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Omicron is milder than Delta. So why are hospitals full?

January 19, 2022, 5:21 PM UTC

The good news: Omicron causes less severe COVID-19 in most people, especially vaccinated people, than the Delta variant. The bad news: It’s still pushing the hospital system past the breaking point. 

As of Jan. 16, a record high of more than 142,000 people were hospitalized with confirmed COVID-19 around the country, according to CDC data. The majority of the sickest are unvaccinated, but vaccinated and even boosted patients also make up a portion of those occupying much-needed beds. Hospitals around the country are struggling to meet demand, with some rescheduling procedures and even shutting down essential wings like labor and delivery as they grapple with the surge.   

Many of the hospitalized are less sick than in previous waves, with a much smaller percentage needing to be on ventilators or receive other ICU care. But experts told Fortune that doesn’t mean they don’t need to be in the hospital at all. 

“Part of it is just a math problem,” says Benjamin Singer, a critical care and lung health doctor at Northwestern University in Chicago. Even though the percentage of Omicron infections that will require hospitalization is much smaller than for Delta, the variant is significantly more transmissible. That means the scale of its impact is different in ways that may not be immediately apparent, he says. 

With Omicron, the percentage of infected who end up in hospitals is much lower than with Delta, the last variant of concern. But since the total number of cases is much, much higher than for other variants, even a low percentage of severely ill is still a huge number of people ending up in the hospital.

The majority of those patients are infected with the Omicron variant, although Delta is still around. Randy Roth, chief medical officer of Singing River Health System in Mississippi, says his hospital isn’t testing patients with COVID-19 to see which variant they have, but staff can usually tell during the intake assessment, and they make treatment decisions accordingly. 

Whereas patients during the Delta wave were having serious problems deep in their lungs, he says, “Omicron, down here at least, is much more head and neck.” Delta causes severe, overwhelming pneumonia. Omicron causes more congestion in the upper respiratory tract, leading to sore throat, runny nose, headaches, and a cluster of other symptoms. Most patients with this variant are in the hospital for just three to five days while they receive treatment to help them get over the worst of it, he says, and make sure they continue to recover. 

Most Omicron patients who are hospitalized don’t need mechanical ventilators, one of the hallmarks of earlier waves. Many are in regular hospital rooms, rather than the ICU. But they still need care that is difficult or impossible to give without admitting them, Singer says.  

Medications like the antiviral remdesivir, which are delivered via IV, are difficult to administer to outpatients, he says. In addition, many Omicron patients are dealing with comorbidities that could make their infection rapidly worsen. 

“The main reason, though, is going to be oxygen,” he says. Many of the hospitalized patients around the country need extra oxygen to support their own breathing. In an outpatient setting, people with conditions like chronic obstructive pulmonary disease can be supported with portable oxygen delivered at relatively low concentrations by units they carry with them and breathe from using face masks. But the oxygen needs of COVID-19 patients can’t be served this way, Singer says. They require higher concentrations of oxygen and regular monitoring to change the dose as needed. 

Hospitals have high-concentration oxygen piped through the walls from a central supply and staff on hand to make sure patients are getting what they need through a tube called a nasal cannula that noninvasively pushes air into their nostrils. 

The other thing to keep in mind, says Roth, is that most patients who get sick enough with Omicron to require hospitalization have comorbidities like diabetes, heart and lung problems, or cancer. Some are also dealing with long COVID from previous infections. Most are over 65 years of age. The relationship between their conditions results in more complex and difficult-to-treat illness that can be unpredictable. 

Of the 86 COVID-positive patients who were in Singing River’s three hospitals on Monday, Roth says, nearly half were being treated for something else and either came in with an infection or got it in the hospital. For many of those patients, he says, their case of COVID-19 alone wouldn’t merit hospitalization. 

Sixteen COVID-primary cases were in the hospital system’s three ICUs, with seven on ventilators. The rest of the patients are in regular hospital rooms, he says, receiving a mix of supportive care—bed rest with monitoring—and targeted treatments like oxygen or drugs. 

All of these extra patients, even though their needs are different than those in previous waves, have taken a huge toll on the already overstressed hospital system. Health and Human Services data indicates that almost 80% of inpatient hospital beds around the country are presently in use, with more than 20% of those being occupied by COVID-19 patients. At press time, the department had not responded to an inquiry from Fortune about whether its available bed statistic conveyed the number of beds with sufficient staffing or the overall number of beds. 

Singing River has eight empty intensive care beds right now, Roth says, because there just isn’t enough staff. For many hospitals, including Roth’s, the Omicron variant’s transmissibility has meant a high number of staff getting sick and having to isolate for days or even weeks at a time. 

At Singing River, Roth says, 40% of staff are unvaccinated, which means they are among the most vulnerable to Omicron. Each sick nurse, doctor, or other staffer means fewer people on the floor at the already understaffed hospital. 

“Are we overrun with COVID? I think the answer to that is no,” he says. “We’re overrun with a staffing shortage.”

The shortage has caused hospitals around the country to temporarily or even permanently halt services, reports Becker’s Hospital Review

Although indications are that the Omicron wave is nearing its infection peak or already at it, we still have miles to go, says University of Texas at Austin epidemiologist Lauren Ancel Meyers, who is the director of the UT COVID-19 Modeling Consortium.

Meyers and her colleagues released a range of projections earlier this month looking at different possible outcomes for the Omicron variant. These projections were intended to give the CDC and other health bodies a range of possibilities to plan for, rather than predicting what was to come. In good news, however, the optimistic projection showed infections peaking between Jan. 9 and Jan. 18. The real-time data appears “very consistent” with that scenario, she says, although the current high “could be a false summit.” 

That peak hides a great deal of variation around the country, and for some areas the peak may be far off. But for a highly transmissible variant such as Omicron, Meyers says that the peak is also an early stage in the crisis for hospitals. The variant will spread very quickly, she says, and then infections will decline much more slowly than they increased. The same is true for the hospitalization rate, which is further complicated by the fact that severely ill patients can be in the hospital for weeks or even months. “More than half the people who are going to be infected in this Omicron wave are going to be infected after the peak,” she says. 

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