Why Are Hospitals Supposedly Struggling?

 

I’m genuinely curious about something that the media are reporting but (of course) only superficially. As usual, there are questions no one seems to be asking.

We all remember how, in the spring of 2020, we went into lockdown to “flatten the curve,” essentially a desperate attempt to prevent hospitals from being overwhelmed. Whether the lockdown had any effect or not, the feared crisis didn’t happen; hospitals were busy, even very busy, but never beyond their ability to cope.

The US overall case count peaked early this year — still no stories of overwhelmed hospitals — and then fell sharply until July. Since then it has been climbing again, presumably driven by the spread of the Delta variant. But it has not climbed back up to the highs from earlier in the year, and there are signs that it might be starting to fall (or at least plateau) again. Meanwhile, we are told that although Delta is more transmissible, it generally cause less serious disease.

Why, then, is the news full of stories about hospitals supposedly struggling under a massive case load? This is apparently genuinely happening; I have heard anecdotes (not through the media) of people who couldn’t be admitted to hospitals because no beds were available. Why should hospitals be full to capacity now when they weren’t in January, when the case load was higher and the virus more dangerous? And what happened to all of the overflow capacity we had, but didn’t need, in 2020?

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  1. EJHill Podcaster
    EJHill
    @EJHill

    There was, for about a year, a website that allowed you to check the daily admittance of any hospital in a America. That was shut down and now it’s over at HHS. You would think that this information would be on the landing page of every local news site in the US. But it’s not.

    Addendum: Not every hospital reports.

    • #1
  2. Full Size Tabby Member
    Full Size Tabby
    @FullSizeTabby

    One explanation I have heard is that the hospitals are being even more aggressive than they were last year about labeling every patient who tests positive for Covid (all incoming patients are tested) as a “Covid patient,” even if the patient has no Covid symptoms. 

    • #2
  3. Bartholomew Xerxes Ogilvie, Jr. Coolidge
    Bartholomew Xerxes Ogilvie, Jr.
    @BartholomewXerxesOgilvieJr

    Full Size Tabby (View Comment):

    One explanation I have heard is that the hospitals are being even more aggressive than they were last year about labeling every patient who tests positive for Covid (all incoming patients are tested) as a “Covid patient,” even if the patient has no Covid symptoms.

    But that wouldn’t affect how many patients are hospitalized; that would just change the statistics on how many of them are supposedly COVID patients. So whether the hospitals are full of COVID patients or not, the question is why are they full at all?

    • #3
  4. Arahant Member
    Arahant
    @Arahant

    I have heard, although I am far too lazy to look up statistics or check into it, that a lot of folks are leaving the medical field due to new requirements. If you have a hundred beds, but only doctors and nurses to take care of ten, you can only fill the ten beds. That might be a path for research into what is happening.

    • #4
  5. Stina Member
    Stina
    @CM

    Bartholomew Xerxes Ogilvie, Jr.: Why, then, is the news full of stories about hospitals supposedly struggling under a massive case load? This is apparently genuinely happening; I have heard anecdotes (not through the media) of people who couldn’t be admitted to hospitals because no beds were available. Why should hospitals be full to capacity now when they weren’t in January, when the case load was higher and the virus more dangerous? And what happened to all of the overflow capacity we had, but didn’t need, in 2020?

    First, a nurse shortage was existent before COVID. Second, COVID burnout led to nurses leaving. Third, Vaccine mandates have led to nurse walkouts.

    So hospitals are severely understaffed and ER and ICU bed availability is based on a ratio of care providers to beds. If the hospital lacks the care, the beds are not available.

    • #5
  6. Jager Coolidge
    Jager
    @Jager

    Bartholomew Xerxes Ogilvie, Jr. (View Comment):

    Full Size Tabby (View Comment):

    One explanation I have heard is that the hospitals are being even more aggressive than they were last year about labeling every patient who tests positive for Covid (all incoming patients are tested) as a “Covid patient,” even if the patient has no Covid symptoms.

    But that wouldn’t affect how many patients are hospitalized; that would just change the statistics on how many of them are supposedly COVID patients. So whether the hospitals are full of COVID patients or not, the question is why are they full at all?

    Possibly because the hospitals are reacting to the different surges in cases. There is a positive correlation in my County between the news that cases are on an up swing and stories about hospitals being full. When cases drop the hospital again has capacity. Maybe they are not overwhelmed because they keep shutting down elective procedures. The spinal surgery guy did not have the surgery so he is not in a bed, that bed is now available for the COVID guy. 

