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% 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.
Warnings of a crisis from state and hospital leaders
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."
Crowded conditions lead to worse outcomes
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."
'There is rationing happening every day right now'
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.
Not just COVID patients suffer
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% 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."