dying in the waiting rooms,” Dr. Bradley Dreifuss, an emergency medicine physician in Tucson, Ariz., told reporters on Friday.
All over the country, governors are mobilizing National Guard members to bolster beleaguered hospitals, including in Ohio.
“The hospital is filled to the brim,” said Dr. Kristin Englund, an infectious disease physician at the Cleveland Clinic. “Our intensive care units are full, our regular hospital bed floors are full, and a lot of it is COVID.”
The medical consequences of this latest surge could affect any American who needs medical care, whether for COVID-19 or another acute illness or injury, because research shows that when hospital admissions reach crisis levels, more patients die.
“When hospitals are strained, everyone suffers,” White says.
Before omicron hit, many U.S. hospitals were already faltering under heavy demand from patients infected with the delta variant, as well as patients seeking care because of treatment that was put off earlier in the pandemic. In addition, the shortage of health care workers had reached crisis levels. And now huge numbers of doctors, nurses and other health care workers are also testing positive and missing work, just as they’re needed most.
Following patterns seen in other countries, there are early signs in the U.S. that omicron causes less severe disease than the delta variant. Some hospitals are finding that fewer patients need ICU-level care or mechanical ventilation — a welcome sign.
“But the problem is that [omicron is] so transmissible, the sheer number of cases is going to be so high,” says Dr. Sameer Kadri, an infectious disease and critical care physician at the National Institutes of Health Clinical Center.
Omicron’s extreme infectiousness, when coupled with a depleted health care workforce, leaves hospitals unable to provide the same standard of care for patients as they normally would.
Kadri and his colleagues studied earlier surges and found that one in every four COVID-19 deaths was potentially caused by the strain of overcrowding. In the most overwhelmed hospitals — where the demand for ventilators and other resource-intense care was greatest — the mortality risk for COVID-19 patients doubled.
“What surprised me was the sheer magnitude of the impact,” says Kadri, lead author of the study published last fall. “There are less eyes, less hands, and for these patients who require high precision care, that might mean the difference between life and death.”
Much of this breakdown in care is unfolding out of sight for most Americans, but doctors on the front lines like Pittsburgh’s Dr. White are seeing deadly consequences every day.
“We got a call from a hospital out of state with a patient that had acute renal failure and needed to go on dialysis to replace the kidney function in order to survive,” White says. “We didn’t have any beds.”
Neither did any other hospital. “That patient died in the hospital that didn’t have this sort of basic therapy that we provide all the time to patients — dialysis,” he says.
“These are the very real concrete examples of patients dying in high-quality American hospitals right now because they can’t get transferred to higher levels of care,” he adds. “And the same thing is happening for patients with acute heart attacks or acute strokes.”
State agencies and hospitals have protocols for what to do when patient demand threatens to outstrip hospital capacity.
These protocols, called “crisis standards of care,” help triage patients and guide decisions about who gets care and who doesn’t in a disaster, epidemic or mass casualty event. The crisis standards can help determine how to allocate equipment like ventilators or drugs like monoclonal antibodies and activate systems to transfer patients between hospitals within states or regions. In the current surge, some hospitals have activated their crisis plans, including ones in Maryland.
White says more health officials need to follow suit and admit that much of the U.S. health care system is already operating in de facto crisis mode, whether or not they’ve officially made that declaration.
“There is a huge disconnect between reality and what is in the public awareness, and what, in my view, many state governments are willing to acknowledge,” he says. “The simple reality is that there is rationing happening every day right now in American medicine.”
This rationing happens in many ways and may not be obvious to the public but the consequences are very real: a single nurse forced to care for more patients per shift than is safe; procedures and surgeries canceled or delayed; and lifesaving care that simply isn’t available for some who need it.
Some epidemiologists predict total cases will peak this month. However, hospitalizations for COVID-19 tend to trail infections by about two weeks, which means hospitals must brace for more patients in the coming weeks, even after infections reach their peak and start to fall.
Surges affect all kinds of patients, not just those suffering from coronavirus. One study found a significant increase in overall mortality when patients were admitted during COVID-19 surges.
For 30 of the most serious conditions — stroke, heart attack, gastrointestinal hemorrhage — mortality rose by nearly 1{b574a629d83ad7698d9c0ca2d3a10ad895e8e51aa97c347fc42e9508f0e4325d} during surges early in the pandemic. That’s the equivalent of one additional patient out of every 100 patients with these conditions dying, if the hospital wasn’t dealing with a surge of patients, says Dr. Amber Sabbatini, an assistant professor of emergency medicine at the University of Washington.
“It’s a substantial increase,” she says. “If units are stressed by COVID patients, they may get to a heart failure patient or a septic patient in a less timely fashion.”
While the study couldn’t pinpoint why these patients died, Sabbatini says the exhaustion of health care workers caring for patients day in and day out — oftentimes without enough help or with new staff who aren’t familiar — can inevitably affect care.
