Hospitals Are in Serious Trouble

[Eric]

The healthcare system is buckling at the hands of antivaxxers, it's a shame too. They're all out there holding up their signs against drugs then ending up in the hospital unable to breathe and begging for them.

Hospitals Are in Serious Trouble

Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.

www.theatlantic.com

Hospitals Are in Serious Trouble​

Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.

When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me.

When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die.

This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me.

 

[AG_PhamD]

Yup. Here in the Boston area we have a very high vaccination rate, but something like 80% of hospitalizations are still the unvaccinated. And even with 20% being vaccinated, the number of omicron cases is so high that even that adds up to a large problem.

The biggest problem is staffing though. All of the hospitals here have a substantial portion of staff, especially staff that deals directly with patients, out with COVID or having left from burnout. And this affects all patients trying to be hospitalized for anything. God forbid there was a mass casualty event, we could find ourselves in a lot of trouble. Even the snowstorm we just had has put hospitals on edge due to the potential influx of ED patients from slips, falls, car accidents, etc.

I normally work at a psych hospital but have been redeployed 2x throughout the pandemic to work at a general hospital under the same ownership umbrella. I was supposed to go back to the general hospital last week but my normal worksite was so under-staffed I couldn’t. And I’ve been working 11-12+ hour days, in some cases doing work I’m way overqualified for, just to keep the ball rolling. Even hospital admins with medical licenses have had to leave their desk to give direct patient care due to shortages. In fact, the CEO of one mass hospital has been giving COVID tests because they’re so short staffed. Supposedly I’m going back to the general hospital later this week assuming our absent staff can return.

The fact testing has become such a cluster YEARS into the pandemic is unacceptable and a failure of state and federal authorities. People really need to expect and demand better. COVID doesn’t care about your politics, so pointing this out should not be some political debate.

 

[Eric]

Yup. Here in the Boston area we have a very high vaccination rate, but something like 80% of hospitalizations are still the unvaccinated. And even with 20% being vaccinated, the number of omicron cases is so high that even that adds up to a large problem.

The biggest problem is staffing though. All of the hospitals here have a substantial portion of staff, especially staff that deals directly with patients, out with COVID or having left from burnout. And this affects all patients trying to be hospitalized for anything. God forbid there was a mass casualty event, we could find ourselves in a lot of trouble. Even the snowstorm we just had has put hospitals on edge due to the potential influx of ED patients from slips, falls, car accidents, etc.

I normally work at a psych hospital but have been redeployed 2x throughout the pandemic to work at a general hospital under the same ownership umbrella. I was supposed to go back to the general hospital last week but my normal worksite was so under-staffed I couldn’t. And I’ve been working 11-12+ hour days, in some cases doing work I’m way overqualified for, just to keep the ball rolling. Even hospital admins with medical licenses have had to leave their desk to give direct patient care due to shortages. In fact, the CEO of one mass hospital has been giving COVID tests because they’re so short staffed. Supposedly I’m going back to the general hospital later this week assuming our absent staff can return.

The fact testing has become such a cluster YEARS into the pandemic is unacceptable and a failure of state and federal authorities. People really need to expect and demand better. COVID doesn’t care about your politics, so pointing this out should not be some political debate.

It's really hard to blame those who are burnt out, imagine doing nothing but dealing with hostile antivaxxers all day long, they surely never signed on for such a thing. I couldn't imagine a worse job.

 

[NT1440]

People who don’t get vaccinated are a problem, yes, but the systemic dismantling of hospital capacity over the last 40 years certainly is just as big a problem.

Now that the system is actually under load, the anemic system is stressing under the cracks. The end result of privatization.

 

[AG_PhamD]

It's really hard to blame those who are burnt out, imagine doing nothing but dealing with hostile antivaxxers all day long, they surely never signed on for such a thing. I couldn't imagine a worse job.

Trying to get people vaccinated is bad enough. I don’t understand the people who got the first 2 rounds of shots but now refuse the booster, which is a lot of people.

But if you think that’s bad, try dealing with patients who refuse COVID tests… including rapid ones. And these aren’t just psychotic patients thinking we’re trying to steal their DNA to clone them. In fact, that’s rarely the situation.

That said, I don’t think the burnout is necessarily just because of the unvaccinated- though having to watch hundreds of people die is terrible, especially at this point where 98% of death is preventable. A lot of medical staff left the field at the beginning the pandemic and there’s been understaffing and continued attrition since.

