Podcast: All Healthcare Is Politics?

Does Your Vote Affect Your Healthcare?

What role should the federal government play in addressing major healthcare issues? And does the way you vote affect your prospects for a long and healthy life? We talked about it on today’s episode of the 4sight Friday Roundup podcast.

  • David Johnson is CEO of 4sight Health.
  • Julie Vaughan Murchinson is Partner of Transformation Capital and former CEO of Health Evolution.
  • David Burda is News Editor and Columnist of 4sight Health.

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Michael Dowling: ‘Every single US hospital leader should be screaming about what an abomination this is’

Americans and global leaders have responded to the May 24 shooting at a Texas elementary school with heartbreak, anger and calls for change to better fight gun violence. But if you’re paying attention, the calls out of healthcare — from trauma surgeons, pediatricians, nurses, leaders and more — carry a distinct type of exasperation and sorrow. 

“I’m in one of my hospitals now, sitting with some staff talking about it — it’s just so frustrating,” Michael Dowling, president and CEO of New Hyde Park, N.Y.-based Northwell Health, told me over the phone early Wednesday morning. “This does not represent what the United States stands for — that we allow people who should never be allowed to carry a gun to do so and walk into a school and kill fourth graders.”

The attack by a lone 18-year-old gunman at Robb Elementary School in the small town of Uvalde, Texas, has left at least 19 students and two adults dead. Students in the school, grades 2 through 4, were two days away from summer vacation. 

Unlike many other known threats to our health, seeing the medical community condemn mass shootings still seems to leave some Americans doing a double take. It’s increasingly difficult to see what has them confused. 

In 2016, the American Medical Association declared gun violence a public health crisis after a lone gunman killed 49 people and wounded 53 more in a mass shooting in a gay nightclub in Orlando, Fla. Even after the declaration, healthcare professionals and leaders continued to defy insistence from gun rights advocates that gun violence was not within their specialty or expertise. Or as the National Rifle Association put it in simpler terms in 2018: “Someone should tell self-important anti-gun doctors to stay in their lane.” The #ThisIsOurLane movement started then. The attempt to silence medical professionals ironically made their calls for action louder.

As healthcare professionals responded to the ongoing public health emergency of COVID-19, the arms race grew and gun buying intensified — “a surge in purchasing unlike anything we’ve ever seen,” as one gun researcher at the University of California, Davis, put it. People who already owned guns bought more, and people who had never owned a gun bought them too. In 2020, firearm-related injuries were the No. 1 cause of death of children and teens, according to the CDC

Every day, 321 people are shot in the United States, and more than 40,000 Americans die from gun violence each year. Yet some healthcare executives still fear that taking the position that gun violence is a public health crisis will throw them into political turmoil given how toxic politics are in this country. It’s one position for the AMA and its 250,000-plus members to take, but another for an individual leader who may be the face of an organization in their community. There are risks of offending board members, donors, elected officials and other constituents ⁠— including patients. But here’s the thing: There will always be a reason to delay, to soften language, to wonder if this mass shooting is the one to react to.

Mr. Dowling urges his colleagues to step it up, noting how hospital and health system leaders can be ambassadors for gun safety in their communities, given the influence they wield as the largest employers in many communities.

“This is about protecting people’s health. This is about protecting kids’ lives. Have some courage. Stand up and do something,” he said. “Put the interest of the community in the center of what you think about each and every day. Our job is to save lives and prevent people from illness and death. Gun violence is not an issue on the outside — it’s a central public health issue for us. Every single hospital leader in the United States should be standing up and screaming about what an abomination this is.

“If you were hesitant about getting involved the day before May 24, May 24 should have changed your perspective. It’s time.”

Northwell established The Gun Violence Prevention Learning Collaborative for Health Systems and Hospitals, a grassroots initiative that gives healthcare professionals the space to have open dialogue about the impact of gun violence, share best practices and collectively take action. Learn more here

Covid deaths no longer overwhelmingly among the unvaccinated as toll on elderly grows

Unvaccinated people accounted for the overwhelming majority of deaths in the United States throughout much of the coronavirus pandemic. But that has changed in recent months, according to a Washington Post analysis of state and federal data.

The pandemic’s toll is no longer falling almost exclusively on those who chose not to or could not get shots, with vaccine protection waning over time and the elderly and immunocompromised — who are at greatest risk of succumbing to covid-19, even if vaccinated — having a harder time dodging increasingly contagious strains.

