Recently, I held a patient’s hand as he gasped to breathe, while my boss ran through the hospital floor-by-floor to find him an ICU-level bed so that we could give him the ventilator machine that he desperately needed.
I will never forget the fear in his eyes as he struggled to breathe while we waited; it was all I could do to hold back my own panic as I did my best to reassure him that we would be able to get him ICU-level resources soon, praying that I was right. Unfortunately, it’s now hard to find ICU beds in time for patients like him that need one.
He did not have COVID; yet stories like his are unfortunately the norm now. Understanding why is the key to understanding why this wave of the pandemic is much worse than the one in March.
In the Spring, many people opted not to seek medical care, so hospitals were largely filled with people sick from COVID. Now, those months of decreased health care utilization are catching up to us. Cancer diagnoses and treatments were delayed. Insulin was rationed. Needed procedures and follow-up were postponed. And so, nine months later, we are not only battling the second wave of COVID, but also facing a third surge of patients: those with chronic medical conditions who avoided leaving home to seek health care. They are now so sick that they have no choice but to come to the hospital and risk dying without their family nearby, or to stay at home with a more certain outcome of death.
This hurts our already strained health care system in several ways. First, it means that the non-COVID patients that we care for are much sicker than normal. As a result, more people need ICU beds at a time when there is already an ICU bed shortage due to COVID. In fact, at times, it is harder to get an ICU bed as a non-COVID patient than as a COVID patient, because many medical ICUs have been turned into COVID-only ICUs to combat the surge, and patients without COVID need to be protected from those with the disease.
Even sending patients safely out of the hospital is harder now. Typically, many patients who are hospitalized for serious illnesses require short-term inpatient care at a skilled nursing facility (or “SNF”) after hospital discharge, in order to get strong enough to function at home. However, many beds in these SNFs are now occupied by patients who are recovering from COVID. As a result, SNF beds are now in limited supply. This forces many patients to stay in the hospital longer, until a bed opens up, further limiting the availability of inpatient resources.
These challenges are compounded by another resource that’s stretched thin — health care providers. In the spring, the outbreak was isolated to the Northeast and health care professionals from across the country were able to go to “hot spots” like New York City to help out. Now, hospitals across the country are facing spikes all at the same time; there is no reserve of health care providers to shift around this time. And, like much of this pandemic, these challenges are exacerbated for underserved communities.
As a physician, these ramifications of COVID on every level of the health care system are soul-crushing. We need your help.
Please think very carefully about whose air you are sharing. While we all so very much long for laughs and cheers and closeness — oh, do we long for this — do everything you can to ensure you are not part of the spread of COVID by avoiding new contacts, staying 6 feet apart, wearing masks when you are around non-household contacts (even family members) and trying to ensure you are out of doors if at all possible. If you have chronic conditions, please talk with your doctor by phone or via video to try to ensure you are treating this the best you can at this time. Given that flu season often lands people in the hospital, please take a flu shot. If you get sick please get testing for COVID, and if positive, please let anyone whom you spent more than 15 minutes indoors with know so they can be tested too, and then isolate yourself for the recommended time.
While we wait for vaccines to make a significant difference, your masking and distancing really does save lives. Please learn from my patient’s story, so that it doesn’t have to be yours.
Lochan Shah (lochanshah2019@gmail.com) is an internal medicine doctor at Johns Hopkins who has been caring for both COVID & non-COVID patients.
