This is the fourth attempt to warn you about the impending disaster facing all of us. 

Our incredibly dysfunctional healthcare system is collapsing, falling apart as thousands of highly-experienced and very well-trained critical staff leave care provider roles.

Two national nursing experts:

• nurses who are inexperienced are replacing those who retired or were enticed by financial incentives to become travel nurses.
• So many older nurses have quit, and younger nurses are at the bedside.

Hospitals are turning to traveling staff, costing facilities 4 to 5 times more than full-time workers. In response, and in a classic “treat the symptom while ignoring the problem” move some well-intentioned but pretty clueless elected officials are trying to pass a bill that would restrict traveling staff agencies’ pricing.

That is both pointless and pathetic. It reflects those officials’ paying attention to healthcare executives while ignoring what’s happening to care workers on front lines.

Instead our Representatives should be:

• confronting those who are lying about COVID and vaccines,
• using every tool and lever they have to support health care workers,
• implementing financial penalties for illegitimate vaccine refusers in the form of higher premiums, copays, and deductibles.

It’s even worse at long-term care and rehab facilities…and it has undoubtedly gotten worse since those data were collected back in June 2021. And it’s happening in Florida, California, and Indiana – and in your state too.

Here’s why. And no, it’s not vaccine mandates.

From a great piece in The Baltimore Sun:

The great “financialization” of the health care industry has finally trickled down. Capitalism and the unfettered and unfiltered drive for the dollar has degraded the nursing profession in many regards. The historic exploitation of nurses to increase productivity and reduce costs, worsened by the pandemic, has led to a historic nursing shortage being faced today. [emphasis added]

This is the macro, structural driver – the unbound drive for profits..

COVID – and more specifically disinformation and vaccine resistance – has greatly accelerated and deepened the crisis. 

The multiple waves of COVID and the relentless flood of disinformation and lies have crushed the life out of nurses and healthcare workers, each successive wave burying healthcare workers ever deeper until many can see no escape.  Nurses are at much higher risk for suicide than most other workers.

Experienced, trained, passionate and skilled nurses and healthcare workers are leaving patient care.

What does this mean for you?

Sooner or later you will bring a family member to a hospital.

The staff will be less experienced, less skilled, less knowledgeable and less able to provide care.

Lies and disinformation have consequences.

In a tiktok video circulating among healthcare workers a traveling nurse bluntly describes the very near future – no beds. For those blithely going on about their lives, ignorant of the impact of the anti-vaccine movement on our healthcare system and the people who take care of us, the video should be required viewing.

There is a direct connection between vaccine resistance and the dire state of our healthcare system, yet most resisters seem quite unconcerned about the effects of those decisions on their neighbors, family, friends, coworkers, and the healthcare system and healthcare workers.

Today, one out of five hospitals is critically under-staffed, the result of staff burnout, increasing frustration and intolerable working conditions. Over the last year the nation has lost more than 10,000 staffed ICU beds and almost 4 out of 5 of the remaining beds are occupied.

The combination of a flood of COVID patients and staff losses from resignation and COVID quarantine is exacerbating the staffing crisis and affecting non-COID patients. In almost half of all states, hospitals are postponing elective surgeries  – forcing patients to delay  hip replacements, cancer surgery, non-urgent cardiac bypass operations and other non-emergency care. Legally required to care for COVID patients regardless of their ability to pay, a growing number of hospitals have been forced to limit or forgo elective procedures. The longer this persists, the bigger the financial impact on facilities unable to bill private payers for lucrative services.

Here in New Hampshire’s Upper Valley hospital ICUs are nearing full capacity, National Guard troops are helping staff emergency rooms because ER nurses are needed in ICUs and CCUs. What used to be 12-hour shifts are now stretching beyond 13.

Nurses don’t have time to use the bathroom much less grab a bite to eat or get off their feet for a few minutes.