The vaccinated made up 42 percent of fatalities in January and February during the highly contagious omicron variant’s surge, compared with 23 percent of the dead in September, the peak of the delta wave, according to nationwide data from the Centers for Disease Control and Prevention analyzed by The Post. The data is based on the date of infection and limited to a sampling of cases in which vaccination status was known.

As a group, the unvaccinated remain far more vulnerable to the worst consequences of infection — and are far more likely to die — than people who are vaccinated, and they are especially more at risk than people who have received a booster shot.

“It’s still absolutely more dangerous to be unvaccinated than vaccinated,” said Andrew Noymer, a public health professor at the University of California at Irvine who studies covid-19 mortality.“A pandemic of — and by — the unvaccinated is not correct. People still need to take care in terms of prevention and action if they became symptomatic.”

A key explanation for the rise in deaths among the vaccinated is that covid-19 fatalities are again concentrated among the elderly.

Nearly two-thirds of the people who died during the omicron surge were 75 and older, according to a Post analysis, compared with a third during the delta wave. Seniors are overwhelmingly immunized, but vaccines are less effective and their potency wanes over time in older age groups.

Experts say they are not surprised that vaccinated seniors are making up a greater share of the dead, even as vaccine holdouts died far more often than the vaccinated during the omicron surge, according to the CDC. As more people are infected with the virus, the more people it will kill, including a greater number who are vaccinated but among the most vulnerable.

The bulk of vaccinated deaths are among people who did not get a booster shot, according to state data provided to The Post. In two of the states, California and Mississippi, three-quarters of the vaccinated senior citizens who died in January and February did not have booster doses. Regulators in recent weeks have authorized second booster doses for people over the age of 50, but administration of first booster doses has stagnated.

Even though the death rates for the vaccinated elderly and immunocompromised are low, their losses numbered in the thousands when cases exploded, leaving behind blindsided families. But experts say the rising number of vaccinated people dying should not cause panic in those who got shots, the vast majority of whom will survive infections. Instead, they say, these deaths serve as a reminder that vaccines are not foolproof and that those in high-risk groups should consider getting boosted and taking extra precautions during surges.

“Vaccines are one of the most important and longest-lasting tools we have to protect ourselves,” said California State Epidemiologist Erica Pan, citing state estimates showing vaccines have shown to be 85 percent effective in preventing death.

“Unfortunately, that does leave another 15,” she said.

‘He did not expect to be sick’

Arianne Bennett recalled her husband, Scott Bennett, saying, “But I’m vaxxed. But I’m vaxxed,” from the D.C. hospital bed where he struggled to fight off covid-19 this winter.

Friends had a hard time believing Bennett, co-founder of the D.C.-based chain Amsterdam Falafelshop, was 70. The adventurous longtime entrepreneur hoped to buy a bar and planned to resume scuba-diving trips and 40-mile bike rides to George Washington’s Mount Vernon estate.

Bennett went to get his booster in early December after returning to D.C. from a lodge he owned in the Poconos, where he and his wife hunkered down for fall. Just a few days after his shot, Bennett began experiencing covid-19 symptoms, meaning he was probably exposed before the extra dose of immunity could kick in. His wife suspects he was infected at a dinner where he and his server were unmasked at times.

A fever-stricken Bennett limped into the hospital alongside his wife, who was also infected, a week before Christmas. He died Jan. 13, among the 125,000 Americans who succumbed to covid-19 in January and February.

“He was absolutely shocked. He did not expect to be sick. He really thought he was safe,’” Arianne Bennett recalled. “And I’m like, ‘But baby, you’ve got to wear the mask all the time. All the time. Up over your nose.’”

Jason Salemi, an epidemiologist at the University of South Florida College of Public Health, said the deaths of vaccinated people are among the consequences of a pandemic response that emphasizes individuals protecting themselves.

“When we are not taking this collective effort to curb community spread of the virus, the virus has proven time and time again it’s really good at finding that subset of vulnerable people,” Salemi said.

While experts say even the medically vulnerable should feel assured that a vaccine will probably save their lives, they should remain vigilant for signs of infection. As more therapeutics become available, early detection and treatment is key.

When Wayne Perkey, 84, first started sneezing and feeling other cold symptoms in early February, he resisted his physician daughter’s plea to get tested for the coronavirus.

The legendary former morning radio host in Louisville had been boosted in October. He diligently wore a mask and kept his social engagements to a minimum. It must have been the common cold or allergies, he believed. Even the physician who ordered a chest X-ray and had no coronavirus tests on hand thought so.

Perkey relented, and the test came back positive. He didn’t think he needed to go to the hospital, even as his oxygen levels declined.

