As Hospitals Fill With COVID Patients, Medical Reinforcements Are Hard to Find

Yves here. It’s only early December and doctors and nurses are already exhausted. The grim figures in this article are already dated; Covid hospitalization just hit a new high of 100,000 in the US.  How are hospitals going to keep their troops from falling over? The earliest time when conditions might be better than now is April, when infections will hopefully moderate due to the Thanksgiving/Christmas/New Year spikes abating and warmer weather blunting the rate of transmission. Mind you, we’re unlikely to have enough vaccines distributed over the winter for that to have much of an impact.

By Blake Farmer, Nashville Public Radio and Carrie Feibel. Originally published at Kaiser Health News

Hospitals in much of the country are trying to cope with unprecedented numbers of COVID-19 patients. As of Monday, 96,039 were hospitalized, an alarming record that far exceeds the two previous peaks in April and July of just under 60,000 inpatients.

But beds and space aren’t the main concern. It’s the workforce. Hospitals are worried staffing levels won’t be able to keep up with demand as doctors, nurses and specialists such as respiratory therapists become exhausted or, worse, infected and sick themselves.

The typical workaround for staffing shortages — hiring clinicians from out of town — isn’t the solution anymore, even though it helped ease the strain early in the pandemic, when the first surge of cases was concentrated in a handful of “hot spot” cities such as New York, Detroit, Seattle and New Orleans.

Recruiting those temporary reinforcements was also easier in the spring because hospitals outside of the initial hot spots were seeing fewer patients than normal, which led to mass layoffs. That meant many nurses were able — and excited — to catch a flight to another city and help with treatment on the front lines.

In many cases, hospitals competed for traveling nurses, and the payment rates for temporary nurses spiked. In April, Vanderbilt University Medical Center in Nashville, Tennessee, had to increase the pay of some staff nurses, who were making less than newly arrived temporary nurses.

In the spring, nurses who answered the call from beleaguered “hot spot” hospitals weren’t merely able to command higher pay. Some also spoke about how meaningful and gratifying the work felt, trying to save lives in a historic pandemic, or the importance of being present for family members who could not visit loved ones who were sick or dying.

“It was really a hot zone, and we were always in full PPE and everyone who was admitted was COVID-positive,” said Laura Williams of Knoxville, Tennessee, who helped launch the Ryan Larkin Field Hospital in New York City.

“I was working six or seven days a week, but I felt very invigorated.”

After two taxing months, Williams returned in June to her nursing job at the University of Tennessee Medical Center. For a while, the COVID front remained relatively quiet in Knoxville. Then the fall surge hit. There have been record hospitalizations in Tennessee nearly every day, increasing by 60% in the past month.

Health officials report that backup clinicians are becoming much harder to find.

Tennessee has built its own field hospitals to handle patient overflows — one is inside the old Commercial Appeal newspaper offices in Memphis, and another occupies two unused floors in Nashville General Hospital. But if they were needed right now, the state would have trouble finding the doctors and nurses to run them because hospitals are already struggling to staff the beds they have.

“Hospital capacity is almost exclusively about staffing,” said Dr. Lisa Piercey, who heads the Tennessee Department of Health. “Physical space, physical beds, not the issue.”

When it comes to staffing, the coronavirus creates a compounding challenge.

As patient caseloads reach new highs, record numbers of hospital employees are themselves out sick with COVID-19 or temporarily forced to stop working because they have to quarantine after a possible exposure.

“But here’s the kicker,” said Dr. Alex Jahangir, who chairs Nashville’s coronavirus task force. “They’re not getting infected in the hospitals. In fact, hospitals for the most part are fairly safe. They’re getting infected in the community.”

Some states, like North Dakota, have already decided to allow COVID-positive nurses to keep working as long as they feel OK, a move that has generated backlash. The nursing shortage is so acute there that some traveling nurse positions posted pay of $8,000 a week. Some retired nurses and doctors were asked to consider returning to the workforce early in the pandemic, and at least 338 who were 65 or older have died of COVID-19.