“The impacts on the staff caring for these patients, that cognitive burden, that emotional burden is very high,” she says. “So there’s these subtle, difficult-to-test factors that could be contributing to why maybe patients are receiving poorer quality of care or they’re not having as good of outcomes as they [normally] would.”
Mary Venus, a nurse from the Philippines, on duty at Billings Clinic in Billings, Mont. Nick Ehli/Kaiser Health News hide caption toggle caption Nick Ehli/Kaiser Health News Mary Venus, a nurse from the Philippines, on duty at Billings Clinic in Billings, Mont. Nick Ehli/Kaiser Health …
Yaritza Martinez developed a Zika virus infection in 2016 when she was pregnant with her son Yariel, who is now 5 years old. Yariel is enrolled in a long-term study following a group of babies in the U.S. and in Colombia to see how they …
Blake Farmer plays with his kids, Louisa, 2, and Turner, 8, on the trampoline in their backyard in Nashville, Tennessee. After Thanksgiving, the family all had breakthrough COVID cases, resulting in a couple weeks spent at home. The trampoline served as a distraction for the kids, says Blake Farmer, their father.
Erica Calhoun for NPR
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Blake Farmer plays with his kids, Louisa, 2, and Turner, 8, on the trampoline in their backyard in Nashville, Tennessee. After Thanksgiving, the family all had breakthrough COVID cases, resulting in a couple weeks spent at home. The trampoline served as a distraction for the kids, says Blake Farmer, their father.
Erica Calhoun for NPR
When our 2-year-old tested positive for COVID-19 after Thanksgiving, we knew it would put our mostly vaccinated household to the test – because the only place she seems to cough or sneeze is in her parents’ faces.
And if you’re thinking, “but couldn’t she just wear a mask?” then you haven’t been raising a toddler during the pandemic.
Breakthrough experiences are becoming more common as our vaccine protection wanes, our pandemic precautions fade and the variants become more prevalent and more evasive.
Our family’s saga began the Monday after Thanksgiving. And it left us with a handful of questions that I’ll try to answer in the hopes that our experience may help others navigate the December holidays.
As the boys in my 8-year-old’s Cub Scout den fumbled around with a compass in a dark church parking lot, I received a text from Moriah, my wife of 16 years.
“You probably need to come home … now,” she wrote. An 11-year-old, a cousin, who was at our house for Thanksgiving, had tested positive for COVID.
“[Expletive],” I thought.
Moriah’s first thought: “I’m a bad person. What was I thinking, inviting 20 people from Texas and Tennessee over to the house?”
As a health care journalist what went through my mind was: “This will be really interesting to see who gets sick.”
Ironically, this transmission event may have begun because our extended family members were trying to maximize the power of the vaccines. The presumed source of infection, the 11-year-old distant cousin, could theoretically have gotten a dose of the Pfizer vaccine for 5-11 year-olds before Thanksgiving.
But the cousin was on the cusp of turning 12, so her mother had decided to wait until her daughter’s birthday at the end of November. At that point, she would qualify for the bigger adult dose of the COVID vaccine.
That’s a reasonable thought, though it did remind me of some prescient words from Dr. James Hildreth, president and CEO of Meharry Medical College in Nashville. Whenever reporters asked him whether people should wait for the most effective vaccine, he responded with advice that became his mantra: The best COVID vaccine is the one you can get right away.
In our household, our immediate concern was our unvaccinated 2-year-old, Louisa. But the next morning we also tested Turner, the 8-year-old. He had just received his second dose of the pediatric Pfizer vaccine the day before and was actually feeling a tad puny.
Here in Nashville, it’s still remarkably easy to get a free PCR test with no appointment. And that night Turner’s results arrived by email — “virus detected.”
At that point we now had two little COVID patients. Louisa, whom we call “Lou,” was snotty and coughing. But neither kid had a fever.
We alerted their schools. Fortunately, Turner’s elementary in Metro Nashville Public Schools strictly enforces a mask requirement — despite the Tennessee legislature effectively outlawing mask mandates. So no one else had to quarantine. He was sent home to isolate for 10 days.
But Lou’s preschool class got the dreaded email: Sorry parents, class is out for at least a week.
Moriah felt guilt and shame. My take was more philosophical: Sorry, but this is just life in the age of COVID.
As for the two of us, we were putting our own vaccines to the test. I’ve been fully Pfizer’d since mid-April. Moriah had snagged Moderna shot a few weeks before me. Neither of us had made time yet to get the booster, though we were planning on it. But Moriah probably did have a little more protection than me, since she also had antibodies after falling ill with a pretty mean case of COVID back in 2020.
By the first weekend after Thanksgiving, everyone in our house was feeling rather sick of each other, but otherwise we were healthy. Still, I decided to get myself tested, since I was supposed to go to the radio station for an on-air fundraising drive.
And to my surprise I was positive.
I had no symptoms that I noticed, though I began thinking maybe my sniffer was a little off. Could have been my imagination. But at least I no longer had to pretend I was keeping my distance from my COVID-ridden kids.
