Health officials are concerned that the increase in the number of Covid patients will add to the strain on hospitals, already strained by the effects of two other viral diseases, influenza and respiratory syncytial virus, widely known as RSV.
Nearly 20,000 Americans were hospitalized with influenza during Thanksgiving week, most this week in more than a decade and almost twice as many as in the previous week.
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Nancy Foster, of the American Hospital Association, said members are still primarily expressing concerns about RSV and flu, not Covid.
“We could be seeing a lot more Covid patients than RSV or flu in a week or two, but the real concern is we’re going to see a big influx of everyone who has the capacity of hospitals to care for those , really puts a strain on very sick patients,” said Foster, the association’s vice president for quality and patient safety policy.
Experts warn holiday gatherings are prime time for coronavirus spread as millions of Americans travel and gather. The increase in hospital admissions likely reflects a combination of patients who became infected before the Thanksgiving holiday rush and patients who were exposed during Thanksgiving week, health experts said.
Daily new Covid hospital admissions are now above 9,000 after hovering between 5,000 and 7,000 for most of the autumn.
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Winter is typically hectic for hospitals, particularly in cold-weather states where people are more likely to congregate indoors, giving respiratory viruses ample opportunity to spread.
In late 2020 and early 2021, before the widespread availability of coronavirus vaccines, Covid patients put an enormous strain on the country’s hospital wards, with deaths peaking at more than 3,000 a day. And last winter, the explosion of cases triggered by the Omicron variant of the coronavirus meant hospitals struggled to provide essential services as they suffered understaffing as the virus ripped apart their workforce.
This winter, most people in the United States have some level of immunity from vaccinations, previous infections, or both, which should reduce the severity of infections. And those who do get sick have a wider range of therapeutics to speed recovery and keep them out of the hospital.
“If we see a big spike, it’s going to start accelerating now, and it’s going to widen and probably peak in late December and early January,” said Columbia University epidemiologist Jeffrey Shaman. “The hope, of course, will be that it will be somewhat mild and enough refresher and prior exposure will keep a large proportion of people out of the hospital.”
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At Banner Health, Arizona’s largest healthcare system, Covid hospitalizations have doubled to nearly 600 patients in the past month. They make up less than 10 percent of all patients, compared to almost 40 percent in earlier stages of the pandemic. However, the relatively lower Covid caseload is offset by an early rise in influenza and RSV cases that exceeds the five-year average.
“What is already happening this winter and what we can continue to expect is that influenza and RSV will not reach unprecedentedly low levels,” said Marjorie Bessel, Banner’s chief clinical officer. “We’re going to have a high-volume winter like we’ve had before in the pandemic. How much volume arises from all of these gatherings is unknown.”
For hospitals already burdened by other viruses, the coronavirus is an added complication.
At the Norton Healthcare system in Louisville, coronavirus cases are stagnant, RSV is declining, and the flu is rising.
“Some winters are more challenging than others, and I think we’re in for a more challenging winter this year,” said Steven Hester, Norton’s senior vice president and chief clinical and strategy officer. “We will see Covid as part of our regular challenge.”
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RSV cases have hit Orange County Children’s Hospital in California, prompting the county to declare and extend an emergency. The hospital’s emergency department had a record inflow of 12,000 patients in November and had to temporarily divert patients to other medical centers. Now Children’s Hospital is also seeing an increase in Covid hospitalizations, although nowhere near the number of cases related to RSV. Some children arrive infected with multiple viruses.
“It forces us to be organized and thoughtful, and we need to innovate in space. We always have to look for supplies,” said Sandip Godambe, the system’s chief medical officer.
Although children’s hospitals and pediatric departments have faced the most stress due to other respiratory viruses, older patients account for most of the new Covid hospitalizations, according to Health Ministry data.
Experts say the trend highlights the importance of people aged 65 and over receiving updated booster shots tailored to the Omicron variant. Less than a third of this age cohort has received their most recent vaccination, according to the Centers for Disease Control and Prevention estimates.
“The main problem we’re addressing is immunity fading,” said Eric Topol, a professor of molecular medicine at the Scripps Research Institute. “We are under-vaccinated and under-inflated, especially in the elderly.”
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To ease the burden on hospitals, the California state epidemiologist said it’s important to increase uptake of booster shots among the elderly and to ensure medically vulnerable patients get antiviral treatments like Paxlovid soon after they test positive.
“Even if you have mild or moderate symptoms, if you’re over 50 or have any medical conditions, you can likely benefit from treatment for a few days so you don’t need to go to the hospital,” Erica Pan said.
Carmela Coyle, the president and chief executive officer of the California Hospital Association, said the public should still be concerned about hospitals’ ability to provide care even if there are fewer coronavirus patients this winter compared to earlier in the pandemic . A shortage of healthcare workers has left hospitals understaffed, and hospitals have struggled financially for nearly three years after the pandemic, she said.
“Covid for hospitals has been like a flood,” Coyle said. “And while the flood waters may have receded, if you look at the last two winters compared to where we are now, the damage is still there.”