What COVID Hospitalization Numbers Are Missing

For weeks now, as COVID-19 cases have ticked upward in the Northeast and mid-Atlantic, pundits and political leaders have offered a supposedly reassuring refrain: Cases might be climbing, but hospitalizations aren’t yet following suit. In some places, that has been true. Several health-care workers around the country told me they’re seeing the lowest caseloads since last summer. A few aren’t having to treat COVID patients at all. Others are only seeing mildly sick people who need little more than IV fluids. “I don’t think there’s a huge amount of anxiety over what the next month might bring,” Debra Poutsiaka, an infectious-disease specialist at Tufts Medical Center, told me. “I could be wrong. I hope not.”

The Biden administration shares those hopes: Having apparently given up on curtailing the coronavirus, it is counting on vaccines and treatments decoupling infection from severe illness enough to prevent the health-care system from becoming inundated again. The CDC’s current guidelines effectively say that Americans can act as if COVID is not a crisis—until hospitalizations reach a high enough threshold.

The country still may be heading to that point. Hospitalizations are climbing in 43 states, especially in the Northeast. In Vermont, the rate of new admissions has already neared the peak of the recent Omicron surge. Earlier this month, “three different emergency-room docs said this is by far the worst that COVID has been at any point,” Tim Plante, an internist at the University of Vermont, told me. “They’re bewildered that it’s happening again.” Meanwhile, people in most of New York City are now advised to mask indoors again, after rising hospitalizations triggered the CDC’s “high” alert level.

But even in calmer spots, Biden’s strategy overlooks a crucial truth: The health-care system is still in crisis mode. The ordeals of the past two years have tipped the system—and its people—into a chronic, cumulative state of overload that does not fully abate in the moments of respite between COVID waves.

Some of the problems I’ve written about before: Even in quieter periods, health-care workers are scrambling to catch up with backlogs of work that went unaddressed during COVID surges, or patients who sat on health problems and are now much sicker. Those patients are more antagonistic; verbal and physical assaults are commonplace. Health-care workers can also still catch COVID, keeping them from their jobs, while surges elsewhere in the world create supply-chain issues that keep hospitals from running smoothly. All this, on top of two years of devastating COVID surges, means that health-care workers are so exhausted and burned out that those words have become euphemisms. In trying to describe his colleagues’ mental state, Plante brought up Migrant Mother—the famous photo from the journalist Dorothea Lange, which captured unimaginable hardships in a single haunting expression. “That look in her eyes is what I see in folks who’ve been on the front lines,” Plante told me.

Enough health-care workers—nurses, in particularhave quit their jobs that even when hospitals aren’t deluged, the remaining workforce must care for an unreasonable number of patients over longer hours and more shifts. In a survey of nearly 12,000 nurses, conducted by the American Nurses Foundation this January, 89 percent said that their workplace was short-staffed, and half said the problem was serious. Worse, almost a quarter said that they were planning on leaving their jobs within the next six months, and another 30 percent said they might. Even if just a small fraction of them follow through on their intentions, their departure would heap more pressure upon a workforce that is already shouldering too much. “There’s a palpable concern that this can’t be our new normal,” Beth Wathen, president of the American Association of Critical-Care Nurses, told me.

The problems are substantial and numerous enough that “if this moment was occurring without the horror of the moments that preceded it, we’d be shocked,” Lindsay Ryan, a physician at UC San Francisco, told me. “The calamity of the last years has numbed us to the calamity of the present moment.”

America’s current pandemic strategy is predicated on the assumption that people can move on from COVID, trusting that the health-care system will be ready to hold the line. But that assumption is a fiction. Much of the system is still intolerably stressed, even in moments of apparent reprieve. And the CDC’s community guidelines are set such that by the time preventive actions are triggered, high levels of sickness and death will be locked in for the near future. For many health-care workers, their mental health and even their commitment to medicine are balanced on a precipice; any further surges will tip more of them over. “I feel like I’m holding on by a thread,” Marina Del Rios, an emergency physician at…

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