Hospitals Know What’s Coming
To hear such talk from someone at UNMC, the best-prepared of America’s hospitals, should shake the entire nation. In mid-March, when just 18 Nebraskans had tested positive for COVID-19, Shelly Schwedhelm, the head of the hospital’s emergency-preparedness program, sounded gently confident. Or, at least, she told me: “I’m confident in having a plan.” She hoped the hospital wouldn’t hit capacity, “because people will have done the right thing by staying home,” she said. And people did: For a while, the U.S. flattened the curve.
But now about 2,400 Nebraskans are testing positive for COVID-19 every day—a rate five times higher than in the spring. More than 20 percent of tests are coming back positive, and up to 70 percent in some rural counties—signs that many infections aren’t being detected. The number of people who’ve been hospitalized with the disease has tripled in just six weeks. UNMC is fuller with COVID-19 patients—and patients, full stop—than it has ever been. “We’re watching a system breaking in front of us and we’re helpless to stop it,” says Kelly Cawcutt, an infectious-disease and critical-care physician.
Cawcutt knows what’s coming. Throughout the pandemic, hospitalizations have lagged behind cases by about 12 days. Over the past 12 days, the total number of confirmed cases in Nebraska has risen from 82,400 to 109,280. That rise represents a wave of patients that will slam into already beleaguered hospitals between now and Thanksgiving. “I don’t see how we avoid becoming overwhelmed,” says Dan Johnson, a critical-care doctor. People need to know that “the assumption we will always have a hospital bed for them is a false one.”
What makes this “nightmare” worse, he adds, “is that it was preventable.” The coronavirus is not unstoppable, as some have suggested and as New Zealand, Iceland, Australia, and Hong Kong have resoundingly disproved—twice. Instead, the Trump administration never mounted a serious effort to stop it. Whether through gross incompetence or deliberate strategy, the president and his advisers left the virus to run amok, allowed Americans to get sick, and punted the consequences to the health-care system. And they did so repeatedly, even after the ordeal of the spring, after the playbook for controlling the virus became clear, and despite months of warnings about a fall surge.
Not even the best-prepared hospital can compensate for an unchecked pandemic. UNMC’s preparations didn’t fail so much as the U.S. created a situation in which hospitals could not possibly succeed. “We can prepare over and over for a wave of patients,” says Cawcutt, “but we can’t prepare for a tsunami.”
A full hospital means that everyone waits. COVID-19 patients who are going downhill must wait to enter a packed intensive-care unit. Patients who cannot breathe must wait for the many minutes it takes for a nurse elsewhere in the hospital to remove cumbersome protective gear, run over, and don the gear again. On Tuesday, one rapidly deteriorating patient needed to be intubated, but the assembled doctors had to wait, because the anesthesiologists were all busy intubating four other patients in an ICU and a few more in an emergency room.