More Americans are currently hospitalized with Covid-19 than at any prior point in the pandemic, a grim milestone that indicates the coronavirus pandemic is not slowing down in the US.

On July 22, 59,628 people across the United States were in the hospital after testing positive for the novel coronavirus, according to data collected by the Covid Tracking Project; that total surpassed the previous daily high of 59,539 on April 15, when the New York City area was the epicenter of the US outbreak.

Christina Animashaun/Vox

Covid-19 has migrated across the country to many more regions in the three months between those peaks. Hospitalizations were overwhelmingly concentrated in the Northeast in the spring, but now more than half of hospitalized Covid-19 patients (35,624) are in the South. The West has also seen the number of hospitalized Covid-19 patients double since April, while the Northeast now accounts for fewer than 5,000 of the nearly 60,000 current hospitalizations.

The current total is likely an undercount. Two states, Kansas and Hawaii, do not report current hospitalization data, and some states may temporarily not be reporting full hospitalization numbers because of a recent change in the reporting system ordered by the Trump administration.

“The hospitalization number is the best indicator of where we are,” Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute, told Vox. “We’re going to go to new heights in the pandemic that we haven’t seen before. Not that what we saw before wasn’t horrifying enough.”

The growth has been driven by accelerating spread in Arizona, California, Florida, Georgia, and Texas in particular. On April 15, when New York City hospitals were nearly being overrun with Covid-19 patients, Texas had about 1,500 patients hospitalized with the disease. Today, more than 10,000 Texans are hospitalized with Covid-19.

Some areas are reaching a woeful tipping point of hospitals stretched to maximum capacity, scrambling to find beds in other facilities for Covid-19 patients. Miami-Dade County reported this week that the number of patients in need of ICU care had exceeded the number of available ICU beds. More than 50 hospitals across the state say they have no ICU beds available.

Texas Medical Center in Houston has already filled up its usual non-pandemic ICU unit and been forced to rely on its surge capacity plans to handle the patient load. Earlier this month, 10 out of the 12 hospitals in the Rio Grande Valley reported that they were completely full and needed to start transferring patients to hospitals elsewhere in the state.

This was, unfortunately, to be expected. Nearly all of the states currently experiencing an increase in new cases and hospitalizations started relaxing their social distancing restrictions in May and June before meeting the government’s reopening guidelines of having sufficiently reduced the virus’s spread and adequately ramped up their testing and tracing capabilities. New cases began rising and hospitalizations followed a few weeks after that. Now deaths are ticking up again, reversing a steady decline that had begun in early May.

Four million Americans have had confirmed cases of Covid-19. More than 143,000 of them have died. With hospitalizations reaching the new peak and several states still reporting thousands of new cases a day, experts say we are in for a difficult August and fall.

“We’ve still got 91 to 92 percent of people who are still vulnerable, who have not been infected,” said Topol. “And so that just shows how many more people can be hurt. Obviously many won’t get so sick, but many will.”

The new hospitalization record, and the untenable pressure it’s putting on the health care system, is also a reminder of how critical it is for states to implement and enforce measures like mandatory face masks, and for the federal government to solve testing and contact tracing problems. “It should be an all-points bulletin to really bear down on this because otherwise there’s no limit on where this might go,” said Topol.

Hospitals are running out of staff, supplies, and beds for Covid-19 patients

Hospitals in hot spots across the country are expanding and even maxing out their staff, equipment, and beds, with doctors warning that the worst-case scenario of hospital resources being overwhelmed is on the horizon if their states don’t get better control of the coronavirus.

“With Covid, a lot of times people who aren’t sick enough yet get pushed to the back, and then they can become really, really sick unfortunately because we were focusing our efforts on the people who are on the brink of death,” an emergency room doctor at the Banner Health system in the Phoenix metro area, who asked to go unnamed fearing retaliation from his employer, told Vox recently.

Other doctors in Arizona, where 85 percent of hospital beds statewide were in use as of Thursday, have said the scarcity of resources means they’ll soon be rationing medical care, as doctors in Italy were forced to do.

“The fear is we are going to have to start sharing ventilators, or we’re gonna have to start saying, ‘You get a vent, you don’t.’ I’d be really surprised if in a couple weeks we didn’t have to do that,” says Murtaza Akhter, an emergency medicine physician at Valleywise Health Medical Center in Phoenix.

The rampant transmission of the virus in Arizona and resulting pressure on hospitals are particularly infuriating to some emergency room and ICU staff, who say they’re having to make decisions on the fly that they’re uncomfortable making.

