COVID-19 cases have been surging upward over the course of the summer with the rise of the delta variant, but not all parts of the U.S. have been feeling the same impact.
With vaccination rates, masking requirements and other public health policies varying from state to state, certain pockets of the country have reported sharper increases in new cases and community spread.
These more concentrated pockets of COVID-19 have put a strain on the hospitals and health systems in those hard-hit areas, many of which have warned of dwindling capacity and workforce shortages that threaten their ability to deliver care. This week alone, public officials across several states took upon themselves to intervene by announcing new investments in clinical staffing, relaxed licensing requirements, patient transfer orders and other initiatives.
See below for the latest numbers on COVID-19 admissions, ICU bed usage, remaining capacity and other preventive measures among 10 states with health systems sounding alarms.
According to the Alabama Department of Public Health, 2,731 patients were hospitalized with confirmed COVID-19 as of Aug. 18.
The state has reached its capacity of 1,557 ICU beds, and hospitals have begun to repurpose other parts of their facilities as temporary ICU units, Alabama Hospital Association President Don Williamson, M.D., told local NBC affiliate WSFA 12 Aug. 17.
“We’ve never been here before. We are truly now in uncharted territory in terms of our ICU bed capacity,” he said.
Williamson also told WSFA 12 that he would not be surprised if Alabama does not receive federal staffing assistance.
As of an Aug. 18 update from the California Department of Public Health, the Golden State has 7,697 patients hospitalized with confirmed COVID-19 and another 435 who are hospitalized with suspected COVID-19. It had reached a peak of almost 22,000 hospitalizations in January.
There are also 1,717 COVID-19 patients in the ICU as well as 62 who are suspected to have the disease. The state says there are 1,696 available ICU beds.
Earlier in the week, the department issued an order (PDF) that requires hospitals statewide to accept patient transfers from locations with limited ICU capacity. Gov. Gavin Newsom also issued an executive order waiving licensing requirements for out-of-state medical personnel to increase California’s response capacity.
"We are continuing to see an increase in cases and hospitalizations due to the delta variant of COVID-19 and are taking action to ensure the state's health care delivery system is prepared and can respond should the situation worsen," Tomás J. Aragón, M.D., California Department of Public Health director and state public health officer, said in a statement.
According to Department of Health and Human Services data updated weekly, Florida has 16,521 patients currently hospitalized with confirmed COVID-19. These patients make up more than a third of Florida’s total inpatients and leave the state with 14.2% inpatient bed availability and 8.2% adult ICU bed availability.
Meanwhile, the Florida Hospital Association is warning of likely staffing shortages among its membership. Just over three-quarters (75.6%) of hospitals told the organization in its most recent weekly survey that they expect a critical staffing shortage to occur within the next seven days.
“There can be no question that many Florida hospitals are stretched to their absolute limits,” said Mary Mayhew, president and CEO of the Florida Hospital Association, in a statement. “While hospitalizations continue to increase, three out of four Florida hospitals expect to face critical staff shortages in the next seven days, an increase of nearly 10% since last week, and half of our hospitals will no longer accept transfer patients from other facilities.”
According to the Centers for Disease Control and Prevention's Aug. 16 data, Georgia has seven-day averages of more than 4,700 confirmed cases and over 600 new hospitalizations. Per its department of public health, the state is currently at 89.2% ICU capacity, 80.7% emergency department capacity and 86.2% inpatient capacity. Roughly 4,500 COVID-19 patients are currently in its hospitals.
To offset staffing shortages being shared by hospital leaders across the state, this week Georgia Gov. Brian P. Kemp announced that the state's public health department would be funneling $125 million toward the employment of 1,300 to 2,800 hospital staff.
The investment runs through the first of December, he said, and will add an additional 450 beds across nine regional coordinating hospitals.
During an Aug. 17 press event, state officials said that Idaho’s hospitals are treating 326 people with COVID-19, its highest number since January. ICU COVID cases had also reached 108, nearing the pandemic’s record of 122 people.
The state’s public health officials told the press that Idaho is on pace for 2,500 weekly hospital admissions by mid-October and a case rate exceeding the previous highs from last December.
The officials also pointed to widespread staffing vacancies across the state, highlighting one hospital that currently has two-and-a-half times the number of open positions as usual.
"We have been submitting emergency assistance requests to bring staff in from federal sources, which puts us in competition with other states experiencing the same emergency," Elke Shaw-Tulloch, administrator for Idaho’s Division of Public Health, reportedly said during the press event. "We are convening our hospitals several times a week to problem solve. We've called on our crisis standards of care activation committee to convene later this week on protocols and are ready to activate crisis standards of care on a moment’s notice, if needed."
