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Rising hospitalizations aren’t only about COVID-19 cases

Mental health problems and delayed surgeries are also driving the increase

Health care workers  inside the COVID-19 intensive care unit in North Oaks Hospital in Hammond, La., on August 13.
Health care workers inside the COVID-19 intensive care unit in North Oaks Hospital in Hammond, La., on August 13. (Emily Kask/AFP via Getty Images)

Hospitals across the country are reaching capacity, the result not only of increasing COVID-19 cases, but also side effects of the pandemic, from delayed surgeries that are now urgent to mental health problems among children.  

Exacerbating the problem, hospitals are facing new staffing challenges as doctors, nurses and other support staff buckle under the pressures.   

Hospital leaders are calling on the Biden administration to help by extending more financial aid, importing medical staff from abroad, and reducing regulatory hurdles to help move patients who aren’t critically ill out of much-needed beds.  

Many of the hospitals that are hardest hit right now are clustered in the southeastern part of the United States, which has lower vaccination rates than other parts of the country and has seen cases rise most rapidly this summer as the virus’s delta variant spreads.  

In Missouri, for example, the number of patients hospitalized with COVID-19 has nearly quadrupled since the end of May to more than 2,400.  

Mary Mayhew, president and CEO of the Florida Hospital Association, said Florida hospitals had nearly 17,000 confirmed COVID-19 hospitalizations on Aug. 19, its most ever. Last year, the number of COVID-19 patients in Florida hospitals peaked at 10,200.  

But the problem goes beyond COVID-19, she said. “There is added pressure in the system, because in addition to the dramatic increase, and number of COVID hospitalizations, we have a significant volume of critically ill, non-COVID, hospitalizations,” she said.

The confluence of rising COVID-19 cases with delayed non-COVID-19 medical procedures is having a ripple effect, forcing some patients who need care to travel further and further away from their homes, said Dave Dillon, the spokesman for the Missouri Hospital Association.

Even states less affected by the current wave of COVID-19 cases have reported spikes in hospitalizations and limited intensive-care bed availability as more modest increases in COVID-19 cases combine with a backlog of surgeries put off in 2020 and surges in mental health cases linked to the pandemic.

The biggest worry for hospitals is staffing. Health workforce issues existed prior to the COVID-19 pandemic, but increased needs and provider burnout have further complicated the situation. 

“It’s not just that more people are coming in the door, but increasingly we’re having some struggles, getting people out of the hospital, in part because we’re seeing staffing shortages, all throughout health care,” said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association.

Staffing shortages are also a national issue, making it difficult to send health care workers from another part of the country or to shift patients to hospitals that aren’t overwhelmed with COVID-19 patients.  

Beyond COVID-19

Hospitals say two pandemic side effects are adding to the pressure from an influx of COVID-19 patients: delayed care and mental health crises.

When U.S. hospitals temporarily delayed non-emergency surgeries last year, it spurred a backlog of needed medical procedures. Many patients also delayed care because they feared contracting the virus.   

A group of physicians and researchers at Johns Hopkins University detailed the problem in a piece for Harvard Business Review this month, explaining that the new surge of COVID-19 patients, combined with hospital staffing problems, is exacerbating the delays for patients who need surgery.

James C. Denneny, executive vice president and CEO for the American Academy of Otolaryngology–Head and Neck Surgery, said he has heard from surgeons who have had to delay procedures.  

“I think we’re looking at next spring before things are all caught up,” he said. “I hope it doesn’t dissuade people once it calms down from getting care. Long term chronic disease, regardless of COVID, needs to be treated.”

Even states with relatively high vaccination rates have seen upticks in hospitalizations.

Jeff Tieman, president and CEO of the Vermont Association of Hospitals and Health Systems, said that while his state has a small population and a vaccination rate that is tops in the country, hospitalizations are rising. More than 77 percent of Vermont residents are fully vaccinated. 

“Some of it is COVID but a lot of it is not,” he said. The state has seen an increase in hospitalizations among people who delayed elective surgeries last year as well as increases in patients with mental health needs.  

Children’s hospitals have also seen upticks in patients, some for COVID-19, but also for other respiratory illnesses and mental health crises, says Mark Wietecha, chief executive of the Children’s Hospital Association.  

“It’s a little harder to fix because it’s not the same problem, but they all are COVID derivative,” he said.

Seeking federal fixes

Hospitals are now calling on the Biden administration for help.  

Mayhew of the Florida Hospital Association says the administration could assist by allowing more foreign nurses to come to the United States on temporary work visas.  

Florida and Louisiana have also called on the Centers for Medicare and Medicaid Services to issue guidance requiring Medicare Advantage plans to increase flexibilities to allow them to more easily transfer patients out of hospitals.

“The more that we can ensure that individuals who need a hospital bed are in a hospital bed, that others can be timely discharged, that reduces some of the burden on the system and the pressures on staffing,” said Mayhew.  

Federal emergency funding is also back on the table. Hawaii announced on Aug. 18 it would receive $46 million from the Federal Emergency Management Agency to hire over 500 health care professionals for temporary stints.  

“Our emergency rooms, medical-surge units and intensive care units are being overwhelmed,” said Hilton Raethel, chief executive of the Healthcare Association of Hawaii.   

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