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Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning, everyone. We're going to begin today by trying to make sense of the confusing statistics that show the Omicron variant of COVID tends to be less severe than earlier variants especially in vaccinated people, but that our hospitals are in crisis at the same time. Some of the news here is actually very good. Hospitals are filling up, but ICUs aren't. Ventilators are largely going unused, but the number of hospitalized people is still way, way up in our area compared to any time except the first horrible months of the pandemic two years ago.

Nationwide, an average of 1,600 people are dying with COVID every day since new year's, including more than 130 deaths a day in New York state. That's up more than 30% compared to late last year. Back in the summer, the daily death count in New York had dropped to single digits. On the surface, the math is simple. A smaller percentage of people who get Omicron are dying or being hospitalized from it than with earlier variants, a smaller percentage, but Omicron is so widespread.

The total number of deaths and hospitalizations is still way up, but there's also at least one confusing complication. About half the people being listed as hospitalized with COVID right now didn't come in for COVID. They came in for other health problems and then tested positive during routine screening. Here's governor Hochul at her press briefing on Friday.

Governor Hochul: Who was being admitted for COVID purposes that they're sick enough to have to be hospitalized for COVID. It's that severe versus people who present themselves to a hospital are automatically tested as a matter of routine now which is good, they're tested positive for COVID, but they're in there for other reasons. Think of all the other reasons people end up at a hospital. It's an overdose, it's a car accident, it's a heart attack.

Brian Lehrer: We'll give you those actual stats for New York City in a minute, but the question is, what should that do to our understanding of Omicron and how lethal it is, and how much we need to protect ourselves from it. We're very happy to have back with us Dr. Craig Spencer, emergency medicine physician, and director of global health in emergency medicine at the New York-Presbyterian Hospital, Irving Medical Center in upper Manhattan.

Some of you may remember him as the Ebola doctor who was in the news a little bit after he survived that virus back in 2014 after he had bravely traveled to Africa to assist the doctors there. Dr. Spencer has an op-ed in the New York Times right now called As an E.R doctor, I Fear Healthcare Collapse More Than Omicron. Dr. Spencer, always good to have you on the show. Welcome back to WNYC.

Dr. Craig Spencer: Thank you. Thanks for having me back on, Brian. It's good to be here.

Brian Lehrer: Let's start with some of the good news you wrote in your op-ed that you haven't needed to put any of your patients on a ventilator yet during the current surge. Can you use that as a starting point to compare what's happening in the hospital today to March of 2020?

Dr. Craig Spencer: Yes, I would love to because I think it is really important for people to hear the good news. This is not March 2020. As many people may recall back then for providers, it felt like walking into the apocalypse. Every day, just having emergency rooms filled with really sick people on oxygens, struggling to breathe. I remember one day walking into the emergency room through the ambulance bay and looking around and seeing an ER full of patients who are all intubated, on life support, on ventilators.

All I heard was just the din of the monitors that were just sounding around me. We are not at that point. We have come very, very far. We have really good treatments now that lower the risk of severe disease, of dying from COVID. We're not putting people on ventilators at all in similar rates to what we were beforehand. We figured out other things like high flow oxygen pruning which is turning people over to help their oxygen level come up. Other things that we can do that aren't requiring the same level of serious interventions.

We have other medications like oral antivirals that are coming out now that are still in short supply but have the promise of significantly lowering hospitalizations. Most importantly, we have vaccines which in a sense are undergoing this crisis in terms of, what do they do, how much do they actually protect us, but they have done an incredible amount over the past year to keep people out of the hospital.

If you look at the data, the difference between those that are getting really sick and those that are dying from COVID between those that are unvaccinated and those that are vaccinated, it's just astronomical. Vaccination, even if you're still able to get an infection as Omicron spreads is the most helpful way to keep you from getting sick, from coming into the ER and seeing me or dying from COVID. We are not in March 2020 and that is definitely reflected on the type of patients that I'm taking care of in the emergency department.

Brian Lehrer: In fact, let's stay on that vaccination issue for just a second before we get to the governor Hochul clip and the difference between hospitalized for COVID and hospitalized with COVID. You tweeted a graph. People won't see this in your Times op-ed, but you tweeted a graph comparing hospitalization among vaccinated and unvaccinated people. If I'm reading this right, among the vaccinated, only 4 people per 100,000 are being hospitalized for COVID right now. Among the unvaccinated, it's around 94 per 100,000. 4 versus 94, do you know the graph I'm referring to?