Blake Farmer with his wife Moriah Farmer, and two kids, Turner, 8, and Louisa, 2, in the backyard of their home in Nashville, Tennessee. After a family gathering over Thanksgiving, Louisa contracted COVID-19 after showing symptoms of coughing and sneezing. This resulted in breakthrough cases for the whole family, who navigated working remotely and having kids home from school for nearly two weeks.
Erica Calhoun for NPR
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Blake Farmer with his wife Moriah Farmer, and two kids, Turner, 8, and Louisa, 2, in the backyard of their home in Nashville, Tennessee. After a family gathering over Thanksgiving, Louisa contracted COVID-19 after showing symptoms of coughing and sneezing. This resulted in breakthrough cases for the whole family, who navigated working remotely and having kids home from school for nearly two weeks.
Erica Calhoun for NPR
In the end, we got through this unexpected holiday outbreak just fine, as a family. My wife and I are fortunate, in that we can work from home. We had to lean on screen-time more than we would have liked. The pandemic gift of a trampoline came in especially handy at this time, to keep the kids sane and somewhat exercised.
We served our isolation time, and resumed our normal routines on Dec. 13. We got ourselves PCR tests just to be sure, and they came back negative. We sent the kids back to school for a few more days before Christmas break. And that concluded our holiday-time brush with COVID.
But the experience left me with some questions, which I spent some time trying to answer.
Having nearly 20 people under one roof for a few days is a risk. We knew all the adults were vaccinated. And the grandparents, who had the highest risk of severe illness, were boosted. The kids who came to our house were a mixed bunch, as far as their vaccine status.
In hindsight, it would have been a good idea if everyone had taken rapid tests just before gathering. Epidemiologists say it doesn’t eliminate the risk of transmission, but it does give you a window of lower risk. At the same time, if I’m being honest, there was a part of me that just didn’t want to know. We had already called off Thanksgiving at the last minute in 2020, because of a local surge, and frankly, we missed gathering as a family.
The current official advice from the Biden administration, as Christmas approaches, doesn’t map easily onto the situation we faced.
President Biden said during a speech about omicron, on Dec. 21: “I know some Americans are wondering if you can safely celebrate the holidays with your family and friends. The answer is yes, you can, if you and those you celebrate with are vaccinated, particularly if you’ve gotten your booster shot.” And he added, if you “follow the precautions that we all know well.”
But how would that apply to our family, with its mix of vaccinated adults, and unvaccinated children?
CDC director Dr. Rochelle Walensky brought some clarity the following day, when she advised that Americans to “please get vaccinated, get boosted, wear a mask in public indoor settings, and take a COVID-19 test before gathering with others.”
Taking those rapid tests would indeed have been a good idea, in retrospect, but it’s unclear if everyone in our party would have been able to get their hands on those tests. Plus, they’re not free. Compared to Europe, availability of the tests has been erratic in the U.S., and recently many Americans have complained about being unable to find them.
It sure seems like they did. The only person with symptoms in our house was the unvaccinated toddler. While my infection qualified as a “breakthrough” case, the vaccine did its job and kept me from becoming ill, or even feeling ill. It appears that even our 8-year-old, who at Thanksgiving time had only received one of his two pediatric shots, benefited from protection.
This is the only part of the story that sort of scares me. If we hadn’t been alerted, we never would have thought about getting tested. Even little Lou just had what I would consider “the crud.” Her symptoms didn’t seem COVID-like. No one ever had a fever. Asymptomatic cases tend not to spread the virus as much as those that involve lots of coughing and sneezing everywhere. But if we hadn’t been alerted about the exposure, we certainly could have silently infected many more people, possibly someone vulnerable to severe infection.
The official recommendation of the CDC is to get a booster as soon as symptoms clear up. However, there’s some thought among infectious disease experts that it could be ideal to wait even longer, allowing the new antibodies created by a breakthrough infection to “mature.”
But as with many things in this pandemic, the science is still emerging. The official advice remains: Get a booster six months after the second vaccine dose. If you happen to be sick with a breakthrough infection at the time, then wait a little longer until symptoms disappear. There’s no way of being absolutely sure that an infection will be mild, like ours. Any COVID infection, even a breakthrough, can potentially become quite serious, or even fatal, and boosting is the best way to prevent infections.
We haven’t gotten the booster yet, but will.
I pray not for much longer. Life during this pandemic asks a lot of us, even when we follow the science and get vaccinated. By contrast, we don’t go to get tested for the flu, after we learn we’ve been around someone who had the flu. For many families, there are real economic consequences to holing up for two weeks. And it’s psychologically burdensome. I can’t blame people for going on about their business if they’re vaccinated and feel fine, and deciding to see what happens after a possible exposure, rather than seek out a test.
But COVID is also quite different from the flu. COVID is still killing, on average, more than 1,200 Americans a day. So we have to treat it differently and do what we can to protect those around us.
