'There's no place for them to go': ICU beds near capacity across US

In El Paso, Texas, hospitals reported that just 13 of 400 intensive care beds were not occupied last week. In Fargo, North Dakota, there were just three. In Albuquerque, New Mexico, there were zero.

More than a third of Americans live in areas where hospitals are running critically short of intensive care beds, federal data show, revealing a newly detailed picture of the nation’s hospital crisis during the deadliest week of the COVID-19 epidemic.

Hospitals serving more than 100 million Americans reported having fewer than 15% of intensive care beds still available as of last week, according to a Times analysis of data reported by hospitals and released by the Department of Health and Human Services.

Many areas are even worse off: One in 10 Americans — across a large swath of the Midwest, South and Southwest — lives in an area where intensive care beds are either completely full, or fewer than 5% of beds are available. At these levels, experts say maintaining existing standards of care for the sickest patients may be difficult or impossible.

“There’s only so much our frontline care can offer, particularly when you get to these really rural counties, which are being hit hard by the pandemic right now,” said Beth Blauer, director of the Centers for Civic Impact at Johns Hopkins University.

Sharp increases in COVID-19 patients can overwhelm smaller hospitals, she said. “This disease progresses very quickly and can get very ugly very fast. When you don’t have that capacity, that means people will die.”

The new data set, released Monday, marks the first time the federal government has published detailed geographic information on COVID-19 patients in hospitals, something public health officials have long said would be crucial to responding to the epidemic and understanding its impact.

Hospitalization figures collected by the COVID Tracking Project show that the number of people hospitalized with the virus nationwide has doubled since the beginning of November. But existing state-level figures have obscured vast differences within states, making it difficult to recognize local hot spots.

The new data shows that some areas — like Amarillo, Texas, Coral Gables, Florida, and Troy, Michigan — are seeing rates of serious illness from COVID-19 that approach the levels seen in New York City during the worst weeks of the spring.

Political leaders in many states are ramping up measures to try to slow the spread. Last week, California issued stay-at-home orders for regions where hospitals surpassed 85% intensive care occupancy. Gov. Michelle Lujan Grisham of New Mexico, where ICUs are full across the state, is expected to soon announce that hospitals can ration care based on who is most likely to survive.

Doctors and researchers said the shortages are already causing serious damage.

At two hospitals in rural Georgia, officials have expanded the numbers of critical care beds to a total of 30, but on most days lately, all of them are full. Administrators spend hours worrying about how best to juggle the numbers so that no patient is left without proper care.

“22 hours out of 24,” Deborah Matthews, the chief nursing officer for the Tanner Health System, said when asked how much time she is spending worrying about capacity issues. Although COVID-19 patients are by no means the only ones being treated in the hospitals, the added numbers from the virus have stressed the system.

“The worry is what are you going to do with the 31st ICU patient? What are you going to do with the next patient who needs to be on a ventilator?” she said. “You have contingency plans for all of that, but you are just constantly thinking about those things.”

Both hospitals, in Carrollton and Villa Rica, have been operating at more than 100% capacity, according to the new federal data set.

The hospitals serve relatively small communities where many of the medical staff know the patients, so they push themselves to provide the care needed, said Loy Howard, the president of Tanner Health System. “There is not a lot of wiggle room,” he said, “I have been doing this for 35 years and I have not seen this kind of wear and tear on the staff.”

In North Dakota, which for weeks this fall had the worst rate of infection per capita in the country, the number of unoccupied ICU beds across the whole state at times dipped into the single digits in early November. In the small city of Minot, the hospital, Trinity Health, devoted more than an entire floor of its six-floor hospital to coronavirus patients.

Other North Dakota hospitals would normally accept transfers to help ease the burden, but when Dr. Jeffrey Sather, chief of medical staff, called around for help, he found that everywhere else was also full.

Patients kept coming, piling up in his emergency room. “There’s no place for them to go,” he said at the time.

Survival rates from the disease have improved as doctors have learned which treatments work. But hospital shortages could reverse those gains, risking the possibility of increasing mortality rates once again as patients cannot receive the level of care they need.

Thomas Tsai, an assistant professor of health policy at Harvard University, said that when resources are critically constrained, health care workers already facing burnout are forced to make emotionally wrenching decisions about who receives care.

There is some evidence physicians are already limiting care, Tsai said. For the past several weeks, the rate at which COVID-19 patients are going to hospitals has started decreasing. “That suggests that there’s some rationing and stricter triage criteria about who gets admitted as hospitals remain full,” he said.

In California, where a shortage of hospital beds triggered a lockdown in much of the state by Monday, hospital workers are bracing for the next few months. More than 10,000 COVID-19 patients are now hospitalized in the state, more than 70% above levels of two weeks ago, and the effects of the Thanksgiving holiday may not have been fully felt yet.

At the University of California San Diego Medical Center, just nine intensive care beds were unoccupied Monday. The mood in the hospital was one of resignation, said Dr. Chris Longhurst, associate chief medical officer. For months, health workers have watched much of the public ignore their advice to take precautions and avoid the spread of the virus, he said.

“A lot of health care workers have been concerned about this, about the lack of compliance, and now we’re seeing it play out, and you just sort of feel resigned,” he said. “You’ve got to go to work every day and help the people who need hospital care, but we wish that it had stopped upstream.”

So far, policymakers have relied heavily on data on testing and cases to make policy decisions, including whether schools and businesses should remain open. But the new, detailed data on hospitals may lead to a rapid shift in what leaders consider as they make decisions, Blauer, of Johns Hopkins, said.

“If you’re living in a place where there’s no ICU bed for 100 miles, you have to be incredibly careful about the social interaction that you allow the community to take,” she said.