Hospitals are struggling to hold on to nurses and other professionals, staff are traumatized and the influx of patients feels like it’s coming out of a fire hose, doctors say.
The Covid-19 pandemic, entering its third year with 800,000 people dead in the US alone, could damage the health industry for years to come, they predict.
“It feels like you are drinking from a fire hose with no way to control that flow,” Dr. John Hick, an emergency physician at Hennepin Healthcare in Minnesota, told reporters Tuesday.
“I have been practicing for 25 years in the emergency department and every shift I am working these days is like the worst shift in my career.”
And many patients are hostile, making matters worse, said Dr. Jessi Gold, an assistant professor of psychiatry at Washington University in St. Louis. “Now people are yelling at you and telling you that you don’t know anything,” she said. “So it’s like a fire hose in a setting that hates you.”
It got so bad that hospital leaders in Minnesota took out a full-page newspaper ad this week. “We’re heartbroken. We’re overwhelmed,” it read. “Our emergency departments are overfilled, and we have patients in every bed in our hospitals.”
Dr. Rahul Koranne, president and chief executive officer of the Minnesota Hospital Association, said the pandemic hit when hospitals and public health departments were already thin.
“We were already short thousands of workers before the first Covid case showed up, and now the health care workers are exhausted. They are retiring. They are resigning,” Koranne told CNN.
“They are going to other industries. That is limiting our care capacity, and so we’re telling our community that at this point if you had a motor vehicle accident or had a heart attack our care capacity is limited. It’s really a crisis.”
A crisis in care
A CNN analysis of Johns Hopkins University data shows about one in five patients in intensive care units around the country are being treated for Covid-19. Close to 67,000 people are in the hospital with Covid-19 and US Health and Human Services Department data shows a 42% increase in hospitalizations over the past month.
“Our beds are full. Our emergency departments are full. Our hallways have patients in them, some on breathing machines, and at this point our care capacity is stretched to the very limits, so we’re invoking our hearts. We want our communities to know the dire situation that we’re in right now,” Koranne said.
Staff have been leaving, said Hick.
“We can’t get any help. And that’s honestly the bottom line of the biggest problems here is that we just don’t have the staffing, and the personnel resources in particular,” Hick told a briefing organized by SciLine, a science journalism service sponsored by the American Association for the Advancement of Science.
“And that’s really led to an awful lot of burnout … but just the continuing emotional grind, in addition to the physical fatigue of caring for these patients and adapting to the challenges of working in PPE, and being the only connection sometimes between patient and family, has been terribly difficult,” Hick added.
Hostility and disbelief
Patients and their families are often not grateful and sometimes outright hostile.
“Our workforce shortages are extreme, and I think it’s been extraordinarily hard on the workforce to go from being heroes to being questioned to being distrusted, you know, to really feeling like they’re not only under the gun but also sometimes being assaulted by patients,” Hick said.
It’s affecting patients, too, Hick said.
“This morning’s number we had over 246 patients waiting more than four hours in emergency departments across the state of Minnesota for inpatient beds that are simply not available,” he said.
Hospitals, doctors, nurses and other health care workers are now watching to see what the Omicron variant does.
Studies from South Africa indicate the new variant significantly evades the protection offered by vaccines – not completely – and fewer people are ending up in hospitals there. But it’s also apparently far more transmissible than the Delta variant, already accounting for 3% of cases in the US.
That could mean more people in hospitals just because of the sheer numbers of new infections. Thanksgiving holiday travel led to one uptick in cases and the many holidays between now and the end of the year could mean more mixing, mingling, travel – and infections.
“So expect the hospitals to continue to be very overloaded throughout the first quarter of next year,” Hick said.
A profession struggling with trauma
Health care workers already often have poorer mental health than the US public in general, said Gold, who specializes in treating health care professionals.
“Health care workers are not people who had good mental health before Covid,” she said.
“It’s not like Covid came and all of a sudden we’re having problems. We had longstanding problems.”
Medical school students have high rates of depression, she said. “When we mean burnout, it’s workplace-associated and it has to do with emotional exhaustion, depersonalization, which in health care workers looks like a lack of empathy or sort of like treating patients like objects, and a reduced sense of personal accomplishment,” Gold said. “In physicians, it’s about 50% when you look at burnout, and that’s before Covid.”
Doctors, nurses and other health professionals feel like the pandemic has sent things spinning out of control, Hick said.
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“I think one of the biggest contributors to burnout and PTSD symptoms is powerlessness. And I think that’s what an awful lot of our providers are experiencing right now. And, as Jessi mentioned, there’s no way to fix that right now. I mean, we’ve got to have all hands on deck.”
Gold doesn’t see the problems ending any time soon.
“It’s not like Covid’s going to stop and all of a sudden, we’re magically better,” she said.
“I think we’ll see a higher increase in mental health outcomes for the whole population but particularly in healthcare workers, and the studies we have with comparisons from other pandemics would suggest at least two years out we will be seeing this.”