Hospital bed capacity is not the only problem with critical Covid care

As of mid-December, hospitals had, on average, only 22 percent of the beds for their intensive care units (ICUs) available nationwide, and many were completely full. As the wave of Covid-19 continues to intensify, the lack of ICU beds can have dire consequences, including the inability to properly care for the sickest patients, potentially rationing rescue care.

But even these bed capacity numbers don’t tell the whole story.

Adding extra beds for critical care in other wards or buildings takes up valuable time, resources, and space. But adding trained staff is much harder, especially deep in the pandemic.

When there are no trained staff, it is even more difficult for hospitals to best meet the needs of patients with critical care. These patients include people who are very ill with Covid-19, but also many who for other reasons must be in an intervention unit, such as those who have had a heart attack or stroke, are recovering from major surgery, or are sick with the flu, among others.

The number of people with Covid-19 currently in intensive care in the U.S. reached its highest level in mid-November and has been climbing ever since.
Our world in data, with data from the COVID Tracking Project and the COVID19 Tracker

Only a dozen states had more than 30 percent of ICU capacity on December 15, and the number of coronavirus cases has only accelerated since then. And the reality on the ground is much worse in many areas, as reported by the New York Times.

According to Times data collected from the U.S. Department of Health and Human Services, for about 100 hospitals in the Los Angeles area, more than 65 reported ICU occupancy of 90 percent or more. Cedars-Sinai Medical Center occupied 112 percent of its capacity.

In Dallas, the fourth largest metropolitan area in the country, out of 47 hospitals with more than 20 patients with Covid-19, 80 percent of them had no zeros or only one bed left on the ICU. The most open beds in any hospital were five.

In Minneapolis-St. Paul, half of the hospitals with more than 20 patients with Covid-19 had more than 95 percent ICU beds.

In Oklahoma, which has the third highest rate of new cases per capita in the country, of the hospitals with more than 20 Covid-19 cases, most had more than 90 percent occupancy of ICU beds.

Nancy Nagle, a pulmonologist and emergency physician at the Integris Health System in Oklahoma City, who reported the full occupancy of JT in the latest HHS data, says they have turned regular patient rooms into ICU rooms to try seriously. solve the onslaught of sick people. Despite this, she said, “occasionally patients with Covid-19 have to stay in the emergency department for several hours waiting for their bed to become available.”

And there are few signs of relief in many parts of the country, with an average of 200,000 new Covid-19 cases reported daily since early December.

“Patients keep coming, and we have to take care of them no matter the number of employees,” Vox wrote in an email to Gisella Thomas, a respiratory therapist at the Desert Regional Medical Center in Palm Springs, California. “I’m afraid there’s been so long that staff can hold out before the break, which could ultimately limit capacity in itself.”

Covid-19 can be a long, unpredictable, complicated disease

The sickest patients with Covid-19 can stay in the ICU for weeks – or longer. And although we’ve learned a lot since the spring about how to better treat seriously ill Covid-19 patients, the disease is still challenging to deal with, and we have no cure for it. Which means that 2 percent of people who get Covid-19 and end up in need of critical care are often on ICU until they recover – which often involves invasive intubation treatment – or die.

One of the reasons JILs fill up is that when a patient with Covid-19 becomes ill, they are unlikely to stabilize quickly. A September study found that the average ICU stay for a patient with Covid-19 was about a week – almost twice the usual stay of 3.8 days for other OJO patients. Other anecdotal reports show that many patients may be in intensive care for weeks or even months. And determining this number is crucial for projecting how many beds may be available in the future if cases continue to climb.

As pointed out in the October study, if the average length of stay in the ICU is 10 days, it means that there is only a 10 percent chance of opening a new bed every day. So when admission exceeds that rate, the ICU is likely to be overwhelmed.

This is something that those who work with the critically ill with coronavirus have to contend with. “Unfortunately, Covid-19 patients stay in the ICU for a long time,” Nagle said. “The course of the disease is very slow, and that contributes to the lack of free beds.”

And while they are patients with Covid, meeting their needs can be extremely labor intensive. “Patients with Covid-19 can be incredibly ill, with multiple monitoring and adjustment devices, with multiple medications to give and laboratory results for drawing and viewing results,” Nagle said. And while we now have a better understanding of possible ways to treat seriously ill patients, “patients still respond in different ways, and their progress and possible outcome are always unpredictable.” This is another reason why hospitals do not always have a good projection of how many ICU beds they will have in the coming weeks or days.