Staff nurses making $45 an hour are working alongside traveling nurses earning 3 times that. At some hospitals workers exposed to or testing positive for COVID are required to take PTO (personal time off) while in quarantine, a policy that infuriates the very people tasked with caring for us.

The explosive spread of COVID has led to more primary care physicians refusing to see patients in person, demanding patients go to Emergency Rooms for COVID tests, throat cultures, blood pressure tests, and other diagnostics. Staff are furious at this as it further overloads ERs and more people are needlessly exposed to COVID.

Of late, every day brings more bad news for staff. PPE supplies are tightening , the American Heart Association just released a policy change telling healthcare workers they don’t need PPE while doing CPR on COVID-positive patients and the CDC is telling healthcare workers exposed to COVID they need only isolate for 5 days.  A few facilities are asking nurses that tested positive for COVID to come to work anyway. Hardly the policies, practices, and statements that will engender loyalty and strengthen commitment among healthcare staff.

It’s not as if administrators have many other options. They are beyond swamped, scrambling to find enough people to fill the next shift, unable to plan much beyond that. With more and more nurses and other staff quitting, that task will just get harder and harder. That said, hospital administrators can and SHOULD be doing a lot more for front-line staff.

Retention bonuses, day-care assistance, hazardous duty pay are among the measures smart administrators should be taking.  Alas few are.

Health care is in crisis today in Alabama, Ohio, New York, Washington DC, Michigan, Georgia, and Rhode Island.  More southern states are about to enter crisis stage, overwhelmed with COVID patients most of whom are unvaccinated.

The reality is America is not “in this together”; far from it.

Our healthcare workers, our healthcare system and the mask-wearing vaccinated are on one side, desperately trying to protect all, care for grievously ill patients and save lives. The unvaccinated and their enablers are on the other, blithely ignoring the consequences of their decisions while demanding care when they fall ill.

While some groups have every right to be careful if not outright suspicious of vaccines (the Tuskegee tragedy’s fallout is still resonating), the vast majority of the anti-vax crowd’s claims are patently false and easily refuted. Some states are even paying unemployment benefits to vaccine refusers who’ve lost their jobs, rewarding behavior that is directly responsible for our collapsing healthcare system.

It’s not as if COVID is the only problem facing our healthcare system.  The mess that is information “sharing”, fee for service reimbursement, balkanized delivery systems, ineffective over- and under-regulation and the for-profit motive that drives most of US healthcare all contributed to the crisis. But COVID – and the politicization of vaccines and masks – is different.

With choice comes consequence, with freedom comes responsibility.

Unfortunately, that’s exactly what is missing – a willingness on the part of most vaccine refusers to take responsibility. What’s also missing is a willingness to hold refusers accountable. Pundits and politicians want us to be patient, to listen, to engage, educate, empathize and respect divergent opinions. For two years we have been doing just that, and while we have been listening and seeking to understand our healthcare system nears collapse.

We respect vaccine refusers’ right to make those decisions, and they must accept and take responsibility for their central role in the collapse of our healthcare system.

 Without that, we will never be in this together.

Some good news on the COVID front – well, good compared to the $%*#%Storm we’ve had for two years.

First, the good news is tempered by reality – Omicron is incredibly transmissible. It feels like you could catch the damn thing if you drive by a patient on the highway.

Three studies published yesterday or just before agree – Omicron-infected patients generally aren’t as sick as those infected with other variants. A UK study and one in Scotland had similar results – Omicron patients had less severe and shorter hospital stays – and fewer of them. Another from South Africa indicated Omicron patients were hospitalized a quarter as often as non-Omicron patients.

Warning – these are PRELIMINARY reports and have not been peer-reviewed; it is possible results will change after the review process is completed.

And, Pfizer’s COVID treatment bill got the nod from the FDA. From FiercePharma:

Pfizer has agreed to supply the U.S. with 10 million courses of Paxlovid for $5.29 billion ($529 per course). On Wednesday, the company also revealed it will supply 2.5 million courses to the U.K. on top of a previous agreement for 250,000 courses.

