The U.S. set a new COVID-19 hospitalization record Monday, exceeding 140,000 patients for the first time since the start of the pandemic — a warning sign, experts say, that the nation’s Omicron surge is already more severe than in other countries and will only get worse as it spreads from highly vaccinated cities to less protected parts of the U.S.
America’s previous.hospitalization peak came on Jan. 6, 2021, when 139,781 COVID patients were hospitalized nationwide, according to New York Times data. But that was several months before a mass vaccination effort kicked in and shielded recipients from the vast majority of severe disease.
On Monday, the number of Americans hospitalized with COVID-19 hit 142,388.
Word of a new U.S. hospitalization record may surprise Americans who have repeatedly heard that the hypermutated Omicron variant — which has triggered an unprecedented wave of breakthrough cases in vaccinated and previously infected individuals — is ultimately milder because it’s less likely to seriously sicken those who catch it.
“I think people have fixated on this idea that it’s mild,” New York University epidemiologist Céline Gounder recently told New York magazine. “Mild means mild — relatively mild — for the individual who’s infected. But it does not necessarily mean mild at a population level.”
The new U.S. hospitalization numbers — including rising ICU admissions in the cities Omicron has struck first — suggest just that: If even a milder variant infects enough people, the resulting surge can be anything but “mild.”
The problem, as Gounder and others have pointed out, is twofold.
First, there is a ton of virus circulating right now, with an average number of new daily cases (the current 7-day average stands at 677,243) that’s nearly three times higher than ever before. Virologist Trevor Bedford of the Fred Hutchinson institute in Seattle has calculated that tests are now catching just one in four or five U.S. infections — which means that Omicron is actually infecting more than 3 million Americans each day.
Second, this once unthinkable level of spread guarantees that Omicron is finding as many people at increased risk of hospitalization as possible: the entirely unvaccinated (83 million Americans); the vaccinated but unboosted (132 million Americans); and especially seniors who are not boosted (26 million) or even fully vaccinated (7 million) and who remain most susceptible to severe disease.
Then, just like earlier versions of the virus, Omicron is sending far too many of them — nearly all of whom are unvaccinated or undervaccinated — to the hospital.
“If a lot of people get infected, even if it’s a relatively benign virus, enough of those people will still [get] hospitalized and die that this is really going to be very overwhelming for the health care system,” Grounder explained.
Not all of the news about U.S. hospitalizations is grim. Doctors are reporting fewer patients on ventilators and shorter hospital stays in comparison to past waves, data that is consistent with higher population immunity and a variant that doesn’t latch onto lung cells as well as its predecessors. And data from various states show a significant fraction of COVID-19 patients tested positive “incidentally” upon admission for some other ailment, meaning that Omicron isn’t the thing that’s making them sick enough to seek care.
Unfortunately, as New York City emergency room doctor Craig Spencer explained Monday on Twitter, “entering the hospital WITH Covid versus FOR Covid isn’t a relevant distinction if the hospital doesn’t have the beds or providers needed to care for its patients. And the distinction isn’t always clear even to providers. Nor does it matter practically.”
“Every Covid + patient requires the same isolation to protect other patients from getting infected,” Spencer continued. “They require the same use of PPE. And they all represent another infection risk to providers. Most importantly they all require the same space in a bed. And that’s in short supply.”
In a New York Times op-ed published Monday titled, “As an E.R. Doctor, I Fear Health Care Collapse More Than Omicron,” Spencer elaborated on why U.S. hospitals trying to treat more than 140,000 COVID-19 patients at once represents an “unfolding tragedy.”
Among the reasons he mentioned: “‘classic’ COVID-19 patients, short of breath and needing oxygen,” all of whom are unvaccinated; “elderly patients for whom Covid rendered them too weak to get out of bed”; “people with diabetes in whom the virus caused serious and potentially fatal complications”; and on top of that “many hospitals [now] seeing their highest levels of employee infections of the pandemic,” with some having “lost 15 percent of their workforce or more.”
“The Omicron surge is real — and even if Omicron is ‘milder,’ it's not mild,” Spencer concluded on Twitter. “It causes severe disease half as often as Delta, but infects 2-4x as many people, potentially washing out any potential 'benefit.’”
