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'Never-ending nightmare': The hospitals where the ICU occupancy stayed high

Hospitals in Texas, California and Florida are among the most burdened in the country.
Sharp Surge In COVID-19 Cases In Texas Overwhelms Hospitals
Nurses tend to patients in hallways at the Houston Methodist The Woodlands Hospital, near Houston, on Aug. 18. Of the 100 most-burdened intensive care units, Texas is home to more than any other state.Brandon Bell / Getty Images

Early this month, Grady Memorial Hospital in Atlanta delayed elective surgeries and procedures. The reason: There were so many Covid-19 patients in the hospital's intensive care unit that there was just no room for anyone who isn't seriously ill.

“We have had to postpone some nonessential surgical procedures because we did not have an inpatient bed for them after they had their surgery,” said Dr. Robert Jansen, the Grady Health System chief medical officer.

While the state of Georgia — and the United States as a whole — have been dealing with another surge of Covid cases since August, data from the Department of Health and Human Services shows that Grady’s ICU has been full for much longer. Every week, for the past 12 months, it has been 100 percent full. Before the pandemic, Jansen estimated it was full 70 percent of the time.

“ICU capacity is always a challenge,” Jansen said. “What we are now facing is that with a significant number of Covid patients requiring critical care, we are running above capacity. That is not something that is unusual for us on occasion, but right now it's constant.”

Grady's ICU is one of many across the country that have been consistently packed. While Covid cases and deaths have ebbed and flowed nationally, an NBC News analysis of Health and Human Services data shows that 20 hospitals nationwide had full ICUs for more than 52 weeks since the onset of the pandemic. And health experts say these repeated Covid surges create monumental challenges to patients and health care providers.

A 2014 study on intensive care occupancy and ventilator use found that from 2005 to 2007, ICU occupancy rates ranged from 57 percent to 81 percent, much lower than Grady’s current 100 percent.

Health experts say that an ICU packed with Covid patients needing extended care means that there isn’t room for patients who need treatment for sudden, serious emergencies.

Cindy Zolnierek, CEO of the Texas Nurses Association, said that if someone gets into a car accident or is having a heart attack, hospital beds may not be available for them.

“They're not available for all these other situations where someone has a medical crisis and needs an ICU,” she said. “If it's a Covid patient, then that bed is not available to these other folks.”

Such a scene played out this month in Alabama, where a patient with a heart condition died after his hospital was unable to find an ICU bed for him, even after contacting 43 nearby hospitals.

The Health and Human Services data suggests that hospitals in the South and the Southwest have experienced this extended surge more than anywhere else in the country. Of the 100 intensive care units that have spent the most weeks at or over patient capacity from July 2020 to Sept. 23, Texas is home to 17, the highest in the nation. California has 13 of the 100 most burdened hospitals, and Florida has 10. Alabama has seven, Kentucky and Georgia have six. No other state has more than five hospitals.

Health and Human Services hospital-level data only goes back to July 2020, and excludes hospitals reporting fewer than four hospitalizations in a given week.

As of the week of Sept. 23, the country’s ICU capacity was about 79 percent full on average, and August saw more ICUs maxed out than in January, when the U.S. was counting more than 3,000 Covid deaths a day and before widespread Covid vaccinations.

“It's been tough not having the ICU capacity, because that's really where our bottleneck has been over the month of July,” said Tena Knight, associate chief nursing officer for Southeast Health in Dothan, Alabama.

“Even today, the number of ICU patients that we have, we've just experienced anywhere from maybe 10 to 15 patients that are needing ICU beds, sometimes upwards of 20 patients needing ICU beds, and there's just no place to put them.”

This summer’s Covid surge has only made things more difficult for packed hospitals. In Alabama, ICUs were maxed out in the latest surge, and other states have had to resort to rationing care in certain hospitals.

Idaho began to ration health care early this month as hospital beds filled up with a deluge of Covid patients. Idaho has one of the lowest vaccination rates in the U.S., with only 41 percent of its population fully vaccinated, according to data from the Centers for Disease Control and Prevention. Currently, 55 percent of the country’s population is fully vaccinated.

By comparison, in New Jersey, where 64 percent of the population is fully vaccinated, only 45 percent of the ICU beds are filled.

There are more than 5,000 hospitals reporting weekly to Health and Human Services, with nearly 1 in 4 reporting that more than 90 percent of their ICU beds were full for the week ending Sept. 23. In early June, before the delta variant fueled a case surge, only 1 in 10 hospitals were at that level. Last week’s data shows that number decreasing slightly for the first time since July.

In Florida, about 86 percent of the ICUs are full. But data suggests that the state’s surge has ebbed, with only 39 hospitals reporting 100 percent occupancy, down from 50 percent the week prior, and down from a peak of 72 percent the week ending Aug. 26.

In Texas, data shows that ICUs have stayed more than 90 percent full since the middle of August, and have stayed around 80 percent since July 2020, with some of its hospitals reporting 100 percent ICU occupancy for months.

In McAllen, Texas, the Rio Grande Regional Hospital can barely catch a break. Located in the southern part of the state, the hospital has enough staff for 20 to 30 ICU beds a week, and data indicate they’ve been at full capacity for nearly the entire year, and much of 2020.

In an emailed statement, Adriana Morales, a hospital spokesperson, said they’re balancing the influx of patients by adding staff to increase the number of ICU beds.

Rio Grande was not the only Texas hospital experiencing repeated weeks of full ICUs. Park Plaza Hospital in Houston has seen 55 weeks of full occupancy since July 2020. HCA Houston Healthcare Southeast in Pasadena saw 45 weeks of full capacity during that time. More than 200 hospitals in the state have been maxed out at least once, but many more have tread close, with occupancies of more than 90 percent.

Burnout is another challenge in hospitals facing surge after surge.

“The strain that health care workers are under is unbelievable,” Zolnierek of the Texas Nurses Association said. “And it's not ending. It's been a year and a half now. After the vaccine, everyone was feeling, ‘Oh, my gosh, there's a light at the end of the tunnel.’ And then the delta variant came, and it kind of feels like this never-ending nightmare.”

She said some of her member nurses will be retiring.

“There are some nurses that are saying: ‘I'm going to hang on, my colleagues, my patients need me right now. But as soon as we're done with this wave, I can't go through this anymore.’”