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American's Hospitals Are in Serious Trouble [推广有奖]

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Nicolle 学生认证  发表于 2022-1-15 03:06:22 |显示全部楼层

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  1. Hospitals Are in Serious Trouble
  2. Omicron is inundating a health-care system that was already buckling under the cumulative toll of every previous surge.

  3. By Ed Yong
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关键词:HOSPITALS American America trouble Serious

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Nicolle 学生认证  发表于 2022-1-15 03:07:03 |显示全部楼层
  1. When a health-care system crumbles, this is what it looks like. Much of what’s wrong happens invisibly. At first, there’s just a lot of waiting. Emergency rooms get so full that “you’ll wait hours and hours, and you may not be able to get surgery when you need it,” Megan Ranney, an emergency physician in Rhode Island, told me. When patients are seen, they might not get the tests they need, because technicians or necessary chemicals are in short supply. Then delay becomes absence. The little acts of compassion that make hospital stays tolerable disappear. Next go the acts of necessity that make stays survivable. Nurses might be so swamped that they can’t check whether a patient has their pain medications or if a ventilator is working correctly. People who would’ve been fine will get sicker. Eventually, people who would have lived will die. This is not conjecture; it is happening now, across the United States. “It’s not a dramatic Armageddon; it happens inch by inch,” Anand Swaminathan, an emergency physician in New Jersey, told me.
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Nicolle 学生认证  发表于 2022-1-15 03:22:30 |显示全部楼层
  1. In this surge, COVID-19 hospitalizations rose slowly at first, from about 40,000 nationally in early November to 65,000 on Christmas. But with the super-transmissible Delta variant joined by the even-more-transmissible Omicron, the hospitalization count has shot up to 110,000 in the two weeks since then. “The volume of people presenting to our emergency rooms is unlike anything I’ve ever seen before,” Kit Delgado, an emergency physician in Pennsylvania, told me. Health-care workers in 11 different states echoed what he said: Already, this surge is pushing their hospitals to the edge. And this is just the beginning. Hospitalizations always lag behind cases by about two weeks, so we’re only starting to see the effects of daily case counts that have tripled in the past 14 days (and are almost certainly underestimates). By the end of the month, according to the CDC’s forecasts, COVID will be sending at least 24,700 and up to 53,700 Americans to the hospital every single day.

  2. This surge is, in many ways, distinct from the ones before. About 62 percent of Americans are fully vaccinated, and are still mostly protected against the coronavirus’s worst effects. When people do become severely ill, health-care workers have a better sense of what to expect and what to do. Omicron itself seems to be less severe than previous variants, and many of the people now testing positive don’t require hospitalization. But such cases threaten to obscure this surge’s true cost.
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在这次激增中,COVID-19 住院人数起初缓慢上升,从 11 月初的全国约 40,000 人增加到圣诞节的 65,000 人。但随着超级传播的 Delta 变种和传播能力更强的 Omicron 的加入,从那以后的两周内,住院人数飙升至 110,000 人。 “到我们急诊室就诊的人数与我以前见过的任何情况都不一样,”宾夕法尼亚州的急诊医师 Kit Delgado 告诉我。 11 个不同州的卫生保健工作者呼应了他的话:这种激增已经将他们的医院推向了边缘。而这仅仅是个开始。住院人数总是落后于病例大约两周,因此我们才刚刚开始看到在过去 14 天内每日病例数增加了两倍(而且几乎可以肯定是被低估了)的影响。根据 CDC 的预测,到本月底,COVID 每天将有至少 24,700 至 53,700 名美国人送往医院。

在许多方面,这种激增与以前的不同。大约 62% 的美国人完全接种了疫苗,并且大部分人仍然可以免受冠状病毒最严重的影响。当人们确实得了重病时,卫生保健工作者会更好地了解会发生什么以及该做什么。 Omicron 本身似乎没有以前的变种那么严重,而且现在许多检测呈阳性的人不需要住院。但此类案件有可能掩盖这一激增的真实成本。