    • #6
  7. iWe Coolidge
    iWe
    @iWe

    I heard earlier today from a doctor in Israel who does telemedicine for rural US hospitals, as well as managing a COVID ICU in Israel. As he tells it, because US hopsital beds are full and not every hospital has cardiologists, for example, he finds himself needing to give end-of-life counseling to heart attack victims and their families – patients who would be fine if they had access to a cardiologist and a capable bed. All by telemedicine robot.

    For him, this is unprecedented and crazy. It sounds pretty awful to me, too.

    • #7
  8. DrewInWisconsin, Oaf Member
    DrewInWisconsin, Oaf
    @DrewInWisconsin

    One explanation given to me this morning was that people who had delayed procedures are now heading back into hospitals to have them done.

    One local hospital (who was beating the “We’re at capacity! Please lock yourselves in your homes!” drum last year) has started beating that drum again. But the other two hospitals in our fair city haven’t said a single thing about being at capacity.

    Always remember that hospitals generally expect to operate at around 75–85% capacity. So when you hear the media yelling that hospitals are at 85% capacity that’s . . . normal?

     

    • #8
  9. DrewInWisconsin, Oaf Member
    DrewInWisconsin, Oaf
    @DrewInWisconsin

    Also, if a hospital starts firing people who won’t get vaxxed, and then whines that they don’t have staff, . . . well . . . maybe don’t fire everyone?

     

    • #9
  10. MWD B612 "Dawg" Member
    MWD B612 "Dawg"
    @danok1

    EJHill (View Comment):

    There was, for about a year, a website that allowed you to check the daily admittance of any hospital in a America. That was shut down and now it’s over at HHS. You would think that this information would be on the landing page of every local news site in the US. But it’s not.

    Addendum: Not every hospital reports.

    And it tries to report the percentage of bed used for COVID patients in a state. Here’ the data for NC:

    Thogh as EJ notes, not all hospitals report.

     

    • #10
  11. sawatdeeka Member
    sawatdeeka
    @sawatdeeka

    Perhaps the story is different in every location.  Our hospital prepared a separate ward for Covid patients, but it wasn’t used. Locals sometimes point to that empty area as argument that we weren’t hit hard out here. However, I talked to more than one nurse last month who said that they are understaffed. One explained to me that if you use the special ward, you have to move staff to that location and then other areas of the hospital get a skeleton crew. Another nurse described how, on her ER shifts, she takes care of admitted Covid patients who don’t really have any place else to go in the hospital, despite the Covid ward. She said that she had nine patients who were ill with Covid in there. 

    I think it’s important that we keep in touch with local health professionals to find out what is actually going on in our own counties. 

    • #11
  12. EJHill Podcaster
    EJHill
    @EJHill

    sawatdeeka: However, I talked to more than one nurse last month who said that they are understaffed

    Which explains why they want to fire unvaxxed staff.

    • #12
  13. Arahant Member
    Arahant
    @Arahant

    EJHill (View Comment):

    sawatdeeka: However, I talked to more than one nurse last month who said that they are understaffed

    Which explains why they want to fire unvaxxed staff.

    That’s just a religious matter.

    • #13
  14. sawatdeeka Member
    sawatdeeka
    @sawatdeeka

    EJHill (View Comment):

    sawatdeeka: However, I talked to more than one nurse last month who said that they are understaffed

    Which explains why they want to fire unvaxxed staff.

    I am not sure any Montana entity is allowed to require vaccines, due to Gov. Gianforte’s order months ago. Although to me, it makes sense for businesses who work with vulnerable populations to at least strongly encourage the vaccine for employees. I oppose top-down mandates, and viscerally so, but I think organizations and businesses ought to be able to decide what is required for their workers. (Although any individual business requirement for vaccines should not be in response to government pressure.) 

    Hospitals may find out that making vaccines a condition of working there is leading to more staff shortages, due to workers who are exercising their freedom to work elsewhere. If so, they may revise their rules. I think businesses and organizations should be able to hire who they want, require what they want, produce what they want.  Once they experience the real-world consequences for them, they can go back to the drawing board. That’s freedom, too. 

    • #14
  15. CRD Member
    CRD
    @CRD

    sawatdeeka (View Comment):
    Although to me, it makes sense for businesses who work with vulnerable populations to at least strongly encourage the vaccine for employees. I oppose top-down mandates, and viscerally so, but I think organizations and businesses ought to be able to decide what is required for their workers.

