The exponential improve in Covid-19 hospital stays on one chart

Far more Americans are currently hospitalized with Covid-19 than at any other time in the pandemic, a grim indicator of the third major wave of falls in the US is the worst wave yet.

On December 2, 100,226 people were hospitalized in the United States after testing positive for the novel coronavirus, according to the Covid Tracking Project. This is significantly higher than the last two highs on April 15 and July 23, when New York City and the Southeast and Southwest were epicentres of the US outbreak, respectively. (As the Covid Tracking Project notes, national and state hospital data were erratic and incomplete, and reported totals may continue to shift.)

Christina Animashaun / Vox

The data shows that Covid-19 migrated to new regions across the country this fall. In the spring, hospital stays were mostly concentrated in the northeast. In the summer, more than half of Covid-19 patients were hospitalized in the south and west: states like Arizona, California, Florida, Georgia, and Texas.

Now every state is fighting an active outbreak, and many of them are severe. "There are so many places with so many people that the numbers are only dramatically higher," Daniel McQuillen, assistant professor of medicine at Tufts and senior physician in the infectious diseases division at Beth Israel Lahey Health, told the Society of America's November briefing for infectious diseases.

"There are no more hot spots," said Murtaza Akhter, an emergency medicine doctor at Valleywise Health Medical Center in Phoenix, Arizona. "There's a hot spot everywhere."

As of December 3, California had the highest number of hospitalizations of any state (9,702) and Texas was second with 9,151 hospitalized people. Midwestern states such as Michigan, Illinois, and Ohio have also seen record highs in the past few weeks, each having hospitalized more than 4,000 people.

"The hospital stay number is the best indicator of where we are," Eric Topol, professor of molecular medicine and director of the Scripps Research Translational Institute, told Vox this summer. This is because the severity of the pandemic can be measured better than Covid-19 tests, which only detect a fraction of cases and include milder cases. "We're going to reach new heights in the pandemic we've never seen before. Not that what we've seen before wasn't terrible enough."

Medical staff treats a coronavirus patient in the Covid-19 intensive care unit at the United Memorial Medical Center in Houston, Texas on November 10, 2020.

Go to Nakamura / Getty Images

Some states like Utah and North Dakota have fewer overall hospital stays, but also fewer hospitals and hospital beds – and they are now reaching a sad tipping point with hospitals operating at full capacity.

“Here in Salt Lake City we offer a lot (specialized infectious diseases and intensive care) to people in four states as far as Montana, Arizona and Wyoming. Our hospitals and nurses are extremely stressed, "said Andrew Pavia, the chief of pediatric infectious diseases at the University of Utah Medical School at the IDSA briefing. "Our intensive care units are full, but they also include specially designed overflow intensive care units that use the time we had to plan."

Unfortunately, this was to be expected (although it was not inevitable). As the weather turned cooler and states could not fully control their outbreaks, transmission increased when people moved indoors. Almost every state that has seen more cases and hospitalizations now has no major outbreaks in the spring or summer. As a result, residents were less anxious and took fewer steps to prevent the virus from spreading.

"There has been a political climate of distrust of the government and reluctance to take tough action," Pavia said in places like Utah. "Many of these states did not have mask mandates until recently, and some do not even have them today and have very limited restrictions on mass gatherings."

Deaths have also almost hit a new record high, hitting 2,733 on December 2, reversing a steady decline that began in early May after the first wave and in August after the second wave.

In total, 13.9 million Americans have tested positive for Covid-19 since the pandemic began, and more than 267,000 of them have died. CDC Director Robert Redfield said Americans were "the most difficult in this country's public health history" on Wednesday as hospital admissions increase and several states report thousands of new cases daily.

The new hospitalizations and the unsustainable pressure they are putting on the health system are also a reminder of the importance for states to implement and enforce measures such as mandatory face masks, restrictions on bars and restaurants, and for the federal government to address testing and contact tracing issues remedy. "It should be an all-points bulletin to really substantiate this, otherwise there is no limit to where this could go," Topol said.

The hospitals are running out of staff and beds for Covid-19 patients

The good news is that infectious disease experts believe many hospitals are better prepared for surges in Covid-19 patients than they were in the spring. For the most part, they have the equipment they need and they know how to use it. They also have a more standardized protocol for treating the sickest patients.

However, hospitals in troubled areas across the country are exhausting their staff, equipment and beds, and doctors and nurses are warning that the worst scenario of hospital resource overload has already arisen as their states have failed to take control of the coronavirus.

