The impact of the COVID-19 pandemic on hospitals became severe for some hospital systems of the United States in the spring of 2020, a few months after the COVID-19 pandemic began. Some had started to run out of beds, along with having shortages of nurses and doctors. By November 2020, with 13 million cases so far, hospitals throughout the country had been overwhelmed with record numbers of COVID-19 patients. Nursing students had to fill in on an emergency basis, and field hospitals were set up to handle the overflow.
At the beginning of 2021, cases had reached a peak, forcing some hospitals to periodically close their doors because they were overwhelmed with COVID-19 patients. In some places, as hospital space filled up, ambulances often waited hours to deliver patients. In addition, patients already admitted might get discharged earlier than usual to make room for others more severely ill. By early September, at least seven states had called in their National Guard to help overworked hospitals, including Oregon, Idaho, Montana, Kentucky, Tennessee, Georgia, and South Carolina.
The summer of 2021 saw another surge due to the new Delta variant of the virus. As a result, health care in U.S. hospitals was severely affected and led to crisis standards of care. Many hospitals were thereby unable to offer adequate medical care as a result of tight resources. For example, one hospital system in Oregon had to cancel or delay hundreds of surgeries as of mid-August. Hospitals also began seeing younger patients. And some experts found that the Delta variant was often more severe among younger age groups, whose vaccination rates were lower.
States like California saw over ten times more cases than they had just a few months earlier. By mid-August 2021, nearly all states experienced double-digit growth in COVID-19 hospitalizations. Some, like Washington, had a 34% increase of patients over a single week in September. At various medical centers, ICUs had reached capacity, forcing doctors to postpone routine surgeries. In addition, countless hospitals were also short of beds and nurses, making care and response times a lot slower. It meant that patients might wait in the ER for many hours. While some hospitals with no more capacity had to find alternate medical facilities in other states, often hundreds of miles away.
Emergency medical services in the United States also experienced a significant labor shortage, lengthening the time it took some patients to be transported to a hospital.
Timeline 2020 In the spring of 2020, the pandemic was concentrated in large cities like New York City. Six months later, despite months of planning, many of the nation's hospital systems had begun to run out of beds for patients, along with having shortages of nurses and doctors. Some hospitals had to turn away transfer requests from other hospitals for patients needing urgent care or incoming emergencies. By November 2020, with 13 million cases in total that year, hospitals throughout the country had been overwhelmed with record numbers of COVID-19 patients."Covid Overload: U.S. Hospitals Are Running Out of Beds for Patients", New York Times, November 27, 2021 Hospitals faced a crisis-level shortage of beds and staff to provide adequate care for patients.
States such as Iowa had no more available beds, considering their situation at crisis level. Nurses were working overtime and were feeling the strain of the constant flow of patients. And some patients needing special medical attention, were unable to be sent to another hospital that was full. Nursing students were asked to fill in on an emergency basis, as hospitals were willing to accept travel nurses. However, because they were in high demand across many states, they were expensive to hire.
The sudden rise in cases in parts of New York City led to the re-opening of a field hospital that was originally set up in April 2020 and was no longer needed by June."New York City to open field hospital for first time since spring as Covid-19 cases spike", NBC News, November 23, 2020 A 1,000-bed Navy hospital ship docked in New York Harbor in April as a backup facility and another one in Los Angeles."The 1,000-Bed Comfort Was Supposed to Aid New York. It Has 20 Patients", New York Times, April 2, 2020 The head of New York's largest hospital system appreciated the opening up of such field hospitals, stating that "we're in a crisis here, we're in a battlefield."
January–June 2021 At the beginning of 2021, hospitals in Los Angeles County had to declare an "internal disaster" and close their doors at times because they were overwhelmed."California Hospital Maxes Out in COVID-19 Crisis" , Firefighter Nation, January 6, 2021 As a result, ambulances needed to conserve oxygen, and to first resuscitate certain patients, such as those with cardiac arrest. As hospital space filled up, ambulances often waited hours to deliver patients, with tents sometimes used where doctors can assess the patient while waiting for space inside. Some patients who would typically stay in a hospital longer were being discharged early to make room for more severely ill patients. In other cases, patients were being treated in hallways, chapels or wherever there was room."Why activating 'crisis standards of care' is crucial for overwhelmed hospitals", The Conversation, January 6, 2021
In addition, states and counties around the country had become overwhelmed by rising case numbers. Experts began to warn that hospitals likely had not yet seen the worst of the COVID-19 surges. They might need to declare "crisis standards of care" due to a more contagious strain of the virus that began circulating."Covid-19 Crisis Forces California Hospitals to Plan Who Gets Life-Saving Care", Wall Street Journal, January 8, 2021 Shortly after Thanksgiving, a medical research team issued a warning memo to the Arizona Department of Health Services. They stated that failing to issue a shelter-in-place order to stave off a crisis in hospitals "risks a catastrophe on a scale of the worst natural disaster the state has ever experienced.""Los Angeles is running out of oxygen for patients as covid hospitalizations hit record highs nationwide", Washington Post, January 5, 2021 The crisis the researchers had warned of came true, with only 7 percent of the state's ICU beds available at the beginning of the year.
