Hospitalisations of Covid-19 patients are surging across the US, leading to a shortage of medical staff and threatening to force state governors to make difficult decisions about rationing access to intensive care.
New field hospitals were being opened from the Wisconsin state fair grounds to the El Paso Convention Center in Texas, as US Covid-19 cases surged to an all-time high a week before the presidential election.
There were 41,776 Covid-19 patients in hospital, according to the Covid tracking project, the highest since the summer surges in the sunbelt states. Intensive care beds were at over 70 per cent capacity in 19 states including the swing states of Florida, Pennsylvania and Michigan, according to data from the federal health and human services department.
The worsening picture in hospitals came just eight days before the election and could hurt President Donald Trump’s campaign, given that he has claimed the surge in cases is merely a product of more testing rather than a sign the pandemic is entering another dangerous phase. Mr Trump scores poorly in opinion polls asking whether he or his Democratic opponent Joe Biden would better handle the virus.
“There’s no secret now that things just spiral out of control very quickly,” said Carri Chan, an associate professor who specialises in healthcare systems at Columbia Business School. She added that “hospitals are crying out for help and sounding the alarm that they are reaching capacity” but the public is not helping stop the spread.
In Utah, local press reported that hospital administrators had warned the governor they would soon need his permission to start prioritising patients who were more likely to survive as they did not have enough staff to cope with the surge.
Ms Chan warned that governors across the country may have to make decisions about how to ration ventilators and other care. New York avoided this worst-case scenario because it managed the “very challenging” feat of doubling intensive care capacity, she said.
“Smaller hospitals might not have the staff that they can reallocate in the way that was done in New York back in the spring,” she said.
She added that expanding staffing is even harder when physicians are exhausted and their mental health is suffering. In a paper published in September, 63 per cent of US healthcare professionals treating Covid-19 patients reported burnout, the highest rate of any in the 60 countries studied.
Nancy Foster, vice-president at the American Hospital Association, said there were conversations in several states about getting prepared for rationing care — although hospitals hoped it would not come to that. The AHA is calling for the last $30m of funding secured by the CARES Act to be released to healthcare providers.
She explained that staffing was “incredibly difficult” as so many states were hit at once. “There are broad surges across the country, and every community is feeling vulnerable to the potential for a surge. It would be hard for a practitioner to leave his or her own community,” she said.
Physicians in the US were also feeling aggrieved after Mr Trump suggested at the weekend they might be wrongly attributing deaths to Covid-19 in order to profit from the pandemic.
Jacqueline Fincher, president of the American College of Physicians, said: “To suggest that physicians would misstate the cause of death for financial gain is false, and represents a reprehensible attack on our profession and ethics.”
Many health systems were also still short of personal protective equipment. A volunteer organisation called #GetUsPPE said it was only able to fulfil 10 per cent of requests. In particular, demand for gowns and gloves has been rising, it said.
Ali Raja, the #GetUsPPE co-founder who leads emergency medicine at Massachusetts General Hospital, said the US was still suffering from a lack of a co-ordinated national strategy for obtaining PPE. Some PPE suppliers have refused to sell to smaller providers because they did not have large enough orders, and even larger health systems may struggle if the surge continues for months, he warned.
“We just don’t know how bad it is going to get in the dead of winter,” he added.
The latest wave of Covid-19 cases was hitting many rural communities for the first time. Alan Morgan, chief executive of the National Rural Health Association, said rural areas were already suffering from staff shortages, making them vulnerable when healthcare professionals catch Covid-19.
“You lose a couple of primary care doctors in New York City, you have other primary doctors to fill in,” he said. “If you’ve lost your clinical staff or in a rural setting, you’ve lost your clinical staff.”
Rural areas tend to have older populations, putting them at greater risk of hospitalisation and death from Covid-19. But he said rural America had been late to adopt preventive measures because of a “misconception” that the virus dwelt only in urban areas. A paper published this month found that a person was four times more likely to see shoppers wearing a mask in an urban setting compared with a rural area.
“If you’re a farmer in western Nebraska, you pioneered the concept of social distancing,” he said. “But in hundreds of small towns all across the US, with a couple of stop lights, they are all going to Dollar General, Walmart and churches together — and they are a community at risk.”