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Nicolle 学生认证  发表于 2022-1-15 03:24:32 |显示全部楼层
  1. Omicron is so contagious that it is still flooding hospitals with sick people. And America’s continued inability to control the coronavirus has deflated its health-care system, which can no longer offer the same number of patients the same level of care. Health-care workers have quit their jobs in droves; of those who have stayed, many now can’t work, because they have Omicron breakthrough infections. “In the last two years, I’ve never known as many colleagues who have COVID as I do now,” Amanda Bettencourt, the president-elect of the American Association of Critical-Care Nurses, told me. “The staffing crisis is the worst it has been through the pandemic.” This is why any comparisons between past and present hospitalization numbers are misleading: January 2021’s numbers would crush January 2022’s system because the workforce has been so diminished. Some institutions are now being overwhelmed by a fraction of their earlier patient loads. “I hope no one you know or love gets COVID or needs an emergency room right now, because there’s no room,” Janelle Thomas, an ICU nurse in Maryland, told me.

  2. Here, then, is the most important difference about this surge: It comes on the back of all the prior ones. COVID’s burden is additive. It isn’t reflected just in the number of occupied hospital beds, but also in the faltering resolve and thinning ranks of the people who attend those beds. “This just feels like one wave too many,” Ranney said. The health-care system will continue to pay these costs long after COVID hospitalizations fall. Health-care workers will know, but most other people will be oblivious—until they need medical care and can’t get it.
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Omicron 的传染性如此之强,以至于医院仍然挤满了病人。美国继续无法控制冠状病毒,导致其医疗保健系统萎缩,无法再为同样数量的患者提供同样水平的护理。医护人员纷纷辞职;在留下来的人中,许多人现在无法工作,因为他们患有 Omicron 突破性感染。美国重症监护护士协会候任主席阿曼达·贝当古(Amanda Bettencourt)告诉我:“在过去的两年里,我从未像现在这样认识这么多感染 COVID 的同事。” “人员配备危机是大流行以来最严重的一次。”这就是为什么过去和现在住院人数之间的任何比较都具有误导性:2021 年 1 月的数字将压垮 2022 年 1 月的系统,因为劳动力已经如此减少。一些机构现在正被其早期患者负荷的一小部分所淹没。 “我希望你认识或爱的人现在没有感染 COVID 或需要急诊室,因为没有房间,”马里兰州 ICU 护士珍妮尔·托马斯告诉我。

那么,这就是这次激增最重要的区别:它是在所有之前的浪潮之后出现的。 COVID的负担是累加的。这不仅反映在被占用的病床数量上,还反映在就诊者的决心摇摇欲坠和人数减少上。 “这感觉就像一波太多了,”兰尼说。在 COVID 住院人数下降后很长一段时间内,医疗保健系统仍将继续支付这些费用。卫生保健工作者会知道,但大多数其他人会浑然不觉——直到他们需要医疗护理却得不到。
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Nicolle 学生认证  发表于 2022-1-15 03:29:43 |显示全部楼层
  1. The Patients
  2. The patients now entering American hospitals are a little different from those who were hospitalized in prior surges. Studies from South Africa and the United Kingdom have confirmed what many had hoped: Omicron causes less severe disease than Delta, and it is less likely to send its hosts to the hospital. British trends support those conclusions: As the Financial Times’ John Burn-Murdoch has reported, the number of hospitalized COVID patients has risen in step with new cases, but the number needing a ventilator has barely moved. And with vaccines blunting the severity of COVID even further, we should expect the average COVID patient in 2022 to be less sick than the average patient in 2021.

