Perhaps the worst way a leader can respond to the current surge of COVID-19 is with an exaggerated sense of familiarity.

Although communities have before experienced growing positivity rates, cases, hospitalizations and deaths from COVID-19, the summer 2021 surge involves some new or evolved factors that are worthy of consideration for leaders to best respond to the needs of their teams, patients and communities. 

COVID-19 surges may not be new for hospitals or health systems, but here are seven reasons the one unfolding now differs from those before. 

1. COVID-19 vaccinations are available. The fact that acute COVID-19 resulting in hospitalization is largely avoidable is a sticky film coating everything about this surge. Under the direction of President Joe Biden, all adults were eligible for the COVID-19 vaccine by May 1. As of Aug. 2, 49.7 percent of the U.S. population is fully vaccinated and 70 percent of adults have received at least one dose of a COVID-19 vaccine, the latter of which is a milestone the president aimed to meet by July 4. Unvaccinated individuals account for 97 percent of the COVID-19 hospitalizations and deaths in the U.S., Jeff Zients, White House COVID-⁠19 response coordinator, said July 22. 

2. Clinicians are experiencing a distinct and deep brand of exhaustion. The term “burnout,” which healthcare recognized long before the pandemic, doesn’t cut it. Many clinicians today are managing competing emotions about patient care, with some feeling resentment slogging through long hours and COVID-19 surges that now feel preventable. “You’re just angry,” Terrence Coulter, MD, critical care medical director at Springfield, Mo.-based CoxHealth, told The Atlantic. “And you feel guilty for getting angry, because they’re sick and dying.”  

3. Hospitals are grappling with labor shortages. Nationwide, organizations are experiencing labor and talent deficits, both of which have been exacerbated by the pandemic. COVID-19 has left many professionals exhausted, with nearly 30 percent of physicians, nurses and other healthcare workers reporting that they have considered leaving healthcare altogether because of pandemic-related burnout, according to a survey by The Washington Post and the Kaiser Family Foundation. At the end of July, PeaceHealth St. John Medical Center in Longview, Wash., said it was facing “unprecedented patient volumes,” with its workforce alleging that a staffing crunch is leading to poor working conditions, according to The Daily News. On the other side of the nation, two North Carolina hospitals have at least 700 unfilled nursing positions — each, reported WNCT-TV. In South Carolina, there are more open positions for registered nurses than any other job in the state, with 4,955 openings, according to a May data analysis by WYFF.

4. The delta variant is more contagious. The delta variant, first detected in India, appears to be as contagious as chickenpox and appears to cause more severe illness than earlier strains, according to an internal CDC presentation obtained by The Washington Post. The report says vaccinated people infected with delta have had similar viral loads as unvaccinated people infected with the strain, which suggests vaccinated people may spread the virus just as easily as those who are unvaccinated — findings based on still unpublished data from studies and outbreak analyses. The variant is thought to contain genetic changes that allow it to spread twice as fast as earlier strains.

5. Public health guidance is more nuanced. In the earliest stage of the pandemic, before the vaccines, public health guidance from the CDC was written for every person as our defense against COVID-19 was collectively minimal. Now, as the number of fully vaccinated populations varies from 68 percent in Vermont to 34 percent in Alabama, the CDC has revised indoor masking guidance to a county level, with nearly 70 percent of U.S. counties experiencing a community transmission rate that meets the CDC threshold for an indoor mask recommendation. The CDC released new guidance for fully vaccinated Americans’ COVID-19 testing the same week. These are two examples of how public health guidance that in past surges was largely “one size fits all” is now tailored to specific circumstances. While precision and right-sized solutions are generally a good thing, nuance can also cause confusion. 

6. COVID-19 patients are younger and fitter. At the start of 2021, people 65 and older made up 53 percent of COVID-19-related hospitalizations and people 18-49 made up 20.5 percent, according to data from COVID-Net, a CDC surveillance system that draws data from numerous states, representing roughly 10 percent of the population. As of Aug. 2, those numbers shifted where people 65-plus now make up 26 percent of COVID-19-related hospitalizations while people 18-49 make up 41 percent. 

7. Non-COVID patients are sicker. Pre-surge, many emergency rooms were already feeling the strain of staffing shortages combined with patients of higher acuity as a result of delayed or deferred care throughout the pandemic. Stanford (Calif.) Healthcare is “outstripping beds everyday,” Dale Beatty, DNP, RN, chief nurse executive and vice president of patient care services, told Becker’s. The hospital is seeing “sicker” patients, reporting higher volumes of critically ill non-COVID-19 patients. COVID-19 long-haulers are also accounting for a significant portion of the patients, Dr. Beatty said. COVID-19 leaves thousands of survivors with health effects that place additional demand on the healthcare system. Nearly one-quarter of people who had COVID-19 still have at least one condition.