Even in the psychiatric field there’s been a decrease in staffing and uptick in mental illness, substance use, overdoses, suicides, etc. I just found out today one of my former clients, younger guy, professional athlete, well educated, father of multiple children died recently. Not sure how yet. But he is just another one in a longer than usual list over the past couple years.

 

[SuperMatt]

A very short time ago, right-wingers were complaining that requiring vaccinations would lead to staff shortages. Instead, the exact opposite came to pass. How many times will those arguing against masks, vaccine mandates, etc. need to be discredited before they stop?

 

[AG_PhamD]

I should also mention that currently our state’s general hospitals missing staff are being filled in to a small extent by the national guard- things like moving non-emergency patients, providing observation, security, food services, etc.

These men and womens’ help is very much appreciated. They’re putting themselves in a lot of cases in the worst possible COVID situations for what I presume in many cases is not great pay.

 

[Runs For Fun]

One of the local hospitals here is basically not accepting anyone new to the ER. They’re diverting everyone. This situation is so infuriating because despite what these stupid antivaxxers think, their decision absolutely does affect other people. And because of their stupidity people who legitimately need care are not able to get it because their dumb asses are taking up a bed which would have been completely avoidable had they gotten a vaccine.

 

[NT1440]

One of the local hospitals here is basically not accepting anyone new to the ER. They’re diverting everyone. This situation is so infuriating because despite what these stupid antivaxxers think, their decision absolutely does affect other people. And because of their stupidity people who legitimately need care are not able to get it because their dumb asses are taking up a bed which would have been completely avoidable had they gotten a vaccine.

My girlfriend has been exposed, because she works in daycare….because this country puts keeping the gears of work cranking despite the human cost. Anti vaxxers are definitely a problem, but the die was cast from the very beginning when this country (as always) put business ahead of people. Blaming just the stupid is merely a way to give this utterly broken and failing system a pass.

 

[Renzatic]

How many times will those arguing against masks, vaccine mandates, etc. need to be discredited before they stop?

There is no stopping them. Any evidence that runs contrary to their beliefs is immediately dismissed, and eventually explained through another random conspiracy theory.

In the end, anything bad that happens to come to pass will eventually be made out to be your fault, not theirs.

 

[lizkat]

There is no stopping them. Any evidence that runs contrary to their beliefs is immediately dismissed, and eventually explained through another random conspiracy theory.

In the end, anything bad that happens to come to pass will eventually be made out to be your fault, not theirs.

Yeah I'm starting to refine my opinion of some of the Trump voters these days. How they voted was up to them and really I always blame a party and not the potential electorate for situations where a candidate is manifestly unsuitable for a ticket, never mind the office he wants to occupy (and in the case of Trump, not relinquish on schedule?!!).

However, for some T voters to follow a set of political scripts on public health care issues just boggles my mind, and it's CLEAR ENOUGH by their own statements exactly who all are playing at being a complete jackass now about covid.

That's way past ever thinking to begin with that a vote for that f'g guy could fall in the realm of cost-free, even if they voted for him just to throw a bird at the very idea of federal government. Also clear they may not understand how government does serve the people. They may vote for congress critters who are essentially ripping down walls, destroying ceilings and cellars and the very plumbing of the people's own damn House (and, Senate). This even as locals welcome news of any federal largesse that their pols had voted against "on conservative principles" but who end up featured in the back-home photo ops with the money. But again it's the craven pol and their press flacks I hold more responsible there.​

Covid-related behavior though is a bridge too far for me to say well it's on the Rs for letting jerks run for office. No way.

A voter has to at least ask what's in this no-vax no-mask thing for my own family? Is it the same level of investment or core principle as something like flying a F^ck Biden flag? Or does guarding one's health and caring about a neighbor's or colleague's health maybe run a little deeper? The voter that can't deal with that question honestly is a selfish _____ or plain stupid, take yer pick.

 

[User.45]

People who don’t get vaccinated are a problem, yes, but the systemic dismantling of hospital capacity over the last 40 years certainly is just as big a problem.

Now that the system is actually under load, the anemic system is stressing under the cracks. The end result of privatization.

THis statement is entirely incorrect.

 

[Thomas Veil]

I don't find that too hard to believe. There's no need for excess capacity except when we have an event like this one. There'd have been no point in keeping a lot of extra hospital beds (and the attendant facilities) for the last four decades. Now, of course, we find them in short supply, but that's because of a singular wave of idiocy re people stubbornly refusing medical advice until it's too late.

