ER doctors say this COVID wave is forcing them to deny treatment to other patients, who are dying as a result: 'Every shift is like the worst shift of my career.'
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- Top ER doctors in several states say they're being forced to refuse life-saving emergency care to patients.
- Around 30-40% of their beds are tied up with COVID-19 cases.
- "We say 'no' day after day," one ER doctor said. "And that's led to preventable deaths."
There is not enough room for all the sick and injured people in Minnesota to receive the emergency care they need.
Hundreds are waiting, some on the floor, in the hopes that a bed or operating table might open up. On Tuesday morning, 246 patients statewide had been waiting for more than four hours for a bed.
It's a backlog created by yet another surge of COVID-19 cases. Doctors and nurses say there's no end in sight, and people are likely dying in the shadows of this wave of infections.
"I'm examining peoples ankles who are sitting on the floor, because we have literally run out of any space to put them," Dr. John Hick, medical director for emergency preparedness at Hennepin County Medical Center, told Insider.
Medical teams from the US Department of Defense have been brought into his hospital to help deal with the overflow. These days all 50 beds in the department are filled, with up to 70 more patients waiting for care in the triage area at any given time.
"Every shift I'm working these days is like the worst shift in my career," the 25-year ER veteran told a group of journalists last week.
"We're electing to have to leave patients in rural hospitals," and discharging patients "that I normally would've admitted," Hick told Insider, calling it a "first come first serve" system, which is not how emergency medicine is supposed to work.
It doesn't have to be like this anymore, Hick said. Last week, his hospital system, along with eight others across the state, took out a full page newspaper ad, urging people in Minnesota to get vaccinated. Almost all of his hospitalized COVID-19 patients are unvaccinated. Like other providers across the country, he has seen the impact vaccines can have on disease severity, and he knows that severe sickness and hospitalization from COVID-19 is by and large preventable today.
"We're very worried about the potential that we're gonna have lives that'll be lost," Hick said.
This COVID wave 'has led to preventable deaths,' doctors say — and it's not all from COVID
It's a problem playing out in spots around the country, as COVID-19 patients spend weeks, if not months, in their hospital beds.
While the average hospital patient might use a bed for two to five days, hospitalized COVID patients require at least a week or two of care, Dr. Nathalie Dougé, a traveling hospitalist who has worked in both New York City and Montana, said. Often, COVID stays can stretch far beyond that, topping well over a month in the ICU as the lungs and body recover from the viral illness.
"Getting those extra beds to help other people isn't happening," Dougé said.
Across Rhode Island, upstate New York, and in Iowa (where elective surgeries are on pause through Christmas), hospitals are stretched to the breaking point. In states including Montana, Minnesota, and Nebraska, that routinely means critical care is being denied to rural patients from smaller hospitals.
"When a doctor from a small town in Nebraska calls and says, 'I need some help' ... in many instances now we've had to say, 'I'm sorry, but, we just don't have the capacity to care for that patient,'" Dr. Mark Rupp, medical director of the University of Nebraska Medical Center's department of infection control, told Insider.
Rupp says "it runs very much counter to our culture here."
"We've always served as a backup, caring for the sickest of the sick," he said. Today, they're so overfilled already that they can't.
Dr. Matthew Prekker, a critical care and lung specialist who works alongside Hick in Minnesota, puts it more bluntly. He says there's no doubt in his mind that people have died because his hospital simply doesn't have enough space for them.
"We have historically been the place where people that have nowhere else to go can come," Prekker said, explaining how critically injured patients from all over the state requiring specialized care would normally "be on a helicopter to our facility within an hour."
"Now, we say 'no' day after day," Prekker said. "And that's led to preventable deaths."
Hick worries about whether any life-saving ECMO heart and lung machines will be available this winter if someone falls through the ice, or gets stuck in the snow. When that happens, people can freeze to death within hours. But, ECMO (extracorporeal membrane oxygenation) machines can help prevent those deaths — if they're not all being used on COVID-19 patients.
"As long as it hasn't been hours and hours, we can often get those people back and discharge them neurologically intact using ECMO," Hick said. "But we don't have the option to do that when we don't have any circuits."
In 2019, at least 62 Minnesotans died cold-related deaths, but the figure would likely be much worse without ECMO. There are only four adult ECMO centers in Minnesota, and they're often at or near capacity these days, the Minnesota Department of Health said.
'People still think "it won't be me"'
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In Minnesota, roughly 43% of state ICU beds are filled with COVID patients. At this point in the pandemic, many being admitted are relatively young, and unvaccinated.
"The great majority of patients I see have been vaccine refusers," Prekker said. On his shift Tuesday, he says he saw "a half dozen young adults that had chosen not to be vaccinated and came in with COVID."
Their admittance quickly creates a backlog in ER departments — as more new patients need care, there are no inpatient beds left to send them to. On top of that, gunshot victims and stab wounds are surging toward recordbreaking numbers in Minnesota this year.
"There's a level of anger and frustration in the community that I've never seen before," Hick said. "And if people get angry and they've got a gun, the guns are going off."
At HCMC, even some of the pediatric beds are filling up with adult patients, Prekker said. It's created a situation where if a rural child needed to be flown in for help, the hospital wouldn't necessarily be able to take them, "because sick adults are taking those beds."
It's both heartbreaking and exhausting for the doctors.
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"People still think 'it won't be me,'" Prekker said. "They're willing to play the odds and can think of a whole lot of rationale why they don't need to take the personal responsibility to get fully vaccinated."
Often these days, he says "one of the last things they say before we have to intubate them and put them on a ventilator is 'can I get the vaccine?'"
Meanwhile, other patients wait.
"You have to tell the family that we just have to play the waiting game and hope and pray that somehow some way, we can find a place for them," Dougé said, describing the process of calling up larger hospitals across Washington, Idaho, and Utah, none of them with any room for critical patients from Montana.
"You do feel betrayed to some degree by the community," Rupp said. "We've been working overtime for so long in order to try to preserve their health. And they're not taking the simple step of getting vaccinated."
Be careful, 'because the care that we would love to give you, it is severely hindered by exhaustion'
The winter COVID-19 wave has not hit everywhere as hard — yet.
In New York City, the pace of COVID-19 hospitalizations is manageable, Dr. Bruce Farber, chief of public health and epidemiology at New York's largest hospital system, Northwell Health, told Insider. Elective surgeries continue in the city, and beds are readily available.
But the Omicron variant is taking off fast.
With more than 80% of New Yorkers vaccinated, Faber doesn't expect the hospital to be overwhelmed with severely sick people. Instead, he anticipates a lot of people — including front line workers — will test positive, and have to isolate at home. That, in turn, will mean fewer staff available to treat patients who are in the hospital.
"I do think it's gonna be a real rough six weeks for sure," Faber said.
For Dougé, whose experience working in New York City during the dawn of the pandemic was recently chronicled in the new documentary film The First Wave, the hours and pay as a staff doctor became untenable during this crisis. Now, she says she earns as much in a week as a traveling doctor as she used to make in a month on staff at Northwell.
"I don't see myself going back to a full-time employee," she added. "I know that's gonna get exploited."
These days, her advice to would-be patients is simple: Be very, very careful.
"Honestly, what I tell people: this is the best time to be in the best shape of your life," she said. "Don't do anything risky. This is not the time to be in a motor vehicle accident because the care that we would love to give you, it is severely hindered by exhaustion, by understaffing, limited resources. No matter what we can do as an individual, collectively, the system is on the brink."
This story has been updated with the latest information from the Minnesota Department of Health on ECMO capacity.
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