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As Covid-19 cases spike all over the country, many healthcare systems are in desperate straits. States that proudly saw thousands of their nurses fly out this spring to “frontline” hotspots like New York City, Seattle, New Orleans, and Boston are now starved for resources themselves. With the latest stage of the pandemic coursing through 48 states, the frontlines are often in smaller cities and rural states that tend to lack the amenities common at metropolitian hospitals. Local and state health care systems are struggling to treat patients amid dire shortages of staff, beds, and equipment.

Under the strain of the present surge, healthcare systems are assigning non-Covid patients to beds in convention centers, hospitals are canceling elective surgeries, ICU nurses are working 60-hour weeks, and nurses who sped to New York in April are now working overtime to treat Covid patients in their hometowns. Areas that are especially overwhelmed, such as El Paso, store their dead in mobile cooling units staffed by jail inmates, and airlift non-Covid patients to hospitals in cities that for the present have escaped the new surge. In addition to seeking aid from National Guard medics, the American Hospital Association’s vice president of quality and patient safety, Nancy Fosterome, told Stat News that some hospitals are even turning to local dentists, Red Cross volunteers, and people with basic health experience to help with tasks that require less training.

In North Dakota, the weight of the Covid caseload—currently the worst in the country and, per capita, one of the worst in the world—has effectively broken the state’s contact tracing system. Kailee Lingang, a University of North Dakota nursing student now helping with contact tracing in the state, told the Washington Post that “Test and trace went by the wayside. Even if we had enough staff to call up everyone’s workplace and contact, there are so many new infections that it wouldn’t be as effective. At this point, the government has given up on following the virus’s path through the state. All we can do is notify people, as quickly as we can, that they have the virus.”

In Indiana, the state and local healthcare systems are sputtering in the wake of a 60% increase in hospitalizations. One doctor in the state, Timothy Mullinder, told MedPage Today that patients “who need to go to the ICU have been stuck in the ER for 24 hours because there are no beds available. Post-operative patients are stuck in the PACU recovery area well over 24 hours because there are no beds available.”

With the entire state out of staffed hospital beds, Iowa’s healthcare system is also overwhelmed. Whitney Neville, an Iowa nurse, told the Atlantic on November 13, “Last Monday we had 25 patients waiting in the emergency department. They had been admitted but there was no one to take care of them.” The strain on the system, combined with the state’s relaxed social distancing policies, prompted one infectious disease doctor to speak in near-apocalyptic tones: “The wave hasn’t even crashed down on us yet. It keeps rising and rising, and we’re all running on fear. The health-care system in Iowa is going to collapse, no question.” The problem, however, extends well beyond North Dakota, Texas, and Iowa. A November 17 Atlantic article found that 22% of all US hospitals are facing staffing shortages, and added, “More than 35 percent of hospitals in Arkansas, Missouri, North Dakota, New Mexico, Oklahoma, South Carolina, Virginia, and Wisconsin are anticipating a staffing shortage this week.”

At the center of the system, nurses and other healthcare workers are working as many shifts as they can, while doing their best to attend to waves of incoming patients. The latest surge, however, has driven a growing number of nurses to express their frustration with incoherent policies and public intransigence on the matter of masking, social distancing, and incredulity over the very existence of the virus. Michelle Cavanaugh, a nurse at the Nebraska Medicine Medical Center, spoke for many when she told a Utah reporter, “We’re seeing the worst of the worst and these patients are dying, and you go home at the end of the night and you drive by bars and you drive by restaurants and they’re packed full and people aren’t wearing masks. I wish that I could get people to see COVID through my eyes.”

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Koren Thomas
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