Dr. Craig Spencer: I sure do. Absolutely. That's the one I come back to pretty frequently. [laughs]

Brian Lehrer: Yes. If people needed any more proof than they already had, there is that.

Dr. Craig Spencer: From the New York city department of health, all of this is publicly available. If you look at the graph, it is incredibly compelling to anyone that looks at this, the difference between what's happening for folks that are vaccinated and unvaccinated. As I said, I know that there's a crisis of confidence in people who are vaccinated right now hearing about a lot of people that have been vaccinated that are having these breakthrough infections. The reality is this, the vaccines are doing exactly what we wanted them to do. They are keeping people out of the hospital, they are keeping people from getting really sick, and they are keeping people from dying from COVID.

Brian Lehrer: Well, it would've been nice if they were also keeping more people from getting infected and having to isolate and be a little sick--

Dr. Craig Spencer: Absolutely.

Brian Lehrer: --but they're doing the heavy lifting as you described. Now, one of your stats, however, is that despite these hopeful developments, despite the effectiveness of the vaccines at keeping people out of the hospital, hospitalizations in New York City have tripled in the past few weeks alone. Does that mean total hospitalizations like there are three times as many people in hospital beds today overall as there were before Thanksgiving say?

Dr. Craig Spencer: What we're looking at is actually that is hospitalizations for people who test positive for COVID. I know we'll talk a little bit about this distinction of with versus for, but the number of people hospitalized with COVID over the past few weeks has indeed tripled. Correct.

Brian Lehrer: Now, since you put it that way, we get to that statistic in the news that is probably still confusing to people right now. The spike in hospitalizations among people because of COVID versus the number with COVID. Here is governor Hochul, a little bit more from her last Friday with the New York City piece of that in particular.

Governor Hochul: The most number of people admitted for non-COVID reasons as of just yesterday or a couple of days ago are in New York City. It's about 50-50. 50-50. Half of the hospitalizations in New York City are someone who needs to be there because of the severity of their COVID situation and the other half are there for other reasons.

Brian Lehrer: Dr. Spencer, can you explain what that means for how we understand the total spike in hospitalizations right now?

Dr. Craig Spencer: Yes, absolutely. That's a really good question. We have seen that the type of patients that are coming in that are testing positive for COVID tend to fit into three different groups. One is your classic COVID patient. Disproportionally, those that are unvaccinated who come in with shortness of breath that may need some supplemental oxygen, may need some oxygen either via the nose or a face mask, that may need treatment for severe COVID, and are getting hospitalized for that.

That makes up a significant number of people that we're still seeing, but definitely a much smaller percentage than in March, April 2020 when it was 100% of the patients we were seeing basically. There's another group of patients that are testing positive for COVID that are presenting with other things. Now, the question in that group is how much of an impact is COVID having in exacerbating that underlying illness. To give you an example, we're seeing a lot of people that have diabetes and we know that COVID can make people's diabetes harder to control and worse.

In some people living with diabetes, there's a condition called diabetic ketoacidosis which in itself is life-threatening and severe. When combined with COVID, it's even more so. We've seen a good number of patients that are coming in with diabetic ketoacidosis that was likely exacerbated by an underlying COVID infection. Similarly, I've seen a lot of older patients that have had COVID, been diagnosed with COVID in the hospital and likely that was why they couldn't get up and get out of bed which is a health and safety risk of course, for people that might fall hurt themselves, break their hip. I've seen a lot of people for whom COVID has exacerbated dehydration where they've had a fever or they've had other illnesses that are being made worse by this underlying infection.

That is another bucket of folks that we're seeing people for whom COVID doesn't look like classic COVID of two years ago or even in many cases two months ago, but whom COVID is definitely still having an impact. Then there's another group of people that are indeed just testing positive incidentally when they come in to have appendix taken out or deliver a baby. We are testing every single person that comes into the hospital because regardless of whether you are in the hospital with COVID or for COVID, if you test positive for COVID, we have to treat you the exact same whether you have symptoms or not.

Brian Lehrer: When Governor Hochul says for 50% of those hospitalized with COVID in New York City right now are not hospitalized for COVID, it sounds like from what you just said, that that's an overstatement. That the people who might be in for diabetes, the people who might be in for dehydration and high fever might there partly because COVID is exacerbating their problems. It's not half of them came in for something completely unrelated and then happened to test positive.