"The increase in Covid-19 patients is affecting our ability to care for the sick patients already living in Arkansas," said a nurse from a major Little Rock health care system who wanted to remain anonymous for fear of retaliation from her employer. "We have quarantined so many nurses that we cannot adequately staff our oncology department and our patients are negatively affected. Covid-19 is currently overloading our health system in Arkansas."

An aerial view of the Field Hospital for Coronavirus Patients at the Ernest N. Morial Convention Center in New Orleans, Louisiana on April 4, 2020.

Chris Graythen / Getty Images

Hospitals in several states are also trying to find enough specialists to treat very sick Covid-19 patients.

"ICU beds don't care about people – they need staff," Pavia said. “And one of the things that many Western nations have in common is a relative shortage of people we need for the very sick during such a pandemic: intensive care doctors, probably most importantly intensive care nurses, and infectious disease doctors respiratory therapists . These people have been working at full speed for eight or nine months and after three months they are exhausted and stressed. "

Personnel is a universal problem in hot spots. Utah Governor Gary Herbert said the state must bring in extra-state nurses to help with the wave, and officials and health care providers in South Dakota, Tennessee, Arizona and Wisconsin are also calling for them

In Texas, officials in El Paso and Lubbock are setting up medical tents to respond to the rapid rise in hospital Covid-19 patients and a dwindling number of hospital beds. “El Paso, Texas, has almost no beds in the intensive care unit. Lubbock, same thing, ”said McQuillen.

"We're the eleventh largest city in the state of Texas and have two field hospitals on our way into town," Jarrett Atkinson, Lubbock's city manager, told KCBD in November. "I can absolutely assure you that in my career I never thought we'd send field hospitals to Lubbock, Texas."

Medics wait outside an apartment to rush a woman with possible Covid-19 symptoms to hospital in Austin, Texas on August 7, 2020.

John Moore / Getty Images

According to McQuillen, both El Paso and Lubbock were "much less strict with their populations (which dictates simple things like wearing masks and social distancing)". He compared this to Massachusetts and other northeastern states, where rigorous measures during the spring rise made a big difference in reversing the steep rise in cases and hospitalizations. But too many states have ignored this critical lesson and are now paying the price.

Daily deaths are creeping back in but are still well below the previous high

As daily hospital stays in Covid-19 increase, another key metric, daily deaths, hit 2,733 on December 2, its highest level since April during the first surge, according to the Covid Tracking Project. It's a ominous sign that deaths will hit dire new levels in the weeks and months to come as cases and hospitalizations now hit new highs.

Experts say fewer people being hospitalized will die during this winter stage of the pandemic compared to spring. As Julia Belluz of Vox reported, mortality in the US and Europe has improved significantly in recent months as doctors' understanding of Covid-19 and its treatment has improved:

Well there is strong evidence of this Steroids like dexamethasone can reduce the risk of mortality in critically ill inpatients. Putt Patients rest on their stomach instead of their back (a practice known as proning) also seems to help.

While there is still much progress to be made, the approach to treatment has standardized over time Jen Manne-Goehler, an infectious disease doctor at Brigham and Women and Massachusetts General hospitals. When she started treating Covid-19 patients in the spring, the practice seemed to change every few days. Now it's leaner – and that undoubtedly helps with survival too.

That said, if hospitals in the hardest-hit states run out of beds and staff to treat the incoming flow of patients, more people who could have been saved may die. When the staff in the intensive care unit were overwhelmed in the spring, "intensive care patients just did not get the same attention," said intensive care doctor Lakshman Swamy, who works with the Cambridge Health Alliance, to Belluz.

Murtaza Akhter, the Arizona doctor, fears his emergency room will be completely overwhelmed around Christmas, about a month after Thanksgiving, when many people are expected to become infected after ignoring it or taking public health advice to avoid family gatherings. He says he is most concerned about the "borderline patients who might otherwise have been admitted to the emergency room – they may be more likely to go home now because there are no hospital beds." And of these people, a very pronounced fraction will have a worse outcome. "

This is a big reason why overwhelmed hospitals will lead to more deaths. "This Covid-19 surge is really having a huge downstream effect everywhere, not just for Covid patients but for everyone else, as it's not like magically stopping car accidents or stopping heart attacks, they're still there . " Those who come in and are discharged are more likely than many to get worse results. "

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