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Omicron cases could overwhelm an already fragile health system

STEVE INSKEEP, HOST:

And we have called Dr. Craig Spencer. He's director of global health in emergency medicine at New York Presbyterian and Columbia University Irving Medical Center in Manhattan, meaning he's in New York City, where cases are already way up. Dr. Spencer, good morning.

CRAIG SPENCER: Good morning, Steve.

INSKEEP: What's it like in your hospitals now?

SPENCER: Well, it's really busy. But to be fair, it was really busy before the pandemic. You know, we don't have a big crush of COVID patients here in New York City yet, not like many other places around the country. But what we have is a lot of patients that have put off their routine care. The other day, I saw someone who needed a heart surgery before the pandemic but was afraid to come into the hospital and put it off so long that he came in when things got much worse. So our hospital is really busy, like many other emergency rooms around the country.

INSKEEP: Wow. So you have a situation, regardless of COVID cases, because of the backup of cases from the past. So what happens, and are you prepared for the possibility - not the certainty, but the possibility - of a big increase in cases in hospitals?

SPENCER: I'm very concerned because even under the most optimistic of those projections, right now so many emergency rooms and hospitals are already teetering on the brink. We've lost around 18% of the health care workers in this country since the pandemic began. According to some studies, about a fifth of nurses are thinking of quitting their job. There's a high incidence of thoughts of self-injury among frontline workers. And we know that we don't have the same capacity to surge nurses from Utah to New York City or from New York City to Arizona, depending on where the flare-up is at, because right now we don't have enough health care providers. And those that are still on the front lines are exhausted and tired and crushed from doing this for the past year and a half.

INSKEEP: Dr. Spencer, I'm thinking about the cost of this pandemic. We passed the 800,000 mark for people killed by COVID in this pandemic in the United States. But when I think about your heart patient that you mentioned, putting off surgery for a couple of years, is it clear to you that many, many more people than 800,000 have died simply because they have not been able to access routine medical care?

SPENCER: I think that's safe to say. Look; we know that there have been long-term impacts from people - from not COVID, from the impact that COVID has had on the ability for people to access mental health services. Obviously, with opioids and with the opioid crisis in this country, we know that there has been a big impact from COVID on non-COVID illness. The other thing that I'm concerned about is that, you know, even one day when COVID is long gone, we're still going to have this shortage of health care workers. We're still going to have so many people that were on the front line that are facing PTSD. I've said since March 2020, April 2020, that we're going to have a generation of health care workers that are going to be scarred by this. And many of them may leave the profession, but many of them may stay out of duty or requirement or whatever it may be. And I think that they're going to carry these wounds with them for a really long time.

INSKEEP: So what do you say to your fellow citizens who have chosen at this point not to get vaccinated and who simply say, this is my health, it is my choice, it is my body, I'm going to do what I want, and it's not really anybody else's business? What do you say to them?

SPENCER: The reality is that we're not fighting this pandemic as individuals. We're fighting this collectively as a country. And we know that the next couple of months are going to be hard. And this is true not just for fancy, wonderful academic medical centers like the one that I work at. This is true in rural hospitals, where nearly all of them are facing a nursing shortage, where ICU beds are already in short supply, and you have to look for hours around to be able to transfer someone. When ICUs fill up, people get put in the emergency room. When the emergency room fills up, you get put in the waiting room.

And whether you come in for COVID or something else, you don't want to sit in the waiting for - waiting room for three times as long as you normally would because even if we have better tools than March 2020 to manage this pandemic, to manage COVID, that doesn't do much if we can't get to you in time, if we can't see you, if you're waiting in the waiting room for seven or eight hours, or if there isn't a hospital bed for us to treat you. And that is the reality that we're going to see in the coming weeks and months if we get a big surge of COVID patients because hospitals have no wiggle room. Health care workers have no wiggle room right now.

INSKEEP: Is there a clash of interests at this moment between the interest of an individual and the interest of the community? Because an individual might very well say, listen; this omicron variant doesn't seem to be as serious. I myself might have gotten vaccinated, which reduces my chance of serious illness. I can stop taking precautions. I can travel. I can run around the country. I can be in crowds. I don't really have to worry that much individually. Whereas the reality for the community might be very different because if millions of people do that, the hospitals are overwhelmed.

SPENCER: I think exactly - that's exactly what the problem has been, is that we have approached this as an individual pandemic in many ways. But pandemics aren't personal, right? They're public. They're a collective, and we are facing this as a society. And yeah, I understand if you have been fully vaccinated and received a third dose and feel like you're protected. You know, we're seeing breakthroughs in that population. And the likelihood that you will get really sick and need to be hospitalized is incredibly low, thankfully. The majority of patients that we are still seeing very sick with COVID are unvaccinated. But the problem is that - I know everyone is tired. I get it. I'm tired. We're tired. But the reality is that the next couple of months are still going to be incredibly difficult, and we need everyone to do their part so that we're able to do our job and come to work for everybody.

INSKEEP: Is it ever going to get better?

SPENCER: I sure hope so. This has been a really long time. And I can see it on the faces of my colleagues. They're exhausted. I hear it whenever I talk to friends working in emergency rooms across the country. They're exhausted. They're tired. It needs to get better. I'm just concerned that even when things get better with COVID, we're still going to be confronting a looming crisis amongst health care and health care workers.

INSKEEP: Dr. Spencer, thanks for your insights. It's good to talk with you again, even under these circumstances.

SPENCER: Thank you, Steve.

INSKEEP: Dr. Craig Spencer, director of Global Health and Emergency Medicine at New York Presbyterian and Columbia University Irving Medical Center. Transcript provided by NPR, Copyright NPR.