In the US, we have seen some of the worst numbers for the Coronavirus, both by deaths and infections. Millions of infections, hundreds of thousands of deaths, and more than one hundred thousand concurrent hospitalizations all due to COVID infections. While many are concerned with the former two, and they are a serious cause or concern, the last statistic may actually be the most troubling. There are only so many hospital beds available for emergency use and COVID care, and the number of cases that occupy those beds makes for a greater concern for several reasons.
When the United States first made a point to say that the pandemic was a problem, the reaction was a lockdown. The government at various levels, for the most part, took the advice of healthcare professionals and limited the ways in which individuals could spread the virus if they were contagious. These lockdowns had, at the time, the goal of what many professionals called “flattening the curve,” and that concept was seldom explained in detail. The simple explanation that most professionals gave was that, if the healthcare system was going to remain functional, any cases that happened had to be limited and drawn out over a longer period of time so that healthcare providers could provide adequate treatment to the people who need it.
The more complicated, or perhaps depressing, truth behind the need for a flattened curve infection rate was what would happen to the US healthcare system if it failed. “Failure” as a term does not quite encompass the devastation that would entail. The failure of the healthcare system means that community healthcare centers, primarily hospitals and emergency care facilities, can no longer guarantee adequate care for any injured or ill individual; regardless of what help they need.
What does this have to do with concurrent COVID hospitalizations? Well, that’s actually straightforward. Concurrent hospitalizations are generally counted by staffed beds in use, that means a hospital bed with a nurse or doctor that can check up on the patient using it regularly; sometimes this also just means any bed in a hospital that can be used. One hundred thousand beds may not sound like a tall order, but most people don’t know the real numbers when it comes to hospitals and available space.
According to the American Hospital Association, there are only six thousand one hundred forty-six hospitals in the entire country. Almost a thousand less if you are only counting community hospitals. Across all of those hospitals, the AHA estimates that there are roughly nine hundred twenty-four thousand staffed beds. Looking at only community hospitals, that number drops to just below eight hundred thousand. That may sound like quite a lot of space, but not if you consider the uses those beds have.
A staffed bed at a community hospital requires that there be, for one thing, a bed, but also a certified healthcare professional to oversee it. And the number of trained medical professionals available to staff beds has decreased over the course of the pandemic due to administrative neglect, death, and depression. But, barring that as a problem many of the beds in a hospital are not for use in emergency departments or intensive care. For instance, the AHA estimates that there are just over one hundred thousand staffed ICU beds in the United States. However, those beds are split up between cardiac, neonatal, burn unit, surgical, and pediatric care (as well as other specialized units). A bed in the pediatric care wing of a hospital is likely staffed by a pediatric nurse, not a doctor or nurse trained to respond to emergency surgical needs or COVID treatment.
Adequate treatment for Coronavirus patients at hospitals has required many facilities to create or convert wings specifically for the treatment of the virus. This means drawing resources, including staffed beds, away from other wings. If the total number of staffed beds available for COVID treatment is only, say, sixty to seventy thousand, we have already hit the point of failure. And we have. Even with vaccines, COVID treatment currently takes a large amount of hospital resources, namely these limited staffed beds.
For a more comprehensive metric of the percentage of occupied beds and COVID we can look back to July of 2020. When the CDC was still receiving statistical information from hospitals, they calculated that of all staffed beds in the United States just over five hundred thousand were in use. That is just over half (62%–64%). Of those inpatient cases, sixty-four thousand were hospitalized for Coronavirus infection (between 8%–9% of all beds). On a national level, that sounds like there is plenty of wiggle room, but since then we have seen close to double those numbers for COVID inpatient hospitalization and on average more non-COVID inpatient care during flu season and the holidays. Many hospitals have operated over capacity, the staff available to help patients has been limited, and people who are in need of other emergency treatment haven’t gotten it.
Particularly in urban areas where COVID numbers are higher and hospitals treat more patients on average without COVID, the odds of being able to receive emergency medical treatment are significantly lower. Major concerns include heart attack, stroke, flu, automotive injury, and other bodily harm. With limited space and primary concern for those suffering from an infectious disease, some individuals who need other emergency medical treatment may not receive adequate care or may be forced to receive treatment at a facility farther away; which may incur heavy costs for emergency medical transportation via ambulance or helicopter.
In this situation, no one wins. And while it may be personally satisfying to say that this failure of the healthcare system could have been avoided, that accomplishes nothing. Even with a variety of vaccines available it has been incredibly difficult to lower the number of COVID cases, particularly in regions resistant to vaccination efforts. Over the past six months the number of patients that have died because there was not room for them in hospitals due to COVID crowding is discouraging. We encourage you to get vaccinated, because keeping yourself out of a hospital also means leaving space for someone whose treatment couldn’t have been prevented.
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