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Are they really overwhelming hospitals? This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are c

Are they really overwhelming hospitals? This keeps being repeated but most hospitals operate at about 80% capacity as-is. Places in Tennessee and Florida are currently, with COVID-19, operating at about 80%. [0] If we look at Israel, which has a very high vaccination rate, we see that they're supposedly running out of hospital space. [1] But the article linked doesn't say _anything about their actual numbers atm_ and points to a fiscal problem rather than a manpower problem. There was a recent Science Magazine article that states that 13% of the hospitalized-and-vaccinated group are under 60. That amounts to 39 people in a country of 9 million. [2] I've asked this before both here and elsewhere: If these vaccines aren't "good enough," what is? At what point does this become "zero COVID" in that "nobody can ever die from this disease again?" [0]: this may have changed -- things are changing quickly -- so I'd be curious if you have any recent (<1 week old) information on this. [1]: https://www.haaretz.com/israel-news/israel-s-public-hospitals-say-they-won-t-take-in-more-covid-patients-1.10141209 https://www.haaretz.com/israel-news/israel-s-public-hospital... [2]: https://www.sciencemag.org/news/2021/08/grim-warning-israel-vaccination-blunts-does-not-defeat-delta https://www.sciencemag.org/news/2021/08/grim-warning-israel-... -- and I took this from Louis Rossmann's video https://www.youtube.com/watch?v=mYtfT7HsJq0 https://www.youtube.com/watch?v=mYtfT7HsJq0

dragonwriter 5y ago
> Are they really overwhelming hospitals? Yes. > This keeps being repeated but most hospitals operate at about 80% capacity as-is. They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity. > Places in Tennessee and Florida are currently, with COVID-19, operating at about 80% In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0] [0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delta-hospitalizations.html https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...
- ekianjo 5y ago
  > there are significant areas over 95% ICU capacity It's not like there is any large ICU capacity anywhere anyway.
  - erhk 5y ago
    Those patients simply go somewhere else and cause more strain. We on hacker knews should known the pain of cascade failures more than other platforms.
- dham 5y ago
  Is every hospital getting overwhelmed though? I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I'm getting fake news?
  - bingohbangoh 5y ago
    I'll throw in a anecdote: my family in nearby hospitals are *not* being mandated to get vaccinated. This is precisely because there is high demand for registered nurses and other medical staff at the moment.
    - qwerty456127 5y ago
      > This is precisely because there is high demand Ok. At least somebody can exercise reason when necessary. By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.
      - bingohbangoh 5y ago
        > what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.
        qwerty456127 5y ago
        Not all Europe. Some countries governments are stubbornly against this and only accept a positive PCR test taken during the actual sickness.
      - SamBam 5y ago
- sumnuyungi 5y ago
  Do you have a non-paywall link to that article or a link to the actual data? The article should list sources.
  - xadhominemx 5y ago
    Have you tried Google?
- zeku 5y ago
  There are NO ICU beds in Tennessee. https://www.tennessean.com/story/news/health/2021/08/19/tennessee-icu-beds-full-most-hospitals-every-major-metro-area/8193199002/ https://www.tennessean.com/story/news/health/2021/08/19/tenn...
Calavar 5y ago
Total bed usage is a very poor metric for this. The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in. Source: I am a physician.
kxyvr 5y ago
Yes. Unquestionably. Here are a few different articles from around the gulf coast states that speak to this: https://www.khou.com/article/news/health/coronavirus/houston-record-covid-19-hospitalizations-44-icu-beds/285-6a81e5c4-cfda-415d-8d47-5998aba484e3 https://www.khou.com/article/news/health/coronavirus/houston... https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-icu-beds https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-... Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full? On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal. In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses. As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then. Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete. Some questions that may help with any personal investigation: 1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be. 2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.
mbesto 5y ago
Here ya go in Texas: https://www.texastribune.org/2021/08/10/coronavirus-texas-hospitals-icu-beds/ https://www.texastribune.org/2021/08/10/coronavirus-texas-ho... As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%. https://covid-texas.csullender.com/ https://covid-texas.csullender.com/ So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.
cogman10 5y ago
So, the anecdotal evidence would be to visit /r/medicine and /r/nursing on reddit. It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients. Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.
- bingohbangoh 5y ago
  I know many nurses and doctors who work at hospitals in and around the NYC tristate area -- they all say capacity is well under the normal rates for them. Note: last April (2020), they said it had exploded due to COVID-19.
  - cogman10 5y ago
    Yeah, the main difference appears to be states that have high vaccine participation and states that don't.
    - bingohbangoh 5y ago
      So what is there to say about Israel or Gibraltar? Both have very high hospitalization rates. Both also have very high vaccination rates.
      - cogman10 5y ago
        IDK, hard to say what's going on there. In the worst case, it may just been that the vaccine effectiveness wanes over time.
    - sreque 5y ago
      This is just your bias showing, nothing more. COVID has been shown to be seasonal and to hit different parts of the world at different times of the year. Southern states appear to get hardest hit in the summer, while the colder Northern states are harder-hit in the winter. Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.
KaiserPro 5y ago
India: yes. The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed. Belgium was overwhelmed. The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=nation&areaName=England https://coronavirus.data.gov.uk/details/healthcare?areaType=...] filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff. if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer. The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless
- qwerty456127 5y ago
  > you could go one more cycle of exponential growth, doubling every n weeks/days I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't. Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.
  - KaiserPro 5y ago
    > Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths. Correct! but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action. We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag. I really hope that you are correct about asymptomatic. but we can't be sure, yet.
zeku 5y ago
Here is the Tennessee reporting. NO ICU beds. https://www.tennessean.com/story/news/health/2021/08/19/tennessee-icu-beds-full-most-hospitals-every-major-metro-area/8193199002/ https://www.tennessean.com/story/news/health/2021/08/19/tenn...
starik36 5y ago
> At what point does this become "zero COVID" In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zealand-lockdown.html https://www.nytimes.com/2021/08/17/world/australia/new-zeala... It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.
- xadhominemx 5y ago
  Definitely not more disruptive in New Zealand over the entire course of the pandemic and also we have suffered 600,000 fatalities as a result of the virus.
  - dcolkitt 5y ago
    I'm virtually certain that the pandemic disrupted everyday life in NZ more than it did in Florida. Now more people died, but Florida demonstrates that even at the height of the pre-vaccine pandemic it's perfectly possible to live a lockdown free life post-Covid without society collapsing.
- DanielR31D 5y ago
  This is untrue. In New Zealand we locked down a reasonable amount for the information we have on the case. With the current lockdown, there was a single case with no known link to the border which had traveled around the country while infectious. Knowing just this and that every case in managed isolation (iirc) was is the Delta variant, we went into lockdown. Also, '5 lockdown' is misrepresentive. We can see on this page https://covid19.govt.nz/alert-levels-and-updates/history-of-the-covid-19-alert-system/ https://covid19.govt.nz/alert-levels-and-updates/history-of-... that while some lockdowns were very restrictive, country wide, and long (2.5 months), most were short and regional (with other regions maybe going to lvl 2 alert)
  - starik36 5y ago
    How is that untrue. There were three Alert Level 3 and two Alert Level 4 instances. > short and regional Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.
JamesSwift 5y ago
Anecdotal, but an acquaintance here in Florida had to wait over 14 hours to get an emergency appendectomy (and over 12 hours to get from check-in to a bed in the ER) recently, due to both COVID protocols as well as COVID workload.

