COVID-19 Surges Threaten to Overwhelm Hospital Staff

Christine Lehmann, MA

November 11, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

As the United States continues to set records for coronavirus cases, the inevitable has been the result: Hospitalizations, too, are hitting higher levels than at any other time in the pandemic.

Nearly 62,000 people were hospitalized with COVID-19 in the U.S. on Tuesday, more than ever before, according to the COVID Tracking Project.

Beds filled as new COVID-19 cases rose 20% across the United States last week. The number of hospitalized COVID patients shot up 14% November 5, straining hospital resources and overworked staff.

Across the country, states have been slammed hard with new COVID cases, overwhelming local hospitals. In the Texas city of El Paso, officials are setting up an alternate care facility to help relieve medical centers.

The Northeast appears next, with surges in new COVID-19 cases in all six New England states, according to The Boston Globe.

The Midwest is now seeing its highest spike in COVID-19 hospitalizations since the pandemic started. COVID-19 cases now take up more than 14% of inpatient beds in Montana, North and South Dakota, Wisconsin, and New Mexico, according to data from the U.S. Department of Health and Human Services.

The Mayo Clinic, which serves patients across the Midwest, is without 1,000 employees who either have COVID or have been exposed.

In Illinois, where hospitalizations have been climbing rapidly, some hospitals are postponing elective surgeries and expecting staffing shortages.

Aspirus health system, which operates 10 hospitals in Wisconsin and upper Michigan, including six small, critical access hospitals in rural areas, has seen COVID-19 cases climb since early October. COVID patients now make up 35% of the system's total patients, says Matt Heywood, CEO and president of Aspirus in Wausau, WI, which serves 600,000 people spread over 30,000 square miles.

Because large urban hospitals are reaching their own bed capacities, rural hospitals may no longer be able to transfer the most critical COVID-19 patients who would benefit from an "ECMO" machine that bypasses the heart and lungs and pumps oxygen directly into the body's tissues.

"It's very stressful. We have to keep calling hospitals daily until a spot opens up. We have sent patients to Shreveport, Tyler, Dallas, wherever an opportunity comes up," says Terry Scoggin, CEO of Titus Regional Medical Center in the city of Mount Pleasant in northeast Texas.

As beds fill up, hospital administrators are even more worried about their staff ― many are out sick, nurses are leaving for better pay, and fatigue and stress have set in.

"Hospitals all over America ― their biggest worry is their workforce, especially in rural areas, where they lack a deep bench of practitioners. If one or two doctors or nurses are out sick, they're struggling with how to take care of all the patients coming to them," says Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association in Washington, DC, which represents urban and rural hospitals.

Staffing Problems

Many hospitals in suburban and urban areas are facing their third major surge in COVID-19 cases. "Their personnel are tired and stressed from fighting the pandemic for many months," says Foster.

Aspirus health system has about 6,000 caregivers. "What keeps me up at night is that I worry about our staff and their ability to keep up the pace, balancing work with their personal lives, which often means homeschooling children and/or helping parents/grandparents. We're asking more of them every day ―how long they can keep up this pace? At what point does the pressure become too great and things become untenable?" says Heywood.

"With each surge there is a different obstacle. During the first surge, we didn't have enough testing; the second surge, it was PPE; and now it's staffing," says Scoggin.

Hospitalized COVID-19 patients require more medical care because they are usually older and sicker from other health conditions. A nurse who typically averages five patients on a medical surgical floor will be assigned only two on a COVID-19 floor. In the intensive care unit, the nurse-to-patient ratio is even lower ― typically one-to-one, says Scoggin.

"The issue is volume and capacity. We have put such a focus on beds when it needs to really be on workforce," says Alan Morgan, CEO of the National Rural Health Association in Washington, DC.


Even if hospitals add COVID-19 beds, they need enough doctors and nurses to take care of those patients, especially if they're in the ICU.

And that's challenging when so many staff are out sick. At Aspirus, 309 hospital employees out of 8,700 caregivers tested positive for COVID-19 or had symptoms as of Nov. 9, says Heywood.

