The ChristianaCare health system in Wilmington, Delaware, implemented “crisis standards of care” for the first time in its 130-year history last month as a fresh wave of Covid-19 infections ripped through the Northeastern U.S.
That gives the organization’s three hospitals, which have more than 1,200 beds, flexibility to treat more than one patient in private rooms and reschedule critical procedures to meet the onslaught of Covid cases.
“There’s nothing mild about what’s going on in our hospital and in our ICUs, particularly if you are unvaccinated or unboosted,” said Dr. Ken Silverstein, the chief physician executive of ChristianaCare. Silverstein was alluding to reports that the highly contagious omicron variant produces milder infections than previous strains.
A shortage of monoclonal antibodies, which were standard care for Covid patients before they proved little use against omicron, has also forced ChristianaCare to make “clinical prioritization decisions about who’s most eligible,” Silverstein said. “Not who’s eligible, who’s most eligible.”
Covid deaths rise
The daily death toll from Covid rose to an average of more than 2,400 fatalities over the previous seven days as of Monday, up 39% over the past two weeks and the highest level in about a year, according to data compiled by Johns Hopkins University.
Jennifer Nuzzo, head of epidemiology at Johns Hopkins Covid Resource Center, said Covid deaths may rise even more because states with lower vaccination rates got hit later by omicron and haven’t experienced the full brunt of the variant yet. She said it’s a tragedy that people are still dying when vaccines are available that protect against severe illness.
“Any time we have deaths after the development of a vaccine — that largely takes off the table the possibility of death — is a tragedy,” Nuzzo said. “There’s no way around that this is a bad development for the pandemic.”
Vaccines weren’t widely available the last time Covid deaths were this high in America. Pfizer and Moderna’s shots didn’t get emergency approval until December 2020, followed by Johnson & Johnson’s about three months later. Just 28 million Covid shots had been administered by this time last year with 4.7 million people getting a second dose. As of Monday, almost 250 million Americans have received at least one shot, and more than 88 million of them have received both primary doses and been boosted.
As infections have soared lately, the vaccines have at least prevented serious illness and death from surging at the same rate; still, with one-quarter of Americans yet to get a single shot, many remain susceptible.
Reported Covid deaths generally lag rises in cases. States that have not yet peaked in infections will likely do so within the next two weeks, with peak deaths following about two weeks later, said Dr. Scott Braithwaite, professor of population health and medicine for NYU Langone Health.
Dr. Shereef Elnahal, CEO of Newark, New Jersey-based University Hospital, said it’s not yet clear if his facility is fully over the hump in Covid-related deaths in this wave. After an increase in deaths over the past couple of weeks, the hospital has seen a plateau in ICU patients and fatalities.
About half as many patients who come in with Covid end up needing intensive care in this wave as compared with previous surges, Elnahal said. “It’s just so transmissible that the absolute numbers of people needing ventilators looked similar to previous waves,” he said.
Some parts of the country are seeing encouraging signs, and cases and hospitalizations are easing nationwide. Hopkins data shows that U.S. cases surged to a pandemic high of close to 1 million new infections a day in mid-January. The country is now reporting a seven-day average of about 450,000 new cases per day, down 36% over the past two weeks.
The roughly 140,000 patients currently in U.S. hospitals with Covid is also down from the recent peak of 159,400 on Jan. 20, according to a seven-day average of Department of Health and Human Services data.
This easing is most evident in the Northeast, where cases were already on the rise when the omicron variant spread earlier than in other parts of the country. Cases and hospitalizations are falling more sharply in that region than others, but it’s now feeling the effects of getting hit first by omicron, with population-adjusted daily deaths higher than anywhere else.
The number of ChristianaCare patients has declined by 33% in recent weeks, but its hospitals were still operating at 99% capacity as of late last week. That includes patients who came to the hospital because of Covid as well as those who were admitted for something else and then tested positive. All patients who test positive for Covid, regardless of why they were admitted, need extra care and resources to isolate them from other patients and staff, which is taxing on the system, Silverstein said.
“There are a lot of sick people, with Covid and because of Covid,” he said.
The mortality rates, the percentage of people with Covid who ultimately succumb to the virus, are lower in the Northeast during this wave than previous surges. But other parts of the country that have lower vaccination rates may not be as lucky, doctors say.
“When you look at the delta period and last winter, as cases increased, hospitalizations and deaths increased in a similar pattern,” Centers for Disease Control and Prevention Director Dr. Rochelle Walensky told reporters last week. “Strikingly, when we compare the past month when omicron was the predominant variant, we see a clear separation between cases, hospital admissions, and deaths.” She attributed the lower death rates to the vaccines, which have proven to provide good protection against dying from Covid.
Cases are currently five times higher than they were during the delta wave, Walensky said, but hospitalizations and deaths haven’t increased at the same rate. Nuzzo said the current wave of infection, hospitalization and death would have been much worse without the vaccines.
“Part of why omicron looks more mild is because it is finding societies that have already amassed a fair amount of immunity from prior infection or vaccination,” Nuzzo said.
In the New York and New Jersey area, “many of the cases did not become fatal, and/or extremely serious because of the high vaccination rates,” said Perry N. Halkitis, dean of the Rutgers School of Public Health. ”But in the rest of the country, that may not be the case.”
That’s both because of lower vaccination rates and because of less-robust hospital health care in other parts of the country, he said, which could even mean a peak in total deaths in those areas surpassing those from last winter’s surge.
“We are in this at least to the end of February, for the rest of the country,” he said.
That’s because so many people in the U.S. have yet to get vaccinated; more than 80 million haven’t received a single shot. Omicron generally makes people less sick than the delta variant, but the rapid jump in new infections over the past month means deaths will continue to follow.
“As long as we have tens of millions of people who will not get vaccinated, we’re going to have full hospitals and needless deaths,” President Joe Biden said earlier this month.
Although omicron generally doesn’t make people as sick as past strains, Walensky said that doesn’t mean the variant is mild. She called on the public to wear masks and get vaccinated and boosted to help ease the burden on hospitals.
“I know many people are tired, but many of our hospitals are still struggling beyond capacity,” Walensky said. “It’s been a long two years. However, please now do your part to lean into this current moment.”