As The Washington Post reports, hospitals in New Mexico have cut down everything else in order to make more room for COVID-19 patients. And it’s not enough. The state is preparing to move to “crisis standards” to deal with a crisis that is filling not just ICUs and emergency rooms, but every floor and every department of every available hospital.
That term may not raise an alarm, but there are others that are more familiar: Triage and rationing. Where New Mexico is going next is a combination of sending home patients who would normally be hospitalized, and bypassing care for patients whose cases are deemed too serious for successful treatment.
But what New Mexico is about to do officially is already being done unofficially at hospitals across the country.
As The Atlantic reports, the United States actually dodged the “worst case scenario” in the initial spring surge, and the larger group of cases that came in the summer. While that first surge took far too many lives in New York and surrounding states, that was largely due to how a lack of testing disguised the scope of the onslaught, and an unfamiliarity with the disease that made treatment of COVID-19 victims a moving experiment. That initial surge, like the pulse of cases that moved through Arizona, Texas, and Florida in July, was largely a regional phenomenon. Which meant that personnel—from military doctors and nurses to civilian volunteers—and resources could be redistributed to hit the areas under the worst assault. Regional health systems strained, but with extra hands and temporary facilities added, largely held up to the wall of new cases.
But this third surge is not a regional phenomenon. It’s an everywhere phenomenon. It’s coming at a time when not only are medical personnel everywhere exhausted and traumatized, but thousands of the people who have been fighting on the front line of this pandemic are dead. It’s no longer possible to rob Peter to pay Paul, because both are drowning.
In early November, the number of hospitalizations in the United States hit the critical number of 60,000. That was the peak number of hospitalizations nationwide at the worst point of the previous surges. But this time, the number of hospitalizations just keeps going up.
Even as officials were begging people to stay home over the Thanksgiving holiday, and even as Donald Trump was refusing to say a word about COVID-19 while continuing to complain about the election, hospitals reached their capacity. And exceeded their capacity. Hospitals also made changes that have been widely misinterpreted as showing things getting “better.”
For months, the relationship between positive tests for COVID-19 and the number of people being hospitalized had been consistent. Over the spring and summer, around 9.5% of those who tested positive were admitted to the hospital within the following week. That number was still holding, right up to October. Then something started to happen. As the total number of hospitalizations increased, the percentage of new cases resulting in hospitalization began to go down. By the end of October, it was under 8%. By the middle of November, it was under 7%. That number is still going down now.
But it’s not going down because the disease is becoming any less dangerous. In fact, the case fatality rate—the percentage of cases that end in death—has actually begun moving upward after declining from almost the beginning of the pandemic. The percentage of people being admitted to the hospital for COVID-19 has decreased week, over week, over week not because people are not getting seriously ill, but because there is no room.
Again, while New Mexico may about to be putting triage in place officially, but all over the nation doctors are already doing it unofficially. They are raising the bar for how sick someone has to be before they get a hospital bed. In some cases, that bar is more or less infinitely high. It’s dependent on someone leaving the hospital—living or otherwise—before there is a place for someone new. Emergency rooms are becoming holding pens, and patients are being sent home in full knowledge that they are likely to die.
And Republicans … still think it’s funny.