  3. In the U.S., many health-care workers told me that they’re already seeing that effect: COVID patients are being discharged more easily. Fewer are critically ill, and even those who are seem to be doing better. “It’s anecdotal, but we’re getting patients who I don’t think would have survived the original virus or Delta, and now we’re getting them through,” Milad Pooran, a critical-care physician in Maryland, told me. But others said that their experiences haven’t changed, perhaps because they serve communities that are highly unvaccinated or because they’re still dealing with a lot of Delta cases. Milder illness “is not what we’re seeing,” said Howard Jarvis, an emergency physician in Missouri. “We’re still seeing a lot of people sick enough to be in the ICU.” Thomas told me that her hospital had just seven COVID patients a month ago, and is now up to 129, who are taking up almost half of its beds. Every day, about 10 patients are waiting in the ER already hooked up to a ventilator but unable to enter the ICU, which is full.
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病人
现在进入美国医院的患者与之前激增的住院患者略有不同。来自南非和英国的研究证实了许多人的希望:Omicron 引起的疾病不如 Delta 严重,并且不太可能将宿主送往医院。英国的趋势支持这些结论:正如英国《金融时报》的约翰·伯恩-默多克报道的那样,住院 COVID 患者的数量随着新病例的增加而增加,但需要呼吸机的人数几乎没有变化。随着疫苗进一步削弱了 COVID 的严重程度,我们应该预计 2022 年的普通 COVID 患者的病情将低于 2021 年的普通患者。

在美国,许多医护人员告诉我,他们已经看到了这种效果:COVID 患者更容易出院。很少有人患重病,甚至那些似乎情况更好的人。 “这是传闻,但我们正在接受我认为无法在原始病毒或 Delta 病毒中幸存下来的患者,现在我们正在帮助他们度过难关,”马里兰州的重症监护医生 Milad Pooran 告诉我。但其他人表示,他们的经历没有改变,可能是因为他们服务于高度未接种疫苗的社区,或者因为他们仍在处理大量三角洲病例。密苏里州的急诊医生霍华德·贾维斯说,“我们所看到的并不是更轻微的疾病”。 “我们仍然看到很多人病得很重,可以住进重症监护室。”托马斯告诉我,她的医院一个月前只有 7 名 COVID 患者,现在已经达到 129 名,几乎占了医院一半的床位。每天,大约有 10 名患者在急诊室等候,已经挂上了呼吸机,但无法进入已满员的 ICU。

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Nicolle 学生认证  发表于 2022-1-15 03:31:33 |显示全部楼层
  1. During this surge, record numbers of children are also being hospitalized with COVID. Sarah Combs, a pediatric emergency physician in Washington, D.C., told me that during the height of Delta’s first surge, her hospital cared for 23 children with COVID; on Tuesday, it had 53. “Many of the patients I’m operating on are COVID-positive, and some days all of them are,” Chethan Sathya, a pediatric surgeon in New York, told me. “That never happened at any point in the pandemic in the past.” Children fare much better against the coronavirus than adults, and even severely ill ones have a good chance of recovery. But the number of such patients is high, and Combs and Sathya both said they worry about long COVID and other long-term complications. “I have two daughters myself, and it’s very hard to take,” Sathya said.

  2. These numbers reflect the wild spread of COVID right now. The youngest patients are not necessarily being hospitalized for the disease—Sathya said that most of the kids he sees come to the hospital for other problems—but many of them are: Combs told me that 94 percent of her patients are hospitalized for respiratory symptoms. Among adults, the picture is even clearer: Every nurse and doctor I asked said that the majority of their COVID patients were admitted because of COVID, not simply with COVID. Many have classic advanced symptoms, such as pneumonia and blood clots. Others, including some vaccinated people, are there because milder COVID symptoms exacerbated their chronic health conditions to a dangerous degree. “We have a lot of chronically ill people in the U.S., and it’s like all of those people are now coming into the hospital at the same time,” said Vineet Arora, a hospitalist in Illinois. “Some of it is for COVID, and some is with COVID, but it’s all COVID. At the end of the day, it doesn’t really matter.” (COVID patients also need to be isolated, which increases the burden on hospitals regardless of the severity of patients’ symptoms.)
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在这一激增期间,创纪录数量的儿童也因 COVID 住院。华盛顿特区的儿科急诊医师 Sarah Combs 告诉我,在 Delta 第一次激增的高峰期,她的医院照顾了 23 名 COVID 患儿;周二,它有 53 人。纽约的儿科医生 Chethan Sathya 告诉我:“我正在接受手术的许多患者都是 COVID 阳性,有些日子他们都是。” “在过去的大流行中,这种情况从未发生过。”与成人相比,儿童对冠状病毒的抵抗力要好得多,即使是重症患者也有很大的康复机会。但此类患者的数量很多,Combs 和 Sathya 都表示他们担心长期 COVID 和其他长期并发症。 “我自己有两个女儿,很难接受,”沙迪亚说。