“In his last voice conversation with me, he said, ‘I thought I was doing everything right,’” recalled Lady Booth Olson, another daughter, who lives in Virginia. “I believe society is getting complacent, and clearly somebody he was around was carrying the virus. … We’ll never know.”

From his hospital bed, Perkey resumed a familiar role as a high-profile proponent for vaccines and coronavirus precautions. He was familiar to many Kentuckians who grew up hearing his voice on the radio and watched him host the televised annual Crusade for Children fundraiser. He spent much of the pandemic as a caregiver to his ex-wife who struggled with chronic fatigue and other long-haul covid symptoms.

“It’s the 7th day of my Covid battle, the worst day so far, and my anger boils when I hear deniers talk about banning masks or social distancing,” Perkey wrote on Facebook on Feb. 16, almost exactly one year after he posted about getting his first shot. “I remember times we cared about our neighbors.”

In messages to a family group chat, he struck an optimistic note. “Thanks for all the love and positive energy,” he texted on Feb. 23. “Wear your mask.”

As is often the case for covid-19 patients, his condition rapidly turned for the worse. His daughter Rebecca Booth, the physician, suspects a previous bout with leukemia made it harder for his immune system to fight off the virus. He died March 6.

“Really and truly his final days were about, ‘This virus is bad news.’ He basically was saying: ‘Get vaccinated. Be careful. But there is no guarantee,’” Rebecca Booth said. “And, ‘If you think this isn’t a really bad virus, look at me.’ And it is.”

Hospitals, particularly in highly vaccinated areas, have also seen a shift from covid wards filled predominantly with the unvaccinated. Many who end up in the hospital have other conditions that weakens the shield afforded by the vaccine.

Vaccinated people made up slightly less than half the patients in the intensive care units of Kaiser Permanente’s Northern California hospital system in December and January, according to a spokesman.

Gregory Marelich, chair of critical care for the 21 hospitals in that system, said most of the vaccinated and boosted people he saw in ICUs were immunosuppressed, usually after organ transplants or because of medications for diseases such as lupus or rheumatoid arthritis.

“I’ve cared for patients who are vaccinated and immunosuppressed and are in disbelief when they come down with covid,” Marelich said.

‘There’s life potential in those people’

Jessica Estep, 41, rang a bell celebrating her last treatment for follicular lymphoma in September. The single mother of two teenagers had settled into a new home in Michigan, near the Indiana border. After her first marriage ended, she found love again and got married in a zoo in November.

As an asthmatic cancer survivor, Estep knew she faced a heightened risk from covid-19, relatives said. She saw only a tight circle of friends and worked in her own office in her electronics repair job. She lived in an area where around 1 in 4 residents are fully vaccinated. She planned to get a booster shot in the winter.

“She was the most nonjudgmental person I know,” said her mother, Vickie Estep. “It was okay with her if people didn’t mask up or get vaccinated. It was okay with her that they exercised their right of choice, but she just wanted them to do that away from her so that she could be safe.”

With Michigan battling back-to-back surges of the delta and omicron variants, Jessica Estep wasn’t able to dodge the virus any longer — she fell ill in mid-December. After surviving a cancer doctors described as incurable, Estep died Jan. 27. Physicians said the coronavirus essentially turned her lungs into concrete, her mother said.

Estep’s 14-year-old daughter now lives with her grandparents. Her widower returned to Indianapolis just months after he moved to Michigan to be with his new wife.

Her family shared her story with a local television station in hopes of inspiring others to get vaccinated, to protect people such as Estep who could not rely on their own vaccination as a foolproof shield. In response to the station’s Facebook post about the story, several commenters shrugged off their pleas and insinuated it was the vaccines rather than covid causing deaths.

Immunocompromised people and those with other underlying conditions are worth protecting, Vickie Estep said. “There’s life potential in those people.”

A delayed shot

As Arianne Bennett navigates life without her husband, she hopes the lesson people heed from his death is to take advantage of all tools available to mitigate a virus that still finds and kills the vulnerable, including by getting boosters.

Bennett wore a music festival shirt her husband gave her as she walked into a grocery store to get her third shot in March. Her husband urged her to get one when they returned to D.C., but she became sick at the same time he did. She scheduled the appointment for the earliest she could get the shot: 90 days after receiving monoclonal antibodies to treat the disease.

My booster! Yay!” Bennett exclaimed in her chair as the pharmacist presented an updated vaccine card.

“It’s been challenging, but we got through it,” the pharmacist said, unaware of Scott Bennett’s death.

Tears welled in Bennett’s eyes as the needle went in her left arm, just over a year after she and her husband received their first shots.