dragonwriter 5y ago

> Are they really overwhelming hospitals? Yes. > This keeps being repeated but most hospitals operate at about 80% capacity as-is. They aren't overwhelming total hospital capacity, they are overwhelming specialized resource capacity, particularly ICU capacity. > Places in Tennessee and Florida are currently, with COVID-19, operating at about 80% In Florida and numerous other states (not Tennessee), there are significant areas over 95% ICU capacity. [0] [0] https://www.nytimes.com/interactive/2021/08/17/us/covid-delta-hospitalizations.html https://www.nytimes.com/interactive/2021/08/17/us/covid-delt...

ekianjo 5y ago
> there are significant areas over 95% ICU capacity It's not like there is any large ICU capacity anywhere anyway.
- erhk 5y ago
  Those patients simply go somewhere else and cause more strain. We on hacker knews should known the pain of cascade failures more than other platforms.
dham 5y ago
Is every hospital getting overwhelmed though? I keep seeing reports of staff getting fired or quitting because of vaccine requirement. Maybe I'm getting fake news?
- bingohbangoh 5y ago
  I'll throw in a anecdote: my family in nearby hospitals are *not* being mandated to get vaccinated. This is precisely because there is high demand for registered nurses and other medical staff at the moment.
  - qwerty456127 5y ago
    > This is precisely because there is high demand Ok. At least somebody can exercise reason when necessary. By the way (I believe that's is nonsensical but I also believe I am probably wrong - I am far from an expert), what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? To me this indicates their immune systems are doing a great job and we should rather avoid teaching them (their perfectly competent immune systems) how they should do it. And I don't know about any evidence of vaccinated people being less contagious than those naturally immune.
    - bingohbangoh 5y ago
      > what's the point of force-vaccinating people who have obviously contacted the infection on many occasions and still are Okay? I don't know but, fwiw, Europe is considering prior infection proven by an antibody test as equivalent to being vaccinated.
      - qwerty456127 5y ago
        Not all Europe. Some countries governments are stubbornly against this and only accept a positive PCR test taken during the actual sickness.
    - SamBam 5y ago
sumnuyungi 5y ago
Do you have a non-paywall link to that article or a link to the actual data? The article should list sources.
- xadhominemx 5y ago
  Have you tried Google?
zeku 5y ago
There are NO ICU beds in Tennessee. https://www.tennessean.com/story/news/health/2021/08/19/tennessee-icu-beds-full-most-hospitals-every-major-metro-area/8193199002/ https://www.tennessean.com/story/news/health/2021/08/19/tenn...