What I do find worrisome, from the staffing position, is recruiting people into the fields of medicine and nursing. Given the current state of affairs, who in their right mind would want to go into those professions? The predictable end result is that many existing medical staff will burn out and leave but fewer will be replacing them.

 

[User.45]

I don't find that too hard to believe. There's no need for excess capacity except when we have an event like this one. There'd have been no point in keeping a lot of extra hospital beds (and the attendant facilities) for the last four decades. Now, of course, we find them in short supply, but that's because of a singular wave of idiocy re people stubbornly refusing medical advice until it's too late.

What I do find worrisome, from the staffing position, is recruiting people into the fields of medicine and nursing. Given the current state of affairs, who in their right mind would want to go into those professions? The predictable end result is that many existing medical staff will burn out and leave but fewer will be replacing them.

Correct. THere's been a major push, esp with the Affordable Care Act to move care away from hospitals to the outpatient setting because, it makes care more, well, affordable. US hospital beds have very strict requirements in terms of staffing and equipment and that's a good thing. Privatization isn't entirely there, because AFAIK unvaxxed people still aren't asked to pay 4x higher deductibles than vaccinated.

 

[dukebound85]

Those that are unvaccinated should be denied care at this point

There are only so much resources.

 

[Eric]

California state health department just announced that staff may return back to work immediately, even if they are positive as long as they are asymptomatic. As you can imagine healthcare workers are pushing back in a big way.

 

[Cmaier]

California state health department just announced that staff may return back to work immediately, even if they are positive as long as they are asymptomatic. As you can imagine healthcare workers are pushing back in a big way.

It’s a mess. New semester just started in my kid’s elementary school, so they had PCR test collection on the school last tuesday, the idea being that they would start in-person on Thursday. (We’ve been in-person for a long time).

My daughter’s test results just arrived *today* (same boat as the rest of the school). The school decided “welp, given the CDC guidance of 5 days quarantine, we’ll just let everyone come to school on Monday regardless of the test results.” If you have a 5-day quarantine and it takes 5 days to get your test results, you may as well not test - just rely on symptoms.

 

[Eric]

It’s a mess. New semester just started in my kid’s elementary school, so they had PCR test collection on the school last tuesday, the idea being that they would start in-person on Thursday. (We’ve been in-person for a long time).

My daughter’s test results just arrived *today* (same boat as the rest of the school). The school decided “welp, given the CDC guidance of 5 days quarantine, we’ll just let everyone come to school on Monday regardless of the test results.” If you have a 5-day quarantine and it takes 5 days to get your test results, you may as well not test - just rely on symptoms.

Seems like that's where we're at right now, what else can you do? If nothing else it seems like this is blowing through like a raging fire and will hopefully burn out quickly.

 

[NT1440]

Correct. THere's been a major push, esp with the Affordable Care Act to move care away from hospitals to the outpatient setting because, it makes care more, well, affordable. US hospital beds have very strict requirements in terms of staffing and equipment and that's a good thing. Privatization isn't entirely there, because AFAIK unvaxxed people still aren't asked to pay 4x higher deductibles than vaccinated.

Brittle supply chains are seen as more efficient, as we built the modern world on “just in time” capacity. That’s “efficient” but it means no equipment for nurses when the system actually has some strain put on it.

The medical industry is almost completely privatized from an equipment standpoint. We have little to no meaningful national capacity because we’ve spent 40 years of neoliberal “let the market handle it.”

 

[User.45]

Brittle supply chains are seen as more efficient, as we built the modern world on “just in time” capacity. That’s “efficient” but it means no equipment for nurses when the system actually has some strain put on it.

Sorry but this is an extremely misinformed viewpoint. The issue has been that
1) healthcare workers take time and resources to train.
2) It actually comes with selectivity - just think about having to have people who are able to understand infection control requirements...
3) Certain states (looking at you Texas) considered healthcare workers as an infinite resource.

Where I did my med school in Europe, we would just roll in an extra bed and call it a bed. In the USA you have to meet very specific staffing and material requirements to be able to call a bed a floor, step-down or ICU bed. So I honestly have no idea what your expectations are, when maintaining staffing is really expensive, even outside the realm of US's nightmarish healthcare expenditures. Please don't conflate this with supply chain issues.