“Last time we got it, we took selfies: ‘Look, we had vaccines,’” Bennett said, beginning to sob. “This one leaves me crying, missing him so much.”

The pharmacist leaned over and gave Bennett a hug in her chair.

“He would want you to do this,” the pharmacist said. “You have to know.”

Methodology

Death rates compare the number of deaths in various groups with an adjustment for the number of people in each group. The death rates listed for the fully vaccinated, the unvaccinated and those vaccinated with boosters were calculated by the CDC using a sample of deaths from 23 health departments in the country that record vaccine status, including boosters, for deaths related to covid-19. The CDC study assigns deaths to the month when a patient contracted covid-19, not the month of death. The latest data published in April reflected deaths of people who contracted covid as of February. The CDC study of deaths among the vaccinated is online, and the data can be downloaded.

The death rates for fully vaccinated people, unvaccinated people and fully vaccinated people who received an additional booster are expressed as deaths per 100,000 people. The death rates are also called incidence rates. The CDC estimated the population sizes from census data and vaccination records. The study does not include partially vaccinated people in the deaths or population. The CDC adjusted the population sizes for inaccuracies in the vaccination data. The death data is provisional and subject to change. The study sample includes the population eligible for boosters, which was originally 18 and older, and now is 12 and older.

To compare death rates between groups with different vaccination status, the CDC uses incidence rate ratios. For example, if one group has a rate of 10 deaths per 100,000 people, the death incidence rate would be 10. Another group may have a death incidence rate of 2.5. The ratio between the first group and the second group is the rate of 10 divided by the rate of 2.5, so the incidence rate ratio would be 4 (10÷2.5=4). That means the first group dies at a rate four times that of the second group.

The CDC calculates the death incidence rates and incidence rate ratios by age groups. It also calculates a value for the entire population adjusted for the size of the population in each age group. The Post used those age-adjusted total death incidence rates and incidence rate ratios.

The Post calculated the share of deaths by vaccine status from the sample of death records the CDC used to calculate death incidence rates by vaccine status. As of April, that data included 44,000 deaths of people who contracted covid in January and February.

The share of deaths for each vaccine status does not include deaths for partially vaccinated people because they are not included in the CDC data.

The Post calculated the share of deaths in each age group from provisional covid-19 death records that have age details from the CDC’s National Center for Health Statistics. That data assigns deaths by the date of death, not the date on which the person contracted covid-19. That data does not include any information on vaccine status of the people who died.

How America’s massive COVID death toll came to feel “normal”

https://mailchi.mp/f6328d2acfe2/the-weekly-gist-the-grizzly-bear-conflict-manager-edition?e=d1e747d2d8

As the US approaches the grim statistic of one million deaths from COVID, journalist Ed Yong’s latest piece in The Atlantic takes a sobering look at how numb we’ve become to that astronomically high toll. In the early days of the pandemic, predictions of a few hundred thousand American deaths seemed shocking, but recent milestones of 800K and 900K lives lost have ticked by with little public attention.

Yong blames the invisibility of the virus: its worst impacts have been disproportionately concentrated among the disadvantaged—making it possible for COVID to more easily “disappear” from the lives of the healthy and economically advantaged. Case in point: while three percent of Americans have lost a close family member to COVID-19, the virus has taken a much larger toll on people of color, the elderly, and those with underlying health conditions.

The Gist: The pandemic has rendered us numb to the ongoing tragic loss of life, leading us to accept over 1,500 COVID deaths each day as “normal”.

As Yong points out, it’s hard to imagine we could turn a blind eye to this number of Americans perishing every day, compared to the number who perish from hurricanes or other weather disasters, for example. While permanent memorials are built for soldiers and victims of terror attacks, they are rarely erected for victims or medical heroes of pandemics, despite the far greater death toll. 

While the pandemic is still far from over, we must ensure the difficult lessons learned are not forgotten by future generations—as has been the case with previous pandemics.   

Why is America’s Covid-19 death rate so high?

Death Rates In The U.S. During Pandemic Far Higher Than Other Countries :  Shots - Health News : NPR

Covid-19 death rates in the United States are “eye-wateringly” high compared with other wealthy nations—a problem that several health experts say underscores the shortfalls of the country’s pandemic response.

U.S. Covid-19 death rates exceed those of other wealthy nations

According to CDC data, over 880,000 Americans have died from Covid-19 since the beginning of the pandemic—a death toll greater than that of any other country. And during the current omicron wave, Covid-19 deaths are now greater than the peak number seen during the delta wave and more than two-thirds as high as record numbers seen last winter before vaccines were available, the New York Times reports.