In Tennessee, Gov. Bill Lee issued an emergency order loosening some regulatory restrictions on who can do what within a hospital, giving them more staffing flexibility.

For months, staffing in much of the country had been a concern behind the scenes. But it’s becoming palpable to any patient.

Dr. Jessica Rosen is an emergency physician at St. Thomas Health in Nashville, where having to divert patients to other hospitals has been rare over the past decade. She said it’s a common occurrence now.

“We have been frequently on diversion, meaning we don’t take transfers from other hospitals,” she said. “We try to send ambulances to other hospitals because we have no beds available.”

Even the region’s largest hospitals are filling up. This week, Vanderbilt University Medical Center made space in its children’s hospital for non-COVID patients. Its adult hospital has more than 700 beds. And like many other hospitals, it has had the challenge of staffing two intensive care units — one exclusively for COVID patients and another for everyone else.

And patients are coming from as far away as Arkansas and southwestern Virginia.

“The vast majority of our patients now in the intensive care unit are not coming in through our emergency department,” said Dr. Matthew Semler, a pulmonary specialist at VUMC who works with COVID patients.

“They’re being sent hours away to be at our hospital because all of the hospitals between here and where they present to the emergency department are on diversion.”

Semler said his hospital would typically bring in nurses from out of town to help. But there is nowhere to pull them from right now.

National provider groups are still moving personnel around, though increasingly it means leaving somewhere else short-staffed. Dr. James Johnson with the Nashville-based physician services company Envision has deployed reinforcements to Lubbock and El Paso, Texas, this month.

He said the country hasn’t hit it yet, but there’s a limit to hospital capacity.

“I honestly don’t know where that limit is,” he said.

At this point, the limitation won’t be ventilators or protective gear, he said. In most cases, it will be the medical workforce. People power.

Johnson, an Air Force veteran who treated wounded soldiers in Afghanistan, said he’s more focused than ever on trying to boost doctors’ morale and stave off burnout. He’s generally optimistic, especially after serving four weeks in New York City early in the pandemic.

“What we experienced in New York and happened in every episode since is that humanity rises to the occasion,” he said.

But Johnson said the sacrifices shouldn’t come just from the country’s health care workers. Everyone bears a responsibility, he said, to try to keep themselves and others from getting sick in the first place.

This story is from a reporting partnership that includes Nashville Public Radio,NPR and Kaiser Health News.

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  1. Maritimer

    “The nursing shortage is so acute there that some traveling nurse positions posted pay of $8,000 a week.”
    The Elite and their human infrastructure will not be short healthcare workers of any sort. Thus, as their demand increases, they will suck up the supply for the lower dregs of society. We will not hear any complaints about this from Fauci, CDC, WHO, etc. all part of the Elite infrastructure and who are the purported Guardians of public health and the good of Humanity.

  2. The Rev Kev

    Those medical health workers are going to need some serious help with mental issues before too long as the strain must be relentless. A few months ago there was a story I read of a Chinese nurse describing her experiences in the pandemic in Wuhan. She told of how she would go into the locker room and find a nurse sobbing in a corner but when the call came, that nurse would pick herself up and go out to the wards again. Incredible courage that.

    At this point I am surprised that there are not more than a few beggar-thy-neighbour schemes being floated. Such as offering any nurse from overseas guaranteed US citizenship if she works a minimum of two years on a Coronavirus ward. That sort of thing. Not saying that after 23 months in that ICE agents would not nab them and deport them if the pandemic tapered off though. Similar stuff has happened with foreigners serving in the US armed forces.

    I wonder if anybody is keeping an eye on nursing school and the like to see if doctors and nurses are being graduated early to fill the intense need for medical personnel. The same happened in the 1918-19 flu pandemic where people were being graduated early to help fill the ranks and I think that I read a story of the same happening at least once a few months ago. That would be a big tell that.

    1. rd

      American medical schools (with the exception of a couple like Johns Hopkins) were a complete joke in 1918. There was no real qualifications or body of knowledge required and certification bodies were often fly-by-night. If you could pay the tuition, you could be a doctor. It would be insanity for a medical student today to come out early as they would be unlikely to get certified by the various boards and would not get their licenses to practice.

