Illinois hospitals are being flooded with patients more than at any other time of the pandemic, a Tribune analysis of state data has found, with fewer beds open than during the deadliest COVID-19 surge a year earlier.
State regulators say hospitals become “seriously stressed” in regions where bed availability drops below 20%. As of Thursday night, intensive care units in the region covering DuPage and Kane counties averaged 15% of their beds available, and that’s the best rate in the Chicago area. At worst, the rate was 7% for hospitals in the region covering Will and Kankakee counties.
Among the reasons for the strain: Hospitals are losing health care workers to burnout or better-paying positions, reducing the number of staffed hospital beds overall. The state also has seen a dramatic increase in patients hospitalized with other ailments, from cancer to heart disease — many of whom are arriving in worse shape because of delayed care.
So when COVID-19 surged again this winter, it was like pouring water into a nearly full tub faster than it can drain.
“We’re surrounded by states that are already overflowing with COVID patients, and I’m very concerned we’re going to be next,” said Dr. Shikha Jain, an oncologist who also helps run the advocacy group Illinois Medical Professionals Action Collaborative Team.
The Tribune’s analysis found Illinois hospitals were staffing about 900 more beds at the height of last year’s patient crush than they are now. At the same time, they are caring for an average of 1,500 more total patients each day. There’s still room to spare, but the struggle has left hospitals with their lowest levels of bed availability since the state began publishing figures in summer 2020.
“Now it just feels, to be honest, overwhelming,” said Erik McIntosh, a nurse practitioner at Rush University Medical Center who sees patients with and without COVID-19. “We’re still dealing with this very deadly virus in this pandemic, but we’re trying to figure out how to live with it and continue business as usual. And that’s tricky, very tricky.”
The space crunch is so bad at Community First Medical Center, in Chicago’s Portage Park neighborhood, that some patients who would normally go to the hospital’s intensive care unit are waiting in beds in the emergency department for more than a week, said ER nurse Kathy Haff.
“It’s just chaos,” said Haff, who’s worked at the hospital for 29 years.
The Illinois Department of Public Health said one hospital, which officials declined to name, has even implemented “crisis standards of care,” a designation indicating it may not be able to provide adequate care to everyone who comes in.
The problem spans the state. In nearly all regions of Illinois, hospitals have fewer than 20% of beds available on average, both in intensive care units and those handling less critical care.
!function(){“use strict”;window.addEventListener(“message”,(function(e){if(void 0!==e.data[“datawrapper-height”]){var t=document.querySelectorAll(“iframe”);for(var a in e.data[“datawrapper-height”])for(var r=0;r<t.length;r++){if(t[r].contentWindow===e.source)t[r].style.height=e.data["datawrapper-height"][a]+"px"}}}))}();
Heading into a second pandemic winter, there are few publicly palatable options to stem the spread of virus variants that have grown increasingly infectious, from delta now engulfing the state to omicron starting to infiltrate. Illinois is among the rare states with an indoor mask mandate, but surveys have shown some people regularly refuse to wear masks, particularly in rural areas.
Gov. J.B. Pritzker has not suggested a return to stricter rules prohibiting indoor dining, drinking or gatherings. His general message to Illinoisans has been to push masking, social distancing and voluntary vaccination, while his administration tries to help hospitals outlast the latest surge by distributing promising treatments and directing supplemental staff to the hardest-hit areas.
“I’m hopeful that what is now a surge of delta variant that is filling our hospitals will abate over time and that we’ll be able to manage through omicron, which so far appears to be a little less virulent,” Pritzker said Dec. 7.
Shrinking staff, fewer beds
Even before the pandemic, many hospitals were struggling to find nurses to fill jobs and had cut beds to make room for more outpatient procedures.
But in the adrenaline-filled days of 2020, Illinois’ hospitals were able to marshal more staff and equipment, state data shows. At the height of the surge a year ago, hospitals said they could staff 32,600 beds within four hours, if need be.
As delta took hold across Illinois, that tally has shrunk by about 3% overall, with the biggest declines occurring in ICUs.
For example, when comparing a recent four-day stretch to a similar one from December 2020, staffed ICU beds dropped by 18% in the region covering Will and Kankakee counties, meaning nearly 30 fewer ICU beds are staffed now than a year ago.
!function(){“use strict”;window.addEventListener(“message”,(function(e){if(void 0!==e.data[“datawrapper-height”]){var t=document.querySelectorAll(“iframe”);for(var a in e.data[“datawrapper-height”])for(var r=0;r<t.length;r++){if(t[r].contentWindow===e.source)t[r].style.height=e.data["datawrapper-height"][a]+"px"}}}))}();
The trend means some hospitals have rooms loaded with equipment but sitting dark.
