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Hospitals Face Strain as Respiratory ‘Tripledemic’ Wanes

Some facilities have taken recent measures that carry echoes of the early days of COVID-19.

While the threat of a “tripledemic” may be waning – a term used to describe the concurrent spread of COVID-19, flu and respiratory syncytial virus, known as RSV – resource strains have forced at least some hospitals to take recent measures reminiscent of those seen during severe surges of the coronavirus pandemic.

Weekly numbers of new COVID-19 cases remained above 400,000 throughout December 2022, well above the totals during the previous month, according to data collected by the Centers for Disease Control and Prevention. This most recent COVID uptick has been compounded by the highest levels of flu activity seen since the pandemic has been in full swing, requiring up to an estimated 600,000 Americans to be hospitalized from Oct. 1 through Jan. 14, according to the CDC.

Signs seem to indicate, however, that the tripledemic is cooling off. CDC data points to the combined weekly rate of hospitalizations for COVID-19, flu and RSV falling from a peak of 22.5 per 100,000 individuals in early Decemberto 6.4 per 100,000 as of Jan. 14.

Yet the collision of respiratory illnesses that has already taken place put additional strain on the nation’s already burdened hospitals, creating capacity-related concerns for facilities in a number of states. As of data updated Wednesday, about 78% of hospital inpatient beds across approximately 5,000 hospitals were in use, according to the U.S. Department of Health and Human Services. Three-quarters of intensive care unit beds were occupied.

Many hospitals have been facing capacity challenges with a diminished workforce, thinned out by an exodus of professionals leaving the field due to burnout and trauma tied to the pandemic. An estimated 333,942 health care providers said goodbye to the workforce in 2021, according to an October 2022 analysis by Definitive Healthcare, a commercial data intelligence firm. Now, many facilities are contending with staffing levels below what they were before the pandemic.

“It leaves many hospitals (caring for more) patients with fewer caregivers available,” says Akin Demehin, senior director of quality and patient safety policy for the American Hospital Association.

In an area including Oregon’s Multnomah County, which includes Portland, only 8% of adult ICU beds and 6% of adult non-ICU beds were open as of Jan. 18, according to data available from the Oregon Health Authority. Since late 2022, key Portland-area health systems have operated under crisis standards of care that can be enacted when patient volumes outstrip hospital capacity, along with other criteria. Area hospitals said they planned to work together to find patient beds. At the same time, the designation gives hospitals flexibility and helps pave the way for triaging patients based on the severity of their condition and the availability of critical care resources, if necessary.

“We recognize and have planned for the possibility that patients could overwhelm Oregon hospitals, forcing decisions about available resources for care. At this time, we are not making triage decisions, but we are entering crisis standards of care in order to optimize all resources, including bed capacity and staffing,” an early December release from the Portland-area health systems states.

As of Jan. 9, Erik Robinson, a spokesperson for Oregon Health & Science University – one of the participating health systems – told U.S. News in an email that OHSU adult and pediatric emergency departments and intensive care units were full, and that some patients were being cared for in designated overflow spaces that included beds in hallways and semi-private rooms.

Despite emergency aid from the state that allowed for additional clinical staff, Robinson says OHSU had postponed non-urgent surgeries and procedures to ensure the health system maintained enough capacity to accommodate patients with more immediate health needs.

“In the face of this unprecedented demand, we continue to meet the needs of our patients thanks to the commitment and dedication of frontline health care workers,” Robinson says.

In the Midwest, Milwaukee’s Ascension Columbia St. Mary's Hospital reportedly has employed a similar strategy. In a memo sent Jan. 9, hospital administrators told clinical staff to review scheduled surgeries through Feb. 10, and that those not deemed urgent should be delayed, per reports. The hospital has faced concerns about staffing shortages and patient safety; it was not clear what role respiratory viruses may have played in the recent decision.

“Ascension Columbia St. Mary’s Hospital Milwaukee has been prioritizing urgent and emergent surgical procedures and will continue to do so as needed,” Caryn Kaufman, director of communications for Ascension Wisconsin, tells U.S. News in an email. “Elective surgeries are continuing based on clinical urgency.”

While many U.S. hospitals have felt the strain of viral illnesses and staffing challenges, some stakeholders feel hospitals are better positioned to continue providing elective procedures than they were in the beginning of the pandemic – even if a sudden influx of virus patients were to hit.

“I don’t think we’ll ever be to a point that we were back in 2020 because we are much better prepared than we were back then,” says Dr. Rachael Lee, an infectious disease specialist with UAB Medicine, a health system in Birmingham, Alabama.

Lee says UAB Hospital has been admitting an average of one to two patients a day for flu-related illness. Since the beginning of the year, the hospital has seen a slight uptick in COVID-19 cases, which she suspects has been driven by contagious strains of the omicron variant.

“It’s a very delicate balance because we have to care for patients that are coming in with respiratory viruses but we also want to have a continuation of our standard care practices,” Lee says.

UAB uses analytics tools to predict the number of patients likely to be admitted on a given day, which helps anticipate how many elective procedures can be performed or will need to be rescheduled.

“If we had a completely new variant that nobody had any sort of an immune response to, hopefully we would see evidence of that before we would rollback (elective procedures),” Lee says. “But never say never – that’s what we’ve learned during this pandemic, right?”

Dr. Daniel Varga, chief physician executive at Hackensack Meridian Health in New Jersey, says despite experiencing a slight increase in COVID-19 cases since last fall, there had not been discussions about delaying elective procedures. As of Wednesday, the 4,692-bed system was caring for roughly 300 COVID-19 inpatients, down from roughly 400 as of Jan. 10, and just 30 inpatients with a primary diagnosis of influenza.

Varga says ongoing workforce shortages have been problematic for Hackensack. He says the health system had been making progress in addressing those issues in 2022 by ramping up recruitment at nursing schools, offering incentives like student loan forgiveness and deploying other tactics.

But Varga says many of those efforts take time. As each new surge in virus cases can cause as many as 200 staffers to be out sick at one time, the health system is often forced to adopt shorter-term solutions like hiring contract nurses to meet the immediate need.

“We were making progress toward it, but you get hit again with another surge and you’re right back in the same pickle,” Varga says.

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