      I don’t see the Trump Administration opening up their arms to welcome in foreign doctors and nurses to address a Covid problem that doesn’t exist in their mind.

      I think one of the biggest morale issues is that this disease came out of essentially nowhere early in the year. There was little people could do to figure out how to avoid it. So medical staff were generally saving innocent victims of a 2×4 that came swinging at people out of the dark. However, the science is now well-defined on how to control transmission and many people are agressively denying that science and getting sick. It must be incredibly disheartening for medical staff to see people doing highly risky activities and then end up in hospital 2 weeks later. This factor will likely double the exhaustion and PTSD level.

      I don’t think Americans comprehend the catastrophe that is coming over the next 2-3 months as the holdiay spread takes hold and the hospitals are in November 1918 mode of triage. Even though we have medicine and staff that is orders of magnitude better than 1918, it doesn’t do any good in an overwhelmed system. You can have the best sump pump in the world but it won’t do any good at elevation 5 foot with a 20 foot storm surge coming. The massive New Orleans pumps couldn’t save the city in Katrina.

  3. vlade

    I saw a comment few days back, that the “first line” comparison of health staff to soldiers is really bad one.

    Because no-one would leave an army outfit in the firing line for 9 months w/o rotation and significant R&R.

    100k hospitalisations is also pretty scary, because IIRC there’s about 100k IC beds in the US (which aren’t homogenuosly distributed, and transporting IC patiens say from Missisipi to NY is logistically pretty hard, and thus costly), so it’s likely that in some places we’ll see shortage of IC beds, if it’s not already the case.

    1. apleb

      Really? In a real war, 9 months and longer is normal. See WW1 trench warfare and WW2 and all the other wars before that. Years of campaigning was normal. R&R that’s funny.

      Expeditionary colonial wars as we have today are different but only for the western invaders. See NVA: there was no R&R, only a bowl of rice per day. A small bowl and if you were lucky you got two per day: that was the R&R then.

      And even those expeditionary wars were a lot more hardship back in the day, e.g. see Cortez and Pizarro, or crusades. The travel to the foreign lands alone took longer than 9 months.

      1. The Rev Kev

        Not true for WW1 trench warfare and for US troops for example-

        ‘Every two weeks, usually at night, new units came up to the front lines through the communication trenches. They relieved those who had served on the line. The unit being relieved then had a week or two of rest in the rear. Usually, this “rest” involved a lot of labor.’

        The NVA had relief as well and there was some beach in Nam where American troops shared it with Vietnamese, many of whom were actually NV fighters. Even in present-day Afghanistan you have a “fighting season” as nobody wants to fight in their winters.

      2. vlade

        No outfits were on the firing lines for 9 months actively fighting. Please read your military history.

        Years of campaigning? Right… Except that the (for example) British Army operated 16 days rotas. * days in front line trenches, 4 days in reserve trenches, 4 days in R&R few miles away from the trenches.

        Other armies, both in WW1 and WW2 run on similar things. Even in somethign like Stalingrad, 64th Soviet Army had a one month in reserve (February 43) – because there’s only so much a human is capable, not to mention that divisions that get worn down to (say) 50% of their strenght have to be rebuilt which you can’t do on the front line.

        Campaign is not a front line engagement. In ACW, a soldier in Army of Potomac might have had 30 fighting days during (i.e where there was an actual battle fought) his first two years of campaigning. Under Hooker, the men got 10 days furlough, rotation by company (30-40 men). So if you were lucky, you might have had 20 days/year furlough, and in theory (not in practice, because the furlough didn’t work well before Hooker) thus more furlough days than battle days.

        1. David

          Yes, even in WW1 British soldiers only spent a few days at a time in the actual front line, rotating through positions at different distances. In the 1970s, troops on emergency tours in Northern Ireland, where they would be out on patrol frequently, were rotated after three months.