Paxlovid will only be available – for now – via the FDA’s Emergency Use Authorization (EUA). If you aren’t vaccinated because you think the vaccines didn’t go through enough testing, you need to understand that Paxlovid has had far less testing – and there’s been zero real world experience with it.

So here’s the bad news.

Because far too many of us are NOT vaccinated, hospitals are swamped with COVID patients – the vast majority of whom are unvaccinated. So, while Omicron isn’t as deadly as other variants, the fact that it is far more transmissible means there are going to be many more patients who WILL be hospitalized, need ICU/CCU care, and many of whom will die.

What does this mean for you?

Get vaccinated and wear a mask. 

Or don’t ask for Paxlovid if you get COVID.

Here in northern New England emergency departments are being staffed by National Guard troops. Hospitals’ ER staff – trained to handle critical care patients – are being shifted to critical and intensive care units already short-staffed due to burnout and overwork.

Hospitals are once again halting all non-emergent care as beds are full, staff are exhausted, and supplies constrained.

Omicron’s incredible transmissibility coupled with a core group of unvaccinated people is driving the disaster – and make no mistake, disaster it is.

In the UK, Omicron infections are doubling every three days.

Here in the US, Omicron accounts for three out of every four new COVID infections.

To date the evidence seems to suggest Omicron infections may be a bit milder than previous variants, although other data appears to contradict that statement. Net – it’s still early.

Two key points (source here)

1.  Vaccinated people are much less likely to get Omicron than the unvaxxed.
   
2. Omicron may still infect those of us who are vaccinated, BUT the infections are relatively mild and, unlike the unvaxxed, we are MUCH less likely to be hospitalized or see the inside of an ICU.

Omicron is likely to burn very hot and very fast through our healthcare system; I’d expect that 6 – 8 weeks from now most will be behind us.

BUT – the damage COVID and the unvaxxed have done to our healthcare workers and the healthcare system will be felt for years.

• About one in five healthcare workers left their job since COVID started.
• There are far fewer healthcare workers in nursing care facilities and community care facilities for the aged today than there were pre-COVID.
• Wages for workers in those sectors are up more than 12% – which will drive costs up too.
• U.S. Bureau of Labor Statistics projects that 500,000 seasoned nurses are expected to retire between now and the end of 2022, creating a shortage of 1.1 million nurses.

Numbers are soulless. Here’s what COVID feels like to those trying to save COVID patients…

Last December, at the height of the winter surge, (a 14-year ICU nurse)  cared for a patient who had caught the coronavirus after being pressured into a Thanksgiving dinner. Their lungs were so ruined that only a hand-pumped ventilation bag could supply enough oxygen. Alexander squeezed the bag every two seconds for 40 minutes straight to give the family time to say goodbye. Her hands cramped and blistered as the family screamed and prayed.

…when the same family called to ask if the staff had really done everything they could, “it was like being punched in the gut,” she told me. She had given everything—to that patient, and to the stream of others who had died in the same room. She felt like a stranger to herself, a commodity to her hospital, and an outsider to her own relatives, who downplayed the pandemic despite everything she told them. In April, she texted her friends: “Nothing like feeling strongly suicidal at a job where you’re supposed to be keeping people alive.”

Shortly after, she was diagnosed with post-traumatic stress disorder, and she left her job.

If that’s not enough, watch these videos of nurses…

Full disclosure – a family member works at Dartmouth-Hitchcock in the emergency department – this is what they deal with every day.

What this means for you.

• Do NOT have an accident, stroke, appendicitis, or slip on ice
• If hospitals in your area are still open for elective procedures, they won’t be in the very near future. 
• Health insurance costs are going to spike
• More of your unvaxxed family and friends are going to die a miserable death.
• Healthcare is going to be harder to get and more expensive, waiting times will be much longer, and the healthcare experience will be more mechanical and less caring.

