Winter has traditionally been a difficult time for hospitals due to influenza and another seasonal pathogen, respiratory syncytial virus or RSV. Now SARS-CoV-2 has joined them to form an unholy trinity of pathogens that multiply in the cold months.
White House Covid-19 response coordinator Ashish Jha said the US health care system may not be able to withstand the continued virus onslaught, straining the system’s ability to cope. load of other serious illnesses.
“I fear that we are going to have, for years, our healthcare system being quite dysfunctional, not being able to take care of heart attack patients, not being able to take care of cancer patients, not being able to take care of load kids with appendicitis because we’re going to be so overwhelmed with respiratory viruses for… three or four months out of the year,” Jha told The Washington Post.
He described a scenario in which the typical winter lockdown for patients starts much earlier than usual – in August or September – because of the coronavirus. It’s a grimmer scenario than the administration has portrayed in the past, and one Jha said most Americans have yet to realize.
“I just think people didn’t appreciate the chronic cost, because we saw it as an acute problem,” Jha said. “We have no idea how difficult this is going to make life for everyone, for long periods of time.”
James Jarvis, a senior executive with Northern Light Health, based in Bangor, Maine’s second-largest health system, shares Jha’s concerns. He said hospitals now expect to see sicker patients, including people with long-term covid, children at higher risk of diabetes due to covid-19 infections and patients with heart problems. linked to previous episodes of the disease.
Jarvis, who also works in a small family medicine practice, had a patient who was hospitalized two months ago with covid-19 and then again with the flu. He was sent back to an acute rehabilitation center, but then suffered a stroke. There was no bed available at Northern Light’s flagship hospital, Eastern Maine Medical Center, so he was treated in the emergency room for four days.
“He never left the emergency room,” Jarvis said. “I felt awful. I would see him and say, ‘I’m so sorry you’re still in the ER.’ The patient received the necessary care and eventually went home, but Jarvis was frustrated that the patient was never hospitalized in bed.
These warnings come at a time when public health officials are still waiting to see how serious the current winter surge in viral infections turns out. So far this covid winter in the United States has been difficult, but not almost as disastrous as the previous two. But most of winter is still ahead of us and covid-19 hospitalizations have increased dramatically since October.
Hospitalizations remained generally stable at the start of January, with around 45,000 patients hospitalized with covid-19 on Wednesday. National numbers may mask geographic surges: East Coast states have been hardest hit so far, while the West has been largely spared.
Public health officials are closely monitoring the spread of XBB.1.5, an omicron subvariant that is the most transmissible form of the coronavirus ever seen. It has already become the dominant bloodline in the Northeast and will likely, at the current rate, take over everywhere, surpassing other omicron variants.
Despite its transmissibility, XBB.1.5 does not appear more likely than earlier forms of omicron to cause severe disease, and since it spreads through a population with significant levels of immunity, it failed to create the same devastating wave of hospitalizations seen in the past two years.
In January 2021, more than 3,000 people a day were dying from covid-19, because hardly anyone was immune at that time and vaccines had just started rolling out. Last year the situation was only slightly better. The American population was much more immune to previous vaccines and infections, but the omicron variant was leaps and bounds more transmissible than earlier ones. Omicron was less likely to be fatal to an infected patient, but so many people fell ill so quickly that the nationwide death toll in January 2022 reached more than 2,500 a day.
This winter, the “triple epidemic” of coronavirus, influenza and RSV has not been as terrible as feared. Pediatric hospitalizations for RSV rose sharply in the fall, but have fallen recently. The flu began its cold-weather onslaught relatively early in the fall, rose rapidly and declined steadily over the past five weeks.
The big unknown now is what will happen when the health care system feels the effects of the holiday gatherings.
Jha told the Post that he compares the healthcare system to a levee, holding back a certain level of water. In winter, when the cases accumulate, the water splashes a little. Hospitals are temporarily staffing up and trying to survive until the water recedes. It’s the old normal.
But SARS-CoV-2 has spilled new water into this sea, and the flood of patients is having cascading effects on other types of medical care.
Anne Zink, chief medical officer for the Alaska Department of Health, said Jha’s levee analogy accurately describes the stress of the pandemic on America’s declining overall health.
“The levee was collapsing before the pandemic, and the waves of the pandemic have created big holes, and this continued assault will degrade the wall and make it worse,” said Zink, an emergency physician who is also president of the Association. of State and territorial health officials.
Additionally, uncertainties in the medical supply chain have become the new normal, said Jarvis of Northern Light Health. Drug and supply shortages are occurring with greater frequency. Critical shortages of nurses and other staff are expected to worsen as doctors and nurses retire, but will not be replaced in equal numbers. More than 7,000 nurses at two major New York hospital systems walked off the job on Monday after staffing and workload negotiations broke down, although tentative agreements were reached on Thursday allowing them to return at work.
Before the pandemic, the hospital system always had some flexibility and was able to manage its shortage of acute care beds, Jarvis said. “But that flexibility is now gone,” he said. “There is no wiggle room or expansion that we would have for anything in store.”
Since the start of the pandemic, experts have warned that covid-19 is not the only killer when health systems are under pressure. People with illnesses may delay tests and screenings, they may be more reluctant to go to hospital for fear of catching an infection, and patients may end up waiting hours for an examination when minutes count.
“Delays in care will result in people getting more serious illness or, unfortunately, dying, and there’s not much we can do to prevent that,” Jarvis said. “You know, it’s always happened, but never to the extent that it’s happening now.”
As for the future, “it’s only going to get worse,” Jarvis said.
Hospitals are already struggling financially due to rising labor costs, physician burnout and the trend towards outpatient treatment. The added strain of coronavirus is likely to push some facilities over the edge, noted Robert Wachter, professor and chair of the department of medicine at the University of California, San Francisco.
“With all of this, you’ll see hospitals…beginning to close at a faster rate, leaving some rural/suburban communities without hospitals and fewer hospitals in urban areas,” Wachter said via email.
So far, Congress and the federal government as a whole have not taken concerted action to address these chronic challenges. There is no cavalry on the horizon for the healthcare system.
Some Biden administration officials aren’t sure the scenario will be as bleak as Jha has portrayed it.
“It’s not an unreasonable assumption,” said a senior administration official involved in the coronavirus response, who was not authorized to speak publicly and spoke on condition of anonymity. “But I don’t think we have reached a stable state of the disease to be able to say for sure what we will see year after year. … It’s very dynamic.
“We all agree that the virus is changing faster than we thought. We just don’t know where the virus is heading. We don’t even know what the next three weeks will hold for us.
As always, the unknown to predict the months and years to come is evolution: viruses mutate. There’s no way to predict what the coronavirus will do next, but experts don’t think it ran out of evolutionary space.
However, for more than a year, all new circulating versions of the virus were subvariants of omicron and showed no signs of making people sicker.
“If XBB.1.5 had the virulence of delta, we’d be in deep weeds,” said Ross McKinney, scientific director of the Association of American Medical Colleges.
McKinney and other experts stress the importance of improving uptake of vaccines to reduce the burden of respiratory disease – to ward off severe cases of covid-19, as well as other illnesses like the flu. Despite all the pain and suffering inflicted during the pandemic, vaccine acceptance remains woefully low, experts say.
“The public’s willingness to accept vaccines to limit the spread of these respiratory diseases is very limited,” said William Schaffner, an infectious disease physician at Vanderbilt University School of Medicine. “If the public does not accept them, there will be more sick people and greater stress on the health care system.