The New York Times has a new map showing ICU occupancy levels across the country. Some areas are surprisingly good – like New Orleans, where intensive care units operate at a perfectly normal capacity of 61%. This shows that, although southern Louisiana was badly hit in earlier stages of the outbreak, it has largely avoided the worst of the current surge. That’s probably because of it Governor John Bel Edwards has kept the state under restrictions that include a mask mandate and restrictions on non-essential businesses. Texas, on the other hand, is a collection of counties that are doing well with hospitals and those that are overrun. It’s difficult to pinpoint a cause in any of these locations as Governor Greg Abbott never issued a statewide mask ordinance, and while some counties have, hospitals often draw patients from multiple counties.
Across the country, some hospitals have ICU capacity well over 100%. These are often regional hubs in rural areas and smaller towns where patient transfer options are limited. As a result, the hospital is in Fort Thomas, Kentucky is operating at 146% of the stated capacity. Nowhere else is it as bad as this, but Henderson, Nevada has 116% of total capacity plus an absolutely full ICU.
Understanding the health system impact of COVID-19 could be better done with a new interactive map from NPR, which shows the percentage of patients in each county who will be hospitalized for COVID-19. This shows areas of the country where COVID-19 is absolutely overcrowding health care facilities. In Deaf Smith County, Texas, 93% of all hospital beds are occupied by a COVID-19 patient. That may sound bad by the time you reach Tioga County, Pennsylvania … where 125% of hospital beds are filled with coronavirus patients. The hospital has literally expanded into hallways and parking lots and still can’t keep up with demand. It’s no wonder the number of COVID-19 deaths is increasing, and it’s no wonder that deaths from other causes are also increasing.
But even when it is planned, not every situation is perfectly clear. For example, in Rapid City, South Dakota, every single bed in the intensive care unit is occupied. At the same time, however, the NPR card suggests that only about 30% of hospital beds are occupied by COVID-19 patients. How do the two things fit together?
Well, as the Denver Gazette noted last week, residents of this state are being overwhelmed by COVID-19 patients from neighboring states.
… COVID-19 patients from Texas, New Mexico, Kansas, Wyoming, and Montana were taken to hospitals in Colorado.
South Dakota is not on this list because South Dakota is not an adjacent state. Yet, as Rapid City’s Argus Leader reports, patients from that state are actually being flown to Colorado and placed in hospitals more than 300 miles away. Colorado wasn’t the only state so gifted by Governor Kristi Noem’s house.
The largest hospitals in South Dakota have the ability, or difficulty, to care for seriously ill COVID-19 patients, forcing some of the sickest patients to be flown out of the state for care.
Between October and December, the national death rate for COVID-19 fell nearly a full percentage point. This sharp decline was somewhat illusory, however, as the number of new cases increased during this period and unfortunately death is a lagging indicator. However, there is no doubt that the death rate from COVID-19 can be significantly lower if every patient is properly cared for. In countries like South Korea, where careful testing and case prosecution prevented hospitals from ever being seriously overrun, the death rate was around 1.4%. The same rate is reflected in many US states, including California. The United States has been slowly lowering the national death rate from COVID-19 … until the past few days when progress stalled with record levels of COVID-19 deaths. And through record levels of overcrowding in hospitals.