ATLANTA (AP) – The recent surge in coronavirus cases is overwhelming many intensive care units and is causing hospitals and states in some locations to run out of intensive care beds.
Kentucky and Texas broke records for COVID-19 hospital admissions this week, joining a handful of other states that had reached the same milestone in the past few weeks. Arkansas said that for the first time since the pandemic began, intensive care beds for COVID-19 patients had run out.
Nearly 80% of the country’s intensive care beds – or about 68,000 – were in use as of Thursday, according to the U.S. Department of Health. And about 30 percent of those beds, or nearly 25,000, have been occupied by someone with COVID-19.
As states get hammered by the super transmissible Delta variant, the surge has raised questions about what it means for individual patients in places where beds are not available. Here are some answers:
What is an intensive care unit?
Intensive care units are designed for the care of acutely ill people. They employ more staff, specialists, and equipment to keep patients alive. Machines monitor breathing and heart rate. In the event of shortness of breath or cardiac arrest, “crash carts” with defibrillators and intubation tubes are available.
Typical patients have just undergone extensive surgery. Some could suffer severe trauma from a car accident. And of course, some could be sick with COVID-19. Their lungs are damaged and they need ventilators. Nurses look after them – but so do pulmonologists, respiratory therapists and specialists in infectious diseases.
“It’s not just about having staff, it’s about having the right specialists or the right type of nurse to take care of that person,” said Nancy Foster, vice president of quality and patient safety for the American Hospital Association.
WHAT HAPPENS IF AN ICU REACHES OR EXCEEDS CAPACITY?
A fully utilized intensive care unit can become a personnel and logistical nightmare.
Nurses who would normally only care for one patient have to keep three or four people alive. Non-intensive employees are called in for support. Patients can secure themselves in emergency rooms and wait for an ICU bed to open. And hospitals are being forced to creatively convert rooms into makeshift intensive care units.
At Phoebe Putney Memorial Hospital in Georgia, the rush of COVID-19 patients has resulted in the hiring of large numbers of staff who normally do not work on patient floors. Including Scott Steiner, President and CEO of the Health System.
On Sunday, Steiner helped put COVID-19 patients on their stomachs so their ravaged lungs could potentially take in more oxygen. The maneuver may require six people, depending on the patient’s weight.
“That’s all hands on deck,” said Steiner.
On some campuses, the surge has displaced beds reserved for procedures like colonoscopes or carpal tunnel surgeries, said Roberta Schwartz, executive vice president of the Houston Methodist Hospital Systems, where coronavirus patients filled nearly half of the intensive care beds earlier this week. A post-surgery recovery bay has been converted into an intensive care unit.
Schwartz compared a flooded intensive care unit to a home overcrowded with overnight guests, and the host blows up air mattresses to accommodate them.
“It’s not very convenient, but it works,” she said. “And an inflatable mattress is better than a sleeping bag, which is better than an outdoor tent.”
HOW DOES IT AFFECT PATIENTS?
Patients may have to stay in emergency rooms waiting for a bed in the intensive care unit, and that spreads to other patients.
This week, some Texas hospital systems temporarily closed their off-site emergency rooms and sent staff to their COVID-19 overwhelmed hospitals.
Patients arriving in a hospital emergency room can wait several hours – and sometimes days – to get to an already overwhelmed intensive care unit.
“We basically do the intensive care unit in the emergency room,” said Schwartz of the Houston Methodist. “You can hold there for 45 minutes and you can hold for three days.”
“You will be very well looked after when you can come to one of our facilities,” added Schwartz. “But ideally you want to get people into the appropriate unit as quickly as possible.”
Another impact affects people who live in rural areas where intensive care units are scarce. According to the American Hospital Association, less than 3% of ICU beds nationwide are in small rural hospitals.
In the intensive care units of larger hospitals, there are often requests to take over transfers.
“We cannot take in many of these patients because we are busy,” said Dr. Steppe Mette, CEO of the Medical Center at the University of Arkansas for Medical Sciences. “All of our intensive care units are full. And our emergency room is full of patients who need intensive care units. “
HOW DOES IT AFFECT THE STAFF?
They are increasingly burning out.
This week, staff in the intensive care units at Memorial Healthcare System in South Florida were caring for 107 COVID-19 patients who were “the sickest of the sick” at one time, said Dr. Aharon Sareli.
Many did not respond to steroids or other treatments. They needed ventilators and faced multiple organ failure. Many were expected to die.
“It is extremely stressful physically and emotionally for the employees,” said Sareli.
Hospitals already have a shortage of nurses and other medical personnel. Some employees leave, and those who stay are upset and lose compassion.
“I think they’re also a little stunned that we’re still doing it after 18 months, and it’s worse than ever,” said Steiner of Phoebe Putney Memorial Hospital in Georgia. “Some are just angry because so many people are not vaccinated.”
Finley reported from Norfolk, Virginia.