Dr. Craig Spencer: That is correct. Think of this scenario where someone comes in and is having a heart attack and they test positive for COVID. Did COVID cause their heart attack or did they have a heart attack and also have COVID? For providers, sometimes it's impossible to say, ''We know that COVID can drop your oxygen and can put more work on your heart, which can exacerbate something like a heart attack.'' For us, it's all about how these things, how they're labeled, and how they're put into different categories and it's not clear.

There's not 100% certain way to say whether this is with COVID this is for COVID. I think ultimately the distinction doesn't necessarily matter, especially because for us, for providers, if someone tests positive for COVID, I need to treat them the exact same way, whether they're on oxygen, whether they're not, whether they're there because they're having their appendix taken out and they have a positive COVID test, or whether they're there for something else that may or may not be COVID directly related if that makes sense.

Brian Lehrer: Yes. You tweeted related to that that another thing different between today and 2020 is that today a COVID patient might be in the same room as a cancer patient who had done everything they could to avoid the virus because it could be so serious for them. That doesn't sound safe. Why is that happening?

Dr. Craig Spencer: Well, remember what happened in March and April of 2020. What I saw in the emergency room was COVID, COVID, COVID, only COVID, everything else cleared out. In March 2020, I remember tweeting, where did all the heart attack and appendicitis patients go? We didn't see them. A lot of patients stayed away from the Emergency Department because they were understandably afraid of being infected with COVID.

What we've seen now that because of the Delta surge a few months ago, because of increasing non-COVID presentation in emergency departments, not just here in New York, but all over the country, we have a record number of people already in our ERs waiting for beds upstairs or coming for evaluation for COVID or non-COVID illness and the result is that people are coming in because they're having complications from their chemotherapy, for example, side effects. Then there in the emergency department, at the same time that we have many other patients in the emergency department, many of whom have COVID.

Now, we do everything that we can to try to isolate folks, but many people come in, they don't have a positive test yet, they may not have those classic symptoms. Everyone is forced to wear a mask, but as it is in New York City emergency departments as in many emergency departments, it's busy, it's bustling, there's not a lot of space and what I get concerned about now is that one of those people that comes in that doesn't have COVID is coming in for something else is being exposed because there's such a huge number of people in emergency departments in the hospital that are testing positive for COVID that have COVID regardless of whether or not they have these symptoms.

We need to do everything that we can to prevent those people who through no fault of their own are being exposed. Many of these folks have been vaccinated. We know that for immunocompromised patients, those that might be on chemotherapy, for example. The vaccines just don't have the same beneficial impact at preventing severe disease as they do in other people, so we're trying to do everything we can to protect them, but with COVID spreading in the community and also in hospitals it's a concerning thing and it's the one thing that I worry about most for my patients.

Brian Lehrer: Is it actually happening? Do you have documented cases of people in your hospital there for other things who contract COVID while in the hospital?

Dr. Craig Spencer: There had been studies earlier on during the pandemic that showed that nosocomial transmission, so getting infected in the hospital was not an incredibly high risk because we have those procedures and protocols in place. I haven't seen any data from the past couple of weeks to suggest that there's transmission happening in hospitals, but if you look what's happening in our communities, I would be incredibly surprised if that's not happening. A lot of people are coming in, many for whom they don't know that they have COVID that are potentially infecting other folks.

It is happening when we have so many people in the beds in our hospital that are COVID positive for providers themselves are falling ill. I'm certain that there's some level of that transmission happening, but that is also the reason that we're doing everything we can to fight back the crunch on the beds and the staffing because when beds get short, when staff are short, that increases the risk of people having those exposures, that increases the risks of potentially putting patients into a more troublesome position if they have to wait longer in the emergency room, for example, or if we have to try to figure out a way to send them back to a nursing home that may not have enough providers because their providers are out sick and maybe they stay longer in a hospital. It becomes a really difficult calculus with a domino effect that impacts the whole system.

Brian Lehrer: Listeners, we can take your calls when tweets for New York-Presbyterian emergency medicine physician, Dr. Craig Spencer on COVID hospitalizations and the hospitalization crisis right now. 212-433-WNYC, 212-433-9692 or tweet @BrianLehrer. Again, maybe some of you saw his New York Times op-ed, As an E.R. Doctor, I Fear Health Care Collapse More Than Omicron, the title of that article. Let's take a phone call. Mike in Madison, New Jersey, you're on WNYC with Dr. Spencer. Hi, Mike.

