This Covid Surge Feels Different

From The New York Times, I’m Annie Correal, in for Michael Barbaro. This is The Daily.

Today: Despite its reputation for mild illness, the Omicron variant is fueling a staggering rise in hospitalizations around the country. I spoke with my colleague, Emily Anthes, about why doctors and nurses inside those hospitals say that this phase of the pandemic feels so different. It’s Tuesday, January 11.

So Emily, you’ve been reporting on hospitals across the U.S. and the challenge that they’re facing at this particular moment in the pandemic. Can you tell us about what you’ve been hearing?

Absolutely. So cases have been skyrocketing in recent weeks. If you look at graphs of cases, they’re basically vertical, and the highest case numbers we’ve seen at any point in the pandemic. And hospitalizations, which tend to lag behind cases, have started to rise, too.

And in some of the early Omicron hotspots — New York, New Jersey, Massachusetts, elsewhere — hospitals are being flooded with new patients. They’re just being inundated. Emergency rooms are filling up. There aren’t enough staff to care for all these patients. And that might seem like a bit of a paradox because we, ourselves, have covered a bit about how evidence is emerging that this variant, Omicron, might be a bit milder than Delta, which caused some of the previous surges.

So we wanted to try to figure out what was at the heart of this tension. If this variant was causing milder illness and so many Americans are vaccinated now, why are hospitals filling up?

So several of my colleagues and I —

— including my colleague, Azeen Ghorayshi —

— started calling doctors and hospitals —

Florida —

— North Carolina.

— California, Maryland, Texas, Rhode Island.

And we asked them —

What are you seeing and how is this surge different?

So what did doctors say about why the hospital system is under such strain at this moment?

Well, there are two big reasons. And the first is just that Omicron moves really, really fast. Several weeks ago, I talked to some forecasters and some modelers who were trying to predict how this would all unfold here. And at the time, they were saying this surge would probably peak in mid to late January with something like 400,000 new cases per day in the U.S.

Well, here we are in early January, and we are already at nearly 700,000 cases a day. We just blew past that forecast. And this thing has moved so much faster than even the experts predicted.

So even if Omicron is half as severe, if it’s causing twice as many infections, you’re sending the same number of people to the hospital.

So hospitals just aren’t used to the volume.

And what doctors are telling us is that this variant is so infectious that they’re finding it in a lot of patients that aren’t even coming in for Covid.

They’re coming in to give birth. They’re coming in because they broke a bone. They’re coming in because they had scheduled a hip replacement a month ago. And when they get tested for the virus, they’re turning out to be positive.

So these incidental infections are part of what hospitals are seeing now. There isn’t really good data on this, especially nationally. But there’s a significant share of patients in hospitals right now who have these incidental infections. So estimates we got ranged from 20 percent to 65 percent at one New York hospital.

So you’re saying that at this hospital in New York, two-thirds of patients coming in for anything — for a hip replacement, or because they’ve given birth, or broken a bone — are turning out to test positive for Covid?

Yeah, and we wouldn’t have even found a lot of these cases, if not for the fact that a lot of hospitals have started testing all of their patients for the virus. So this thing is everywhere.

Right. But just to make sure I understand, these people who come in for other things, they would have come to the hospital regardless. So how is that an added strain on hospitals?

Well, it is true that a lot of them probably would have been coming into the hospital anyway. And the good news is that a lot of people with these incidental infections may not get very sick from Covid. But they can still pose an added strain on hospitals.

And part of that is because they need to be isolated while they’re in the hospital to prevent them from passing the virus onto others. And that requires resources and staffing. And, in some cases, having one of these incidental infections can worsen their own outcomes that can interact with whatever reason it is there in the hospital. And these patients may fare more poorly than they otherwise would have.

OK so more patients are coming in with Covid than ever before. And that’s overwhelming hospital systems. What’s the second reason that hospitals are facing a bigger burden today than during previous surges?

This was a very clear answer from every doctor we talked to.

A huge concern —

— staffing.

Many hospitals were already really struggling with staffing shortages, even before this surge. Over the course of the last two years and the pandemic, a lot of health care professionals and hospital staff have left their positions.

Due to stress, burnout.

So even before this surge started, hospitals were really strapped for staff.

And then you layer on top of that the fact that we’re dealing with this highly contagious variant, and lots of hospital personnel are catching it. And that is further depleting the ranks of hospital staff.

You know, it’s not just doctors and nurses.

But they’re also short on behavioral therapists —

— and pharmacists.

— and custodial staff. Everyone that it takes to sort of make a hospital run smoothly and run well, the entire operation is struggling under the weight of this surge.

I heard that they had, in some places, called in the National Guard to assist, to help people because of that shortage in staff?

That’s right. And some of the doctors I talked to said that was actually really welcome and exactly what they needed, were more hands right now. Obviously, that’s not a long term solution for staff shortages. But right now, it’s really all-hands-on-deck. And they are happy to have whoever they can get.

