“We’ve had to build up during spikes and then try to figure out, ‘Do we keep people or do we let them go when we don’t have spikes?'” said Julie Hirschhorn, director of the Division of Molecular Pathology at the Medical University of South Carolina. in Charleston. “The outbreaks tend to be far enough apart that you don’t know what to do … It’s a difficult new normal.”

The current wave, in which the number of new patients hospitalized with Covid-19 has increased by more than 40 percent in the past month is also putting a new strain on facilities as federal funding to fight the pandemic runs out, leaving some with less flexibility to hire additional staff if they need it.

A financing deal was struck in March to cover the portion White House request for $22.5 billion collapsed because Democrats in Congress opposed the repurposing of unused funds promised states earlier during the pandemic, and Republicans said they accounting was needed $6 trillion that Congress appropriated for pandemic relief in past funding bills before approving the new money.

“There’s a growing concern that that money has run out,” said Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy. “It really doesn’t get enough attention.”

As of July 22, hospitals in nearly 40 states have reported it critical shortage of personnelwhile hospitals in all 50 states said they were expecting within a week.

Several states where the number of Covid-19 cases are increasing have large and growing problems, although non-Covid factors are involved.

In California, for example, only eight hospitals have declared staffing shortages critical as of July 22, but 118 expect to do so within the week. In Louisiana, only one hospital reported a critical shortage last week, but 46 expected to have one this week. More hospitals also expected shortages in Alabama, Florida, Kentucky, New Mexico, Tennessee and West Virginia — all states with rising cases.

“While we’ve experienced staffing shortages in the past, we’re acutely aware of staffing shortages in virtually every position in the hospital right now,” Foster said. “If we have a large influx of Covid patients, it will be much more difficult to meet those demands than ever before.”

A chronic shortage of hospital staff will continue to be a long-term problem, administrators said, and even vaccines that have proven highly effective in preventing serious illnesses are not keeping everyone out of the hospital. There is also a deepening resistance among Americans to mitigation measures such as social distancing and masking reluctance of government officials sounding the alarm during a wave during which fewer people get seriously ill and die than during previous ones.

Hospital intensive care units are not overwhelmed with Covid-19 patients as they were in previous waves, and the daily average number of deaths hovers around 350according to the Centers for Disease Control and Prevention, far below the thousands of Americans who died each day in past peaks.

But the heavy burden on the health care system remains without these grim losses.

“I don’t think people appreciate the consequences of the fact that we’re now willingly allowing the virus to be transmitted,” said David Woll, an infectious disease expert who leads the Covid-19 response at UNC Health in North Carolina. “If there are supply chain issues, if there are delays in services, or if people are saying, ‘Well, I’m understaffed, I can’t do this,’ it’s because of the pandemic.”

“Robbering Peter to Pay Paul”

Shortages of hospital staff—from nurses to doctors to medical laboratory technicians—existed before SARS-CoV-2, the result of both an aging health care workforce and an aging population in general, which increases the demand for health care.

The pandemic has created a kind of domino effect in the medical community, said Sherry Polhill, associate vice president for hospital laboratories, respiratory care and pulmonary function at UAB Medicine in Birmingham, Alabama.

This prompted older workers to leave the workforce sooner and fueled a boom in the lucrative itinerant health care industry, which lured people away from 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 shortage is hitting hospitals — and their patients — in different ways, as BA.5 has proven it can evade immunity and become the dominant strain in the country.

In North Carolina, where cases are on the rise almost 20 percent for the past two weeks, UNC Health has been struggling to meet increasing patient demand for monoclonal antibody treatments.

Hospitals continue to provide antibody treatment to those taking drugs that may interact negatively with the simpler therapeutic drug Paxlovid. Unlike Paxlovid, a pill that can be taken anywhere, the monoclonal antibody is given by infusion, a time-consuming process that requires careful infection control to treat patients in infusion centers that also treat the immunocompromised.

To make it work, Wohl said, the hospital must borrow staff from other departments.

“We have to rob Peter to pay Paul,” he said. “If you have people working in an infusion center doing this, what was their day job before Covid? Some of them worked in intensive care. Some of them worked in the operating room. You just can’t pull people away from those other important functions and make them always work somewhere else.”

Next door in South Carolina, staff shortages at the Medical University of South Carolina have already forced the hospital to stop testing all inpatients for Covid-19, as it had done earlier during the pandemic.

The facility received money from the Covid-19 relief act passed by Congress in March 2020 to expand its testing capacity with new equipment and staff.

Now that money has started to dry up and Hirschhorn has had to cut back on shifts and staff. Her lab, one of their network of hospitals, had 44 employees and contractors at the peak of the pandemic, but today has only 10 full-time employees. His The capacity to test for Covid-19 has dropped from about 3,500 a day to 1,500.

The decision to stop routine Covid testing helped keep the lab from being overwhelmed, even as the number of people hospitalized with Covid rose 34 percent in South Carolina in the past two weeks. But Hirschhorn said it’s frustrating to know she no longer has the resources to step up when she needs to.

“We’re all trying to figure out what our lab looks like now and what we can do to prepare for another outbreak, knowing that we won’t have the same staff as we have in other outbreaks,” she said. . “We’re flying blind.”

Pandemic fatigue

That anxiety is widespread in hospitals, where the pandemic has exacerbated the staff shortages that preceded it.

“Medical laboratory scientists are unhappy right now,” said Susan Harrington, a microbiologist at the Cleveland Clinic and chair of the American Society of Clinical Pathology’s laboratory staffing steering committee. “They work too hard and they work too long.”

“How will it end?” she asked. “I really don’t know the answer.”

Although hospital laboratories are generally much better prepared to handle this wave of cases than they were in 2020, the Medical University of South Carolina is not alone in stopping testing of all inpatients for Covid-19 with -out of state, said Jonathan Miles, chairman of the Board of American Pathologists for Public and Professional Affairs.

The lack of local testing options poses a major risk to patients and the community, he said, especially in rural facilities operating in economically disadvantaged areas. “They act on nothing,” he said. “When you limit testing in rural areas, you exacerbate inequality of care.”

Big city hospitals may be in a better position to juggle periods of high transmission, but with more staff calling in sick and more patients testing positive, they are also under pressure.

In Los Angeles County, where the number of patients hospitalized with Covid-19 has increased sharply since May, despite the area high vaccination rateHarbor-UCLA Medical Center had to find ways to fight back.

“People are getting sick with Covid left and right,” said Anish Mahajan, the facility’s CEO and chief medical officer.

So far, the hospital has dealt with the uptick in what he says are longer wait times in the emergency room because of understaffing and more patients. The hospital may have to prioritize emergency care again if the situation worsens.

The only real way to end the uncertainty is to stop the virus through vaccination and taking measures to stop its spread, he said, such as wearing masks when transmission is high.

“The more the virus spreads in our world, the more likely we will see a generation of future variants,” Mahajan said. “Maybe this option doesn’t result in so many people getting sick in the hospital. But we don’t know what the next options can provide.”


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