2 in 5 Americans live where COVID-19 strains
By Carla K. Johnson and Nicky Forster
The Associated Press
January 31, 2021
Straining to handle record numbers of COVID-19 patients,
hundreds of the nationís intensive care units (ICUs) are running
out of space and supplies and competing to hire temporary
travelling nurses at soaring rates. Many of the facilities are
clustered in the South and West.
An Associated Press analysis of federal hospital data shows
that since November, the share of U.S. hospitals nearing the
breaking point has doubled. More than 40% of Americans now live
in areas running out of ICU space, with only 15% of beds still
Intensive care units are the final defense for the sickest of
the sick, patients who are nearly suffocating or facing organ
failure. Nurses who work in the most stressed ICUs, changing IV
bags and monitoring patients on breathing machines, are
"You canít push great people forever. Right? I mean, it just
isnít possible," said Houston Methodist CEO Dr. Marc Boom, who
is among many hospital leaders hoping that the numbers of
critically ill COVID-19 patients have begun to plateau.
According to data through Thursday from the COVID Tracking
Project, hospitalizations are still high in the West and the
South, with over 80,000 current COVID-19 hospital patients in
those regions. The number of cases reported in the U.S. since
the pandemicís start surpassed 25 million on January 24,
according to Johns Hopkins University.
Encouragingly, hospitalizations appear to have either
plateaued or are trending downward across all regions. Itís
unclear whether the easing will continue with more contagious
versions of the virus arising and snags in the rollout of
In New Mexico, one surging hospital system brought in 300
temporary nurses from outside the state, at a cost of millions
of dollars, to deal with overflowing ICU patients, who were
treated in converted procedure rooms and surgery suites.
"Itís been horrid," said Dr. Jason Mitchell, chief medical
officer for Presbyterian Healthcare Services in Albuquerque.
Heís comforted that the hospital never activated its plan for
rationing lifesaving care, which would have required a triage
team to rank patients with numerical scores based on who was
least likely to survive.
"Itís a relief that we never had to actually do it," Mitchell
said. "It sounds scary because it is scary."
In Los Angeles, Cedars-Sinai Medical Center ran into
shortages of take-home oxygen tanks, which meant some patients
who could otherwise go home were kept longer, taking up needed
beds. But the biggest problem is competing with other hospitals
for travelling nurses.
"Initially, when the COVID surges were hitting one part of
the country at a time, travelling nurses were able to go to
areas more severely affected. Now with almost the entire country
surging at the same time," hospitals are paying twice and three
times what they would normally pay for temporary, traveling
nurses, said Dr. Jeff Smith, the hospitalís chief operating
Houston Methodist Hospital recently paid $8,000 retention
bonuses to keep staff nurses from signing up with agencies that
would send them to other hot spots. Pay for travelling nurses
can reach $6,000 per week, an enticement that can benefit a
nurse but can seem like poaching to the hospital executives who
watch nurses leave.
"Thereís a lot of these agencies that are out there charging
absolutely ridiculous sums of money to get ICU nurses in," Boom
said. "They go to California, which is in the midst of a surge,
but they poach some ICU nurses there, send them to Texas, where
they charge inordinate amounts to fill in gaps in Texas, many of
which are created because nurses in Texas went to Florida or
back to California."
Space is another problem. Augusta University Medical Center
in Augusta, Georgia, is treating adult ICU patients, under age
30, in the childrenís hospital. Recovery rooms now have ICU
patients, and, if things get worse, other areas -- operating
rooms and endoscopy centers -- will be the next areas converted
for critical care.
To prevent rural hospitals from sending more patients to
Augusta, the hospital is using telemedicine to help manage those
patients for as long as possible in their local hospitals.
"It is a model I believe will not only survive the pandemic
but will flourish post pandemic," said Dr. Phillip Coule, the
Augusta hospitalís chief medical officer.
Hospitals are pleading with their communities to wear masks
and limit gatherings.
"There just hasnít been a lot of respect for the illness,
which is disappointing," said Dr. William Smith, chief medical
officer for Cullman Regional Medical Center in Cullman, Alabama.
He sees that changing now with more people personally knowing
someone who has died.
"It has taken a lot of people," he said of the virus, adding
that the death toll -- 144 people in the span of six months in a
county of 84,000 -- "has opened their eyes to the randomness of
The Alabama hospitalís ICU has been overflowing for six
weeks, with 16 virus patients on ventilators in a hospital that
a year ago had only 10 of the breathing machines. "You can see
the stress in peopleís faces and in their body language. Itís
just a lot for people to carry around," Smith said.
"Just the fatigue of our staff can affect quality of care.
Iíve been encouraged weíve been able to keep the quality of care
high," Smith said. "You feel like you are in a very precarious
situation where errors could occur, but thankfully weíve managed
to stay on top of things."
Hospitals say they are upholding high standards for patient
care, but experts say surges compromise many normal medical
practices. Overwhelmed hospitals might be forced to mobilize
makeshift ICUs and staff them with personnel without any
experience in critical care. They might run out of sedatives,
antibiotics, IVs, or other supplies they rely on to keep
patients calm and comfortable while on ventilators.
"Itís really daunting and mentally taxing. Youíre doing what
you believe to be best practice," said Kiersten Henry, a nurse
at MedStar Montgomery Medical Center in Olney, Maryland, and a
board director for the American Association of Critical-Care
Nurses. In Oklahoma City, OU Medicine chief medical officer Dr.
Cameron Mantor said while the vaccines hold promise, hope still
seems dim as ICU cases continue to mount.
"What is stressing everybody out," Mantor said, "is looking
at week after week after week, the spigot is not being turned
off, not knowing there is a break, not seeing the proverbial
light at the end of the tunnel."
Associated Press writers Marion Renault in Rochester,
Minnesota, Nomaan Merchant in Houston, and Ken Miller in
Oklahoma City contributed.
The Associated Press Health and Science Department receives
support from the Howard Hughes Medical Instituteís Department of
Science Education. The AP is solely responsible for all content.