Calavar 5y ago

Total bed usage is a very poor metric for this. The bottlenecks here aren't total capacity, they are (in order of importance) 1. the number of vents, 2. the number of nurses with ICU level training, and 3. the number of ICU beds. The total number of hospital beds doesn't even factor in. Source: I am a physician.

kxyvr 5y ago

Yes. Unquestionably. Here are a few different articles from around the gulf coast states that speak to this: https://www.khou.com/article/news/health/coronavirus/houston-record-covid-19-hospitalizations-44-icu-beds/285-6a81e5c4-cfda-415d-8d47-5998aba484e3 https://www.khou.com/article/news/health/coronavirus/houston... https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-icu-beds https://www.npr.org/2021/08/19/1029260134/alabama-hospitals-... Something that may be a little confusing as well is what does "full" mean. Both morally and legally, it is very difficult for a hospital to turn someone away. Rather than turn someone away, the hospital will have new people wait, attempt to make more room, and provide less care to more people. This leads to the question: Is a hospital full if they're stashing patients in hallways and providing hallway care? Within an ICU, typical care is either one nurse to two patients or one to one depending on the reason for the ICU stay. At the moment, the ratios are 3-4 to 1, which is not the standard of care, but the best they can do. Does this count as a hospital being full? On a more personal note, my wife is an ICU physician. At the moment, I'm writing this from a hotel room because I started traveling with her to help alleviate the stress from her work. On this trip, she will do seven days of twelve hour shifts in a row. The hospital has asked us to stay for longer, but we're exhausted and have work elsewhere. This sort of thing does not happen during flu season, so I will assert strongly that we are still not close to the realm of normal. In a direct answer to your manpower question, this hospital does not have enough staff. They don't have enough physicians and they don't have enough nurses. Recently, this particular hospital acquired multiple new ECMO units, which do absolutely help with care. They can't use them. They don't have the nurses. As one more anecdote, a friend of my wife who is also an ICU physician called the other day with a story from her unit. She just admitted a patient who spent six days waiting in the ER with COVID. They had no available, staffed beds until then. Now, to be sure, I am just another voice on the internet. You can choose to believe me or not and that's fine. I will say that getting news from what actually occurs in the hospital is difficult. Reporters are people too and they're not necessarily trained to understand the nuance of hospital reality. That doesn't mean what they report isn't useful, but it may be frustratingly incomplete. Some questions that may help with any personal investigation: 1. What are the number of staffed bed available in the hospital? Beds are different than staffed beds, but they are sometimes used synonymously. Right now, with the lack of staff, it may not be. 2. Are the ICUs in the Level 1, 2, or 3 trauma centers full? Trauma center designation gives information about the number and type of staff that a hospital is required to keep available 24-hours a day. Generally speaking, the large trauma centers have better staff and better equipment. Even if there is an ICU bed available in a regional medical center, it doesn't mean it can provide the care required. Simply, they may not have the equipment or specialists required for care. As long as the large hospitals in the cities are full then transfer is not possible and overall medical care in that region is reduced.

mbesto 5y ago

Here ya go in Texas: https://www.texastribune.org/2021/08/10/coronavirus-texas-hospitals-icu-beds/ https://www.texastribune.org/2021/08/10/coronavirus-texas-ho... As the pandemic started, ~70% of ICU bed use was normal, since then its been around 80~90% and now approaching 100%. https://covid-texas.csullender.com/ https://covid-texas.csullender.com/ So yes it is overwhelming hospitals. Even if you're vaccinated, this should scare you.

cogman10 5y ago

So, the anecdotal evidence would be to visit /r/medicine and /r/nursing on reddit. It may not be universal, but it certainly appears to be the case that many hospitals are being pushed over the limit due to covid patients. Part of the issue, though, appears to be the fact that hospital admins are unwilling to raise salaries on essential employees like nurses.

bingohbangoh 5y ago
I know many nurses and doctors who work at hospitals in and around the NYC tristate area -- they all say capacity is well under the normal rates for them. Note: last April (2020), they said it had exploded due to COVID-19.
- cogman10 5y ago
  Yeah, the main difference appears to be states that have high vaccine participation and states that don't.
  - bingohbangoh 5y ago
    So what is there to say about Israel or Gibraltar? Both have very high hospitalization rates. Both also have very high vaccination rates.
    - cogman10 5y ago
      IDK, hard to say what's going on there. In the worst case, it may just been that the vaccine effectiveness wanes over time.
  - sreque 5y ago
    This is just your bias showing, nothing more. COVID has been shown to be seasonal and to hit different parts of the world at different times of the year. Southern states appear to get hardest hit in the summer, while the colder Northern states are harder-hit in the winter. Florida has the second-oldest population in the U.S., but it's death rate per 100,000 is average among the states. NYC and NJ are two states with the highest death rate per 100,000.