    I don’t agree with you on this point. (1) I think it’s one thing to set terms at hiring. It’s a different thing altogether to change the terms after hiring. (2) If we are talking about health care workers who do not want to get vaccinated, then don’t we need to remember that they were the people who went to work everyday, while most of us hunkered down in our house last year? They know the effects of Covid, and knowing that, they still prefer to risk getting the virus, should we not respect that? It seems wrong and unjust to me that the people who took so much risk to get us through last year, can now be fired. 

    • #15
  16. Stina Member
    Stina
    @CM

    CRD (View Comment):

    sawatdeeka (View Comment):
    Although to me, it makes sense for businesses who work with vulnerable populations to at least strongly encourage the vaccine for employees. I oppose top-down mandates, and viscerally so, but I think organizations and businesses ought to be able to decide what is required for their workers.

    I don’t agree with you on this point. (1) I think it’s one thing to set terms at hiring. It’s a different thing altogether to change the terms after hiring. (2) If we are talking about health care workers who do not want to get vaccinated, then don’t we need to remember that they were the people who went to work everyday, while most of us hunkered down in our house last year? They know the effects of Covid, and knowing that, they still prefer to risk getting the virus, should we not respect that? It seems wrong and unjust to me that the people who took so much risk to get us through last year, can now be fired.

    I’d be fine with having one of those “requirements” that only mitigates the business’  responsibility on workman’s comp and insurance claims. Not that the employer is going to force you to get a vaccine, but if you contract the disease on the job and are not vaccinated against it, you have no claim against the employer.

    • #16
  17. Sandy Member
    Sandy
    @Sandy

    DrewInWisconsin, Oaf (View Comment):

    One explanation given to me this morning was that people who had delayed procedures are now heading back into hospitals to have them done.

    One local hospital (who was beating the “We’re at capacity! Please lock yourselves in your homes!” drum last year) has started beating that drum again. But the other two hospitals in our fair city haven’t said a single thing about being at capacity.

    Always remember that hospitals generally expect to operate at around 75–85% capacity. So when you hear the media yelling that hospitals are at 85% capacity that’s . . . normal?

     

    Not only do they expect to but they aim for those percentages. In Virginia, you need a certificate of need to build a new hospital, and this is difficult to get. So existing hospitals are full and, just by the way, healthcare costs are high because of the lack of competition. 

    • #17
  18. Captain French Moderator
    Captain French
    @AlFrench

    Stina (View Comment):
    First, a nurse shortage was existent before COVID. Second, COVID burnout led to nurses leaving. Third, Vaccine mandates have led to nurse walkouts.

    There were also nurses and other staff who quit early in COVID because they didn’t want to deal with it, because of fear or other reasons. I think that the number of new nurses graduating was likely down because of limitations on the schools.

    • #18
  19. Lawst N. Thawt Coolidge
    Lawst N. Thawt
    @LawstNThawt

    This will vary by state law, but many have at-will employment which essentially means the employee can quit anytime they want for no particular reason and also means the employer can let someone go anytime they want for no particular reason.  This is true freedom for both and the best situation for a free market.  Now, enter laws that protect some and not others, and often an employee who is fired can seek legal recourse for something, whether it has a bearing on reality or not.

    Disclaimer: I am not an attorney, nor have I played one on TV and it’s been years since I stayed at a Holiday Inn Express.

    • #19
  20. Lawst N. Thawt Coolidge
    Lawst N. Thawt
    @LawstNThawt

    There are also the healthcare workers who left involuntarily in a mortal sense. 

    • #20
  21. kylez Member
    kylez
    @kylez

    I quote my friend, an ICU nurse: “The ICU is always full.”

    • #21
  22. Gromrus Member
    Gromrus
    @Gromrus

    I live in Tennessee. The number of COVID cases in the last week exceeded the peak in winter 20-21. Thus, the daily new cases in TN was 15,411 on 9/11/21 exceeding the previous peak daily new case of 11,787 on 12/16/21.

    TN daily deaths from COVID are not as high this time around, hopefully having peaked at 127 on 9/14/21 versus 203 on 2/6/21.

    Compared to the earlier COVID days, knowledge among intensivists about how best to care for these patients has increased dramatically and patients now live.

    However, compared to respiratory failure from other illnesses, recovery from COVID is very slow. As a pediatric subspecialist, I am now seeing cases in the hospital. One obese young man I cared for daily for a week was requiring exactly the same high ventilatory support when I rotated off as when I came on. Not one bit different.

