US hospitals are filling up. They are filling up with patients who have heart attacks. They are filling up with patients who need chemotherapy and then are immune-compromised for weeks after each round. They are filling up with patients who just had a stroke. They are filling up with new mothers holding their chubby cheeked babies for the first time. They are filling up with people mangled after their car slid on some black ice. These are all normal demand drivers. These are the situations that we have built out both the physical space and the workforce to accommodate. They are filling up with COVID patients who were infected in mid-November. Our hospital systems are not built for this type of demand surge.
Let’s start with hospitalizations: 100,226 total on 12/2/20.
On the average day in 2018, there were 612,000 hospitalized patients. Assume this is 620,000 in 2020 without Covid
— Michael L. Barnett (@ml_barnett) December 3, 2020
The marginal patient is the person who is a coin-flip at that point in time to admit or not admit, to keep or to discharge from a hospital bed.
The marginal patient will be responsive to supply. A doctor could look at a patient who probably will do well enough if they are sent home with a follow-up visit in a few days scheduled, but could do better or at least have less risk if they are admitted to the hospital and monitored for a day. That person is far more likely to be admitted when the doctor looks up and down the hospital hallways and sees half a dozen open rooms on just that floor then if there is one bed that might be open in a an hour or two.
As COVID case counts top 200,000 per day, hospitalizations will follow. Many hospital systems are already at or near capacity. More hospital systems will be at or over regular capacity in the next few weeks. This means the marginal patient will be very different in December 2020 than the marginal patient in 2019. Patients who were easy admits or easy keep for an extra day in 2019 will either never see a hospital bed or will be in and out very quickly. We, as a society, will be taking tremendous number of risks and gambles that we normally never would have taken.
We’re likely to see at least several days of 200,000 or more new, diagnosed infections as Thanksgiving Day infections are just starting to work their way into our data. Anything that we do today to minimize infection spread will not show up on hospitalizations until the middle of the month or later. Until we get infections down and then wait several weeks, the marginal patient who gets a hospital bed will be far sicker and in far more need than typical.