The omicron surge is jamming up hospital emergency rooms with patients who are waiting long hours or even days to get a bed.

"We are being absolutely crushed," says Dr. Gabor Kelen, chair of emergency medicine at the Johns Hopkins University School of Medicine in Maryland.

Nationwide, daily COVID hospitalizations are up about 33% this week from the week before and more than 155,000 people are hospitalized with COVID-19, well above the record set last winter.

But these numbers can't capture the pressure on emergency rooms. Before those patients land in hospital beds, many more of them funnel through emergency rooms seeking care.

Emergency departments essentially act as shock absorbers for the enormous wave of infections, triaging all kinds of patients, from the severely ill to those who might not need to be admitted at all.

"We are like the one open venue for everybody, right? It's the one place you can go without an appointment," says Kelen.

It's another symptom of the unrelenting stress on the health care system as it struggles with staffing shortages, backed-up demand for care and the sheer volume of new infections.

Some of the increased load on ERs is even from patients seeking a coronavirus test which they can't find elsewhere. At some hospitals, cars line up for hours to try to get tests, and hospitals set up tents to handle testing. Yet some patients still come into the ER for tests.

"All of our emergency departments in our hospitals are really getting hit much harder this time around," says Dr. Alok Sengupta, chair of emergency medicine for hospitals in St Louis run by Mercy.

Omicron may be milder but the patient load is not

Research shows that rate of severe disease is likely lower with omicron. But this reduced severity is more than offset by the huge number of patients who are getting infected because omicron is so contagious, says Dr. Gillian Schmitz, president of the American College of Emergency Physicians.

"The percentage of people who are coming in with symptoms, it's still enough to really overwhelm a hospital pretty quickly," says Schmitz. "And then on top of that, we still have all of the same car accidents and appendicitis and other things that would normally bring people into the emergency department."

Several recent studies from the U.S. and overseas show the chance of severe illness is lower compared to delta.

In fact, researchers at Kaiser Permanente in Southern California found the chance of hospitalization is about 50% lower for patients infected with omicron compared to delta, according to a new study of close to 70,000 patients, released this week as a pre-print. Those are similar to earlier findings from researchers at Case Western Reserve University.

But just because omicron can be less severe than delta, it can still lead to the same life-threatening complications of COVID-19, especially in the unvaccinated and the most high-risk patients, says Dr. Greg Miller, chief medical officer for Vituity, a national physician staffing company.

"There's just a lot more unvaccinated individuals it seems showing up with omicron, and we are still seeing some pretty sick patients," he says.

And with the huge patient loads, the omicron wave is worse than previous waves for hospitals despite the lower overall severity, says Casey Clements, an ER doctor at the Mayo Clinic in Rochester, Minn.

"I think it's the most dangerous and most likely to break the system in upcoming weeks," he says.

Long wait times and severe consequences

The backup in the ER is partly due to the fact that there are already too many patients taking up beds in the hospital to easily free up space.

"The admitted patients from the emergency department can't get upstairs," says Kelen. "So they linger and they take up all the acute beds of the emergency department, which means everybody else waits in the waiting room."

When ERs are overtaxed, the most immediate consequences are that patients must wait longer and longer to get care.

Dr. Ruth Franks Snedecor, a hospitalist in Phoenix, Ariz., says ER wait times are now double what they were in 2021 and doctors are seeing a third more patients.

"What we are dealing with in the first month of 2022 is unsustainable," she says.

The pileup can be especially tricky with COVID-19, because ERs have to follow infection control measures and separate patients so they don't infect others. And with so many patients clogging up the waiting room, it's harder to prioritize the true emergencies.

"We have had some of our longest wait times that I've ever seen," says Sengupta in St Louis.

This is being felt acutely at the emergency room where Dr. Bradley Dreifuss works in Tucson, Ariz.

"Our hospitals are totally full. We're not able to admit patients," he says. "It's led to major delays in care and patients sitting in the waiting room, eventually leaving and then coming back even sicker."

In Colorado, the situation is bad enough that ambulances are operating under new crisis protocols, where some patients may not be brought to a hospital if their condition isn't considered serious enough.

Schmitz says many hospitals are so full they are on diversion — meaning they aren't accepting ambulance traffic or transfers — and then patients end up stuck in the ER and waiting for a hospital bed to open up.

"You may be in a bed in the emergency department, not just for many hours, which was already very bad, but possibly even for several days," says Kelen at Johns Hopkins.

In other circumstances, patients who need to be transferred from one ER to another for higher level emergency care are stuck. Snecedor says she's seeing this in Phoenix because the system is so inundated.

"They just sit there and they die, or they have long-term ill effects related to the fact that they couldn't get the care that they needed when they needed it," she says. "And we all know with a lot of these conditions — stroke, heart attack — time is of the essence."

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