The claim: ‘It’s not unusual for hospitals to sit at max or near max capacity on any given day’
Spurred by the highly contagious delta variant, coronavirus infections and deaths are increasing across the country. In states like Texas and Florida, which lead the country in daily average hospitalizations, hospitals are swamped with unvaccinated patients.
But on social media, some say packed hospitals are just business as usual.
“It’s not unusual for hospitals to sit at max or near max capacity on any given day,” reads text in an Aug. 2 Facebook post. “The media would like you to think this is a new thing, but it’s not. They are lying to you to create fear and uncertainty.”
The post, a screenshot of an Aug. 2 tweet, comes from Erin Marie Olszewski, a nurse based in Tampa, Florida. She has previously shared false information about Florida’s coronavirus numbers and promoted hydroxychloroquine as a treatment for COVID-19. (In actuality, randomized control studies have found no evidence to suggest hydroxychloroquine saved lives.)
In this post, which garnered several thousands interactions between the two platforms, Olszewski has somewhat of a point about how hospitals typically coordinate staffing. But the claim misses key context about how the coronavirus pandemic has strained hospitals.
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Doctors, hospital associations and public health experts told USA TODAY it’s not uncommon for hospitals to staff beds at or near maximum capacity to conserve resources. However, Olszewski is wrong to make it seem like the recent influx of COVID-19 hospitalizations is typical. The surge has strained hospitals already hard-hit by the pandemic.
“It is true that hospitals are often overcrowded (in) both ICUs and ERs,” Dr. Georges Benjamin, executive director of the American Public Health Association, told USA TODAY in an email. “The difference is that they don’t have patients in the hallways waiting for ICU beds in the volume that we have today because of COVID.”
USA TODAY reached out to Olszewski for comment.
Hospitalizations rise due to COVID-19
Data show that, over the past few weeks, rising COVID-19 infections have put a renewed strain on hospitals. Several states are seeing their highest hospitalization rates since the coronavirus pandemic began.
Take Olszewski’s home state of Florida, for example, which has the highest daily average and per capita hospitalization rate in the country.
Data from the U.S. Department of Health and Human Services shows that, as of Aug. 6, about 84% of inpatient beds in the state were occupied, 23% of which were for COVID-19 patients. Intensive care units were even more full, with 89% of beds in use, 42% of which were COVID-19 patients.
According to the Florida Hospital Association, as of Aug. 3, COVID-19 hospitalizations were at 113% of the state’s peak in July 2020. Some hospitals are struggling to keep up with the rising demand for beds; 60% expected critical staffing shortages within a week, according to the hospital association.
“Current hospitalizations and the growth rate continue to be extremely troubling,” Mary Mayhew, president and CEO of the association, said in a press release.
Hospitals across the state are seeing record numbers of COVID-19 patients, despite the fact that vaccines are widely available. About 49% of Floridians have been fully vaccinated against the coronavirus, in line with the national average.
The situation in Florida is similar to that in other states with rising hospitalization rates, according to federal data and news reports. Arkansas, Nevada and Louisiana have also recently reported record spikes in COVID-19 hospitalizations.
Those spikes put pressure on hospitals.
“In parts of the country where COVID-19 patients make up a high percentage of the occupancy rate, there are implications for everyone who needs care,” Thomas Jordan, a spokesperson for the American Hospital Association, told USA TODAY in an email. “Caring for COVID-19 patients is resource-intensive.”
What counts as ‘max capacity’
Doctors, hospital associations and public health experts say it’s not uncommon for hospitals to be running at or near maximum capacity. But before the COVID-19 pandemic, that was by design.
The reason why has to do with how hospitals allocate their resources.
“Capacity is measured at least two ways,” Robert Myrtle, a professor emeritus who studies health services administration at the University of Southern California, said in an email. “First is how many beds the hospital is licensed to operate. The second is the beds the hospital is staffing based upon their estimated capacity.”
Federal guidelines stipulate hospitals should report staffed inpatient and ICU beds to the Department of Health and Human Services. That means a hospital may have more physical beds than it’s reporting, but those beds aren’t available for patients because there aren’t health care providers to tend to them.
“Ventilators don’t run themselves – you need respiratory therapists, you need doctors, you need nurses, you need staff,” Dr. Jahan Fahimi, medical director of the University of California-San Francisco’s adult emergency department, said in an interview. “It takes a huge team in order to make a bed in a hospital functional.”
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Hospitals typically adjust staffing to match the demand for services, Fahimi and public health experts told USA TODAY. If demand is low, a hospital may close off some rooms or entire wings to conserve resources. If demand is high, a hospital may reopen those spaces and assign staff to them.
“They design it that way for budgetary purposes,” Marc Lotter, senior vice president of communications, marketing and education at the Florida Hospital Association, said in an email. “It’s very expensive to staff a bed – especially ICU – so hospitals don’t waste resources staffing beds that aren’t likely to be used. As patient cases rise, they expand capacity and staff beds as needed.”
Based on the reported number of staffed beds, it may seem like hospitals are always running at or close to maximum capacity. But experts say Olszewski’s post leaves out important nuance about the realities of the COVID-19 pandemic.
“There have always been long waits in ERs across the country because there’s just a lot of demand for emergency care,” Fahimi said. “But what we’re seeing now is in many ways unlike anything that we’ve ever seen.”
‘More than simply having enough beds’
The pressure that rising COVID-19 infections put on hospitals goes beyond bed occupancy, doctors and public health experts say. It has to do with hospitals’ capacity to scale up their treatment of COVID-19 patients.