          Most emergency services are subject to continual cumulative stress, which is why everyone from police to paramedics generally works a maximum of 4-5 consecutive days. After that, especially with shift-work, tiredness becomes more and more of a factor and judgement suffers badly. And the difference is that, whilst a military unit may spend a week in the front line with nothing actually happening, the same is not going to be true of doctors and nurses.

        2. PlutoniumKun

          Yup, pretty much every successful military leader in history (and well before armies started hiring psychologists) has realised that soldiers cannot take constant combat pressure for more than a few weeks without breaking. I believe the rule of thumb used is that even with breaks, no soldier can take more than 100-120 days of combat, and its far fewer without a break. While being at the frontline of Covid is not quite as stressful as sitting in a foxhole under a mortar barrage, psychologically its not far off.

          1. Discouraged in WI

            Maybe it didn’t apply to medical personnel. My father was a physician during WWII, and was killed in northern France. His unit had been pulled back because they had been at the front for too long, but he had to stay, because they were short of doctors. They worked in pairs, and his partner was a dentist, no doctors available. (Lots of help that was when he was hit.)

        3. rd

          You can also train infantry replacements in a month or two and put them in to replace the dead and wounded. It takes several years to train medical staff. This thing will be done by the time the med students that started in Fall 2019 graduate. The nurses can come out a bit faster, but not much. You would have to restructure the entire curriculum and certification process to speed it up.

          A key reason the German and Japanese air forces lost capabiilty in WW II was that they didn’t have systems to scale up training flight crews. Early on in the war, they were fighting on offense, so somebody shot down had a low probability of coming back (they were dead or captured) and getting in another airplane. In the Battle of Britain, a British fighter pilot could get shot down, get recovered, and fly another sortie the next day after riding into a town on a farmer’s ox cart.

  4. jr

    I salute the strength and sense of duty demonstrated by the health care workers on the front lines. I would also support any one of them that dropped their gear to the floor and headed home to protect themselves and others. This catastrophe has been magnified ten times over by elite mismanagement and the jaw-dropping stupidity and ignorance of some Americans; those in health care have no absolutely no obligation to risk themselves any further.

    1. drumlin woodchuckles

      There really should be a system to dox/record/retain all identifying and locating data on every No Mask Rebel and No Mask Drunken College Student and every other No Masker so that they can be individually and granularly be denied medical attention and in fact forbidden from trespassing onto any property where the possibility of medical attention exists.

      With freedom comes responsibility and with the freedom to boycott the mask should come the responsibility to accept the fate one tempted and die honorably of the disease one willfully and cavalierly courted without draining resources for others who were “citizen” enough to practice infection-slowing behaviors.

  5. ambrit

    In the Spring, the rationale used to justify the ‘lockdowns’ was to preserve the medical system from overwork and collapse. Many “elective” procedures were deferred to free up beds and personnel. Now, the subject of ‘lockdowns’ has become politicized. The backlog of elective procedures should have been cleared, but I find no good figures on that.
    That the capacity of the medical system is being “worried about” this early in this phase of the Pandemic Cycle is worrisome. The “Perfect Storm” of systemic strain and possible collapse is possible this coming Spring. The tell to me is the mention of dual Intensive Care units in a single hospital.
    As “jr” mentions just above, the idea of self preservation trumping all else is now being bruited about in reference to medical workers. Ironically, that would be the manifestation of Neo-liberalism in the “real” world.
    When will the Army start setting up tented medical facilities to deal with the overload? I remember reading about some National Guard units setting up field hospitals last spring in Covid “hot spots.” Then they quietly folded those tents and stole away into the night. Here’s hoping that those same National Guard units do not become “gun shy” this coming Spring.
    We are doing what we can to help ourselves. I really do hope that such a situation does not become “best practice” in this next phase of the Pandemic.
    One useful outcome of the pandemic is that we will find out who our real friends are.
    Stay safe!

    1. polecat

      And Still no accurate test for this thing.. An authoritarian’s wet dream if there ever was one – now happening in realtime!