Moreover, since Dec. 1, when omicron was first detected in the United States, the proportion of Americans who have died from Covid-19 has been at least 63% higher than other large, wealthy countries, including Britain, Canada, France, and Germany, according to a Times analysis of mortality figures.

Currently, the daily Covid-19 death rate in the United States is nearly double that of Britain and four times that of Germany. The only large European countries to surpass the United States’ Covid-19 death rates have been the Czech Republic, Greece, Poland, Russian, and Ukraine—all of which are less wealthy nations where the most effective treatments may be limited.

“Death rates are so high in the States—eye-wateringly high,” said Devi Sridhar, head of the global public health program at the University of Edinburgh. “The United States is lagging.”

Similarly, Joseph Dieleman, an associate professor at the University of Washington, said the United States “stands out” with its high Covid-19 death rate. “There’s been more loss than anyone wanted or anticipated,” he said. 

Vaccination shortfalls plague the U.S.

Lagging Covid-19 vaccination rates among Americans likely contributed to the country’s outsized death toll compared with other nations, several health experts said.

Currently, around 64% of the U.S. population has been fully vaccinated. However, several peer countries, including Australia (80%), Canada (80%), and France (77%), have achieved higher vaccination rates.

Unvaccinated people make up the majority of hospitalized Covid-19 patients, according to the Times, but lagging vaccination and booster rates among vulnerable groups, such as older Americans, has also led to increased hospitalizations.

Around 12% of Americans ages 65 and older are not fully vaccinated, and among those who are fully vaccinated, 43% still have not received a booster shot, leaving them with waning immunity against the omicron variant. In comparison, only 4% of Britons ages 65 and older are not fully vaccinated, and only 9% have not had a booster shot.

“It’s not just vaccination—it’s the recency of vaccines, it’s whether or not people have been boosted, and also whether or not people have been infected in the past,” said Lauren Ancel Meyers, director of the University of Texas at Austin’s Covid-19 modeling consortium.

Similarly, former FDA Commissioner Scott Gottlieb said that the United States‘ lagging vaccination rates compared to the U.K.’s, particularly for boosters, may be due to “protracted wrangling” that “may have sowed confusion, sapping consumer interest.”

How the U.S. could fare in future Covid-19 waves

According to some scientists, the gap between the United States and other wealthy nations may soon begin to narrow. Although U.S. vaccination rates have been slow, the delta and omicron waves have infected so many people that overall immunity against the coronavirus has increased—which could potentially help blunt the effect of future waves.

“We’ve finally started getting to a stage where most of the population has been exposed either to a vaccine or the virus multiple times by now,” said David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “I think we’re now likely to start seeing [American and European Covid-19 death rates] be more synchronized going forward.”

However, other experts noted that the United States has other disadvantages that could make future Covid-19 waves difficult. For example, many Americans have chronic health problems, such as diabetes and obesity, that increase the risk of severe Covid-19 outcomes.

Overall, health experts said the impact of future Covid-19 waves will depend on what new variants emerge, as well as what level of death people decide is tolerable.

“We’ve normalized a very high death toll in the U.S.,” said Anne Sosin, who studies health equity at Dartmouth University. “If we want to declare the end of the pandemic right now, what we’re doing is normalizing a very high rate of death.”

COVID-19 deaths pass peak from delta surge

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Welcome to Wednesday’s Overnight Health Care, where we’re following the latest moves on policy and news affecting your health. Subscribe here: thehill.com/newsletter-signup

Masks come to the Super Bowl: Fans attending the big game next month will be given KN95 masks.  

Despite omicron being less severe on average, the sheer number of cases has driven deaths past the peak from last year’s delta surge.  

The average number of U.S. COVID-19 deaths this week surpassed the height of the delta surge earlier this fall and is at its highest point since last winter, when the nation was coming out of the peak winter surge. 

The seven-day average of deaths hit 2,166 on Monday, according to the latest data from the Centers for Disease Control and Prevention (CDC). Average daily deaths in mid-September before the omicron variant was discovered peaked at around 1,900. 

While increasing evidence shows omicron may be less likely to cause death or serious illness than delta, the sheer infectiousness and the speed at which it spreads has overwhelmed hospitals, primarily with people who have not been vaccinated. 

The U.S. saw the highest numbers of deaths in the pandemic just over a year ago, before vaccines were widely available, when the daily average reached 3,400. The last time the U.S. topped 2,000 deaths was last February, as the country was slowly coming down from the January peak. 

