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.