After the fall lull after Thanksgiving, the number of hospitalizations due to Covid is increasing

Public health authorities are concerned that the surge in Covid-19 patients will exacerbate pressure on hospitals already strained by the effects of two other viral illnesses, influenza and respiratory syncytial virus, commonly known as RSV.

Nearly 20,000 Americans were hospitalized with the flu during Thanksgiving week the most for that week in more than a decade and almost twice as high as the previous week.

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Nancy Foster of the American Hospital Association said members are still mostly concerned about RSV and the flu, not about Covid.

“It could be that in a week or two we’re seeing a lot more covid patients than we’re seeing RSV or flu, but the real concern is that we’re going to see a huge influx of all of them really straining hospital capacity to care for these very sick patients” , said Foster, the association’s vice president for quality and patient safety policy.

Experts warn that holiday gatherings are prime time for the spread of the coronavirus as millions of Americans travel and gather together. The increase in hospitalizations likely reflects a combination of patients who were infected before the Thanksgiving holiday and those who were exposed during Thanksgiving week, health experts said.

The daily number of new hospital admissions infected with covid is now more than 9,000 after hovering between 5,000 and 7,000 for most of the fall.

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Winter is usually busy for hospitals, especially in cold-weather states where people are more likely to congregate indoors, providing ample opportunity for respiratory viruses to thrive.

In late 2020 and early 2021, before the widespread availability of the coronavirus vaccine, patients with covid filled hospital wards in the country under enormous strainwith the highest death toll of more than 3000 per day. And last winter, an explosion of cases fueled by the micron variant of the coronavirus left hospitals they struggle to provide basic care because they were understaffed when the virus tore through their workforce.

This winter, most people in the United States have some degree of immunity due to vaccination, previous infection, or both, which should reduce the severity of infections. And those who do get sick have a wider range of therapeutic drugs to speed recovery and keep them out of the hospital.

“If we’re going to see a big wave, it’s going to start picking up now, it’s going to get longer and probably peak in late December and early January,” said Columbia University epidemiologist Jeffrey Shaman. “We hope that it will be somewhat mild, of course, and that enough reinforcement and pre-exposure will keep a large proportion of people out of hospital.”

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At Banner Health, Arizona’s largest health system, hospitalizations for Covid doubled last month to nearly 600 patients. They account for less than 10 percent of all patients, compared to nearly 40 percent in the earlier stages of the pandemic. But the relatively lower number of covid cases is balanced by an early rise in flu and RSV cases that exceeds the five-year average.

“What is already happening this winter and what we can continue to expect is that influenza and RSV will not be at unprecedented low levels,” said Banner Chief Clinical Officer Marjorie Bessel. “We will have a winter with large volumes as we had earlier during the pandemic. How big the volume is because of all this is unknown.”

For hospitals already burdened by other viruses, the coronavirus is an additional complication.

In the Norton Healthcare system in Louisville, the number of coronavirus cases is unchanged, RSV is decreasing, and influenza is increasing.

“Some winters are more challenging than others, and I think we’re in for a more challenging winter this year,” said Norton’s senior vice president and chief clinical and strategy officer, Steven Hester. “We will see covid as part of the regular challenge we have.”

Medicines for children are hard to come by as respiratory viruses are on the rise

RSV cases hit Children’s Hospital of Orange County, California, prompting the county to declare and extend emergency. The hospital’s emergency department had a record influx of 12,000 patients in November and occasionally had to divert patients to other medical centers. Now the children’s hospital is also seeing an increase in hospitalizations for covid, although nowhere near the number of RSV-related cases. Some children arrive infected with multiple viruses.

“It forces us to be organized and thoughtful, and we have to be innovative in space. We have to always look for supplies,” said Sandip Godambe, the system’s chief medical officer.

Although children’s hospitals and pediatric wards face the greatest pressure from other respiratory viruses, older patients account for the majority of new hospitalizations due to Covid, according to the Department of Health and Human Services data.

Experts say this trend underscores the importance of people 65 and older receiving updated booster doses tailored to the omicron variant. According to the data, less than a third of that age group received the last injection assessments from the Center for Disease Control and Prevention.

“The main problem we’re dealing with is weakened immunity,” said Eric Topol, a professor of molecular medicine at the Scripps Research Institute. “We are insufficiently vaccinated and insufficiently stimulated, especially in older people.”

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To reduce pressure on hospitals, California’s state epidemiologist said it is essential to increase vaccination uptake among the elderly and ensure that medically sensitive patients receive antiviral treatments such as Paxlovid soon after they test positive.

“Even when you have mild or moderate symptoms, if you’re over 50 or if you have any health problems, you’ll probably benefit from a few days of treatment so you don’t have to go to hospital.” Erica Pan said.

Carmela Coyle, president and CEO of the California Hospital Association, said the public should still be concerned about hospitals’ ability to provide care even if there are fewer coronavirus patients this winter compared to earlier in the pandemic. The shortage of health workers has left hospitals understaffed and hospitals struggling financially nearly three years into the pandemic, she said.

“Covid has been like a flood for hospitals,” Coyle said. “And while the flood waters may have receded if you look at the last two winters compared to the current situation, the damage is still there.”