“Even if we have the beds, sometimes we can’t staff them,” said Dr. Russell Fiorella, system chief medical officer and vice president of medical affairs for Sinai Chicago.
Sinai now has more than 100 full-time equivalent positions open for nurses across its hospital system, which includes Mount Sinai and Holy Cross hospitals, Fiorella said.
Full-time jobs can be tough to fill. Many longtime nurses have quit hospitals to become “travel” nurses, earning much more money by working through an employment agency that places them back into hospitals on temporary contracts.
A few health care providers may have balked at vaccination requirements, but hospital executives, doctors and nurses have said that’s not a major driver of staffing shortages.
Instead, many workers have just had it, Jain said, after months of COVID-19 hospitalizations that could have been prevented if more people had gotten vaccinated and were willing to mask up.
“Unfortunately, because enough people didn’t do the right thing, we’re now in a position where our health care systems are stretched to the brink, and our health care workers are completely burned out and feel no help is coming,” Jain said. “So more and more people are leaving the field.”
To get by, hospitals are having to pay more for fewer workers. Across the country, labor costs for hospitals rose 2.7% from September to October, while staffing levels dropped 4.5% compared with last year, according to a recent report by the Chicago-based advisory and consulting firm Kaufman, Hall and Associates.
Overall demand is up
Dr. Susan Lopez has watched the pandemic patient load shift over a year at Rush, a relatively new hospital seemingly built to weather a pandemic.
In fall 2020, the butterfly-shaped hospital was deluged with COVID-19 patients and many people suffering from other ailments stayed away, if they could.
A year later, the hospital’s COVID floor isn’t as swamped. The problem is now seen on other floors, handling all those other patients. They are coming in for the same reasons people sought hospital care before the pandemic, Lopez said. But they’re coming in sicker, often with issues related to those treatment delays of 2020.
“They’re much more medically complicated,” Lopez said. “So they take longer to get better, or get well enough to get home. So the hospital just stays fuller, longer.”
Hospitals across the country are seeing increases in non-COVID patients, said Dr. Michael Barnett, who teaches health policy and management at Harvard University’s T.H. Chan School of Public Health. The reasons may go beyond the pent-up demand of the pandemic, he said, including changes to admissions policies and challenges in discharging patients.
“We didn’t go into the pandemic in great shape, and now that we’re coming out of it, we’re having this increased demand for reasons we have yet to figure out,” he said.
Sinai, for example, has been seeing about 30% more trauma patients, over the last few months, than it did at the same time last year, Fiorella said. Most of Sinai’s trauma patients are victims of violence; they also include people hurt in car accidents, among other injuries.
Statewide, the average number of non-COVID patients in hospitals during the first two weeks of this month was nearly 25% higher than the same period two years ago, according to a Tribune analysis of state data.
In other words, even if all COVID-19 patients were suddenly cured, Illinois’ hospitals still would be treating far more patients than before the pandemic. Add in the surging numbers of patients with COVID-19, and Illinois hospitals are seeing roughly 40% more patients than in December 2019.
!function(){“use strict”;window.addEventListener(“message”,(function(e){if(void 0!==e.data[“datawrapper-height”]){var t=document.querySelectorAll(“iframe”);for(var a in e.data[“datawrapper-height”])for(var r=0;r<t.length;r++){if(t[r].contentWindow===e.source)t[r].style.height=e.data["datawrapper-height"][a]+"px"}}}))}();
Younger patients, staying longer
Patients with COVID-19 may not be in the majority at hospitals, but surges of them can quickly overwhelm resources.
Dr. Tabassum Nafsi has watched the worst of it unfold in the ICU of a Rockford hospital, UW Health SwedishAmerican. The state’s North region, west of the Chicago area, was largely spared from the worst of earlier surges, but residents there are now being hospitalized for COVID-19 at twice the rate of Chicagoans.
Unvaccinated people make up the vast majority of those hospitalizations, state data shows, and Nafsi said her hospital’s ICU is full of unvaccinated residents.
This group is younger than what Nafsi saw during earlier surges, she said. And they tend to spend longer hooked up to a ventilator while their bodies struggle for life. She said one 29-year-old patient spent 75 days on a ventilator before being transferred to another hospital for a possible lung transplant.
Others don’t survive.
“I just pronounced (dead) a 35-year-old, with a 1-year-old at home,” she told a reporter during an afternoon break from tracking and treating about two dozen patients.
While Nafsi’s patients languish in the ICU, others are waiting to get in. It’s a challenge that doctors and nurses say is springing up across the state’s 200-plus hospitals, to varying degrees.