这些数字反映了当前 COVID 的广泛传播。最年轻的患者不一定因为这种疾病住院——Sathya 说,他看到的大多数孩子都是因为其他问题来医院的——但其中很多是:Combs 告诉我,她 94% 的患者因呼吸道症状住院。在成年人中,情况更加清晰:我问过的每一位护士和医生都说,他们的大多数 COVID 患者是因为 COVID 而入院的,而不仅仅是因为 COVID。许多人有典型的晚期症状,如肺炎和血栓。其他人,包括一些接种疫苗的人,都在那里,因为较轻的 COVID 症状将他们的慢性健康状况恶化到了危险的程度。伊利诺伊州的住院医师 Vineet Arora 说:“我们在美国有很多慢性病患者,就像所有这些人现在同时进入医院一样。” “有些是针对新冠病毒的,有些是针对新冠病毒的,但都是新冠病毒。归根结底,这并不重要。” (新冠患者也需要被隔离,无论患者症状的严重程度如何,这都会增加医院的负担。)

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Nicolle 学生认证  发表于 2022-1-15 03:33:21 |显示全部楼层
  1. Omicron’s main threat is its extreme contagiousness. It is infecting so many people that even if a smaller proportion need hospital care, the absolute numbers are still enough to saturate the system. It might be less of a threat to individual people, but it’s disastrous for the health-care system that those individuals will ultimately need.

  2. Other countries have had easier experiences with Omicron. But with America’s population being older than South Africa’s, and less vaccinated or boosted than the U.K.’s or Denmark’s, “it’s a mistake to think that we’ll see the same degree of decoupling between cases and hospitalizations that they did,” James Lawler, an infectious-disease physician in Nebraska, told me. “I’d have thought we’d have learned that lesson with Delta,” which sent hospitalizations through the roof in the U.S. but not in the U.K. Now, as then, hospitalizations are already spiking, and they will likely continue to do so as Omicron moves from the younger people it first infected into older groups, and from heavily vaccinated coastal cities into poorly vaccinated rural, southern, and midwestern regions. “We have plenty of vulnerable people who will fill up hospital beds pretty quickly,” Lawler said. And just as demand for the health-care system is rising, supply is plummeting.
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Omicron 的主要威胁是其极强的传染性。它感染了如此多的人,即使一小部分人需要住院治疗,绝对数量仍然足以使系统饱和。它对个人的威胁可能较小,但对这些人最终需要的医疗保健系统来说是灾难性的。

其他国家在使用 Omicron 方面有过更轻松的经验。但由于美国的人口比南非的人口老龄化,而且比英国或丹麦的人口少接种疫苗或加强疫苗接种,“认为我们会看到病例和住院之间的脱钩程度与他们一样的想法是错误的,”詹姆斯劳勒内布拉斯加州的传染病医生告诉我。 “我原以为我们已经从达美航空那里吸取了教训”,这使美国的住院人数激增,但在英国却没有Omicron 从最初感染的年轻人转移到老年人群,并从接种率很高的沿海城市转移到疫苗接种率低的农村、南部和中西部地区。 “我们有很多弱势群体,他们很快就会填满病床,”劳勒说。就在对医疗保健系统的需求在上升的同时,供应也在直线下降。