Mike: Hi there. Thank you. Doctor, when the news reports the number of deaths due to COVID, they never identify what percentage of those were vaccinated or unvaccinated people, do you know that number?

Dr. Craig Spencer: That's a good question, Mike. What we're seeing is if you look on New York City Departments of Health page, if you look at CDC data or really any public health department of health data from around the country, most are separating the best that they can the number of deaths amongst the vaccinated versus the unvaccinated. Now, I will say in some scenarios it is hard to confirm because we don't have a centrally verifiable system throughout the country.

If some folks say that they've been vaccinated but don't have a documentation of that, there's a small subset for whom that's not necessarily clear, but for the overwhelming majority of patients including those who unfortunately die, we are able to link back whether or not they've been vaccinated and determine whether that death is considered one in someone who's been vaccinated against COVID versus someone who has not. That data definitely exists and I think that what it says is quite clear is that your likelihood of dying, if you have been vaccinated against COVID is incredibly, incredibly, incredibly low.

The one thing that I think is important too, Mike, is that a lot of people are talking about Omicron itself being milder, but it's definitely not mild, especially for those that are unvaccinated and we're continuing to see folks that are getting severe illness and dying and those tend to disproportionately be in the unvaccinated population. There is really good strong data to show that the vaccines even if people are continuing to get breakthrough infections and at sidelining them are still doing exactly what we want, which is keeping people out of the hospital and dying from COVID.

Brian: A follow-up, I think, from Anna in Brooklyn. Anna, you're on WNYC with Dr. Spencer. Hi.

Anna: Hi, Brian. Hi, Dr. Spencer. Thanks for taking my call.

Dr. Craig Spencer: Hi, Anna.

Anna: I'm wondering can we see this surge and I think the answer is yes. Can we see it statistically as a way of sidestepping the with versus of COVID question? Can we just compare the total hospitalization rates now to similar periods pre-pandemic or last year or whatever to see what's the overall impact of COVID even if it's hard to assign blame in particular cases?

Dr. Craig Spencer: That's a really good question, Anna. You can look at just raw numbers of beds then versus beds now whether it's beds before the pandemic or early in the pandemic versus now, but the issue is they're not necessarily comparable. The reason I say that is if you look at what a hospital system or even a state will say is a number of staff beds that they have available, that's a pie in the sky number that says, ''This is what we're capable of doing, but right now, what we're seeing is such an incredible shortage in healthcare workers who are getting sick. Some systems seeing 10%, 15%, maybe even 20% of their healthcare workforce. That is out at a time.

That is having a direct impact on the ability to staff those beds. We're also seeing a lot of people that are being admitted that are in those beds for COVID or otherwise and it's difficult sending them back to a nursing home because there's not enough staffing there or there's other reasons for which, comparing early on or earlier on versus now, it's not apples and apples.

In a sense, it's apples and oranges because we don't have the same capacity. We don't have the same ability to surge like we did in March and in April when we ran out of space in the hospitals so we built tents or we put people on floating ships. We don't have the providers right now that are necessarily able to provide that high quality of care because many of them are being sidelined as well.

Brian Lehrer: A follow-up on that and a thank you for your call from Brooklyn. From Chris, a nurse practitioner in Tarrytown with another report from the front. Hi, Chris. Thanks so much for calling in.

Chris: Hi, how are you guys?

Dr. Craig Spencer: Hi, Chris.

Chris: I'm also a public health nursing instructor at hunter, too. I do pediatrics and it's been horrific. The kids I see are coming in for COVID about third to half maybe just in an estimation are positive. They are sick. Families are put into disarray. We have had to do some telemedicine which really has helped a lot because that way our medical assistants are swabbing the kids after we do the telemedicine and you're taking them at least out of the office where we still have to see newborns and kids with other illnesses, but it's been overwhelming. The number of kids we are seeing with COVID.

Dr. Craig Spencer: I know that this has been an issue really all throughout the country, especially for kids like mine who are under five, who are unable to be vaccinated. We've seen in New York and in other places, the number of hospitalizations for kids has increased in recent weeks. I am at least a bit comforted to hear from my pediatric colleagues that it doesn't seem to be presenting with more severe illness, just a lot more of it.

Even if we're having to admit more kids to the hospital, it seems to be proportionate to what it was before. Now, obviously every single one of those is difficult for children, for the families, and obviously for providers and everyone else. The other thing that we're seeing is that similarly, too, with adults having those kids who are eligible for vaccination get vaccinated seems to be quite effective in keeping them out of the hospital as well.

