'I'm a Doctor in Illinois, We're Scared of Running Out of Hospital Beds'

I remember the first shift back in March where I had a number of COVID-19 patients—nobody really knew what to do. This was before universal mask mandates and before we knew that anyone could contract the virus. The first patient I saw was actually presenting with belly pain and it looked like they had appendicitis, but it was COVID-19.

In that first surge, Chicago where I work was hit pretty hard, but not as badly as places like New York or Detroit. Our hospital saw a huge number of patients sick with the virus, but we shut down nearly all elective procedures and essentially turned the whole hospital into a COVID-19 hospital—we tripled or quadrupled our intensive care unit (ICU) space. The fact that we scraped through without being totally overwhelmed was both close and only because of all the adjustments we made.

Fortunately, by summer we were only seeing a few COVID-19 cases a day, mostly healthy people with flu-like symptoms who were doing OK. Then, starting in the fall, cases have really started to pick up again.

We first started to see a higher number of new patients with COVID-pneumonia and low oxygen levels, and since then the case numbers have been ticking up. It's not yet at the same volume we were at in spring, but we are seeing the numbers going up every shift along with the intensity of how sick people are. We are seeing the low oxygen levels and multi-system illness, more of a variety in the type of symptoms and surprise patients who come in with one problem and end up being COVID-19 positive and develop a fever later.

One of the things I've already seen with this second surge is that while total ICU admissions have only gone up a little overall in the last two weeks, the proportion that are COVID-19 patients has increased dramatically. So we are worried that some top-level numbers do not reflect how bad the situation is getting and we are on track to run out of ICU beds in the lead up to Thanksgiving.

Although we are adapting once more, looking at the numbers we're seeing on the ground now along with the projections, it certainly looks like not only are we going to run out of ICU space by Thanksgiving, but that the aftermath could be worse. Even if only a small fraction of people get together over Thanksgiving with those they don't see on a day-to-day basis, we're going to exacerbate the wave on top of already being out of ICU beds.

Something that can be hard for people to understand is that hospitals in urban areas are generally close to or full all the time, no matter what. But, how we control our capacity varies a huge amount. Hospitals are often largely full from patients undergoing elective surgeries that are life-changing or life-saving, but these are procedures that are not elective in the colloquial sense, but we can schedule. Elective surgeries just mean the surgery, a complex heart surgery for example, doesn't need to happen at 3am that same day. But they are still important. So, if we run out of ICU beds because they are full of COVID-19 patients, at the same time we're also not performing any of those life-saving "elective" surgeries.

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Stock image of a hospital bed in a corridor. Getty/iStock

The anticipation I feel now is similar to when we were coming out of our first big surge and seeing the second wave of cities getting hit—places such as Houston and Arizona. I feel that same sense of frustration I had then of watching that slow motion train wreck. While we have no idea how bad it's going to get at this stage, there are a lot of indicators it's going to be very bad, if not worse, than back in the springtime.

It's easy to look at numbers like death and survival rates. But even if more than 99 percent of people survive, various studies and reports have shown that up to 15 percent of COVID-19 patients are hospitalized. The average hospital stay for surviving hospitalized patients is around nine days, which is miserable even if you do OK. Many of the patients we see hospitalized are people with comorbidities that are as common as high blood pressure or cholesterol, or asthma. These are people who we don't think of as sickly, people who are our friends and neighbors and end up intubated in an ICU. There is also a percentage of people who have long term symptoms that we don't know a lot about yet, people are experiencing long term symptoms that are life altering for at least a number of months.

So it's really tough watching this second wave, even appreciating the privileges I have. I have job security, I get to spend time with people at work who are going through the same thing as me and I'm not totally isolated at home alone. Additionally I know that the work I do is very direct; I get to confront the pandemic head on in some way. There is a pandemic and now I am a pandemic doctor, in many ways I have a sense of agency around the pandemic. It's not just this big existential dread.

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Dr. Seth Trueger is an emergency physician at Northwestern Memorial Hospital in Chicago, Illinois. He has worked with COVID-19 patients throughout the pandemic. Dr. Seth Trueger

I appreciate that for people who don't work in medicine, it's hard to have this abstract threat around. We all want to go back to work and back to normalcy. But it is frustrating because we knew there would be a second wave in the fall and winter, with the way respiratory virus' work around winter and cold weather.

Although there has been promising data around a vaccine, it is not a magic shot. It's going to be very helpful, but the lower the case rates are when we start vaccinating people, the sooner we will get the pandemic under control. It's easier to put out a fire when less of the house is burning.

Medical professionals typically have an understanding that overcoming the virus is not about one single thing. For example, there is so much discussion about whether masks are working. Think about it like driving a car. A car has brakes and airbags, but I still wear a seatbelt and drive safely. We still have civil engineers who have designed safer highways. We still have traffic lights and trauma centers. In a similar way, our response to the virus is a multi-level approach to keep people safe—one piece of it not working perfectly isn't a surprise. A vaccine that is 90-95 percent effective is going to be really helpful, but it's not going to be 100% effective and not everyone will be vaccinated.

Even if less than one percent of the population die from COVID-19, that's still a lot of people. So the behavior I choose impacts other people and their risk. If I go to Thanksgiving and end up getting exposed, I'm not so worried about myself. I'm worried about if I get a mild case of COVID-19, accidentally infect a group of other people, they infect a group of other people and then someone with an increased risk of dying from this virus gets sick in a meaningful way.

I want to go back to normal, I want to go to restaurants, see my family and celebrate Thanksgiving, but the way to get back to normal is to get the pandemic under control.

An aphorism I've seen on social media sums it up well: "We're isolating now so that when we get back together, everyone is still with us and nobody's missing." I believe it's necessary for us all to make sacrifices now so that we can all get back to normal as soon as possible.

Seth Trueger, MD, MPH, FACEP is an emergency physician at Northwestern Memorial Hospital in Chicago, Illinois. He is digital media editor at JAMA Network Open and an editor at Annals of Emergency Medicine. You can follow him on Twitter at @MDaware.

All views expressed in this piece are the writer's own.

As told to Jenny Haward.