So to recap, what we’re looking at is an enormous surge in cases driven by this highly infectious and fast-moving variant, combined with extreme staffing issues. We’ve got all this attrition, people quitting after two years of the pandemic, and doctors and nurses and janitors out sick.

So what is the impact of that on patients?

The impact is enormous.

A lot of the doctors we talked to said that they had already stopped doing or were considering stopping doing any sort of non-emergency procedure — all these elective surgeries.

Really, they can be for quite serious conditions. These might include things like cancer surgeries, transplants, heart surgeries. And they’re being canceled or postponed because hospitals just don’t have the staff and the bandwidth right now.

Another doctor we talked to said that some of these surgeries are essentially canceling themselves because people are coming in for surgeries they’ve scheduled and testing positive for the virus, which means that the surgeries then have to be postponed and care is delayed.

So when hospitals get overwhelmed and staff get stretched really thin —

— everybody’s care suffers.

We’ll be right back.

So Emily, you’ve explained how hospitals can be under such stress at this moment, even though Omicron seems to be presenting as a milder version of the virus. Do you have a sense from your reporting how long this will last? Is there a world in which this is just a short-term hit on the health care system?

Well, in South Africa it took about three to four weeks for cases to peak. And then they started declining. It’s not clear yet if the same pattern will hold here in the U.S. But even if it does, we know that hospitalizations tend to lag about two weeks behind cases. And deaths tend to lag about three weeks behind cases.

And here in the U.S. right now, our cases are still rising. It doesn’t look like we’ve hit that peak yet. So most doctors we talked to unfortunately think that it’s going to get worse before it gets better.

Hmm.

And even if the immediate crisis is short-term, it could have lasting consequences. Delaying these elective or non-emergency procedures could cause them to pile up, could cause patients to worsen. So when they do eventually get medical care, they are sicker and have worse outcomes. And they could further worsen the staff shortages that already exist by driving more people out of the health care field.

The other reason to be concerned here in the U.S. is that we still have a lot of people in this country who are unvaccinated. And Omicron is not necessarily mild for them.

So then are places where more people are vaccinated more likely to fare better with this most recent surge?

So it’s a little bit hard to draw any conclusions about that right now. And part of that is because of the patterns of when and where Omicron arrived first. As it happens, some of the areas of the country that got hit first, and hardest, and fastest with Omicron are areas that have pretty high vaccination rates.

They are places like New York City, New Jersey, Massachusetts, which are highly vaccinated areas. So these are the places that are really seeing hospitalizations surge right now, while some of the less vaccinated places in the country are a little bit behind. So we have to wait for more time and more data to make those kinds of community-level comparisons.

But what we do know is that the overwhelming majority of patients who are getting severely ill and ending up in I.C.U.s are the unvaccinated. Omicron can be quite serious for these patients. And doctors told us over and over again that these are the patients who are on ventilators, these are the patients they worry about, these are the patients who are dying.

So I talked to a critical care doctor in North Carolina, Dr. Ryan Maves. And he’s a former Navy captain who was deployed to Afghanistan.

And he said that what he saw recently in the hospital and especially in the I.C.U. was among the worst weeks of his career. And it actually reminded him of being back at war.

Mm-hmm.

And I think there’s a lot of frustration that America’s not more vaccinated at this point, which could have fended off the worst of this surge.

There’s a doctor in the suburbs of Chicago, Dr. Bob Manam, who said this really explicitly.

So where does that leave doctors and hospitals in this moment?

It leaves them in trouble. I think a lot of us think that we’ll probably pull through this Omicron wave just fine. And most of us, especially those of us who are vaccinated and boosted, probably will. But I don’t think we can forget the toll that this is taking on health care workers who have already been pushed to the limit and who are now being pushed even further by this surge.

You know, my colleague Azeen talked to a doctor in Maryland, Dr. Gabe Kelen, who said he’s not even sure that Americans really know how crushed hospitals are right now. But just because they don’t know doesn’t mean it’s not happening.

Thank you, Emily, very much.

Thanks for having me.

The number of Americans hospitalized with Covid-19 has now surpassed last winter’s peak, according to the U.S. Department of Health. As of Sunday, 142,388 people had been hospitalized, surpassing the previous record set in January of last year.

We’ll be right back.

Here’s what else you need to know today. The Biden administration said on Monday that private insurers will soon be required to cover the cost of eight at-home coronavirus tests a month. The requirement is designed to address the high cost of at-home tests, which has discouraged many Americans from using them. Under the plan, people will be able to buy the tests at no cost from pharmacies approved by their insurance, or buy them elsewhere and file for reimbursement.

Today’s episode was produced by Daniel Guillemette and Asthaa Chaturvedi, with help from Mooj Zadie. It was edited by Mark George and Lisa Chow, features original music by Marion Lozano and Dan Powell, and was engineered by Marian Lozano. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

That’s it for The Daily. I’m Annie Correal. See you tomorrow.