As coronavirus soars, hospitals hope to avoid agonizing choices

The coronavirus pandemic is rolling across America and hitting states surrounding Indiana particularly hard.

In Illinois, the rate of new infections is so high that a group of doctors sent an urgent letter to the governor and mayor. “We’re having to almost decide who gets treatment and who doesn’t,” said one of its leaders.

In Ohio, the rapid spread of the virus has pushed the state health-care system to the brink. Expressing deep concern, Gov. Mike DeWine, a Republican, vowed to enforce his statewide mask mandate and issued new restrictions on social gatherings. “We can’t surrender to this virus. We can’t let it run wild,” he said.

And in Iowa, where a record number of new infections in a day coincided with a record number of deaths, the White House coronavirus task force issued a dire warning about “the unyielding COVID spread” throughout the state.

The number of new daily coronavirus cases in the United States leapt from 104,000 a week earlier to more than 145,800 on Wednesday, an all-time high. Nearly every metric is trending in the wrong direction, prompting states to add new restrictions and hospitals to prepare for a potentially dark future.

Indiana announced its own new restrictions Wednesday as cases and hospitalizations reached new highs.

“We’re at a fairly critical juncture,” said Dave Dillon, a spokesman for the Missouri Hospital Association. The day will soon come when hospital staffing will fall below standards that are normally required, he said. “While we have beds, those beds are only as good as the staff that you can place around them. There are hospitals at this point that have, at a given time, been unable to do admits,” Dillon said.

The number of patients hospitalized nationally with COVID-19—more than 64,000 as of Wednesday—is near the peak of the first wave in the spring, and has already surpassed the numbers driven by illnesses in the Sun Belt during the summer surge.

“The worst of this crisis is playing out in the next six to eight weeks,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia. “The irony is, this is the time we most need our public leadership. Right now.”

Of the hospitalized patients, nearly 3,000 are on ventilators—more than double the number of ventilated patients as of Oct. 1, according to The Post’s coronavirus tracking data.

With the rise in infections came more disturbing news: a significant uptick in the number of deaths. There were 1,408 deaths reported as of Wednesday evening. Tennessee, Alabama and Minnesota all reached new highs in the number of deaths.

None of the numbers are good.

In Illinois, there was a new high of infections again—12,657—marking a toll of at least 10,000 cases each day over the past week. The state’s number of hospitalized COVID-19 patients is at 5,042, topping the old high set near the end of April. Its 153 deaths was just short of a record set in late May.

In Ohio, more than 2,745 people are hospitalized with COVID-19, a number that has doubled in the last 16 days, according to health department data analyzed by The Post. The state also reported an 76 additional deaths and 6,508 new test-confirmed infections.

In Iowa, a record number of patients are in intensive care. State health officials reported 109,573 cases as of 10 a.m. Wednesday—a 1,276 increase in one day. Iowa’s number of deaths, 1,579, was 31 higher than the day before.

“The cat’s already out of the bag,” said Albert Ko, an infectious-disease physician at the Yale School of Public Health who’s treating COVID-19 patients. “We’re having widespread transmission. It’s going to get worse, certainly for the next month.”

A group of Illinois health-care workers wrote an open letter to Gov. J.B. Pritzker, a Democrat, and Chicago Mayor Lori Lightfoot, a Democrat, on Monday predicting that “Illinois will surpass its ICU bed capacity by Thanksgiving.”

Two leaders of the group, the Illinois Medical Professionals Action Collaborative Team, or IMPACT, said Illinois is “on a bad trajectory.”

“Cases have been rising really sharply, especially in Illinois, where for the past four days we had more than 10,000 cases, which was the highest number of cases that a state had experienced,” said Vineet Arora, chief executive of the team.

Arora, who is also a hospitalist at the University of Chicago, is afraid the rate of infection will reach a point similar to New York at the height of its spring surge, “where physicians were having to having to decide, does this patient have a higher chance of surviving or this patient?”

Anticipating a further surge in coronavirus patients, the Cleveland Clinic hospital system decided to postpone most nonessential surgeries requiring a hospital bed, according to an internal memo circulated Wednesday.

The University of Kansas Health System has begun taking steps to manage capacity, said David Wild, vice president for performance improvement. Physicians have been asked to determine which procedures are “deferrable,” to make space, and they’ve had to turn down some transfer requests.

The university’s medical center often receives transfers from across the area because it provides specialty services other hospitals don’t, including reattaching limbs, specialized burn care and leukemia treatment.

“We routinely have to say, ‘Maybe not today,’ or make a decision about whether the patient can stay where they’re at because we’re close to our capacity,” Wild said. “To add to that … we’ve seen an increasing number of calls from hospitals in Missouri and Kansas that are outside of our normal referral patterns.

“We’ve also seen a rapid increase in the number of calls from Oklahoma, Texas, Arkansas, Iowa, Nebraska. We don’t normally see calls from those places, but we are getting them now. And they are saying, ‘We’ve called every place between your hospital and ours. And they can’t help us right now.’ So there are definitely signs that capacity in the Midwest is an issue,” Wild said.

In May, the health system denied about 40 total transfers. In October, it denied 140 transfers. Steve Stites, executive vice president of clinical affairs and chief medical officer for the health system, said he expects the rate of denials has gone up even more since Nov. 1.

“It hurts the rural areas a lot because they often don’t have the resources to take care of patients and so they make seven or eight calls to try to get a patient transferred,” Stites said. “So they spend an average of four or five hours, which is what we’re hearing from our rural colleagues, before they can find someone to accept a patient.”

Hospitals are being forced to make hard decisions to relieve exhausted doctors and nurses, said Janis Orlowski, chief health-care officer at the Association of American Medical Colleges.

Many hospitals are relying on visiting nurses to supplement their staffs. “We might see in the ICU that people are so busy and had so many shifts they need a break,” Orlowski said. So anesthesiologists who are experts at using ventilators are being relocated to intensive care. Technicians are being asked to replace nurses, and workers in ambulatory care are taking shifts in hospitals.

As in the spring, hospitals are complaining about shortages of personal protective equipment, such as gloves, masks and face shields.

“It’s a grave concern,” Orlowski said. “When we first saw the pandemic start in the spring, it was on a rolling basis—some cases in Washington, others in New York. Now we’re seeing increases everywhere. We are seeing hospitals being strained across the country. What we’re seeing is not only burnout but a lot of complications having stress on medical professionals for an extended period of time.”

Some doctors see a return to the dismal days of the spring, when coronavirus tore through nursing homes, causing hundreds of deaths.

“Obviously, there’s a lot of attention on hospitals, but I think the big pressure points are going to be our nursing homes,” Ko said. “If there’s a place that’s going to buckle under because of the COVID epidemic, it’s going to be a nursing home. You only have a limited number of skilled nursing staff that know how to do proper infection prevention. If you have an outbreak on hand, and you have limited staff, and that staff gets stick, that’s a huge gap in a very critical population. We went through that in our initial surge back in March and April.”