Caution urged: Infections are falling in states that were hardest hit earlier, as well as broadly across the nation. Hospitalizations are also falling, but deaths are a lagging indicator and are still increasing. CDC Director Rochelle Walsenky said deaths have increased about 21 percent over the past week. 

The fact that the omicron variant tends to cause less severe disease on average also helped avoid an even greater crisis that would have occurred if it was as severe as the delta variant.  

COVID-19 peaking in Northeast + 2 more forecasts to know

COVID-19 Forecasts: Hospitalizations | CDC

COVID-19 hospitalizations are at record high numbers nationwide, though some parts of the country are seeing cases plateau or fall, Surgeon General Vivek Murthy, MD, said Jan. 16 on CNN‘s “State of the Union.”

In New York and other parts of the Northeast, “we are starting to see a plateau and, in some cases, an early decline in cases,” Dr. Murthy said. Daily average cases in New York have fallen 27 percent in the last 14 days, according to Jan. 18 data tracked by The New York Times. New Jersey, Maryland and Washington, D.C., have also seen cases fall in recent days. 

“The omicron wave started later in other parts of the country. So we shouldn’t expect a national peak in the next coming days,” Dr. Murthy said. “The next few weeks will be tough.”

As of Jan. 17, a record 154,335 people were hospitalized with COVID-19 nationwide, HHS data shows. Hospitalizations had previously peaked at 142,273 on Jan. 14, 2021.

Two other forecasts to know: 

1. Daily COVID-19 hospital admissions will increase over the next four weeks, with 17,900 to 48,000 new admissions likely reported on Feb. 4, according to ensemble forecasts the CDC published Jan. 12. For context, the current seven-day hospitalization average for Jan. 5-11 is 20,637, a 24.5 percent increase from the previous week’s average. 

2. CDC forecasting predicts COVID-19 deathwill increase nationwide over the next month, with 10,400 to 31,000 deaths likely reported in the week ending Feb. 5. Current forecasts should be interpreted with caution, the CDC said, as they may not fully account for omicron’s rapid spread or changes in reporting during the holidays. 

US hospitals seeing different kind of COVID surge this time

https://apnews.com/article/coronavirus-pandemic-business-health-pandemics-49810a71d2ca21c4b56adb1d1092b6dd?fbclid=IwAR1KvwTCWhAHZwDlmzgzMiNL5xhBfOySbZwgzXs3IAXtWlHai_VRfni5eaQ

Registered nurse Rachel Chamberlin, of Cornish, N.H., right, steps out of an isolation room where where Fred Rutherford, of Claremont, N.H., left, recovers from COVID-19 at Dartmouth-Hitchcock Medical Center, in Lebanon, N.H., Monday, Jan. 3, 2022. Hospitals like this medical center, the largest in New Hampshire, are overflowing with severely ill, unvaccinated COVID-19 patients from northern New England. If he returns home, Rutherford said, he promises to get vaccinated and tell others to do so, too. (AP Photo/Steven Senne)

Hospitals across the U.S. are feeling the wrath of the omicron variant and getting thrown into disarray that is different from earlier COVID-19 surges.

This time, they are dealing with serious staff shortages because so many health care workers are getting sick with the fast-spreading variant. People are showing up at emergency rooms in large numbers in hopes of getting tested for COVID-19, putting more strain on the system. And a surprising share of patients — two-thirds in some places — are testing positive while in the hospital for other reasons.

At the same time, hospitals say the patients aren’t as sick as those who came in during the last surge. Intensive care units aren’t as full, and ventilators aren’t needed as much as they were before.

The pressures are nevertheless prompting hospitals to scale back non-emergency surgeries and close wards, while National Guard troops have been sent in in several states to help at medical centers and testing sites.

Nearly two years into the pandemic, frustration and exhaustion are running high among health care workers.

“This is getting very tiring, and I’m being very polite in saying that,” said Dr. Robert Glasgow of University of Utah Health, which has hundreds of workers out sick or in isolation.

About 85,000 Americans are in the hospital with COVID-19, just short of the delta-surge peak of about 94,000 in early September, according to the Centers for Disease Control and Prevention. The all-time high during the pandemic was about 125,000 in January of last year.

But the hospitalization numbers do not tell the whole story. Some cases in the official count involve COVID-19 infections that weren’t what put the patients in the hospital in the first place.

Dr. Fritz François, chief of hospital operations at NYU Langone Health in New York City, said about 65% of patients admitted to that system with COVID-19 recently were primarily hospitalized for something else and were incidentally found to have the virus.

At two large Seattle hospitals over the past two weeks, three-quarters of the 64 patients testing positive for the coronavirus were admitted with a primary diagnosis other than COVID-19.

Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco, said the rising number of cases like that is both good and bad.

The lack of symptoms shows vaccines, boosters and natural immunity from prior infections are working, she said. The bad news is that the numbers mean the coronavirus is spreading rapidly, and some percentage of those people will wind up needing hospitalization.

This week, 36% of California hospitals reported critical staffing shortages. And 40% are expecting such shortages.

Some hospitals are reporting as much as one quarter of their staff out for virus-related reasons, said Kiyomi Burchill, the California Hospital Association’s vice president for policy and leader on pandemic matters.

In response, hospitals are turning to temporary staffing agencies or transferring patients out.

University of Utah Health plans to keep more than 50 beds open because it doesn’t have enough nurses. It is also rescheduling surgeries that aren’t urgent. In Florida, a hospital temporarily closed its maternity ward because of staff shortages.

In Alabama, where most of the population is unvaccinated, UAB Health in Birmingham put out an urgent request for people to go elsewhere for COVID-19 tests or minor symptoms and stay home for all but true emergencies. Treatment rooms were so crowded that some patients had to be evaluated in hallways and closets.

As of Monday, New York state had just over 10,000 people in the hospital with COVID-19, including 5,500 in New York City. That’s the most in either the city or state since the disastrous spring of 2020.

New York City hospital officials, though, reported that things haven’t become dire. Generally, the patients aren’t as sick as they were back then. Of the patients hospitalized in New York City, around 600 were in ICU beds.

“We’re not even halfway to what we were in April 2020,” said Dr. David Battinelli, the physician-in-chief for Northwell Health, New York state’s largest hospital system.

Similarly, in Washington state, the number of COVID-19-infected people on ventilators increased over the past two weeks, but the share of patients needing such equipment dropped.

In South Carolina, which is seeing unprecedented numbers of new cases and a sharp rise in hospitalizations, Gov. Henry McMaster took note of the seemingly less-serious variant and said: “There’s no need to panic. Be calm. Be happy.”

Amid the omicron-triggered surge in demand for COVID-19 testing across the U.S., New York City’s Fire Department is asking people not to call for ambulance just because they are having trouble finding a test.

In Ohio, Gov. Mike DeWine announced new or expanded testing sites in nine cities to steer test-seekers away from ERs. About 300 National Guard members are being sent to help out at those centers.

In Connecticut, many ER patients are in beds in hallways, and nurses are often working double shifts because of staffing shortages, said Sherri Dayton, a nurse at the Backus Plainfield Emergency Care Center. Many emergency rooms have hours-long waiting times, she said.

“We are drowning. We are exhausted,” Dayton said.

Doctors and nurses are complaining about burnout and a sense their neighbors are no longer treating the pandemic as a crisis, despite day after day of record COVID-19 cases.

“In the past, we didn’t have the vaccine, so it was us all hands together, all the support. But that support has kind of dwindled from the community, and people seem to be moving on without us,” said Rachel Chamberlin, a nurse at New Hampshire’s Dartmouth-Hitchcock Medical Center.

Edward Merrens, chief clinical officer at Dartmouth-Hitchcock Health, said more than 85% of the hospitalized COVID-19 patients were unvaccinated.

Several patients in the hospital’s COVID-19 ICU unit were on ventilators, a breathing tube down their throats. In one room, staff members made preparations for what they feared would be the final family visit for a dying patient.

One of the unvaccinated was Fred Rutherford, a 55-year-old from Claremont, New Hampshire. His son carried him out of the house when he became sick and took him to the hospital, where he needed a breathing tube for a while and feared he might die.

If he returns home, he said, he promises to get vaccinated and tell others to do so too.

“I probably thought I was immortal, that I was tough,” Rutherford said, speaking from his hospital bed behind a window, his voice weak and shaky.

But he added: “I will do anything I can to be the voice of people that don’t understand you’ve got to get vaccinated. You’ve got to get it done to protect each other.”

The data is telling a consistent story: Omicron is significantly milder.

