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Currently, more than 100,000 Americans are in the hospital with COVID-19, and that's not so far below the all-time hospitalization peak in January. NPR's Will Stone reports that has some states talking about rationing care.
WILL STONE, BYLINE: After the winter, Dr. Bruce Siegel thought hospitals had gone through the toughest days of the pandemic.
BRUCE SIEGEL: And instead, we find ourselves back mired in disease and in death because we didn't get enough people in America vaccinated.
STONE: Siegel is president of America's Essential Hospitals, a group that represents hundreds of public hospitals across the U.S.
SIEGEL: We're in a very dangerous place, given the level of our surge right before our kids go back to school and right before we start spending a lot more time indoors.
STONE: More than 10 states have reported record hospital admissions during the surge. And the U.S. is averaging more than a thousand deaths from COVID a day.
SIEGEL: We are right on the edge of entering into crisis standards of care. And I hope we don't get to that point, but it could very easily happen.
STONE: That's a formal plan that directs hospitals how to ration medical care when resources are scarce. Kenneth Krell is an ICU doctor in eastern Idaho.
KENNETH KRELL: And it's worse than ever with, at this point, seemingly no end in sight.
STONE: Nurses overwhelmed, ICU patients boarded in the emergency room, doctors scouring the state for the last bed - Krell says it's like this all over Idaho.
KRELL: So by no means are we, at this point, delivering a usual and customary standard of care.
STONE: Which is why Idaho's Republican governor, Brad Little, has said hospitals are on the brink of activating crisis standards. Krell says this is the worst-case scenario for COVID and non-COVID patients.
KRELL: Who gets the most immediate care by their probability of survival and how we can save the most lives? There's a huge downside. We're going to create panic in the state.
STONE: Modeling shows hospitalizations may have peaked in parts of the Southeast, like Texas and Florida. But in much of the country, cases are still increasing.
ARUNA ARORA: I think it has really impacted and fragmented all of health care right now.
STONE: Dr. Aruna Arora is president of the Medical Association of the State of Alabama. Like so much of the country, she says the biggest limitation isn't physical beds or ventilators; it's staff.
ARORA: Everyone is short nurses. EMS response times are a lot slower. Patients are having to wait in the ERs for long periods of time.
STONE: The point of moving to crisis standards is partly to provide a formal road map and legal protection for clinicians. Dr. Eric Toner at the Johns Hopkins Center for Health Security says some states have not officially declared crisis standards, but...
ERIC TONER: In the absence of that, doctors, nurses, on their own are the only ones left to make, you know, these gut-wrenching decisions.
STONE: Toner says there are guidelines for when and how to triage patients when the health care system is overwhelmed. And the aim is to do everything you can to avoid actually going to crisis standards, except Toner worries that isn't happening.
TONER: We're not balancing patients enough between hospitals. We're not sharing resources as well as we should. So we have - despite, you know, over a dozen years of working on this problem, what we're seeing is chaos.
STONE: In New Mexico, things are bad, too. There are waiting lists for ICU beds. And the state has warned, like it did last winter, about the possibility of rationing care. But Dr. Jason Mitchell with Presbyterian Healthcare Services says he thinks hospitals there are better prepared and can avoid it.
JASON MITCHELL: We really have had all of our hospitals in it together, working together, and the state partnering with us. So that's probably the thing that's gotten us through this more than anything.
STONE: The truth is they've had a lot of practice.
Will Stone, NPR News.
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