A January of COVID-19 Like No Other, but Hope is on the Horizon

Nearly three years ago, no one could have predicted that we would soon be in the midst of the public health crisis of our lifetime; 1.35 million daily cases, 136,640 in the hospital, and 1,700 dying from COVID-19 related illness per day. As new individuals get the Omicron variant related symptoms including: a scratchy throat, muscle aches, lower back pain, fatigue, runny nose, nausea, and a headache they find themselves unable to get a doctor’s appointment and unable to find rapid viral antigen tests or the gold standard PCR test to determine if they have the COVID-19 virus. The United States (US) Public Health System has reached a breaking point and is on the brink. Crisis of Care Standards are being implemented in several states and others have them at the ready. This means decisions are being made as to who gets certain levels of care and treatment and who does not. Emergency Departments are temporarily closing and critical services like substance abuse day treatment programs or surgeries are being canceled. Hospital beds are full in some areas and there are not enough healthcare workers to care for patients in 25% of hospitals across the country. This equates to 1 out of every 4 hospitals in the US reporting critical staffing shortages to the US Department of Health and Human Services (HHS). Another 100 US hospitals anticipate being in a staffing crisis within the week.

Hospital expenses per patient are up over 26% from pre-pandemic levels as a result of premiums being paid to try and procure temporary agency nurses to staff positions vacated by burnout, retirement, and/or caregivers becoming sick with COVID-19 themselves. In many states, finding doctors and nurses has become so difficult that what would ordinarily be a violation of basic infection control principles are being put aside as staff who have COVID-19 themselves are being asked to come to work sick in protective gear to care for patients. The HHS, Federal Emergency Management Agency (FEMA), and National Guard are all deployed to help with the critical hospital staffing crisis. Funding is available primarily through FEMA Public Assistance (PA), HHS Provider Relief Fund and other programs. Despite all of this, the US’s healthcare system is falling behind.

UnSplash: Mufid Majnun

While the next four to six weeks will be tough, hope is on the way and there is reason to be optimistic about better times ahead in the very near future. Public health experts who have looked at data and trends from recent Omicron outbreaks in South Africa and England show that Omicron cases are likely to peak in the US starting this week in parts of the country through the end of January. By February, we should begin to return to a level of virus in our communities that we can safely live with, meaning our hospitals will not be overwhelmed and cases and deaths per day will decrease.

The tide will not turn on its own; it will take collective effort us to return to the “new normal” way of living with COVID-19 that the world began adjusting to in the fall of 2021. For us to return to this reality – one that we will be living with for many years to come – we must try to be as safe and respectful of our health and the health of others by:

1. Being thoughtful about your daily interactions with others. The kind of activities you use to do over the summer or fall of 2021 such as gathering with vaccinated family and friends and dining indoors are now likely to expose you to the contagious strain of Omicron. According to the most recent Johns Hopkins Coronavirus Resource Data, 1 out of every 4 people tested each day have COVID-19. This means the likelihood of someone having COVID-19 in an indoor environment with greater than 4 people is high. Choose activities that you must do such as school, work, doctors’ appointments or safe gatherings to balance your mental health and well-being. This is only for a short period of time.
2. Wearing a high-quality fitted mask. The Centers for Disease Control and Prevention (CDC) is expected to change its guidance by recommending the wearing of N-95 or KN95 masks only. This is because we now have a good supply of these masks and given the contagiousness of the new variants which require well-fitting high filtration masks versus cloth masks. If everyone wore a N95 or KN95 mask in public, it is likely we could end this pandemic and spread of virus quickly.
3. Getting vaccinated and boosted. Vaccines are extremely protective against hospitalizations and death from COVID-19. 60-75% of all current COVID-19 Omicron variant hospitalizations are in unvaccinated individuals. The remainder are either vaccinated but immunocompromised, have underlying conditions or were admitted for another reason and then test positive for COVID-19.
4. Testing frequently. Test at the onset of any symptom or prior to getting together with others for a family gathering or event. Testing as close to the event as possible is important as rapid antigen tests are likely to only pick up higher viral loads when you are most contagious.

Moreover, as a nation, we must start now to learn to live with COVID-19 like we do other viruses. We must start to fund programs and initiatives to mitigate the effects of future virus surges and pandemics as well as prevent our hospitals from ever being overwhelmed in the future by:

1. Prioritizing federal funding for Public Health Preparedness. Hospitals are hemorrhaging money implementing emergency measures to take care of patients. 20 years ago, following the September 11^th attacks, the federal government created the Hospital Preparedness Program (HPP). Funding must be increased and tied to specific standardized preparedness deliverables that will strengthen our public health preparedness for the future.
2. Creating standby critical care bed and staff capacity in our hospitals. Hospital bed capacity has been shrinking across the country for decades as more and more care shifts to outpatient settings and healthcare organizations look for improved efficiency in the cost of care. We must find ways to have beds and public health doctors and nurses at the ready to scale up in times of crisis. Easier said than done, but this is a challenge that we must get creative about.
3. Enhance standardized seasonal public health measures and messaging. The US has arguably the greatest healthcare system in the world with leading experts and scientists and doctors. We must find ways develop standardized national public health measures and messaging that are easy for all to understand and subsequently follow. This will be essential for mitigating future virus outbreaks as we balance maintaining a fully functioning society with reasonable public health measures such as hygiene, masking, ventilation, and vaccination guidelines for all.

Jeff Bokser is Hagerty Consulting’s Vice President of Healthcare Programs with strategic expertise in all aspects of healthcare operations, finance, crisis management, and recovery. Jeff has over 20 years of experience as a senior leader at NewYork-Presbyterian and Yale New Haven Health. He advanced performance and increased revenue in clinical and nonclinical settings and led innovation in daily operations and care delivery processes. Jeff is nationally recognized in the healthcare sector for his transformational leadership in the areas of emergency and crisis management; security and safety; pandemic and surge planning; and business continuity. Jeff was the system-level executive responsible for Emergency Medical Services, Emergency Management, Business Continuity, Crisis Management, Safety, Security, and Regulatory Compliance for the entire continuum of the NewYork-Presbyterian Hospital & Healthcare System enterprise. He served as Incident Commander guiding 40,000+ employees through numerous internal and external emergency response and recovery operations including Hurricane Sandy, Ebola, H1N1, and 9/11.