There was also a growing urgency to speed up vaccination programs by January, a year into the pandemic. Most of the world was struggling to contain the virus with social-distancing measures alone. The high infection rates, pressure on hospitals, public weariness with restrictions, and potential economic damage, prompted many governments to hasten their vaccination plans."Nations Push to Get Covid-19 Vaccine Out Faster in Race Against Virus", Wall Street Journal, January 8, 2021
July–September 2021 The delta variant in mid-August accounted for nearly 100 percent of all new COVID-19 cases."The delta variant is putting America's hospitals back in crisis mode", Washington Post, August 18, 2021 Unlike the winter surge, hospitals were already strained because emergency room volumes were back to pre-pandemic levels, and patients were catching up on care they put off. Hospitals had reached a crisis point as they strained to give more people routine care while COVID-19 hospitalizations driven by the Delta variant were surging.
For the week ending August 15, the country reported 911,529 new infections, with an average of more than 130,000 cases a day. The last time the weekly infection count was that high was the week ending January 31, 2021. According to the chief epidemiologist at Mount Sinai South Nassau on Long Island, with rare exceptions, in the vast majority of cases, people who get severely sick have been unvaccinated. He said he was "very concerned about the next few months." He added, "Nothing that I thought was going to happen happened. Delta is much more serious and contagious than I thought it would be...It's extremely rare to see somebody vaccinated struggling to stay alive."
In late August, Texas hospitals were suddenly overwhelmed with an average of more than 1,700 emergency patients each day. "All of a sudden, it's an exponential rise again in the middle of the summer," stated the general medicine physician at the University of Texas Medical Hospital in Dallas."COVID patients overwhelm Texas hospitals, amid 'hair on fire' crisis", ABC News, August 27, 2021
Staffing was also more of a problem in Texas during the summer than at the peak of the pandemic the previous winter. Denton County Public Health Director Matt Richardson was worried about the survival of the entire hospital system."Denton County hospitals in worst crisis since pandemic peak", Denton Record-Chronicle, August 24, 2021
They also began seeing younger patients. According to a professor of Critical Care, "Half the COVID-19 patients right now are younger than I am... The average age of our patient is very, very young. We're not used to taking care of that population -- emotionally, physically." New Mexico was also "close to the point of being overwhelmed" in August."Lea hospitals near COVID crisis point", Hobbs News-Sun, August 19, 2021
In early September, hospitals in California continued to see the effects of the summer surge. The crisis affected their capacity to handle critically ill patients in need of treatment in intensive-care units. Many counties throughout the state were seeing more than 10 times the number of cases than they had two months earlier. The entire San Joaquin Valley, which has 312 ICU beds, saw its available beds fall to less than 5% of the total. As a result, hospitals needed to transfer patients to other parts of the state."Fresno hospitals remain in COVID crisis mode, as ICU beds dwindle over Labor Day weekend", The Fresno Bee, September 8, 2021
The surge has also caused hospitals to discharge some patients earlier than normal, while others were forced to deny care due to lack of capacity. The Delta variant changed the dynamic in the U.S., as few hospitals expected another surge in the summer of 2021 after one the previous winter. According to one hospital official in Oregon, the situation during that August "doesn't really compare to what we saw during the previous fall and winter surge. It's pretty surreal."
By late August 2021, doctors in hard-hit regions were witnessing high stress levels at hospitals that affected patient care, much as it did in December and January 2021, when the U.S. peaked at more than 120,000 hospitalizations."Coronavirus in the U.S.: Latest Map and Case Count", New York Times, daily updates However, doctors and nurses had not expected to see a resurgence of hospitalizations after vaccines became widely available. Despite the summer resurgence, primarily due to the Delata variant, experts estimated that vaccines had nonetheless saved about 279,000 lives and prevented 1.25 million hospitalizations during the previous six months."U.S. vaccine rollout prevented up to 1.25M hospitalizations, 279K additional deaths, study finds", 'Fierce Healthcare, July 7, 2021