The COVID-19 pandemic has strained hospitals across the country to a far greater degree than any recent flu season.
A Washington Examiner analysis finds that COVID-19 hospitalizations have been about four times worse than the most severe recent seasonal flu and many times worse than in a normal flu season.
Medical professionals say that the stress the pandemic has put on the system is not comparable to that of the flu.
“To someone who says that, I’d tell them, ‘Spend a day with me and let me tell you what I’ve seen for the last 10 months,'” said Dr. Comilla Sasson, an emergency physician at the University of Colorado Hospital. Since the pandemic began, Sasson has also assisted at hospitals across the nation, including in New York, South Dakota, and Texas.
“The thing that is striking to me going across the country are these beaten-down, battered healthcare workers whose new sense of normal is not really normal,” she said. “It’s now normal to have a shift where multiple patients die. It’s now normal to not let family say goodbye to their loved ones. It’s normal for me to be the last person you see before I take you off the ventilator.”
Indeed, the coronavirus is considerably more dangerous than influenza, something that is reflected in the sheer numbers of not only deaths but also hospitalizations.
“We’ve never been inundated with cases of flu like we have with COVID-19. There’s really no comparison,” said Dr. Aisha Terry, an emergency physician and associate professor of emergency medicine and health policy at George Washington University School of Medicine and Health Sciences.
A comparison of weekly hospitalizations using data from Johns Hopkins and influenza data from the Centers for Disease Control and Prevention shows that COVID-19 hospitalizations are often five to 10 times greater than those for the flu.
The 2017-2018 flu season was the worst in recent years. During that time, weekly hospitalizations reached a peak of 10 per 100,000 population in early January. In early January 2021, COVID-19 hospitalizations were almost 39 per 100,000. There were about 61,000 flu deaths in the United States during that season. Thus far, there have been over 400,000 COVID-19-related fatalities.
A big reason for the difference is that people can infect others with the coronavirus even if they are not sick with COVID-19.
“Flu is not transmissible until people become symptomatic,” said Susan Hassig, an epidemiology professor at Tulane University School of Public Health and Tropical Medicine. “This variant of coronavirus, SARS-COV2, has this asymptomatic infectiousness problem. And that’s a big deal for containing and controlling infectious diseases.”
Immunity to influenza and the knowledge of how to treat it are also vastly different.
“Many of us have some form of innate immunity to influenza, and we can go get the annual influenza vaccine,” said Dr. Joe Gerald, a program director at the Mel and Enid Zuckerman College of Public Health at the University of Arizona. “Fewer people are at risk for getting the flu compared to COVID. None of us have any innate immunity for the coronavirus.”
“We have been dealing with the flu for, literally, centuries,” said Terry, who is also a member of the board of directors of the American College of Emergency Physicians. “We know how to manage it from year to year. For much of the year 2020, we were learning as we were going along.”
According to Sasson, who is also a professor of emergency medicine at the University of Colorado, the pressure put on healthcare workers and hospitals during flu season is nothing compared to the current pandemic.
“Even in your worst flu season, we know that there is an end in sight,” said Sasson. “With COVID, it’s as though you are on this wave, and you don’t know if you’re on a high or a low or somewhere in the middle because you don’t know where the shoreline is.”
She worries about physicians’ mental health.
“There is some level of PTSD that happens after you have a couple of really bad shifts,” she said. “You tell yourself that you can make it through because it will get better, but then it doesn’t.”
The virus has also had a big impact on hospital operations.
“The stress on the system has gone up,” said Dr. Ross Golberg, vice chairman of the Department of Surgery for Valleywise Health in Phoenix. “Our trauma and critical care guys are now running a COVID unit, and that affects other systems at Valleywise. We’ve had to shut down our elective surgery unit again.”
According to the Department of Health and Human Services, Arizona is currently one of only four states in which over 25% of hospital beds are occupied by COVID-19 patients.
Gerald trains some of the residents and fellows who work at Banner University Medical Center in Tucson. He notes that the pandemic has had a significant impact on how that hospital is organized.
“We have our fully staffed intensive care unit, and then we have three additional add-on ICU teams who would normally be doing research but have been folded into caring for patients,” he said. “Plus, we’ve converted a whole trauma surgery ICU and even some pediatric ICU beds into caring for COVID patients. Even in a bad flu season, we don’t have to do that.”
Few places have been hit harder than Los Angeles County. In early January, nearly 8,000 patients were hospitalized with COVID-19, and deaths were averaging nearly 180 per day. At one point, hospitals in the area had only 54 adult ICU beds available for the nearly 10 million residents in the county. As the crisis has stretched resources, some hospitals have had to form “triage teams” that would decide which COVID-19 patients would receive care.
That, of course, only adds to the stress for physicians.
“We experience what we call moral injury,” said Sasson. “We’re always thinking that you want to save everybody, but there are times, especially now in certain locations, where we have to choose. We have to make these decisions that just add to the stress of taking care of patients.”
