Hospitals need to increase staffing permanently to end the threat of regular waves of COVID-19 straining the system, health professionals and industry groups say.
A buildup in population immunity through vaccination and infection has greatly lowered the threat of COVID-19 overwhelming hospitals. But healthcare executives in many places still warn that they’re struggling to maintain sufficient staff.
Even before the pandemic, the flu and other respiratory viruses sometimes stretched hospital resources. To handle COVID-19 outbreaks without risk to hospital functioning, changes will be needed.
“It’s going to be really important for the next several respiratory virus seasons to make sure that whatever gains they made in the last couple of months in terms of operationally being able to handle COVID, that the momentum doesn’t get erased when cases fall,” said Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security who also practices medicine in Pittsburgh.
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Since early 2020, a preexisting staffing shortage has also gotten progressively worse, with increasing burnout and illness among healthcare workers.
About 1.2 million more nurses are needed over the next decade to address long-running shortages and cope with the realities of COVID-19, according to 2021 estimates from the University of St. Augustine for Health Sciences.
“The bigger story is how do we address that [staffing shortage] as we move towards really understanding that not only the physical exhaustion portion of working in a sustained pandemic, that has been significant,” said Dr. April Kapu, president of the American Association of Nurse Practitioners. “Just working shift after shift, day after day, night after night, picking up for your co-workers.”
Kapu argued that hospitals will have to establish mental healthcare services such as grief counseling for hospital staff who see the coronavirus degrade patients in real time.
“We’re certainly seeing this in many hospitals, that they are putting tremendous focus on increasing, improving, or creating a healthy work environment,” Kapu said. “Those are the types of things we need sent back into our hospitals and health systems — support for mental health services. We need support for education to continue to increase the supply of nurses and healthcare workers.”
The healthcare system was not prepared early on nearly two years ago when an influx of patients led to many hospitals having to transfer those not being treated for COVID-19 to overflow centers such as auditoriums and conference areas to keep ICU beds free.
While there is only so much that hospitals can do to increase physical space for excess patients, individual units in hospitals or affiliated clinics should be outfitted to be flexible in the event of having spillover patients who would not normally be in that unit or clinic, according to Emergency Nurses Association President Jennifer Schmitz.
“I do think this has opened hospitals’ eyes to a different level of flexibility within any unit built. Say you’re going to build an ambulatory surgery center. Can you build it in a way that makes it really a flexible care space if that ever needs to happen? So the approach to units may change and how you upgrade space to better meet capacity needs as they arise,” said Schmitz, who is also chief nursing officer at Southern Maine Health Care.
Then-President Donald Trump also directed the Department of Health and Human Services to waive laws that would keep doctors and nurses from treating as many coronavirus patients as possible, including no longer having to limit the maximum number of beds, 25, they can fill. The subsequent summer outbreak caused even higher case totals and record-breaking hospitalizations exceeding an average of roughly 74,000 patients being treated at one time during the week of July 21, 2020. During the winter 2020-21 surge, hospitalizations swelled to 137,000 patients being treated for COVID-19 at a time.
The rise of the delta variant in the United States last summer again pushed hospitals to a near breaking point as staff burnout and early retirements mounted. At its peak, the delta wave caused over 103,000 hospitalizations at one time. By the fall of 2021, hospitals in Alaska and Idaho had to assume crisis standards, requiring them to ration medical care due to limited space and supplies.
The rise of the omicron variant has caused hospitalizations to spike even further. Nearly 160,000 patients were in the hospital with COVID-19 during the week ending Jan. 20. Since then, hospitalizations have turned a corner down to about 153,000 patients being treated for COVID-19 at one time. As severe outcomes due to COVID-19 and infections continue to fall, the pandemic is expected to transition to a phase in which waves of the virus are easier to predict and manage.
Since the pandemic’s start, seasonal flu rates have plummeted. Still, a normal flu season on top of an existing highly infectious virus could be severe for hospitals and staff.
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“[Flu] is not exactly trivial either. Compared to coronavirus, it feels like it, but between [20,000] and 60,000, sometimes even higher, Americans die each year from flu or flu-related complications, and so hospitals have been crushed,” said Dr. Gabor Kelen, an emergency medicine physician at Johns Hopkins. “Some flu seasons are not as bad as anybody ever thought, and that’s great. Others are more crushing than was thought. So it’s very difficult to anticipate.”
Cases in the past two weeks overall have fallen 21%, a promising sign, though cases are still well above previous waves’ records. In Northeastern states, infection rates are plunging, though they remain high in Southern and Western states such as Alabama, Tennessee, Idaho, and Montana.