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Nicolle 学生认证  发表于 2022-1-15 03:34:42 |显示全部楼层
  1. The Workers
  2. The health-care workforce, which was short-staffed before the pandemic, has been decimated over the past two years. As I reported in November, waves of health-care workers have quit their jobs (or their entire profession) because of moral distress, exhaustion, poor treatment by their hospitals or patients, or some combination of those. These losses leave the remaining health-care workers with fewer trusted colleagues who speak in the same shorthand, less expertise to draw from, and more work. “Before, the sickest ICU patient would get two nurses, and now there’s four patients for every nurse,” Megan Brunson, an ICU nurse in Texas, told me. “It makes it impossible to do everything you need to do.”
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工人
在大流行之前人手不足的医疗保健劳动力在过去两年中已经锐减。 正如我在 11 月报道的那样,一波又一波的医疗保健工作者因为道德上的痛苦、疲惫、医院或患者的治疗不佳或这些原因的某种组合而辞掉了工作(或整个职业)。 这些损失使剩余的医疗保健工作者拥有更少的可信赖的同事,他们使用同样的速记方式,更少的专业知识可供借鉴,以及更多的工作。 “以前,重症监护病房的病人需要两名护士,而现在每个护士有四个病人,”德克萨斯州的重症监护病房护士梅根·布伦森告诉我。 “这使得你无法做你需要做的一切。”

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Nicolle 学生认证  发表于 2022-1-15 03:36:12 |显示全部楼层
  1. Omicron has turned this bad situation into a dire one. Its ability to infect even vaccinated people means that “the numbers of staff who are sick are astronomical compared to previous surges,” Joseph Falise, a nurse manager in Miami, told me. Even though vaccinated health-care workers are mostly protected from severe symptoms, they still can’t work lest they pass the virus to more vulnerable patients. “There are evenings where we have whole sections of beds that are closed because we don’t have staff,” said Ranney, the Rhode Island emergency physician.

  2. Every part of the health-care system has been affected, diminishing the quality of care for all patients. A lack of pharmacists and outpatient clinicians makes it harder for people to get tests, vaccines, and even medications; as a result, more patients are ending up in the hospital with chronic-disease flare-ups. There aren’t enough paramedics, making it more difficult for people to get to the hospital at all. Lab technicians are falling ill, which means that COVID-test results (and medical-test results in general) are taking longer to come back. Respiratory therapists are in short supply, making it harder to ventilate patients who need oxygen. Facilities that provide post-acute care are being hammered, which means that many groups of patients—those who need long-term care, dialysis, or care for addiction or mental-health problems—cannot be discharged from hospitals, because there’s nowhere to send them.
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Omicron 已经把这种糟糕的情况变成了可怕的情况。它甚至可以感染接种疫苗的人,这意味着“与之前的激增相比,生病的员工人数是天文数字,”迈阿密的护士经理约瑟夫法利斯告诉我。尽管接种疫苗的医护人员大多可以避免出现严重症状,但他们仍然无法工作,以免将病毒传染给更脆弱的患者。罗德岛急诊医生兰尼说:“有些晚上,由于没有工作人员,我们的整个病床都关闭了。”

医疗保健系统的每个部分都受到影响,降低了对所有患者的护理质量。药剂师和门诊临床医生的缺乏使人们更难获得检测、疫苗甚至药物;结果,更多的患者因慢性病突然发作而入院。没有足够的护理人员,使人们更难以到达医院。实验室技术人员生病了,这意味着 COVID 测试结果(以及一般的医学测试结果)需要更长的时间才能回来。呼吸治疗师供不应求,使得需要氧气的患者更难进行通气。提供急性期后护理的设施受到重创,这意味着许多患者群体——那些需要长期护理、透析或治疗成瘾或心理健康问题的患者——无法出院,因为无处可送他们。

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悟空322 发表于 2022-1-15 10:29:26 来自手机 |显示全部楼层
Nicolle 发表于 2022-1-15 03:06
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