The Pelican State had 3,013 patients hospitalized with COVID-19 and 476 on ventilators, according to the most recent update from the Louisiana Department of Health. This is well above January’s high of 2,069 hospitalized patients and trending upward.
Current ICU bed availability varies regionally. The state’s first jurisdiction, where New Orleans is located, has a total capacity of more than 500 ICU beds and currently still has 69 available, according to the department’s data. Other regions with total ICU bed capacities of 96 and 81 report just seven and two available beds, respectively.
Last week, the department put out a request for information among qualified hospitals to determine how much additional care they could provide if additional clinical staff were supported.
“Hospital admissions are at all-time highs and current data indicators project that Louisiana will soon maximize the availability of all staffed and operational hospital inpatient beds,” the public health department wrote in the request. “Louisiana hospital chief medical officers have communicated their inability to provide sufficient clinical (including nursing staff and respiratory therapists) to ensure the adequate provision of hospital services, including treatment for COVID-19.
“Considering the current inpatient admission rates and COVID-19 cases in Louisiana, the Department has determined that there may be more benefit to embed clinical staffing within a hospital to assist with inpatient hospital services, emergency room/department services and/or outpatient [monoclonal antibodies] infusion treatment.”
The most recent data from the Mississippi State Department of Health indicate 1,633 patients hospitalized statewide with confirmed infection and another 486 in the ICU.
“Obviously the pressure on our healthcare system, while it is terrifying and unnecessary, still remains and worsens," Jim Craig, senior deputy and director of the Office of Health Protection, said during a hearing this week. "People waiting in emergency rooms right now for beds, reported as of 8:00 this morning, 251 Mississippians are waiting in an emergency room for a bed.
“Staffing for hospitals remains at critical need around the state. We’re still nowhere near the staff we need or the beds we need. Seventy-three hospitals requested over 1,451 personnel. Those hospitals reported that the additional staffing—if we can figure out how to get that staffing to them—will open up 771 medical surgical beds and 235 ICU beds that are currently unstaffed.”
Aug. 18, the state department issued an order allowing certified paramedics, advanced emergency medical technicians and emergency medical technicians to provide care in hospital settings.
Per the New Mexico Department of Health’s Wednesday update, there are 353 individuals hospitalized in the state for COVID-19.
The week’s hospitalization numbers are a six-month high for the state, which according to the public health department has one of the lowest per-capita hospital beds in the country. In a statement released Tuesday, the department highlighted reports of state facilities “reaching or exceeding 100% capacity” and warned that “rising virus hospitalizations create a ripple effect … for other individuals who need care for other purposes within the healthcare system.”
During a news conference announcing a return to indoor mask requirements and new hospital vaccination requirements held the same day, acting Health Secretary David R. Scrase, M.D., said the state’s hospital network has been converting non-patient areas for care and facing “significant problems” with nursing staff shortages, USA Today reported.
Scrase also said the state’s hospitals were two to four weeks from needing to activate crisis standards of care should the current trends continue.
North Carolina has 3,083 patients currently hospitalized with COVID-19, according to an Aug. 19 update from the state’s public health agency.
Aug. 10, the department warned that it had seen “the largest single-day jump in hospital ICU admissions since the beginning of the pandemic,” with ICU admissions jumping from 502 on Aug. 8 to 557 the following day.
North Carolina Department of Health and Human Services officials said that the numbers are on pace to match or exceed January highs and urged vaccination and safe behaviors among residents.
"These high levels of COVID-related admissions jeopardize the ability of our hospitals to provide needed care in our communities," said Kody H. Kinsley, the department’s chief deputy secretary for health, in a statement. "The vast majority of our COVID-19 hospitalizations are in unvaccinated people. This underscores the need for everyone to be vaccinated against the virus and use preventative measures to slow the spread of COVID-19."
According to the Texas Department of State Health Services, the state had 12,402 hospitalized patients with lab-confirmed COVID-19 as of Aug. 17. There were 322 ICU beds available statewide.
Last week, Texas Gov. Greg Abbott called on the state’s hospitals to voluntarily postpone or cancel elective procedures, deployed 2,500 out-of-state medical personnel to hospitals and launched nine COVID-19 antibody infusion centers across Texas. The moves, particularly around staffing, were applauded by the state’s hospital association.
“This help could not come fast enough,” said Ted Shaw, Texas Hospital Association president and CEO, in a statement. “Many hospitals have already idled non-essential services and are diverting patients to extend staffing capability. We look forward to a swift influx of out-of-state personnel, coordinated by the state through staffing agencies.”