‘Not the same’
The details of the Omicron variant are becoming clearer, and they are encouraging.
They’re not entirely encouraging, and I will get into some detail about one of the biggest problems — the stress on hospitals, which are facing huge numbers of moderately ill Covid-19 patients. But regular readers of this newsletter know that I try to avoid the bad-news bias that often infects journalism. (We journalists tend to be comfortable delivering bad news straight up but uncomfortable reporting good news without extensive caveats.)
So I want to be clear: The latest evidence about Covid is largely positive. A few weeks ago, many experts and journalists were warning that the initial evidence from South Africa — suggesting that Omicron was milder than other variants — might turn out to be a mirage. It has turned out to be real.
“In hospitals around the country, doctors are taking notice,” my colleagues Emily Anthes and Azeen Ghorayshi write. “This wave of Covid seems different from the last one.”
There are at least three main ways that Omicron looks substantially milder than other versions of the virus:
1. Less hospitalization
Somebody infected with Omicron is less likely to need hospital treatment than somebody infected with an earlier version of Covid.
An analysis of patients in Houston, for example, found that Omicron patients were only about one-third as likely to need hospitalization as Delta patients. In Britain, people with Omicron were about half as likely to require hospital care, the government reported. The pattern looks similar in Canada, Emily and Azeen note.
Hospitalizations are nonetheless rising in the U.S., because Omicron is so contagious that it has led to an explosion of cases. Many hospitals are running short of beds and staff, partly because of Covid-related absences. In Maryland, more people are hospitalized with Covid than ever.
“Thankfully the Covid patients aren’t as sick. But there’s so many of them,” Craig Spencer, an emergency room doctor in New York, tweeted on Monday, after a long shift. “The next few weeks will be really, really tough for us.”
The biggest potential problem is that overwhelmed hospitals will not be able to provide patients — whether they have Covid or other conditions — with straightforward but needed care. Some may die as a result. That possibility explains why many epidemiologists still urge people to take measures to reduce Covid’s spread during the Omicron surge. It’s likely to last at least a couple more weeks in the U.S.
2. Milder hospitalization
Omicron is not just less likely to send somebody to the hospital. Even among people who need hospital care, symptoms are milder on average than among people who were hospitalized in previous waves.
A crucial reason appears to be that Omicron does not attack the lungs as earlier versions of Covid did. Omicron instead tends to be focused in the nose and throat, causing fewer patients to have breathing problems or need a ventilator.
As Dr. Rahul Sharma of NewYork-Presbyterian/Weill Cornell told The Times, “We’re not sending as many patients to the I.C.U., we’re not intubating as many patients, and actually, most of our patients that are coming to the emergency department that do test positive are actually being discharged.”
In London, the number of patients on ventilators has remained roughly constant in recent weeks, even as the number of cases has soared, John Burn-Murdoch of The Financial Times noted.
3. And deaths?
In the U.S., mortality trends typically trail case trends by about three weeks — which means the Omicron surge, which began more than a month ago, should be visible in the death counts. It isn’t yet:
Data as of Jan. 3.Source: New York Times database
Covid deaths will still probably rise in the U.S. in coming days or weeks, many experts say. For one thing, data can be delayed around major holidays. For another, millions of adults remain unvaccinated and vulnerable.
But the increase in deaths is unlikely to be anywhere near as large as the increase last summer, during the Delta wave. Look at the data from South Africa, where the Omicron wave is already receding:
South Africa reported identification of Omicron on Nov. 24.Source: Johns Hopkins University
The bottom line
Given the combination of surging cases and milder disease, how should people respond?
Dr. Leana Wen, Baltimore’s former health commissioner, wrote a helpful Washington Post article in which she urged a middle path between reinstituting lockdowns and allowing Omicron to spread unchecked.
It’s unreasonable to ask vaccinated people to refrain from pre-pandemic activities,” Wen said. “After all, the individual risk to them is low, and there is a steep price to keeping students out of school, shuttering restaurants and retail shops and stopping travel and commerce.”
But she urged people to get booster shots, recommended that they wear KN95 or N95 masks and encouraged governments and businesses to mandate vaccination. All of those measures can reduce the spread of Covid and, by extension, hospital crowding and death.
What about elderly or immunocompromised people, who have been at some risk of major Covid illness even if they’re vaccinated?
Different people will make different decisions, and that’s OK. Severely immunocompromised people — like those who have received organ transplants or are actively receiving cancer treatment — have reason to be extra cautious. For otherwise healthy older people, on the other hand, the latest data may be encouraging enough to affect their behavior.
Consider this: Before Omicron, a typical vaccinated 75-year-old who contracted Covid had a roughly similar risk of death — around 1 in 200 — as a typical 75-year-old who contracted the flu. (Here are the details behind that calculation, which is based on an academic study.)
Omicron has changed the calculation. Because it is milder than earlier versions of the virus, Covid now appears to present less threat to most vaccinated elderly people than the annual flu does.
The flu, of course, does present risk for the elderly. And the sheer size of the Omicron surge may argue for caution over the next few weeks. But the combination of vaccines and Omicron’s apparent mildness means that, for an individual, Covid increasingly resembles the kind of health risk that people accept every day.