Watching the local news, one sees constant stories about COVID numbers going up in Colorado, with COVID hospitalizations higher than they have ever been except for the spike last December. Some pundits predict last year’s peak will soon be surpassed.
On the surface that doesn’t make sense, since nearly 80 percent of eligible Coloradans have received at least one vaccine dose, suggesting the vaccines are not working as well as they should, or that vaccine immunity is waning, hence the push for booster injections.
Scarier still is that Colorado officials reinstated “crisis standards of care” for hospital staffing, allowing hospitals and other facilities to stretch limited personnel and use volunteers, including National Guard and family members, to help care for hospitalized patients.
ICU beds are in desperately short supply, with fewer than 100 beds available in Colorado as reported by the Denver Post. Are we headed to a situation where patients will be treated in hallways or turned away from overcrowded hospitals to fend for themselves?
With complicateed situations, explanations are also complex and multifactorial. While I don’t have a simple answer, here are some of the factors playing into this current crisis.
How much current hospital care is non COVID related? Remember that for the past two years, routine care and elective surgery were put deferred over fears of catching COVID or the constantly changing rules regarding testing, masks, and vaccines, leading some to wait things out until life returned to normal.
Most insurance plan deductibles reset at the end of the year. Those who have already met their deductible are eager to have their elective procedures before January 1, so the cost is covered under their paid deductible, rather than next year when they have a new deductible to meet.
Some, anticipating an end of year surge in surgery demand due to increasing COVID cases, are trying to get in ahead of the wave to avoid having their procedures put off deferred. While simple procedures are done as an outpatient, more complex surgery, including heart surgery, requires hospitalization, and perhaps a few days in the ICU.
The ICU isn’t just for sick COVID patients, it serves a wide patient population and due to the cost of running and staffing an ICU, it needs to be relatively full, just as airlines prefer their planes to fly with few empty seats, from a business perspective. Hospitals are businesses too and need revenues to cover their costs.
The news articles discussing ICU beds don’t mention whether this shortage represents physical beds or the ability to staff these beds. If a 40 bed ICU only has staff to safely care for 30 patients, and has a census of 28, they are reported to have only two available beds, ignoring the ten beds that cannot be used due to insufficient staff.
Hospital staffing may be an issue. More than 100 million Americans are out of the workforce and this includes healthcare workers. Some are burnt out after a hellacious two years on the COVID front lines. Others have reprioritized their lives and activities. Still others are resisting vaccine mandates.
As the weather turns cooler, Coloradans are heading indoors, into closer proximity to each other unlike when hiking in the mountains or strolling on a golf course. This will increase COVID numbers here and explain the drop in cases in Florida, for example, under the opposite effect of more venturing outside now due to tolerable temperatures, unlike the sweltering Florida summer when many stay indoors.
Remember also that many COVID patients spend weeks or months in the hospital, utilizing beds. COVID has created a mental health crisis for a variety of reasons beyond the scope of this essay, but mental health placement is challenging, with few inpatient beds and facilities, meaning patients lingering in hospitals or emergency departments awaiting placement. These factors keep hospital beds filled.
There are many reasons for the recent surge in COVID cases and hospitalization, and it is prudent to look at the numerous contributory factors rather than simply relying on knee jerk responses of blaming the unvaccinated or unmasked.
Past case surges peaked and fell over time. Hopefully these peaks will soon become smaller and less frequent, as we attempt to return to our pre-COVID lives and world.