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    Friday, September 22, 2023

    Hospitals vs. omicron: Vaccines, treatments a plus; overworked, understaffed health-care workers a minus

    A health care worker prepares a dose of the Moderna COVID-19 vaccine at the CareNow Denver University urgent care center in Denver on Nov. 16, 2021. (Bloomberg photo by Daniel Brenner)

    The omicron variant will be met in the U.S. by a health-care system accustomed to COVID-19 surges yet battered by almost two years of fighting the pandemic with no end in sight. 

    The availability of vaccines, treatments and steady supplies of protective gear have made many hospitals better equipped than ever to cope with COVID admissions that have been rising nationally since early November.

    But medical workers are depleted from battling the virus, and a weary public has abandoned precautions that slowed the early spread of SARS-CoV-2. Much remains unknown about omicron, including its response to vaccines and ability to cause severe infections. Parts of the country already under strain from the recent delta-fueled wave are uneasily watching the new variant, which first surfaced in the U.S. Wednesday in California.

    "The thought of having another round of COVID cases driven by a new variant that we don't yet fully understand would put us in an untenable situation," said Brian Peters, chief executive officer of the Michigan Health & Hospital Association.

    A COVID surge that started in late summer in Michigan has yet to crest, tilting hospitals into crisis, Peters said. They're diverting patients from packed emergency departments and have asked the military for help. The state's hospitals have fewer staff now than when the pandemic began, decreasing the number of available inpatient beds by 875 from last year, Peters said. The 4% decline is equivalent to the disappearance of a big-city hospital tower.

    He called Michigan's situation "as dire as it has ever been since the start of the pandemic." Unvaccinated patients make up three-quarters of those hospitalized for COVID in the state, he said, and an even greater share of those in intensive care.

    Nationwide, almost four out of five intensive care beds are occupied. COVID patients account for 17%. After falling from a late-summer peak, U.S. coronavirus hospital admissions began rising again in November, reaching more than 6,000 every day, according to the Centers for Disease Control and Prevention.

    The first confirmed U.S. omicron case was identified in San Francisco in a traveler who was isolating after returning home from South Africa. The variant alarmed the world in late November when authorities in that country identified mutations that might make it more transmissible than earlier strains. It may be weeks before scientists untangle whether those troubling changes mean the strain will spread faster, make people sicker or weaken immune defenses.

    In that scenario, "we could be seeing multiple new waves of high rates of infections that could overwhelm our health-care systems," said Anne Zink, chief medical officer for Alaska.

    The state faced an extended COVID surge over the summer and fall, straining many of its hospitals in remote areas with limited resources. COVID admissions only began to fall in the last month.

    As the crisis persists, the effects of exhaustion and burnout are escalating, said Zink, an emergency doctor and president-elect of the Association of State and Territorial Health Officials. A survey this year by the Washington Post and the Kaiser Family Foundation found that three in 10 frontline health workers had considered leaving the profession because of the pandemic.

    "In some ways our health-care systems are less prepared than they were two years ago, and that's becoming worse over time," she said.

    UMass Memorial Health in central Massachusetts ran out of intensive care beds Wednesday. The health system is juggling rising virus cases and more visits from people who deferred other care during the pandemic, said CEO Eric Dickson.

    "Now we're seeing this variant come in that is probably going to be more contagious than even the delta variant," Dickson said, "and it's pretty concerning."

    The system has twice as many vacant positions as it typically does. Staff shortages at nursing homes have created bottlenecks in discharging patients from the hospital. Workers who remain "are just doing God's work," he said.

    Still, UMass Memorial has tools it didn't have during the early days of COVID: monoclonal antibodies that can keep patients out of the hospital and antiviral drugs for those who need to be admitted. Clinicians have gotten better at treating the disease over time. The system is also starting to care for COVID patients at home, which Dickson hopes will free up beds inside the hospital and lead to better outcomes.

    When COVID first started filling U.S. hospitals last year, workers in the Providence health-care system in the western U.S. fashioned makeshift protective gear from craft supplies to compensate for shortages. The network of 52 hospitals in five states treated the first known U.S. COVID patient in early 2020 "with Ebola-level precautions," recalls Amy Compton-Phillips, its president of clinical care.

    The situation today is "infinitely better," with greater supplies of protective equipment and a better understanding of how the virus spreads, Compton-Phillips said. Another key difference: While most COVID patients in the hospital are not vaccinated, staff are.

    Still, worker burnout is exacerbated by an "incredibly divisive political environment," she said. Some staff finishing their shifts find fliers on their cars accusing them of genocide for backing vaccinations. With many in the U.S. still hesitant to take vaccines, and many overseas without access, the arrival of omicron, or other variants still unknown, shouldn't be a surprise, she said.

    "This is not panic time," Compton-Phillips said. "This is time to go get your booster."

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