The pandemic is once again putting tens of thousands of people in the hospital in the U.S. Is it more than the health care system can handle? Find out which states are getting close to their limit.



One sign that the United States is in a coronavirus surge - hospitalizations around the country have nearly doubled since late September. Some hospitals are already talking about rationing care. Will Stone has more.

WILL STONE, BYLINE: Back in the spring, Dr. William Melms was watching the surge of COVID patients in New York City and readying his hospitals in Wisconsin to endure the same.

WILLIAM MELMS: We waited and waited. It did not come.

STONE: About six months later, it has arrived. Melms is the chief medical officer at the Marshfield Clinic Health System, which covers mostly rural Wisconsin.

MELMS: We will be pushed to the limit by the end of the month.

STONE: COVID patients are filling up their beds at an unsustainable rate. And because so many parts of Wisconsin and the Midwest are under siege, Melms says there are not many places they can turn to either to send their patients or to get extra staff.

MELMS: Creating the manpower to take care of our patients is the dilemma. You know, we don't have any areas to decompress. We don't have safety valves to put our patients.

STONE: This is the message coming from more hospitals in more states every day. For weeks, the U.S. coronavirus pandemic has shattered records. In the wake of those sky-high numbers come hospitalizations. Lauren Sauer studies hospital capacity at Johns Hopkins University.

LAUREN SAUER: We have legitimate reason to be very, very concerned about our health system at a national level.

STONE: That's because this surge could wash over many places simultaneously. In at least 18 states, COVID patients account for more than 10% of all hospitalizations.

SAUER: Above that 10% is where we really think, OK, perhaps we have to start enacting surge strategies and crisis standards of care in some places.

STONE: Crisis standards of care - a broad term for how hospitals make decisions around treatment when resources are limited. In the worst-case scenarios, it can lead to rationing of care. Some states, including Utah, have recently warned this could be on the horizon. Mahshid Abir is an emergency physician and researcher at the University of Michigan and the RAND Corporation. If there are many epicenters, Abir says it will be much harder to shuffle around resources because everyone will be overwhelmed.

MAHSHID ABIR: So it's space, staff and stuff. And you need all three. And if you don't have one, it doesn't matter if you have the other two.

STONE: And most U.S. hospitals already don't have much cushion. They usually run close to capacity, especially during flu season. Then on top of that, add COVID patients, who can require lots more time and care, and it strains the system.

ABIR: This is a scarce resource. Critical care nurses are scarce. Ventilators are scarce, as you know. Respiratory therapists are scarce.

STONE: And, she worries, about to become even more scarce.

For NPR News, I'm Will Stone.

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