Get vaccinated and wear a mask. If you don’t, then take responsibility for your decision.

The healthcare system is in perilous shape.

The fourth wave of COVID is pushing many workers past exhaustion, anger and frustration to despair.  If you are one of the anti-vaxxer, anti-mask, “personal freedom” people, this is on you.

Healthcare workers say:

• “You feel expendable. You can’t help thinking about how this country sent us to the front lines with none of the equipment needed for the battle,”
• “You look at staffing, preparedness, what the priorities were for many hospitals during the crisis, and it’s clear the industry is driven by profits rather than well-being of patients or health workers,”
• “As psychiatrists, I think we were all seeing the warning signs. You had doctors suddenly writing their wills, talking about how they felt abandoned to die, how the only choice they faced was being called a hero or coward,”
• “It’s hard to let go of the anti-mask thing…The worst thing is the panic you see on dying people’s faces when they realize this could be it…”
• “There have been many healthcare workers who have not only thrown in the towel, but have said they are never coming back,”

Over half a million healthcare workers quit their jobs in August, and more have left since then. Three of every ten healthcare workers are considering quitting.

Traveling nurses in many areas are getting north of $100 an hour, while their full-time colleagues are making less than half of that. Yet traveling nurse staffing agencies have more than 40,000 unfilled vacancies.

Oh, and the average nurse is over 50 years old, and that has not been an easy 25 years with often-brutal shift hours, lots of standing, lifting and emotional stress. Combine wage disparities with the risk of bringing COVID home to family and children with the pandemic of the unvaccinated and we get…

a disaster in the making.  The toll is not only personal, it is national.

Hospitals in several states are again postponing all but emergency surgeries.

Some areas are so overwhelmed patients requiring higher-level care are being shipped out of state.

What’s truly awful about this is so much of it was preventable.

What’s even worse is the continued refusal by many to get vaccinated and wear masks. These people are destroying our healthcare system and the people who take care of us.

This is personal for me; family members are front-line healthcare workers and I see the toll this is taking on them every day.

What does this mean for you?

Get vaccinated. Wear a mask. Take responsibility. 

Hospitals in Idaho, Alaska, Alabama, Montana and other states are rationing care – a painful decision necessitated by unvaccinated patients suffering from severe COVID infections overwhelming available facilities.

In Idaho, the State Department of Health and Welfare now “allows hospitals to allot scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients.

• In Kootenai Health’s ICU, one critical care nurse might be supervising up to six patients with the help of two other non-critical care nurses. The usual ratio is one ICU nurse for one ICU patient.
• “nearly 92% of all of the COVID-19 patients in St. Luke’s hospitals were unvaccinated. Sixty-one of the hospital’s 78 ICU patients had COVID-19.”

A Montana hospital “was also forced to implement crisis standards of care amid a surge in COVID-19 patients” when all critical care beds were already occupied.

In Houston Texas, a military veteran died when no hospitals near him had space or staff to treat a sudden case of gallstone pancreatitis.

A 73 year old Alabama man died of a cardiac condition when the hospital in his hometown of Cullman, Ala., contacted 43 others in three states — and all were unable to give him the care he needed. Three weeks ago there were 60 more ICU patients than beds in ICUs.

There are many. many more examples.

This. Should. Never. Have. Happened.

And wouldn’t have if not for COVID deniers, anti-vaxxers, and the media channels that gave them a megaphone to spread their nonsense.

Getting anti-vaxxers to change their views is incredibly difficult; the media is replete with stories of COVID patients telling their doctors they don’t believe they have the virus (look them up).

Medical providers’s option is stark indeed – treat the patients with a self-inflicted disease, or send them home…and treat the heart attack, car crash, pancreatitis, stroke, burn, asthma attack and other patients.

It has come to this.

What does this mean for you?

With personal choice comes personal responsibility.