“We had to ramp up during the swings and then try to figure out, ‘Do we keep people or do we let them go when we don’t have swings?'” Said Julie Hirschhorn, director of molecular pathology at the Medical University of South Carolina at Charleston. “The surges are usually just far enough apart to not know what to do… It’s a tough new normal. ‘”
The current wave, which has seen the new number of patients hospitalized with Covid-19 rise by more than 40 percent in the last month, is also putting renewed pressure on facilities as federal funding to respond to the pandemic dwindles and some remain less flexible to hire more staff when the need arises.
In March, a funding deal to cover part of the White House’s $22.5 billion request fell through because Congressional Democrats objected to the reuse of unspent funds promised to states at the start of the pandemic, while Republicans said they need accounting for the $6 trillion Congressional Pandemic Aid provided in previous funding bills before approving new money.
“There is growing concern that this money has run out,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “It doesn’t really get enough attention.”
As of July 22, hospitals in nearly 40 states were reporting critical staffing shortages, while hospitals in all 50 states said they expect to do so within a week.
Several states where the number of cases of Covid-19 is rising have large and growing problems, although factors beyond Covid are involved.
In California, for example, only eight hospitals reported their staffing shortages as critical on July 22, but 118 expected to do so within the week. In Louisiana, just one hospital reported a critical shortage last week, but 46 expected to have one by this week. Other hospitals also expected bottlenecks in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia – all states with increasing case numbers.
“While we have previously experienced staffing shortages, we are currently acutely aware of staffing shortages in virtually every position within the hospital.” said Foster. “When we have a large influx of Covid patients, it becomes much more difficult than ever to meet those demands.”
Chronic shortages of hospital staff will continue to be a long-term problem, administrators said, because even vaccines that have proven highly effective at preventing serious illnesses are not keeping everyone out of the hospital. There is also a growing resistance from Americans to mitigation measures like social distancing and masking, and a reluctance by officials to sound the alarm during a wave that is seeing fewer people becoming seriously ill and dying than in previous ones.
Hospital intensive care units are not swamped with Covid-19 patients like in previous waves, and average daily deaths are about 350, according to the Centers for Disease Control and Prevention, well below the thousands of Americans who die each day in past peak periods .
But without those murky tolls, serious strains on the healthcare system remain.
“I don’t think people appreciate the implications of allowing us to transmit the virus almost indiscriminately now,” said David Wohl, an infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina. “If there are problems in the supply chain, if there are delays in the delivery of services, or if people say, ‘Well, I’m understaffed, I can’t do this,’ then that’s because of the pandemic.”
“Robbing Peter to Pay Paul”
Staffing shortages in hospitals – from nurses to doctors to medical lab technicians – existed before SARS-CoV-2, reflecting both an aging healthcare workforce and an aging population overall, which is driving demand for care.
The pandemic has created something of a domino effect in the medical community, said Sherry Polhill, associate vice president of hospital laboratories, respiratory care and pulmonary function services at UAB Medicine in Birmingham, Alabama.
It prompted older workers to quit their jobs earlier and sparked a boom in the lucrative industry of traveling medical professionals, which lured people away from their white-collar jobs.
“You have this vacuum of vacancies that you need to fill, and you can’t do that easily,” Polhill said, adding that it could take years to fill the vacancies she has in her labs.
The deficit is affecting hospitals – and their patients – in different ways, as BA.5 has proven capable of bypassing immunity and becoming the dominant strain in the country.
In North Carolina, where cases have risen nearly 20 percent in the past two weeks, UNC Health is struggling to meet rising patient demand for monoclonal antibody treatments.
Hospitals are still offering the antibody treatment for those taking medications that could negatively interact with a simpler therapeutic, Paxlovid. Unlike Paxlovid, a take-anywhere pill, monoclonal antibodies are administered by infusion, a labor-intensive process that requires careful infection control to treat patients in infusion centers that also treat the immunocompromised.
In order for this to work, Wohl says, the hospital has to borrow staff from other departments.
“We have to rob Peter to pay Paul,” he said. “If you have people working in an infusion center, what was their day-to-day work before Covid? Some of them worked in the emergency room. Some of them worked in the operating room. You just can’t take people away from these other critical functions and keep them working somewhere else.”
Next door in South Carolina, staff shortages at the Medical University of South Carolina have already prompted the hospital to stop testing all inpatients for Covid-19 like earlier in the pandemic.
The facility received money from a March 2020 Congress on the Covid-19 Relief Act to expand its testing capacity with new equipment and staff.
Now the money is drying up and Hirschhorn has to reduce shifts and employees. Her lab, one of a network of theirs at the hospital, had 44 staff and contract workers at the height of the pandemic but only 10 full-time staff today. It is Covid-19 testing capacity has dropped to 1,500 from around 3,500 a day.
The decision to halt routine Covid testing has helped ensure the lab is not overwhelmed. although the number of people hospitalized with Covid has risen 34 percent in South Carolina in the past two weeks. But Hirschhorn said it made her uneasy knowing she no longer has the resources to boot back up if necessary.
“We’re all trying to figure out what our lab is like now and what we can do to prepare for another climb, knowing we won’t have the same staffing levels as other climbs,” she said. “We’re flying blind.”
That fear is widespread in hospitals, where the pandemic has exacerbated the staffing shortages that preceded it.
“Medical laboratory scientists are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chair of the Laboratory Staff Steering Committee for the American Society for Clinical Pathology. “They work too hard and they’ve worked too hard for too long.”
“What’s the end of this?” She asked. “I don’t really know the answer.”
Although hospital labs are, by and large, far better prepared to handle this surge of cases than they were in 2020, the Medical University of South Carolina is not the only one to stop testing all inpatients for Covid-19 due to staff shortages, said Jonathan Myles. Chair of the Council on Government and Professional Affairs of the College of American Pathologists.
A lack of local testing facilities poses a greater risk to patients and the community, he said, especially in rural facilities that operate in economically disadvantaged areas. “They operate with a minimum,” he said. “If you limit testing to rural settings, you exacerbate the inequality of care.”
Large city hospitals may be better positioned to juggle periods of high transmission, but as more staff call in sick and more patients test positive, they too are under pressure.
In Los Angeles County, where the number of patients hospitalized with Covid-19 has risen dramatically since May despite the area’s high immunization coverage, Harbor-UCLA Medical Center has had to find ways to deal with it.
“People are getting Covid left and right,” said Anish Mahajan, the facility’s CEO and chief medical officer.
So far, the hospital has managed this increase in cases with some longer wait times in the emergency room due to staff shortages and more patients, he said. The hospital may need to reprioritize urgent cases if the situation worsens.
The only real way to end uncertainty is to stop the virus through vaccination and take measures to stop its spread, he said, like putting on masks when transmission is high.
“The more the virus is transmitted in our world, the more likely it is that the generation of future variants will take hold,” Mahajan said. “Maybe this variant will not lead to so many people ending up sick in the hospital. But we don’t know what the next variants could do.”