  6. PlutoniumKun

    This is a key point where the anti-lockdown brigade have gotten things so badly wrong. They simply don’t understand how health systems operate. It is the constant, relentless pressure that will break a health system. Here in Ireland they haven’t managed things perfectly, but I have family members on the front line, and they have all have had some rest time. April to June was a nightmare for all staff, but since then they’ve been able to go back to more normal hours (and have breaks) in preparation for an inevitable winter peak (along with the usual flu peak). In fact, one doctor relative said that she was quite bored back in October, as a lot of staff were sitting around waiting for patients who haven’t arrived, and as non-essential patients were being discouraged from going to hospital (no bad thing for many of them), they had less regular work than usual.

    Lockdowns work. They are a pressure release valve for health systems and allow them to deal with the inevitable waves. If you don’t have them, you end up with a relentless series of waves hitting your health system and it is the workers as much as the Covid victims that suffer. As Vlad above has observed, even in dire wartime situations militaries do not expect even cannon fodder to withstand constant pressure and perform without regular R&R.

    1. Yves Smith Post author

      The one thing that might change the dynamic is political figures waking up and realizing that overloaded hospitals mean that if they or an immediate family member has a heart attack, stroke, bad head injury, or any other event that would normally put you at the front of the line for ER triage, too bad, so sad, no one to do triage so that person dies or is permanently impaired. They’ll finally impose lockdowns out of raw selfish interest.

      1. apleb

        Since politicians and their immediate families are literally a different class from normal patients, this will not happen or only if it’s way way past dead laying in the streets scenario.

        In the countryside aka flyover country it might work since there is only one hospital for all, but politicians, especially senior ones who ultimately decide, live in cities where you can always have one private hospital for the elite and another one for the rest of society.

        1. Yves Smith Post author

          No, there were gurneys in corridors in NYC in Lenox Hill Hospital (in the middle of the toniest part of the East Side) and 30 hours waits to be triaged. The well off coped by going to a less busy hospital. Even in NYC, there were significant differences and if you had the clout to commandeer an ambulance for a longer ride and were stable enough, there’s always the hospital affiliated with Yale’s med school, which is top notch.

          All ERs in a state/region being over capacity changes the picture dramatically. In Texas and Az, mere mortals were being shuttled long distances in search of hospital beds in the worst of the last outbreak.

          And recall that the rich and top professionals, to large degrees, have bought new homes either a couple of hours from where they once lived or even in a new area. They don’t have roots there. They haven’t given to local charities, haven’t made friends, all they are are assholes who’ve bid up local house prices. You think they’ll get special treatment from the local hospital if they haven’t donated to it and either have no local MD or are new to him?

          Sure, some might be able to try to call in chips. But in a hospital stretched to its breaking point, the staff on duty calls the shots. And I bet that the admins are or will become good at adept putting off of people who try to jump the queue: “Oh for your condition you really need to see our XYZ specialist, but he won’t be on duty for hours. Otherwise, a resident have a look.”

          1. apleb

            So you agree with me: “the well off coped by going to a less busy hospital” by commandeering an ambulance if necessary.

            And even if totally all the hospitals in the region are over capacity, one can still go to the preferred one and take away the resident from some other, lower class patient: real world triage. The hospital administration at least knows what to do if someone powerful comes in the door, even if the lowly ER resident doesn’t, and will act accordingly: the hospital has more than one MD in house and at least one of them will find the time.

            What treatment did Mr. Trump get vs. Joe Public who has a HMO for the same disease? Just medical treatment, not the unusual perks of nice room or rather nice wing with more nurses, helicopter delivery and departure, etc.

            So that scenario of politicians losing family members due to overcrowded hospitals is almost impossible to actually happen. The differences in actual, real privilege are way too big. And when it happens it’d need to happen to someone with real clout, like Pelosi or thereabouts not some congress first time backbencher to have real impact. What are the chances?

            1. Anthony G Stegman

              The really well off have their own ICUs staffed by their own medical staff. They never need to go to a hospital, not matter how ill they are.

              1. Yves Smith Post author

                Anyone who has a home ICU is a moron.

