Omicron Will Overwhelm America’s Emergency Rooms

Hospitals are already strained, and many health-care workers have little left to give.

A doctor wearing personal protective equipment
Nathan Howard / Getty

About the author: Craig Spencer is an emergency-medicine physician and director of global health in emergency medicine at New York Presbyterian/Columbia University Medical Center.

Like most of my colleagues, I haven’t arrived at this moment unscathed. I weathered the brutal first wave of the pandemic, often witnessing more COVID deaths during my shifts in New York City than I saw working in an Ebola-treatment center in West Africa in 2014.

When I was vaccinated against COVID a year ago, I was already exhausted. But better times seemed close at hand. Perhaps soon we wouldn’t have to endure wearing full personal protective equipment for hours on end. I was wrong.

After two years of dealing with this virus—working extra shifts, watching families sob on grainy FaceTime calls while their loved ones slipped away—many health-care workers are already in a dark place. With a new wave of COVID upon us, we face this grim truth: You can’t surge a circuit that’s been burned out. For frontline providers, there’s simply no new fuse that can fix the fact that we’re fried.

Many people are holding out hope for the possibility that the Omicron variant may cause less severe disease. But this is little comfort for those worried about our hospitals and the people who work there: A large surge of even a more mild variant will still produce more patients than our already maxed-out system can handle. Moreover, doctors and nurses will themselves get sick.

The looming tidal wave of Omicron cases comes at an already challenging time for emergency departments across the U.S. The Delta wave never fully subsided, and a lot of ERs are already attending to too many COVID patients. Also making things worse: Emergency-room visits are up for non-COVID illness as well, in part because people have postponed some routine medical care throughout the pandemic. As a result, we head into winter with emergency rooms across the country overwhelmed and over capacity.

That will make this surge harder, in a way, than what we saw in the spring of 2020. Early in the pandemic, as many emergency rooms were inundated with COVID-19, others sat eerily quiet while patients avoided a visit unless absolutely necessary. ER-visit rates ebbed and flowed across the country as the virus moved from region to region. But overall, the first year of the pandemic saw ER visits drop to half their normal levels nationwide, though the patients we saw were much sicker on average.

With visits now exceeding capacity, hospitals will attempt to cope. They will cancel elective surgeries and hire more workers where they can. In recent weeks, the governors of New York, Maine, New Hampshire, Indiana, and Ohio have deployed thousands of members of the National Guard to support medical facilities. They will also attempt, as the CEOs from nine health systems in Minnesota recently did, to persuade more people to get vaccinated, warning that their hospitals are “overwhelmed.” Similarly, to encourage vaccination and prevent added strain on an already struggling system, hospitals in Cleveland filled nearly a whole page in The Plain Dealer with one word: “Help.”

But all of that is unlikely to turn things around. There’s no nice way to put this: In much of the country, the next few months will be a really bad time to be really sick with COVID-19. Or to break an ankle. Or to get appendicitis.

Those who will care for the people who do get sick will do so with limited emotional reserves. I overhear their patient encounters. Exhaustion has crowded out their usual empathy. In their voices I hear the desperation of providers who’ve been at the bedside of too many patients who didn’t make it.

Early in the pandemic we asked you to flatten the curve. But the next curve could truly flatten us.

In March 2020, we worried about running out of ventilators. Now it’s nurses that are in short supply. Unfortunately, it’s a lot easier to produce a ventilator than a nurse.

The first advice I was given when I was accepted to medical school came from my mother, who has spent too much time as a patient in her life. She admonished me to always be kind to nurses, because they have the hardest job in the hospital. As the providers who spend the most time at patients’ bedside, nurses bear the brunt of the psychological toll of losing patients. Of all providers, they’ve also been disproportionately more likely to lose their life to COVID.

Nationwide nursing shortages have hit critical levels, and both metropolitan medical centers and rural hospitals are struggling to hire enough of them. In Kentucky, the governor recently declared the nursing shortage an emergency.

Many factors are driving this shortage. A small number refused to comply with vaccine mandates. Others quit long-term jobs to pursue more lucrative travel deployments, understandably seeking positions paying triple their previous salary. And a lot are just burned-out and have quit altogether. For the nurses who remain, many are taking care of more patients than is generally considered safe.

As an emergency physician, I promise that you’d rather face the next few months fully vaccinated. If you haven’t received a booster, now is the time, especially if you’re older or have underlying health conditions.

I’d also recommend some extra vigilance. Upgrade your masks. Limit your indoor gatherings, and rapid-test when you can.

I recognize that you’re all tired too, but if you know a health-care worker, maybe reach out to tell them thanks. They might need it to keep going.