“Sending people with Covid home with oxygen tanks because we don’t have the resources for them? This is something I’ve never done in my life before,” says Akhter. “This is crazy. And this is gonna be even worse in a couple of weeks. So far we’re trying to hold steady, but how long will that last?”

The psychological toll, he says, is serious too.

“To come off a shift and be like, ‘I’m losing hope’ — that’s a dangerous place to be in,” he says. “I don’t want to feel that way. And that’s because despite the horrible numbers, despite the fact I’m still getting the Covid cases [in the ER], despite what we’ve been saying to the media from the front line, I drive home from work and I literally see lots of people congregating together closely and in the grocery store not wearing masks.”

Texas hospitals say they are in better shape now with personal protective equipment than they were in March and April, but that could change as the crisis gets worse. Roberta Schwartz, executive vice president at Houston Methodist, says her facilities have sometimes had trouble getting gowns and disinfectant wipes. John Henderson, who represents a trade association for rural hospitals in the state, says he recently “got a couple of SOS calls.”

Staffing is a universal problem in hot spots. Houston Methodist has already brought in out-of-state nurses and asked its administrative staff with nursing certifications to start doing medical work again. Nurses are also being asked to work longer and overnight shifts.

Rural hospitals in Texas aren’t running out of beds yet, but they are running into a staffing shortage. These facilities might typically have five patients in a given unit, and the hospitals have staffed them accordingly. But now there might be as many as 20 patients.

“You’re working every nurse as much as you can work them and still not meeting the need,” Henderson says.

It’s not clear where more staff could come from. The state has already sent about 2,300 volunteers to the Rio Grande Valley, one of the hardest-hit areas in the state.

“Other areas are requesting that workforce support,” Henderson says. “But there’s not much more in terms of resources to be sent.”

Another concern is ventilators. Rural hospitals in Texas would ordinarily transfer their patients in serious condition, the kind who might be on a ventilator for days, to a larger hospital in the city. But because urban hospitals are already overrun with Covid-19 patients, there is nowhere for the rural hospitals to send their patients. Instead, they are forced to keep those patients, causing their beds to fill up even more quickly.

And while the current coronavirus patients are younger than those seen in the spring, Henderson says his hospitals don’t have enough of the nasal oxygen hookups that are used to help those patients breathe on their own and prevent them from being put on a ventilator.

“They’ve shown to be effective, but everybody’s trying to get them,” he says.

El Centro Regional Medical Center in Imperial County, one of California’s biggest Covid-19 hot spots right now, has already brushed up against its worst-case scenario. The hospital recently saw its available ventilators dwindle to one.

Adolphe Edward, the hospital’s CEO, convened an impromptu committee to evaluate the patients currently on ventilators so they could prioritize if another patient who needed one came through their door. They checked the patients’ lung capacity and considered whether they could risk taking one or two of them off the ventilator if the need arose.

Luckily, Edward figured out a workaround. He called another nearby hospital and asked if they had any ventilators available. They had two, which they shipped over to El Centro. For now, the machines are still there, though Edward says he and the other hospital have stayed in constant contact in case the ventilators need to be transferred again.

Daily deaths are creeping up again but are still far below the earlier peak

While daily Covid-19 hospitalizations reached a record high on July 22, another key metric, daily deaths, 1,126, was still less than half of its May 7 peak of 2,742, according to the Covid Tracking Project. Yet the trend is ominous, since daily deaths were dropping steadily by mid-June and then began rising again in early July.

On Thursday, Florida reported a new record single-day death toll of 173. Texas hit its own respective record on Wednesday, with 193 deaths.

Since many Covid-19 fatalities to date have occurred among people who were hospitalized for weeks before succumbing, experts say they expect deaths will continue to rise in the coming days and weeks. Yet it’s possible, they say, that fewer people who are hospitalized will end up dying in this summer stage of the pandemic as compared to the spring.

“Hospitalizations undoubtedly are going to be associated with more deaths or chronic illnesses, but I’m hoping that the deaths are not as steep as they were back in March and April,” said Topol. “And maybe that’s because they are more young people that are sick and they will pull through. Maybe it’s also because the treatments are getting better, not just the drugs but just the whole approach.”

Overall, he says, “The hope is that the relationship between hospitalizations and fatalities won’t be as tight as it was, but we have to watch this closely because that’s the optimistic view.”

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