                It’s already well recognized in medical circles that the doctors who provide concierge medicine are less good practitioners because you get good treating a lot of cases. A doctor who’d treat someone who has a serious ailment outside a hospital is taking monster professional risk and has high odds of not being very skilled. Hospitals can do tons of tests you can’t do in a small setting, plus in a hospital, you have access to many many specialists.

                1. PlutoniumKun

                  This applies to all small private hospitals or clinics. You pay for the furnishings and nicer food.

                  Its a not so well hidden secret that private hospitals have significantly higher mortality rates than big public hospitals, especially teaching hospitals. Its a simple matter of scale and diversity of care (i.e there are more experienced doctors on hand to deal with any contingency). Pretty much any doctor who studies the stats will send their family members to a big public hospital if there is a choice, unless its for a very specific and non-hazardous procedure.

                  Some private hospitals of course hide this by selecting patients carefully. A nurse relative of mine with a serious cancer – she had worked on oncology wards for many years – was refused treatment by one such hospital in NY – she would have made their stats look bad. Fortunately, she had the contacts to make sure she had excellent care and is healthy and cancer free now.

            2. Yves Smith Post author

              You presume facts not in evidence. “Politicians” covers a broad range of people. Yes, a hospital would likely give a mayor or governor special attention, if nothing else because the press would be all over them if he died. But if you think, say, being the spouse of a member of New York City’s Council gets you to the head of the line, you are smoking something strong.

              Even rich people can’t readily pull ER strings; their normal route is to get admitted into the fancy pants wing via your MD, who presumably has an affiliation with that hospital. You would need to have connections to the administration of a particular hospital. That happens directly ONLY if you are a significant donor. And even then, you have to call your fundraising contact, who then calls an admin person, who then maybe calls the ER staff. Hint: fundraising people don’t work nights and weekends. A super top tier donor, like someone whose name is on a wing or is on the board, would have a direct relationship to the hospital president, but others, not likely.

              And you further assume that the person running to an ER has good enough personal/financial relations with a person on the board or the hospital president to pull strings. You have to be tight to pull a favor like that, particularly fast enough to interfere in triage decisions.

              Trump got special treatment because he is the President. Help me. It’s not even clear Walter Reade Army Hospital was the best place to treat him. John Hopkins is a vastly better hospital. But he needed to go somewhere that the Secret Service could secure the area and not mess up hospital operations, and Walter Reade has a presidential suite set up with security in mind.

              The big advantage politicians have is access to testing. White House staff were/are tested daily. Congress has a clinic on site. The antigen test has a strong tendency to deliver false positives in asymptomatic people, but a positive, whether false or not, would lead the person getting the test to moderate activities and get treated pronto if they showed symptoms, way earlier than mere mortals. Early intervention reduces the odds of needing to go to the hospital at all.

          2. rd

            Many of the new homes are now in smaller communities without the big hospitals and clinics they are used to. If they were smart, they hightailed it to smaller cities with teaching hospitals. But I think many went for the view instead….

            Unless they brought their own hospital suite and staff to the Hamptons, that area would be overwhelmed very quickly.

      2. NotTimothyGeithner

        Hence their behavior in the spring when Tom Hanks was sick, but now there is treatment for VIPs and stocks are high! Or Maddow’s tears when Trump was sick.

  7. Synoia

    There is an alternative, The Black Death approach. “Bring out your dead, bring out your dead.” The UK’s 1666 plague response. The wealthy, the 1%, left London and retreated to their estates. In the 1300s plague response the death toll was so high it broke the back of the feudal system,

    I believe Winston Churchill’s aphorism applies:

    Americans can always be counted on to do the right thing once they have exhausted all other alternatives.

    Why did the US fail to copy the South Korean example?

    1. Yves Smith Post author

      Remember that Pelosi said that Trump closing down air travel with China was racist and she was going to go eat dinner in Chinatown? How Saint Cuomo fought De Blasio over closing NYC schools in March? How Saint Cuomo bullied Rhode Island into backing down when they wanted to bar drivers from New York? Lots of blame cast at Trump and the Rs (deservedly) but the Dems behaved badly too.