Early this spring, hospitals reported an average of about 10,000 open beds, about 1,000 of them in ICUs. The latest figures have dropped below 6,000 beds, with fewer than 350 in ICUs.
!function(){“use strict”;window.addEventListener(“message”,(function(e){if(void 0!==e.data[“datawrapper-height”]){var t=document.querySelectorAll(“iframe”);for(var a in e.data[“datawrapper-height”])for(var r=0;r<t.length;r++){if(t[r].contentWindow===e.source)t[r].style.height=e.data["datawrapper-height"][a]+"px"}}}))}();
“If we weren’t having this surge of unvaccinated COVID patients, we would not being having the strain we’re having on our ICU beds right now,” said Dr. Kalisha Hill, regional chief medical officer at Amita Health.
When ICUs and other hospital wards fill up, hospitals may be forced to “board” patients in emergency rooms. Doctors and nurses then must watch over these patients while triaging even more arrivals, sometimes delaying emergency care for hours.
That’s what Haff said is happening at Community First, in Portage Park.
The longtime nurse said at least three ICU patients are boarding in the emergency room at nearly all times now, as rooms back up and patients keep streaming in, meaning hourslong waits for care in the ER and nurses who are stretched thin.
“We’ve been through hell and back and this is still the worst it’s been, and it’s getting worse,” she said. “You’re so afraid you’re going to miss something important because you’re running.”
Community First Chief Nursing Officer Dina Lipowich said in a statement: “We are definitely starting to feel the impact of the latest COVID surge in our communities,” and she encouraged people to get vaccinated and to get tested and seek treatment if they’ve been exposed to the illness.
Overstretched hospitals can ask the state to declare them on “bypass” — meaning ambulances are diverted elsewhere — but the state has tightened the rules during the pandemic. IDPH said it couldn’t immediately provide a list of those whose requests it approved.
Hospitals also can stop taking transfers from other overloaded facilities.
Among facilities slowing their intake of transfers is Northwestern Memorial Hospital in Chicago. As of Tuesday, its medical ICU — an ICU unit for patients with problems such as COVID-19, respiratory illnesses and diabetes — had 52 patients despite typically having 42 beds. The extras were put in other ICU units in the hospital.
“It’s just literally almost impossible to get an external transfer in unless it’s an extreme emergency,” said Dr. Richard Wunderink, medical director of the hospital’s medical ICU.
At their worst, hospitals can impose “crisis standards of care.” That’s a designation in which a hospital declares to state regulators that “demands for space, supplies and staffing are highly disproportionate to the available resources and the hospital is forced to ration supplies and modify standards of care,” according to IDPH’s website.
After the Tribune asked if any hospitals had imposed that designation, IDPH acknowledged Wednesday night that one had. But it wouldn’t name the facility except in response to an open-records request, which the Tribune filed that same night. Such requests can take weeks to fill.
What’s next?
It’s tough to predict trends of COVID-19 hospitalizations. One early indicator — the percentage of COVID-19 tests coming back positive — appears to be stabilizing. But COVID wards could fill back up with patients infected with the omicron variant.
Omicron may be a milder variant than delta, but it could also spread faster and infect plenty of people still vulnerable to serious illness. Millions of Illinoisans have yet to get vaccinated, the best way doctors say people can limit the risk of hospitalization.
Doctors continue to implore people to get vaccinated, mask up indoors and — if getting together with friends or family during the holidays — get tested beforehand.
Calling the increase in COVID-19 hospitalizations “very concerning,” IDPH said it’s discussed the challenges with hospitals.
The big relief valve for hospital officials a year ago was canceling nonemergency surgeries, but that step has drawbacks, delaying important care while depriving hospitals of resources at a time when they are already drained from the pandemic.
New York has ordered some elective surgeries canceled in the busiest hospitals in the hardest-hit areas, but Illinois has not. An IDPH spokesperson, Melaney Arnold, told the Tribune it wouldn’t be fair to punish people needing hernia surgeries, knee replacements or other important, pain-reducing procedures “because their neighbors refuse to get vaccinated.”
Some hospitals have adjusted their surgery schedules without canceling all elective surgeries. Otherwise, IDPH guidance suggests that hospitals cancel surgeries if numbers suggest they won’t have enough beds to handle a surge without imposing crisis standards of care.
Even if COVID-19 cases ease off, hospitals expect they’ll remain extremely busy with all the other patients they’re now seeing. Nobody can say how long it will be until patient loads settle close to pre-pandemic levels, but health care workers cautioned there is no quick fix.
“I would say it’s going to be a while,” Lopez said.
interactive_content