    More patients alive and requiring a lot of support for a long time means beds are full. Our hospital has been intermittently on diversion several times in the last few weeks–meaning unable to accept an additional patient from a smaller rural facility.

    I have a colleague in an adjacent state whose mother had to be admitted to an ICU 90 miles from home for respiratory complications from chemo because it was the only ICU they could find.  Our hospital is delaying elective procedures. I have a patient with a needed bone surgery put off for 2 1/2 months, hoping the Delta surge will be over.

    • #22
  23. Aaron Miller Member
    Aaron Miller
    @AaronMiller

    DrewInWisconsin, Oaf (View Comment):
    Always remember that hospitals generally expect to operate at around 75–85% capacity. So when you hear the media yelling that hospitals are at 85% capacity that’s . . . normal?

    That’s the explanation I heard. Hospitals are businesses. They are designed to maintain high capacity to keep the lights on and staff paid. They are designed with leeway for variation, but not for epidemics. 

    Then add over-regulation, burnout, etc.

    • #23
  24. Lawst N. Thawt Coolidge
    Lawst N. Thawt
    @LawstNThawt

    Maybe someone has said this.  I tend to get lost in the woods (threads).   Adding to this same mix is the supply chain has moved more and more to just in time, so there was no surplus for a lot of supplies.  And then when things need to ramp up, who decides what to increase in supply first, assuming the same facility can make either this or that but not both at the same time. 

    • #24
  25. Brian Clendinen Member
    Brian Clendinen
    @BrianClendinen

    I due believe the reports that hospital are full, it’s just not a big deal. It happen s all the time. It only starts becoming a big deal if all your regions hospital beds are maxed out. And that’s a pretty large region from my understanding it can include multiple counties.   So they are taking a fact and not comparing it to something like you always need to do in statistics. I have a friend who spent over 30 years as a hospital executive or high-level Hospital consultant. He confirmed this and he said most icu’s sop to operate where they only have one or two beds open. So it’s normal for all your icu beds at times to be full because of the massive Staffing operating cost.  You can’t have all the this excess crazy expensive capacity staying open.

    • #25
  26. James Salerno Coolidge
    James Salerno
    @JamesSalerno

    I dont have any sympathy for the hospitals anymore. They’re just another arm of the bureaucratic state.

    If they’re in danger of overcapacity, it is up to them to figure out ways to increase capacity. 

    • #26
  27. Connie the Cat Member
    Connie the Cat
    @ConnietheCat

    Hospitals in my area were laying off employees in the summer of 2020.  Now they’re firing them for not being fully vaccinated.  Before the state stopped reporting it, you could see the number of hospital beds slowly falling throughout the pandemic.  It’s not the behavior of people who think there about to be overwhelmed by COVID.

    • #27
  28. Brian Clendinen Member
    Brian Clendinen
    @BrianClendinen

    Connie the Cat (View Comment):

    Hospitals in my area were laying off employees in the summer of 2020. Now they’re firing them for not being fully vaccinated. Before the state stopped reporting it, you could see the number of hospital beds slowly falling throughout the pandemic. It’s not the behavior of people who think there about to be overwhelmed by COVID.

    That’s because they were losing money and hurting. People were not going into hospitals to get the procedures done that made the hospitals all the money. But yes hospitals overreacted  they should not have canceled a  lot of needed surgeries but they just didn’t know. Cancelling things like elective surgeries yes but delaying things like heart surgeries that they should have never done.

    • #28
  29. Lawst N. Thawt Coolidge
    Lawst N. Thawt
    @LawstNThawt

    The US has a relatively low number of physicians, hospitals, and beds compared to other developed countries.  I assume this is due to the overall better health of the population.  

    • #29
  30. Jager Coolidge
    Jager
    @Jager

    Aaron Miller (View Comment):

    DrewInWisconsin, Oaf (View Comment):
    Always remember that hospitals generally expect to operate at around 75–85% capacity. So when you hear the media yelling that hospitals are at 85% capacity that’s . . . normal?

    That’s the explanation I heard. Hospitals are businesses. They are designed to maintain high capacity to keep the lights on and staff paid. They are designed with leeway for variation, but not for epidemics.

    Then add over-regulation, burnout, etc.

    Yes Hospitals are a business. But a weird business. They have to provide some services to people with no way of paying. They provided services to Medicare and Medicaid patients where they get paid but not at the normal rates.

    Hospitals rely on elective surgery’s from people with personal or employer insurance to make their money. When Hospitals are cancelling elective surgeries it is actually a big deal to their bottom line. 

    • #30