      More specifically:

      1. South Korea had experience with SARS so it took Covid seriously

      2. South Korea had mandatory 14 day quarantines for people entering the country. No messing around. You got a test, installed an app on your phone so officials could locate you, were given a case worker who’d call at least 1x a day, were giving initial food, water, cleaning supplies, masks, etc and were put in an apartment if you couldn’t isolate at home (as in had your own BR and bath). They even gave special garbage bags that the officials would collect, it appeared to be treated like medical waste. You called for more food when you needed it and it was brought to you. If you left your unit or turned your phone off, the case worker would be all over your ass and you’d be fined big time if you did it again.

      We don’t have the will to make people quarantine. Trump maybe could have done it under the same emergency public health powers he used to halt evictions. But any financial support for quarantines would be a budgetary item and thus require Congressional approval. No way would that happen.

      Do you hear Team Biden making any mention of quarantines with teeth? Nope. And that’s before getting to the fact that a government of MBAs and lawyers can’t manage its way out of a paper bag.

      1. Ford Prefect

        The restaurants, bars etc. are generally owned by the 10%. Many of the staff are foreign getting paid low wages. Historical US policy has been to avoid ever giving that class any benefits at all.

        The spring stimulus was a magical change of thinking and the ruling class has vowed not to repeat that “mistake”. I think it is out of spite and racism, because it was really clear that giving cash to the bottom 50% sent money flooding through communities very quickly, unlike tax cuts for the wealthy that still haven’t been spent. By the time Congress figures out they have blundered, there will be a lot of dead and evicted but with vaccines available to them. Congress will immediately respond by giving the S&P 500 bailouts so that the economy can be rescued.

        A number of other countries tried to set up the economy like Brigadoon where large segments could just go to sleep for a few months and then come back to life largely unchanged. They seem to be doing much better than the US.

        1. Yves Smith Post author

          No, restaurants are a great way to lose money. Any 10% er with a competent financial advisor would tell them to stay well away. They have a high failure rate but are still the preferred entrepreneurial option for chefs or other people who fancy they have a niche cooking approach that can take off.

  8. carl

    Anecdote: was speaking with our mail carrier the other day; his wife is a nurse in a local hospital. He said that they are not testing the medical staff. The stated reason is that if one person tests positive, the whole “team”–doctor, anesthesiologist, nurse, aides, have to quarantine. He also mentioned her having to hold patient’s hands as they passed away, because family members can’t be there, of course.

    1. rd

      My wife is a teacher. They have been doing major testing in the inner city school district. Typically positive rates are 0.1% or less for staff and students while community spread is in the 3%-5% range. The schools have good protocols and people are following them quite well. This thing can be managed effectively. We have simply chosen not to.

  9. Bob Hertz

    Patients with serious, life-threatening Covid can stay in the ICU for up to three weeks or more.

    This is one reason why hospitals can be ‘full’ so soon.

    Also I suspect that many hospitals will need a lot of money to survive. Most Covid patients will never be able to pay all their bills.

  10. jhallc

    If this gets to the point of hospitals being overrun I wonder if we will hear any Mea Culpas from the “It’s a hoax and “no worse than the flu” crowd. Somehow I doubt it.

    Maybe Cuba can send us some extra doctors and nurses. S/:)

  11. LaRuse

    I read this morning in a Richmond, VA region news-aggregation that the largest hospital system in SW Virginia is nearly out of regular beds across the region and down to only 13-14 ICU beds. A refrigerated truck morgue was moved into NE Tennessee this week and a second is on the way. This news is landing BEFORE the post-Thanksgiving infection wave rolls in during the next couple of days.
    Now a anecdotal spleen vent from me – this is exhausting. My Mother in Law survived COVID. You would think she would be using care and caution in her behaviors, but just last week she told us “I would rather die than not go to Church.” Well, okay, that is all well good for her to choose for her 81 year old, newly widowed self, but now her disabled (and fresh out of gall bladder surgery) daughter lives with her – and my Sister in Law, to our knowledge, hasn’t had COVID. You think my SiL would also be using care and caution given the death of her father and her mother’s illness, but yesterday’s drama was that she missed her monthly hair appointment because she overslept – she’s 60 years old and still insisting on getting her hair colored and straightened a week after gall bladder surgery.
    Yet I am still buying their groceries and delivering them to keep them out of the grocery stores. And they are upset when I refuse to visit or take off my mask now.
    Not even an actual brush with death seems to reach some people.