KaiserPro 5y ago

India: yes. The UK: in local areas, patients had to be diverted sometimes hundreds of miles to a hospital with space. all non emergency hospital care was stopped, and some emergency routine care was delayed. Belgium was overwhelmed. The issue is this, we can't just not admit the over 60s. even if we did, that would only free up 50% capacity (ie you could go one more cycle of exponential growth, doubling every n weeks/days)[source https://coronavirus.data.gov.uk/details/healthcare?areaType=nation&areaName=England https://coronavirus.data.gov.uk/details/healthcare?areaType=...] filling hospitals means that the resources used to treat both sudden hospitalizations and long term are diverted. so car accident/drinking/heavy sports/DIY injuries have worse outcomes, and cancer outcomes drop off a cliff. if the UK manages to keep the total number of patients in hospital with covid to less than 7-10k that would be a brilliant outcome for winter. we are currently at ~6k, and its still summer. The issue is there are not enough trained doctors and nurses. They take at least 8 years to train. that's the main constraint. Suitable beds can be made up in a number of weeks (see china and the "nightinggale hospitals") but if there is no staff, they are pointless

qwerty456127 5y ago
> you could go one more cycle of exponential growth, doubling every n weeks/days I'm not sure a big percent- of people is prone to hard covid. I tend to believe the majority of people has already went through it asymptomatically/easily and so will the majority of those who still hasn't. Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths.
- KaiserPro 5y ago
  > Exponential growth in positive tests doesn't imply infinite (limited only by the size of the population itself) exponential growth of severe cases or deaths. Correct! but when in the growth phase we can't know when it will stop. We have a fixed[1] upper bound on the number of people we can deal with at one go. so when we see we are getting close, we have to take drastic action. We know that testing in the uk is a proxy for actual infection, it tends to favour symptomatic as its "self selecting". The ONS survey is more accurate but has a significant lag. I really hope that you are correct about asymptomatic. but we can't be sure, yet.

zeku 5y ago

Here is the Tennessee reporting. NO ICU beds. https://www.tennessean.com/story/news/health/2021/08/19/tennessee-icu-beds-full-most-hospitals-every-major-metro-area/8193199002/ https://www.tennessean.com/story/news/health/2021/08/19/tenn...

starik36 5y ago

> At what point does this become "zero COVID" In New Zealand, it already has. Every time there is a single case or two, the entire locale (Auckland in this case) fully locks down. This is the 5th time it locked down. https://www.nytimes.com/2021/08/17/world/australia/new-zealand-lockdown.html https://www.nytimes.com/2021/08/17/world/australia/new-zeala... It's ironic that Covid has been arguably more disruptive in NZ than in US, which has a ton of cases.

xadhominemx 5y ago
Definitely not more disruptive in New Zealand over the entire course of the pandemic and also we have suffered 600,000 fatalities as a result of the virus.
- dcolkitt 5y ago
  I'm virtually certain that the pandemic disrupted everyday life in NZ more than it did in Florida. Now more people died, but Florida demonstrates that even at the height of the pre-vaccine pandemic it's perfectly possible to live a lockdown free life post-Covid without society collapsing.
DanielR31D 5y ago
This is untrue. In New Zealand we locked down a reasonable amount for the information we have on the case. With the current lockdown, there was a single case with no known link to the border which had traveled around the country while infectious. Knowing just this and that every case in managed isolation (iirc) was is the Delta variant, we went into lockdown. Also, '5 lockdown' is misrepresentive. We can see on this page https://covid19.govt.nz/alert-levels-and-updates/history-of-the-covid-19-alert-system/ https://covid19.govt.nz/alert-levels-and-updates/history-of-... that while some lockdowns were very restrictive, country wide, and long (2.5 months), most were short and regional (with other regions maybe going to lvl 2 alert)
- starik36 5y ago
  How is that untrue. There were three Alert Level 3 and two Alert Level 4 instances. > short and regional Downplay it all you want. Auckland is a pretty big place. Alert Level 4 means that 1/3 of New Zealand population is locked down.

JamesSwift 5y ago

Anecdotal, but an acquaintance here in Florida had to wait over 14 hours to get an emergency appendectomy (and over 12 hours to get from check-in to a bed in the ER) recently, due to both COVID protocols as well as COVID workload.