Letters to the Editor

Letter: I’m a doctor at a Region 1 hospital, where care is being rationed. I expect it will get worse

“This COVID surge is the worst we’ve seen”: One regional doctor’s look at the crisis of overwhelmed hospitals during the latest COVID-19 surge

Editor’s note: The following is a letter to the editor written by a doctor who lives in DeKalb County and works at a hospital that serves residents in Region 1, a geographical area designated by the Illinois Department of Public Health that includes DeKalb County, north to Rockford, and the Sauk Valley area.

To the Editor:

Many thanks to you and to Northwestern Medicine’s Dr. Michael Kulisz for Wednesday’s article “If you don’t have to come to the hospital, please don’t.”

Dr. Kulisz is one of the first to be bold enough to speak the earnest truth as to how devastating COVID-19 has been to those of us who work in hospitals. And to those who need hospitals but can’t receive appropriate or timely care because the systems are overwhelmed with patients who have a primary diagnosis that did not even exist a few years back.

I live in DeKalb County and thus I am fully aware of all of the local and regional issues which COVID-19 has created. I am sending you this letter not on behalf of any particular hospital or healthcare system, but because I am a physician with significant visibility over the healthcare status of all hospitals in Illinois Region 1 and in the southern Wisconsin region I would like to share some insight.

As of this Wednesday morning, (Dec. 29) at the largest referral hospital [where I work] in Region 1, there are zero open [intensice care unit] beds, zero open floor beds, zero open emergency department beds, zero open mother/baby beds. Multiple patients are on admission status on an emergency room cart awaiting an in-patient bed to open up somewhere in the hospital.

None of the major university hospitals within an hour’s drive are accepting transfers because they are full.

Why is this? This COVID surge is the worst we have seen.

That largest hospital I mentioned has not had fewer than 100 patients admitted with respiratory failure due to COVID-19 for the past three weeks.

These aren’t incidentally positive COVID-19 patients and they are not elective post-op patients found to have COVID-19 via screening. These are patients sick with COVID – so sick they need to be in a hospital.

Ninety percent of the ICU patients [at my hospital] have COVID-19 pneumonia and the other 10% are critically ill patients with the usual diagnoses which require an ICU bed. But there are many other patients in non-ICU beds who under normal circumstances would require an ICU bed.

But there are none left.

Numerous elective surgeries have been canceled over the past four weeks to make room for COVID-19 patients. These elective surgeries include cardiac bypass surgeries, neurologic surgery cases, joint replacements and countless others. Thus, COVID-19 is making it extremely difficult for health systems to care for non-COVID-19 patients.

The truth is that care is being rationed all over the state, and I expect that it will get worse.

The vast majority of those admitted to the hospital with COVID-19 are unvaccinated. In fact, more than 90% of those in the ICU with COVID-19 pneumonia are unvaccinated. In the largest hospital in Region 1, only one of those patients is older than 70. Patients in their 30s, 40s, 50s, and 60s are among the rest.

Among those who are were previously vaccinated, about half were fully vaccinated but were due for a booster, and some are fully vaccinated but immunocompromised from ongoing chemotherapy, organ transplantation or frailty. There are also plenty of those who thought they had natural immunity due to prior infection.

We are also seeing increasing numbers of patients in the emergency department who were fully immunized get breakthrough COVID – most often from variants partially resistant to the vaccines or prior infection; fortunately the vast majority of them are not sick enough to need hospitalization.

Because DeKalb County has so many who have rejected the vaccine, I suspect that the unvaccinated will continue to make it difficult for the entire community to have all of their serious healthcare needs met.

DeKalb County is also fraught with noncompliance when it comes to wearing masks in public spaces.

This is truly an example of where one’s individual freedom has adversely impacted the freedom of others. Ordinarily, one’s freedom to throw a punch stops short at another’s face, but those who reject COVID-19 compliance measures based on the personal freedoms argument do not accept that their exercise of freedom takes away the freedoms of others.

Those who reject all of the measures to reduce this disease are the ones who are perpetuating the crisis. The ratio of those who’ve been infected, and those who are fully vaccinated, is not enough to reach herd immunity levels.

More than 126 million Americans are still vulnerable to getting infected. If we rely on natural immunity alone, approximately 2 million additional Americans will need to die before herd immunity will be achieved. Whereas only 1.5% of those who contract COVID-19 die, many of the 5% to 10% of COVID patients who require hospitalization but do not die from COVID suffer long term physical, psychological, and financial consequences.

Doctors, nurses, technicians and all of the non-health care personnel who staff hospitals (including the cooks, housekeepers and security personnel) are immensely burned out with having to deal with too many COVID-19 patients and not enough resources in the country to care for them.

We are all running out of numerous essentials such as drugs, IV catheters and even normal saline. In many places our supplies are day to day. More health care workers have quit or will soon quit compared to those who have been let go for violating state and institutional vaccination policies.

How can ordinary people help? I suggest we all act like patriots and fight this battle as if an invisible enemy is knocking at our doors.

Like all of the military veterans who despite the risks volunteered for combat duty for the greater good of all Americans, have the courage to step up and sacrifice a bit for the overall well-being of the rest of society and the rest of our nation. Fight this invisible enemy with what we know works. To be a patriot means to get vaccinated.

Follow the examples of Presidents Donald Trump and Joe Biden who have both been vaccinated and boosted. If you are fully vaccinated but due for a booster, get one.

If you feel at all sick, get tested. If you test positive, isolate yourself from others and let your contacts know that they have been exposed. When you are indoors in public buildings, wear a mask to minimize your unintentional spread of pre-symptomatic COVID-19 to anyone around you.

For those who are still skeptical, know that there is a more than a MILLION-fold increased risk of dying from COVID-19 than from dying of the vaccine. Choose wisely.

Dr. James Cole