A1 0 eZ Re the washington post.monday, july 27 , 2020
the coronavirus pandemic
BY FRANCES STEAD SELLERS
AND ABIGAIL HAUSLOHNERshortages of health-care work-
ers are worsening in Houston, Mi-
ami, Baton Rouge and other cities
battling sustained covid-19 out-
breaks, exhausting staffers and
straining hospitals’ ability to cope
with spiking cases.
That need is especially dire for
front-line nurses, respiratory
therapists and others who play
hands-on, bedside roles where
one nurse is often required for
each c ritically i ll p atient.
While many hospitals have de-
vised ways to stretch material re-
sources — converting surgery
wards into specialized covid units
and r ecycling masks and gowns —
it is far m ore difficult t o stretch the
human workers needed to make
the s ystem function.
“A t the end of the day, t he capac-
ity for critical care is a balance
between the space, staff and stuff.
And if you have a bottleneck in
one, you can’t take additional pa-
tients,” said Mahshid Abir, a s enior
physician policy researcher at the
Rand Corp. and director o f the
Acute Care R esearch Unit (ACRU)
at the University of Michigan.
“You have to have all three... Y ou
can’t have a ventilator, but not a
respiratory therapist.”
“What this is going to do is it’s
going to cost lives, not just for
covid patients, but for everyone
else in t he hospital,” she warned.
The increasingly fraught situa-
tion reflects packed hospitals
across l arge swaths of the country:
More than 8,800 c ovid-19 p atients
are hospitalized in Te xas; Florida
has more than 9,400; Georgia has
more than 3,100; and at least a
dozen other states also have more
than a thousand hospitalizations,
according to data compiled b y The
Washington Post.
Facilities in several states, in-
cluding Te xas, s outh Carolina and
Indiana, have in recent weeks re-
ported shortages of such workers,
according to federal planning doc-
uments viewed by The Post, pit-
ting states and hospitals against
one a nother to recruit workers.
on Thursday, Louisiana Gov.
John Bel edwards (D) said he
asked the federal government to
send in 7 00 health-care workers to
assist besieged hospitals.
“even if for some strange rea-
son... y ou d on’t c are about c ovid-
19, you should care about that
hospital capacity when you have
an automobile accident or when
you h ave your h eart attack or your
stroke, or your mother or grand-
mother has that stroke,” edwards
said at a n ews conference.
In Florida, 39 hospitals have re-
quested help from the state for re-
spiratory therapists, nurses and
nursing assistants. In south Caroli-
na, the national Guard is sending
40 medical professionals to five
hospitals in r esponse to rising cases.
Many medical facilities antici-
pate their staffing situation will
deteriorate, according to the plan-
ning documents: Texas is hardest
hit, with south Carolina close be-
hind. needs range from pharma-
cists t o physicians.Hot spots stretch across the
country, f rom Miami and Atlanta t o
southern California and the Rio
Grande Valley, and the demands
for help are as diffuse as the suffer-
ing.
“What we have right now are
essentially three new Yorks with
these three major states,” White
House coronavirus task force co-
ordinator Deborah Birx said Fri-
day during an appearance on
nBC’s “ To day” s how.
But t he diffuse transmission r e-
quires innovative thinking and a
different response from months
ago in new York, experts say.
While some doctors have been
able to share expertise online and
nurses have teamed up to relieve
pressures, t he strains a re growing.
“We missed the b oat,” said sere-
na Bumpus, a leader of multiple
Te xas nursing organizations andregional director of nursing for
the Austin Round Rock Region of
Baylor scott and White Health.
Bumpus blames a lack of coor-
dination among national and
state officials. “It feels like this
free-for-all,” she said, “and each
organization is just kind of left up
to t heir own d evices t o try to figure
this out.”
In a disaster, a hospital or local
health system typically brings in
help from neighboring communi-
ties. But that standard emergency
protocol, which comes into play
following a hurricane or tornado,
“is predicated on the notion that
you’ll have a concentrated area of
impact,” said Christopher nelson,
a senior political scientist at Rand
and a p rofessor at t he Pardee Rand
Graduate s chool.
That is how Texas has func-
tioned in the past, said JenniferBanda, vice president of advocacy
and p ublic policy a t the Texas Hos-
pital Association, recalling the in-
flux of t emporary h elp after H urri-
cane Harvey deluged Houston
three y ears a go.
It is how the response took
shape early in the outbreak, when
health-care workers headed to
hard-hit new York.
But the sustained and far-flung
nature of the pandemic has made
that approach unworkable. “The
challenge right now,” Banda said,
“is we are taxing the system all
across t he country.”
Theresa Q. Tran, an emergency
medicine physician and assistant
professor of emergency medicine
at Houston’s Baylor College of
Medicine, began t o feel the crunch
in June. only a few weeks before,
she had texted a friend to say how
disheartening it was to see c rowdsof people reveling outdoors with-
out m asks on M emorial Day week-
end.
Her fears were borne out when
she f ound herself making call a fter
call after call from her eR, unable
to admit a critically ill patient
because her hospital had run out
of ICU space, but unable to find a
hospital able to take them.
Under normal circumstances,
the transfer of such patients —
“where you’re afraid to look away,
or to blink, because they may just
crash on you,” as Tran describes
them — happens quickly t o ensure
the close monitoring the ICU af-
fords.
Those critical patients begin to
stall in the eR, stretching t he abili-
ties of the nurses and doctors at-
tending to them. “A lot of people,
they come i n, a nd they need a tten-
tion immediately,” Tran said, not-
ing t hat emergency physicians are
constantly racing against time.
“Time is brain, or time is heart.”
An eR physician in the Rio
Grande Valley said all three of the
major trauma hospitals i n the area
have long since ceased being able
to absorb new ICU patients.
“We’ve been f ull for weeks,” said
the physician, who spoke on the
condition of anonymity because
he feared retaliation for speaking
candidly a bout the conditions.
“The truth is, the majority o f our
work n ow in the emergency depart-
ment is ICU work,” he said. e ach
one of those critically ill patients
needs a nurse to stay w ith them.
When ICU space does open up
— maybe two, t hree, four beds — i t
never feels like relief, he said, be-
cause in the time it takes to move
those patients out, 20 new ones
arrive.
even with the help his hospital
has received — the procuring of
masks and gowns and the dou-
bling of the staff i n recent weeks
with relief nurses and other health-
care workers — it is not enough.
The local nurses are exhausted.
some quit. even the relief nurses
who helped out in new York in the
spring s eem h orrified by t he s cale o f
the d isaster i n south Te xas, he said.
“If no one comes and helps us
out and gives us the ammo we
need to f ight t his thing, we a re not
going to win,” the doctor s aid.
see NURSES on AGrowing shortages of health-care workers strain hospitals
tasos KatopodIs/getty Images
Shoes are placed at a vigil for nurses who’ve died of covid-1 9 at the U.S. Capitol last week in D.C. Attendees urged the Senate to pass the
Heroes Act, which would provide personal protective equipment and regulatory protections for front-line health care workers.Author of “Too Much and NeverEnough: How My Family Created theWorld’s Most Dangerous Man”Hosted by The Post’s Robert Costa onMonday, July 27 at 5:30 p.m. ETTo receive a live stream reminder for this event,visit: washingtonpostlive.com@POSTLIVE #POSTLIVE