Caring for patients with Covid-19 also requires many more steps and precautions than when ICU staff work with other patients, further stuck units. All staff entering the ICU Covid-19 room must wear clothing and protective equipment each time, which requires large resources. “This also creates real difficulties if someone crashes because it slows down our response,” Thomas said. “The need for more thorough cleaning of all equipment also creates delays and makes the usual number of staff inadequate for a pandemic.”

Meanwhile, doctors, nurses and other health professionals are trying to provide the best care they can, while they are being asked to address more and more patients. “Critically ill patients are very complex,” said Orlando Garner, a pulmonary physician for critical medicine at Baylor School of Medicine. “At the same time, there are a lot of moving parts that need the same priority.” But, he said, “when you’re stretched beyond your means, you can’t provide the same quality care if you don’t create more qualified health workers, and as we’ve learned, it’s a scarce resource.”

The staff is even smaller than the bed

Although hospitals can often expand the number of beds and the amount of supplies to some extent, the staff is significantly shorter. “The most valuable resource in any hospital is human beings capable of caring for patients,” Sarah Delgado, an acute care nurse and clinical practice specialist at the American Nurses Association, wrote for Vox. e-mail. “It’s a limiting factor.” Without enough of these people to take care of all those who are very ill, “patient outcomes are likely to suffer,” she said.

And it’s not just JIL doctors and nurses who are in short supply. “Critical care is more of a team sport,” Garner said. “This includes care and interventions provided by the doctor, but also a careful dose of drug selection with pharmacists, qualified nursing care, respiratory therapists, mid-level service providers, nutritionists, early mobilization with physical therapists.” To this list, Nagle adds all the other hospital staff needed to perform other important tasks in the ICU, including bathing patients, changing bedding, and other functions.

In order to accept the overweight patients of very sick Covid-19 patients, many hospitals had to rework their staffing structure. At Christiana Hospital in Delaware, nurse Lauren Esposito and her colleagues typically work with critical heart patients. But this year, her unit served as a topping for the Covid-19 critical cases. “It was a little uncomfortable at first,” she wrote for the American Nurses Association.

Their hospital implemented a multiple employment strategy in which cardiac nurses would work under trained ICU nurses. “During the shift, if a patient collapsed, we managed to bend over and force the nurse to go to that patient to provide care,” she wrote. They could also provide rapid training to nursing staff, for example, on working with intubated patients. However, excessive duties were tense and not relieved given the intensive isolation of these patients to stop the spread of infection. “I remember when I first walked into the patient’s room, it really struck you that you were the primary caregiver and that no one else could enter.”

Also, staff now often have to visit multiple patients at once. In California, where an average of more than 44,600 people tested positive for coronavirus each day last week, Governor Gavin Newsom reduced the ratio of nurse to patient in the state from 1: 2 to 1: 3 in an attempt to meet the growing number of Covid-19 hospitalizations. .

In Oklahoma, Nagle notes that while the nurses he works with typically care for one to two patients during a shift, “with a shortage of critical care nurses, each nurse can have three, and in very extreme conditions even four patients to care for. ”

This increase in the number of patients that each nurse has – especially in a complex disease like Covid-19 – is a major adjustment. “Nurses are with the patient every hour every day, giving rescue medication, cooperating with other members of the health team, passing information to families and providing end-of-life presence when those families cannot visit due to strict isolation requirements,” Delgado said. “This job cannot be done when the number of patients exceeds the staff capacity.”

And staff often get sick from the virus. According to a November report, as many as a quarter of Covid-19 infections in some states are among healthcare workers.

“It could have been me.”

Garner, whose entire family fell ill with Covid-19 earlier this year, including his four-month-old daughter, says the illness alone has given him a new perspective on patients now flooding into local Texas ICUs.

“It could have been me, my wife or one of my kids on that bed,” he said. “It’s easy to rationalize the amount of sick patients thinking, ‘oh, they didn’t distance themselves’ or ‘they didn’t wear masks,’ but the fact is that no one deserves to catch this virus and get sick from even people who suspect it.” As the spike continues to grow, compassion is the only thing that can stop us from becoming bitter and burnt out.

The other side of it is the recollection of compassion for the healthcare professionals who care for these patients, especially as the holidays approach. Many of these workers will not only continue long shifts during the holidays, but will do so knowing that many people ignore public health warnings to avoid gatherings.

“We need the public to do its part,” Delgado said. “Stop unimportant travel, strictly adhere to the guidelines of wearing masks and social distancing, and limit socializing with those outside your household,” Delgado said.

Katherine Harmon Courage is a freelance science journalist and author Cultural ii Octopus! Find her on Twitter at @KHCourage.