“These patients are much, much sicker and require much more respiratory support,” Benjamin said. “We also don’t, in the normal course of business, have to set up intensive care beds in holding rooms, tents and operating rooms. During the peak of the pandemic, we were doing that, and many hospitals are on the brink of doing this again.”
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Last year, some hospitals entered crisis-care mode when the demand for COVID-19 care surpassed available staff. In several states, hospitals paused elective surgeries to keep up with that demand. Others weighed how to allocate a limited number of ventilators to a growing number of COVID-19 patients.
Doctors and public health experts worry that may soon become a reality in the pandemic’s fourth wave.
“In the past, if you showed up with a sprained ankle, you may have had to wait a couple of hours,” Fahimi said. “Now you show up with COVID and need oxygen, and you’re in line with other people who have COVID and need oxygen.”
Then there’s the question of staffing.
“During COVID, demand exceeded the number of staffed beds, so to the extent possible we increased the number of staffed beds,” Myrtle said. “But certain service areas, such as ICU, have required staffing ratios that are higher than are required by law or labor contract for general patient populations. So the real limiting factor was the availability of nurses, and we have a nursing shortage (and an aging one as well).”
That shortage, which also includes primary care and specialty physicians, is partially due to burnout from the pandemic.
In December, when the U.S. started breaking coronavirus hospitalization records, the nurse-to-patient ratio went from the recommended 1-to-1 to 1-to-4. The stress of juggling multiple COVID-19 patients at once, often for long hours, has driven some to quit the profession. Hospitals across the country have started offering big sign-on bonuses to get more nurses in the door.
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“The limitations on hospital capacity are more than simply having enough beds,” Jordan said. “After many months of dealing with the pandemic, our doctors, nurses and other staff are exhausted. Some have chosen to leave direct patient care work in favor of other jobs. This limits hospitals’ ability to open additional beds to care for surges in patients.”
Our rating: Missing context
Based on our research, we rate MISSING CONTEXT the claim that “it’s not unusual for hospitals to sit at max or near max capacity on any given day.” It’s true that hospitals typically staff at or near their maximum capacity of staffed beds in order to save resources. But prior to the coronavirus pandemic, that was by design – not out of necessity. The post misses key context about how COVID-19 has strained hospitals in terms of bed space, resources and staffing.
Our fact-check sources:
- NurseErin, Aug. 2, Twitter
- Marc Lotter, Aug. 3, Email exchange with USA TODAY
- PolitiFact, July 27, Florida’s COVID-19 numbers aren’t ‘hype.’ Right now, they’re quite bad
- Associated Press, Aug. 1, Florida breaks record for COVID-19 hospitalizations
- USA TODAY, Aug. 2, New York Gov. Cuomo urges businesses to adopt ‘vaccine-only admission’; Delta yields more reinfections, Fauci says: Latest COVID-19 news
- USA TODAY, July 28, How mutations led to the most transmissible COVID-19 virus yet: the delta variant
- USA TODAY, Aug. 3, New York to become first major US city to require vaccination proof for indoor activities: Live COVID-19 updates
- USA TODAY, Aug. 1, Infections surging and ‘things are going to get worse,’ Fauci says; Florida breaks another record: COVID updates
- Florida Times-Union, Aug. 1, Jacksonville’s Mayo Clinic to activate ‘surge plan,’ reaches capacity amid COVID-19 increase
- Fox News, June 13, 2020, Undercover nurse: NY hospital didn’t properly isolate coronavirus patients
- U.S. Department of Health and Human Services, accessed Aug. 4, Hospital Utilization
- The New York Times, Aug. 4, Coronavirus in the U.S.: Latest Map and Case Count
- Robert Myrtle, Aug. 4, Email exchange with USA TODAY
- USA TODAY, Aug. 4, The delta variant is ‘ripping through the unvaccinated’ and crowding hospitals in Florida, Texas
- Georges Benjamin, Aug. 4, Email exchange with USA TODAY
- Thomas Jordan, Aug. 3 and 4, Email exchange with USA TODAY
- Johns Hopkins University, accessed Aug. 4, COVID-19 United States Cases by County
- Florida Hospital Association, Aug. 3, Florida Hospital Association Provides COVID-19 Update
- The Hill, Aug. 2, Arkansas reports biggest one-day spike in COVID-19 hospitalizations
- Nola.com, Aug. 4, Louisiana COVID hospitalizations break record for second day with 2,247 in hospitals
- The Hill, Aug. 3, Hospitalizations in Nevada break last summer’s record
- Washington Examiner, July 29, Florida hospitals struggle with COVID-19 surge
- U.S. Department of Health and Human Services, May 27, COVID-19 Guidance for Hospital Reporting and FAQs For Hospitals, Hospital Laboratory, and Acute Care Facility Data Reporting
- Dawn Walker, Aug. 4, Email exchange with USA TODAY
- Dr. Jahan Fahimi, Aug. 4, Interview with USA TODAY
- Arizona Republic, Dec. 30, Banner Health pausing elective surgeries as COVID-19 cases surge in Arizona
- Memphis Commercial Appeal, Nov. 30, Methodist, Baptist hospitals pause elective surgeries as COVID-19 cases rise
- USA TODAY, April 4, Which coronavirus patients will get life-saving ventilators? Guidelines show how hospitals in NYC, US will decide
- 24/7 Wall Street, Dec. 19, Coronavirus pandemic: These are the US cities with the most, fewest nurses
- CNN, Feb. 25, Traumatized and tired, nurses are quitting due to the pandemic
- Naples Daily News, June 21, Nurses can get big sign-on bonuses as Southwest Florida hospitals recover from COVID-19
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