Yes.
> This keeps being repeated but most hospitals operate at about 80% capacity as-is.
They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity.
> Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%
In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0]
[0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...
https://www.tennessean.com/story/news/health/2021/08/19/tenn...
It's not like there is any large ICU capacity anywhere anyway.
In the country? No. In large areas? Yes.
> I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I’m getting fake news?
There are vaccine requirements being adopted some places, and there are departures related to it. But if you are seeing news suggesting that that is the major source of capacity strain (or even the major source of COVID-related causes of people departing healthcare jobs), it is, at least, distorted news.
This is precisely because there is high demand for registered nurses and other medical staff at the moment.
Ok. At least somebody can exercise reason when necessary.
By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.
I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.
This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.
A vaccine is nothing more than exposing the immune system to the antigens. If their immune systems are already geared up to fight Covid, they will simply respond to the vaccine as another Covid infection and fight it accordingly.
As for whether there is any benefit, there absolutely is. Multiple exposure events greatly increase the storage of the antibodies in the memory cells of the immune system. This is why most vaccines require at least two shots, and why the CDC is now recommending a third booster shot for some people.
Plenty of studies show that the immunity of people who are vaccinated is stronger than those who were infected naturally (e.g. [1]), and that the immunity of people who have had Covid is significantly more robust after subsequent vaccination (e.g. [2], [3]).
1. https://www.biorxiv.org/content/10.1101/2021.04.15.440089v2....
2. https://apnews.com/article/science-health-coronavirus-pandem... ("The survivors who never got vaccinated had a significantly higher risk of reinfection than those who were fully vaccinated, even though most had their first bout of COVID-19 just six to nine months ago.")
3. https://www.medrxiv.org/content/10.1101/2021.04.25.21256049v...
>This makes no sense from an immunological perspective, and sounds like one of those pseudoscientific ideas that "natural" immunity is somehow stronger than "vaccination" immunity.
There's nothing unscientific about it; it's been known for a while now that some vaccines like the flu vaccine are inferior to natural immunity: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870374/
Ok, well I've cited two studies that say the opposite, and one of those studies looked at antibody responses over time from matched individuals. The "on the ground" results in Israel are completely confounded by who is an isn't vaccinated, with at risk people (including healthcare workers) being significantly more likely to be vaccinated.
> it's been known for a while now that ...
Oh my. Did you read that study? It shows nothing of the sort. It is a mathematical Markov simulation of what happens assuming natural infection is stronger than vaccines.
The kicker is in the discussion:
> Under the plausible assumption that protection against influenza infection lasts longer after naturally acquired infection than after vaccination, we show that ...
This is literally begging the question. The authors make the assumption that naturally-acquired immunity is stronger. Then they write a model that repeatedly exposes people given that assumption. Then they "show" that, surprise surprise..... people with naturally-acquired immunity catch the flu less frequently.
In Israel, as almost everywhere else (other than early in the pandemic with nursing homes in many places), implementation of and compliance with vaccination and other COVID countermeasures had been strongest among the elderly and immunocompromised; at the same time, COVID infection has been more likely to lead to death in the elderly. So, the population most likely to be infected if exposed has a higher baseline vaccination rate and a smaller rate of prior COVID infection, both due to countermeasures and inverse survivorship effects. Without controlling for that, which bare population numbers like this don’t do, you have no idea what the relative immunity effect of prior infection vs. vaccination is.
The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed.
Belgium was overwhelmed.
The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=...]
filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff.
if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer.
The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless
I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't.
Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.
Correct!
but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action.
We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag.
I really hope that you are correct about asymptomatic. but we can't be sure, yet.
In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zeala...
It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.
> short and regional
Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.
https://www.texastribune.org/2021/08/10/coronavirus-texas-ho...
As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%.
https://covid-texas.csullender.com/
So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.
It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients.
Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.
Note: last April (2020), they said it had exploded due to COVID-19.
Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.
Both have very high hospitalization rates. Both also have very high vaccination rates.
In the worst case, it may just been that the vaccine effectiveness wanes over time.
Positive covid tests require a hell of a lot more hospital overhead to deal with, even if they don’t have symptoms and are in for something else. It could very well be the case that this is a self made problem. We very well could be artificially overloading hospitals because we dictate that every positive test, regardless of symptoms, invokes massive overhead.
And again, every article I read never clarifies this. In fact many conflate “people with covid but there for something else” and “people sick with covid”.
I am fully inclined to believe that this hospital shortage is a self inflicted problem. If this was literally a hospital full of people choking on their own ooze, the media would be all over it like moths to a flame.
The stories on the reddits I suggested are all pretty much the same. Patient comes in struggling to breath, tests positive for covid, ends up with blood clots or pneumonia which pushes them into the ICU.
Here's just one of many stories of burnout [1]
[1] https://www.reddit.com/r/nursing/comments/p9ps06/the_burn_ou...
> So, the anecdotal evidence would be...
I'm not trying to represent it as anything other than that.