At Titus Regional Medical Center, which serves 32,000 people in four counties, more than 100 of 750 employees tested positive for COVID-19 last week. This coincides with a third surge in COVID-19 cases, which have filled nearly one-third of the hospital's average bed occupancy of 60, says Scoggin.

Titus Regional Medical Center is facing a shortage of nurses and paramedics because of illness, but some have left for better-paying contract positions on the East Coast or West Coast, says Scoggin. The state has provided some nurses and paramedics to fill in those gaps.

Doctors are staying, and if they test positive for COVID-19, they can use telehealth to take care of some patients, Scoggins says.

Montana's hospitals also have staffing shortages. The Montana Nurses Association says it's asking local nursing unions to encourage their members to take extra shifts, and the association is also helping state health officials get the word out about the Montana Mutual Aid System, which provides volunteer staff to fill in gaps, according to Montana Public Radio.

Registered nurses, licensed practical nurses, paramedics, emergency medical technicians (EMTs), and certified nursing assistants are the positions most requested from the Montana Mutual Aid Systemradio's blog post.

Aspirus has hired contract staff and created hiring bonuses to attract more nurses. The hospital system also got help from a federal disaster medical assistance team of doctors, nurses, and other health care personnel so more beds could be opened at one of the critical access hospitals. That served as "step-down" unit for COVID-19 patients discharged from the regional medical center, which freed up beds for other critically ill patients, says Heywood.

The disaster medical assistance teams are intended to help the federal Public Health Service Corps, which has been filling in during the pandemic but can't cover the entire United States, says Foster.

Taking Preventive Measures Seriously

Morgan says that when he recently visited towns in Missouri and Kansas as the CEO of the National Rural Health Association, he was surprised that so few people gathering at public places like cafes were not wearing masks or social distancing.

"Many rural populations have felt immune to the coronavirus because they saw the first wave come and go, and their communities weren't affected," he says. "Now, we're hearing from our members that it has permeated rural towns across the U.S."

Scoggin says, "It's difficult to get people to wear masks. I tell them it's not political and that although the mortality rate is low, we don't know who that will impact." He does Facebook Live COVID updates with local community leaders and encourages everyone to take precautions.

Wisconsin reflects "a 50/50 split between people who accept that the disease is serious, wear masks, and try to manage it and those who don't," says Heywood.

He has worked with local chambers of commerce since May to get the message out to businesses that "we want to try to help keep them open by providing symptom checkers and reinforcing prevention so we can all manage and keep the spread down," he says.

The real issue is "we need to stop the coronavirus from spreading. That goes back to three things ― wearing masks, social distancing, and hand washing ― and staying home when you're sick. If we can get people to do that consistently, hopefully the surge will slow down and we can get this over quicker so we don't have the stress on doctors and staff," he says.


Matt Heywood, CEO and president, Aspirus health system, Wausau, WI.

Terry Scoggin, CEO, Titus Regional Medical Center, Mount Pleasant, TX.

Nancy Foster, vice president for quality and patient safety policy, American Hospital Association, Washington, DC.

Alan Morgan, CEO, National Rural Health Association, Washington, DC.

The COVID Tracking Project: "US Currently Hospitalized."

The COVID Tracking Project Blog: "Cases Still Rising, Hospitalizations Spiking, Nursing Homes in Trouble: This Week in COVID-19 Data, Nov 5."

U.S. Department of Health and Human Services Public Protect Data Hub. "State Representative Estimates for Hospital Bed Occupancy Hospitalizations."

The Boston Globe: "Pandemic worsens across New England, leading many to wonder what went wrong ― and whether there is time to reverse course."

Reuters: "COVID-19 cases, hospitalizations surge, governors crack down."

The Mayo Clinic: "Extracorporeal membrane oxygenation (ECMO)."

Montana Public Radio: "Montana Hospitals Facing Staff Shortages Amid COVID-19 Surge."


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.