Emergency rooms are at their breaking point with patients waiting for days

According to the COVID-19 Hospital Capacity Circuit Breaker Dashboard, 600 U.S. counties are at full capacity with no hospital beds available. Another 476 counties are forecasted to reach capacity within the next seven days. The consequences of this crisis are already emerging. 

At an online press conference last week, health officials in Kansas reported that 45 people died in December waiting to be transported from rural hospitals to larger medical centers—five times the previous three months’ average. These tragic situations made national news when they happened during the summer and fall. Now they barely register.

In California, hospitals are turning away EMS teams, leaving ambulances to circle for hours before they can find a hospital that will admit their patients. As a result, there are fewer open ambulances available, so wait times for them are longer, too.

“Pre-COVID times, this would only happen every once in a while and only for one hospital at a time in an area. At the moment, this is happening all the time because all of the hospitals are full,” says a travel nurse currently stationed in Orange County who asked to remain anonymous. “An ambulance may arrive with a patient, the staff at the hospital will evaluate the patient, and say, ‘Okay, they’re stable enough to wait.’ Maybe they are still in pain, and they still need a bunch of tests and things like that, but they’re stable enough to wait. They are not immediately dying.”

The reason hospitals are overwhelmed is threefold: the spike in COVID-19 cases caused by Omicron’s unchecked spread; the increasingly urgent medical needs of a country that’s put off care for two years; and a depleted workforce with burnt-out doctors and nurses leaving the profession, plus many of those who remain being out with COVID-19 themselves.

“Whatever Omicron brings to us, whether it’s technically milder than Delta or earlier strains, it’s occurring on a health system that already is under stress because of all these factors,” says Esther Choo, a professor of emergency medicine at Oregon Health & Science University. “The contraction of the workforce, the expansion of patient-care needs right now, the catch-up care that’s happening. It just feels like all these things are converging to make it really difficult to provide care.”

Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital who helped develop the hospital capacity dashboard, says that many hospitals were already at 75% capacity pre-Omicron, about 10% higher than they were before the summer’s Delta wave. “If you look at the United States’ in-patient hospital capacity right before the Delta wave, the average occupancy was far lower in most hospitals in this country than the average occupancy that was present right when Omicron hit,” he says. “We had less room in the inn, literally, and that means less wiggle room.”

During previous surges, hospitals were able to increase their capacity by creating bump-out spaces, like putting tents in front of the emergency department. But with the current wave hospitals are limited not by space but staffing shortages. “What good is expanded physical space if you don’t have staff for that?” says Choo.

Despite all this, the experts say that if you have a medical emergency, don’t hesitate to come to the ER. A nurse will triage you within 20 minutes, and if they’re worried that you’re having a heart attack, for example, you will be treated in under 30 minutes. But if your ailment is not life threatening, be prepared to wait for hours, maybe even days, before you receive care.

“You will be seen by a triage nurse when you come in, but whether they can handle you after that is another story,” says Thomas Moore, an infectious disease specialist in Wichita. “If you break a limb, we will be able to take care of you, but not for days.”

Another concern is you could contract COVID while you’re in the ER. Moore estimates that half of the patients he sees test positive, so overcrowded waiting rooms will be teeming with the virus. 

“We can’t do adequate infection control in the ER,” Moore says. “We try to put COVID-19 cases in one area of the waiting room, but it’s suboptimal.”

Most concerning, when beds are unavailable, some patients who might normally be admitted could just be held in the ER for observation and then sent home. This has raised concerns that someone with a serious ailment could fall through the cracks.

“If it starts to be that hospitals are sending home more and more people, the odds get a little worse each time,” Faust says. “If under normal times, I’m allowed to discharge a certain number, but now I’m letting myself discharge more and more because I have no choice, at some point I made a call that I wish I didn’t have to have made.”