Here are a few different articles from around the gulf coast states that speak to this:
https://www.khou.com/article/news/health/coronavirus/houston...
https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-...
Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full?
On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal.
In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses.
As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then.
Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete.
Some questions that may help with any personal investigation:
1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be.
2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.
Are these difficulties because there are fewer nurses on the market, the existing staff are burned out, there are better opportunities to work locums, or some other factor? Not sure. Mostly, it's to say that there was never a conversation between us on the lack of nurses prior to COVID.
As far as physicians, also not sure. I will say that demand was consistent prior to COVID, but now demand for both temporary and permanent positions is extremely high. They won't stop calling. Something to understand here is that the supply of new critical care physicians takes a very long time to ramp up, four years of medical school, four years of residency, and two years of fellowship. They're not easy to replace.
As a final side note, whether they do or not, they would all like to quit. They're burned out. This has gone on too long. The families dealing with end of life care are often abusive. Virtually all of their patients are unvaccinated, which means that this is preventable. They're frustrated that their professional opinion has very little impact on the public discussion of COVID, especially when they deal with the issue so intimately and they spent a good portion of their life dedicated to understanding and treating the issues behind illness.
[0]: https://www.beckershospitalreview.com/finance/20-hospitals-l...
Isolation from other patients means that they need other rooms and other nurses. It is not safe to have a nurse go from a clean room to a COVID room repeatedly if they don't have enough PPE to fully gown between rooms. Otherwise, there is cross contamination. Currently, there is not enough PPE. If a hospital has the staff, they will also isolate the physicians to either COVID or non-COVID wards to prevent cross contamination. Often, they do not have the physicians, so there is a time cost to constantly changing PPE. Time spent changing PPE means time not taking care of patients.
When a patient dies in a COVID room, the room must be cleaned. This takes time and staff. Failure to do so can also lead to increased infections.
To be clear, infections that spread in the hospital are very well studied. It's the reason why hospitals have very strict rules about things like hand hygiene. It's one of those inspections that can cost a hospital a lot of money.
That's a long way to say, it's not a self made problem. A patient that comes in for something like a heart stent who is also COVID positive is far more work than one who does not have COVID. I do not know if these news articles are referring to these cases as COVID hospitalizations. In some sense, it doesn't impact the broader issue: In a good number of states, hospitals are effectively full. The reason behind this issue is unvaccinated people catching COVID.
We need to accept that vaccines exist and work. It shouldn’t matter if the dude in the hospital has a positive covid test because everybody in that room can be vaccinated if they want to.
This mass testing created a bunch more problems than it solved.
The difference between COVID and something like cancer is that cancer is not highly contagious. COVID is. Further, it's contagious and deadly. That's why it requires special care. COVID is also not the only disease where these kind of precautions are taken. Another one is TB. Now, there are other diseases that are contagious, but not right now. For example, syphilis is both contagious and deadly. However, you're not going to catch syphilis when you're sitting next to someone who is positive. With COVID, you potentially will. That's why they have to test for it in the hospital.
Now, I will agree that vaccines exist and work. In the sense that there are people who choose to refuse vaccination, I will also agree it is a self made problem. However, this affects everyone to a high degree and not just the vaccinated.
Case in point, my wife and I are vaccinated. If she gets COVID, she most assuredly won't die, but she can't work in the ICU. She would risk getting her patients infected even though she is vaccinated. That means the hospital loses a physician in short supply. They're going to test you in the hospital because they can't afford you getting their staff sick.
This also affects you. You're vaccinated. However, say you're appendix bursts, you may or may not be able to get into the ER before you become septic. Yes, the ER will triage based on need. However, if there's no beds there's no beds and you will not be seen.
However, to reiterate, the hospital will always test you for diseases that they believe will affect their staff. You come in with respiratory symptoms. You're getting a COVID test. Having surgery? They'll test you for HIV. It's a protection issue. COVID is a pain because airborne infections are hard to contain.
https://www.tennessean.com/story/news/health/2021/08/19/tenn...
The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in.
Source: I am a physician.
This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%. [0]
If we look at Israel, which has a very high vaccination rate, we see that they're supposedly running out of hospital space. [1] But the article linked doesn't say _anything about their actual numbers atm_ and points to a fiscal problem rather than a manpower problem.
There was a recent Science Magazine article that states that 13% of the hospitalized-and-vaccinated group are under 60. That amounts to 39 people in a country of 9 million. [2]
I've asked this before both here and elsewhere: If these vaccines aren't "good enough," what is? At what point does this become "zero COVID" in that "nobody can ever die from this disease again?"
[0]: this may have changed -- things are changing quickly -- so I'd be curious if you have any recent (<1 week old) information on this.
[1]: https://www.haaretz.com/israel-news/israel-s-public-hospital...
[2]: https://www.sciencemag.org/news/2021/08/grim-warning-israel-... -- and I took this from Louis Rossmann's video https://www.youtube.com/watch?v=mYtfT7HsJq0