    1. DonCoyote

      I doubt it could ever be counted, but I wonder how many COVID/illness deaths are really deaths of despair. IMO the hollowing out of social connections and the precariat life of late-stage capitalism make people, consciously or unconsciously, value their lives less. So “despair” may be rational for an increasing number of people, who, while they aren’t ODing or committing suicide (traditional deaths of despair), are (trying to) get busy living rather than get busy dying.

  12. Big Tap

    I have scheduled for December 22 surgery on a bile duct stent I need. I’m wondering if this will need to be rescheduled to later date due to the influx of Covid-19 patients. My present my surgery is still on for now.

    1. Sue inSoCal

      If you’re in severe pain from gall duct issues (been there), can’t say I wouldn’t consider having it done. But if you can eat and keep your weight up without climbing the walls from pain, if it were me, I’d probably wait. Tough call. Hope you feel better regardless of your decision.

  13. Lex

    I have old degrees as both a medical assistant and medical secretary. Back in the days of yore, the difference between someone like me and a nurse, was that legally I couldn’t give injections or draw blood… although I didn’t have a single employer who recognized that little nicety.

    So, I’ve been reorganizing the troops in my mind a little differently. All the currently state licensed doctors, nurse practitioners, physician assistants, RN’s, and LPN’s in the middle treating patients. Every other task normally handled by those same staff members are to be done by medical assistants and volunteers. I think that outside circle of support could relieve the concentric circles leading inward toward the patient, of a lot of the paperwork (yes, despite laptops there’s still a lot of paperwork), miles on their feet gathering supplies, and custodial clean-up.

    Not all of these doctors and nurses have support at home. How depressing would it be to arrive home exhausted to find no hot meal to eat, no food in the fridge, sheets that need to be changed, desperately lonely pets, dead plants, mail piling up, etc, the list would be long. Not all of these folks have family and friends who will step up to relieve them of those personal chores. Teams of such support could be organized so that all the primary staff need give their attention to are the patients themselves.

    And we’ll do it for nothing — no pay — because it’s in our best interests to do so to get through this winter. We shoulder a little more responsibility to keep from burning out our healthcare workers.

  14. landline

    So much talk about flattening the curve. So little talk and, more importantly, action to raise the horizontal line. Why did it drop so low?

  15. phichibe

    I saw an interview today with a woman MD who was the head of a large hospital chain in the southwest US; I believe the interview was on the PBS newshour. The interview was very sobering, as can be imagined given the state of the Covid pandemic. However, what was arresting was when she was asked about the mental health of her caregivers. She paused, looked distressed but squared herself, and said that 6 of her doctors and nurses had taken their own lives since the pandemic began. There was an episode during the early summer when a woman M.D. at one of New York’s hard hit hospitals took her own life. She had contracted Covid and was at her parents’ house in Virginia when it happened. I don’t think those of us who are outside the healthcare system understand the impact of the relentless tide of sick and dying patients is having on these people, most of whom entered medicine to help people. This is occurring world wide, of course, but in the U.S. so much can be laid at the feet of Donald Trump and his absolutely criminal neglect of his duty as the leader of a nation under siege. Even if he starts a senseless war between now and January 20 it is unlikely he will have killed more people than his dereliction has already. He deserves utter obliquoy.

  16. Adrian D.

    A friend of mine who works in HR for a London NHS ‘trust’ yesterday told me that given what information has been (press-)released so far they’re expecting around 25% of their staff to be off sick in the days after they receive the Pfizer/Biontech vaccinations. That’s obviously not going to help with the staffing this Winter. Neither is the fact that they’re not sure whether those staff will test positive for the virus later simply for having received the vaccination. The information release so far about any of these vaccines leaves a lot to be desired.

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