The data from early U.S. Omicron hot spots is starting to bear this out. In Chicago, hospitalizations have surpassed 150 percent of last winter’s peak; today, there are already more Chicagoans in the ICU or on ventilators than there were one year ago.
Hospitalizations have also topped last winter’s highs in New York City and Washington, D.C. — and ICU and ventilator numbers are following the same, nearly vertical trajectory.
Initially, experts were encouraged by reports out of London showing that “despite steep rises in cases and patients, the number on ventilators has barely risen,” as Financial Times data journalist John Burn-Murdoch tweeted last Tuesday. Meanwhile, Burn-Murdoch continued, “the number of people in London ICUs has fallen in recent weeks, and is not following the same path as last winter.”
The hope was that the pattern would repeat itself in the U.S. because of Omicron’s relative mildness. But it hasn’t. Before Omicron arrived, the number of U.S. COVID patients in the ICU (per capita) was about twice as high as the number of U.K. COVID patients in the ICU. Today, two months later, that disparity is more than five times as high. While the U.K.’s ICU curve has remained flat, the U.S. curve has gone up about 100 percent — to the point where it’s just 21 percent lower than last winter’s pre-vaccination peak.
Why? Former Food and Drug Administration Commissioner Scott Gottlieb has theorized that “lower U.S. vax/booster rates” may be to blame.
“U.S. decoupling between cases, hospitalizations, deaths, while measurable vs prior waves, isn't as strong as UK; perhaps due to lower U.S. vax/booster rates (50% eligible adults boosted),” Gottlieb tweeted Sunday. “Our protracted wrangling over boosters may have sowed confusion, sapping consumer interest.”
Indeed, while America’s two-dose vaccination rate (62 percent of the total population) is somewhat lower than the U.K.’s (69 percent), its boosted rate is less than half as high: 23 percent here vs. 52 percent there. U.K. data shows that three vaccine doses prevent 88 percent of Omicron hospitalizations while two vaccine doses prevent just 52 percent.
What this means for U.S. Omicron deaths remains to be seen. A New York Times analysis published Monday shows the trajectory of COVID deaths rising steeply in New York City, Boston and Washington, D.C. — and tracking closely with the trajectory of cases from three weeks earlier. (It typically takes a terminal COVID patient about that long to succumb to the disease.)
And while those cities have been suffering fewer deaths per case so far this winter than last, they’re also reporting far more cases now than there were then — more than six times as many per day in New York City, for instance. Once the worst of those cases work their way through the overloaded hospital system, the absolute number of deaths may also wind up being higher this winter.
On the other hand, the deadlier Delta variant was already spurring its own wave in the Northeast when Omicron took hold. So, lingering Delta cases may be making Omicron look worse than it is.
Either way, the next few weeks will see Omicron spreading from cities like New York, where 74 percent of the population is fully vaccinated, to places like Mississippi, where just 49 percent of the population is fully vaccinated — and where COVID cases have increased by 702 percent over the last two weeks, more than any other state.
In fact, every state where Omicron is now spreading the fastest is a low-vax state like Mississippi: Texas (+678 percent), South Carolina (+652 percent), Kentucky (+578 percent), Louisiana (+546 percent), Arkansas (+526 percent) and Alabama (+522 percent).
“As Omicron advances into less vaccinated rural regions with more limited health systems capacity, it will overwhelm already strained hospitals, exacerbate sharp rural disparities in COVID deaths, and further constrain access to non-COVID care,” Anne Sosin, a public health researcher at Dartmouth College, predicted Monday.
Meanwhile, 20 percent of hospitals in a state like Maryland are reporting staff shortages — and the COVID-19 Hospital Capacity Circuit Breaker dashboard shows that every single county there appears to have reached or exceeded its hospital capacity.
“I can attest the situation in Maryland is [expletive] horrendous,” one physician wrote to the dashboard’s creator. “The state has been maxed out for about 2 weeks. Multiple hospitals are operating under crisis standard of care. EMS [i.e. ambulances] is now so taxed that Baltimore County started transporting people in fire trucks last week. This is absolutely unheard of and absurd. Reports of people waiting over 1-2 hours on scene with fire fighters before an EMS unit gets there. Then when they get to the hospital they wait literally hours for a bed. Transfer centers now just laugh when you call, the system is so backlogged. It’s mind-boggling to me how none of this has been national news.”