The latest COVID-19 variant, Omicron, is raising new fears—among policymakers, parents, educators, business owners and, well, just about everyone. And for good reason, as initial reports suggest that it is significantly more transmissible than prior variants. But for those of us engaged in clinical care and public health—we’re an emergency physician and trauma surgeon—there’s a different fear: with almost every part of our system already overtaxed, we are on the verge of a collapse that will leave us unable to provide even a basic standard of care. Even if Omicron ends up being mild, it could well be the straw that breaks our back.
Long before the pandemic started, American healthcare was stretched thin. This problem has only gotten worse over the past 20 months. Despite the federal support received by healthcare systems during the pandemic, healthcare facilities are facing catastrophic shortages of resources, ranging from basic medications, to operating room staff, to ability to find cooks for nursing homes. Each is vital to allow for the delivery of high-quality care to trauma patients, critically ill diabetics, or those with surgical emergencies, much less nursing home patients and those with behavioral health problems.
The reasons for the shortages are manifold.
The breakdown in our supply chain—the same factors slowing the shipping of microchips and holiday gifts—is part of it. The simple lack of funds is another cause, especially for smaller and rural healthcare systems. Early in the pandemic, we cancelled elective surgeries to make sure there were enough nurses, beds, masks, and ventilators to treat COVID-19 patients. That decision was critical to save lives, but most of healthcare depends on the revenue from surgeries to subsidize other aspects of care delivery and now budgets are strained even more with the escalating cost of contract temporary labor. We also spent more money than ever before on personal protective equipment. The Great Resignation—the dramatic drop-off of people in the workplace—is another.
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But in healthcare, staffing shortages are emblematic of much more. (And vaccine mandates are not the reason for shortages: in Rhode Island, for example, the two largest healthcare systems have retained more than 95% of staff after mandates were implemented, and other large systems retained even more.)
The reason is that nurses, technicians, doctors and other healthcare professionals have simply had enough. After 20 months of fighting this virus, handling overflowing patient loads, and dealing with angry and distrustful communities, they are leaving in waves. Although we are paying more for the scarce staff who remain, it still may not be enough to keep up safe staffing standards. Without healthcare workers, we have no care.
Right now, many hospitals are having to once again pause surgical cases and other elective procedures- not because of COVID-19, but because there is no longer adequate staff or beds. Even without a massive surge in patients with COVID-19, when we can’t transfer patients out of the hospital into a nursing home, the hospital beds stay full; when hospital bed are full, patients can’t be admitted from the emergency department; and when patients can’t be admitted, emergency departments’ waiting rooms and primary care offices fill up with untreated acute problems. Nurses and doctors are frustrated that they can’t provide timely care, and patients and families are angry at the waits. Everyone gets hurt, in the short term.
But these cancellations set off a chain reaction of debilitating systemic effects that will hurt for a long time to come. The people whose surgeries are being cancelled really need them—it’s not cosmetic surgery, but people suffering from conditions like gallbladder disease or people who need a colonoscopy. These folks are likely either to remain debilitated by whatever was leading to their need for a procedure, or continue to flood emergency departments with what could have been a preventable emergency. Further down the road, the continued cancellations will further hurt hospitals’ ability to pay for core functions, and may lead to the closure of units within hospitals or even whole hospitals.
For those of us on the front line, it feels like a game of Whac-A-Mole in which we are no longer able to react fast enough to the “moles” popping up.
And all of this, of course, is occurring when Omicron has barely hit our shores and we are just gathering the data to help us respond to what may be ahead.
The pandemic has already decimated communities, worsened long-standing health inequities, and demonstrated the importance of public health preparedness. We are watching firearm injury, opioid overdoses, and other public health emergencies increase dramatically. And our fractured health care system is facing huge stress as we lose the one remaining piece that has been the glue holding us together for so long—healthcare workers. Healthcare workers come day or night, weekdays or weekends, birthdays or holidays, sacrificing so much, including their own lives to help others during their most vulnerable moments. That’s our job, and we are proud to do it. At the same time, we cannot overstate the physical, emotional, and mental toll this pandemic has had on our colleagues is immensely important. If we really want to save lives, we must act now.
Yes, we must continue to push for vaccinations, masks, testing, and ventilation, to hold off another COVID surge. But in the meantime, let’s look around. Our hospitals have nothing left to give. If we are to avoid a descent into crisis standards of care, it’s time to shore up our hospitals and clinics.
We would encourage the government to help us invest in both increasing the healthcare workforce pipeline and supporting adequate pay for nurses, advanced practitioners, technicians, home healthcare aides, and all the other ancillary staff; bolster our remaining staff, in the short-term, through on-the-ground civil-military cooperation; consider the deployment of healthcare professionals within the U.S. Public Health Commissioned Corps to reinforce clinics, nursing homes, and other critical healthcare functions; and make real commitments, both monetary and otherwise, to supporting our public health preparedness and prevention systems, so we don’t end up in a worse place than we are right now. To truly support the mental health and well being of our frontline workers requires more than just COVID-19 precautions.
While no one wakes up expecting to be injured or sick, we can tell you that people do expect to be taken care of if they are. And we of course want to be there for you. But we need a little help, to make it happen.