Right now, we have about maybe just over half of the 12-17-year-olds that are eligible for vaccination vaccinated and around 15% across the country of the 5-11 groups. There's still a lot of kids that haven't been vaccinated yet. Understandably, in daycares and in schools people have a lot of concerns about their exposure of their kids and the impact it has on their families right now, including myself.

Chris: Oh, and it's been a struggle to get kids vaccinated, to get parents to vaccinate their kids. They're still believing a lot of the Facebook lies. We have had a kid with MIS-C also hospitalized. I have 30 years experience and we have not gone through anything like this ever before.

Brian Lehrer: In terms of the number of pediatric hospitalizations, Chris?

Chris: Mostly in terms of the numbers of kids that are sick and the spread of it. Like I said, we did have a kid with MIS-C where she was hospitalized and it was--

Brian Lehrer: What is MIS-C?

Chris: -- a horrible thing? Oh, it's multisystem inflammatory disease of COVID.

Brian Lehrer: That thing we've heard since early on can affect children where a lot of their organs get inflamed?

Dr. Craig Spencer: Correct.

Chris: Yes, exactly.

Dr. Craig Spencer: Some that presents a couple of weeks after a COVID infection that can have severe illness resulting in hospitalization. Thankfully, the CDC just put out a study on this within the past week that showed that being vaccinated against COVID dramatically lowers the risk of MIS-C. This is something that I've been trying to tell people as well, that

we haven't thankfully seen the same level of severe disease in kids.

We've had, in this country, around just under 800 children younger than 18 that have died from COVID, which of course for every single one of those families is devastating. It's not at all the same proportion or close to the same proportion for older folks. It's been hard to counter the misinformation saying that vaccination isn't helpful for kids or it's not as important as it is for older folks.

It's important in a very different way, which is gaining some of that normalcy, making sure that they're able to go to school safely, and if they're exposed, their likelihood of being infected is lower. Now, we know that their likelihood of developing severe illness like MIS-C is dramatically lower as well. If it were me and I had a kid that was eligible for vaccination, I absolutely would be vaccinating them. I'm trying to share that story in the story of why with everyone I talk to that has similar concerns.

Brian Lehrer: Thank you for your call, Chris. Thank you for your service--

Dr. Craig Spencer: Thanks, Chris.

Brian Lehrer: -- as a pediatric nurse and public health professor. We'll finish up with Dr. Spencer in a minute. We have a few things to get to. I'm curious about his take on the new CDC guidelines that let some people who work in hospitals go back to work after testing positive after just five days, even with no negative test. We have a caller who it looks like has a triple-vax pregnant wife and wants to know if it's safe to go to the hospital, they're around term and a few other things. Stay with us. Brian Lehrer on WNYC.

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Brian Lehrer: Brian Lehrer on WNYC. A few more minutes with Dr. Craig Spencer, emergency medicine physician at New York-Presbyterian and author of the New York Times op-ed: As an ER Doctor, I Fear Healthcare Collapse More Than Omicron. I want to hear about Michael in Brooklyn and his 38-week pregnant wife. Hi, Michael, you're on WNYC. Thank you for calling in.

Michael: Hey, Brian, long-time listener, first-time caller, and my wife is over 38 weeks pregnant right now. There's a lot of anxiety that's just heating up with us right now about going into the hospital. There's just a lot of unknowing about. We're hearing different stories about different hospitals and different protocols. I was just hoping that Dr. Spencer could shed some light on what we might expect and how we can prepare, I don't know.

Dr. Craig Spencer: That's a good question, Michael. One, congratulations. I don't know if this is your first, but it is wonderful and exhausting and incredible. I have a baby who was born just over one year ago today. Really in the US when we recorded our most COVID cases, I had just been vaccinated a few days before that, but my wife hadn't been. As you can imagine, we were quite concerned and we had a lot of worry about going to the hospital at that time. Thankfully for us, everything turned out okay.

I'm really glad to hear that your partner is triple vaccinated especially in pregnancy. We know that vaccination in pregnancy is safe and it's helpful to prevent those severe outcomes. Look, in so many ways, you are as protected as you could ever be. Obviously, when you go into the hospital, you're going to want to take the same precautions that you're hopefully taking everywhere else, which is wearing a mask. As of right now, I know that the concern for a lot of people is what happens once you get to the hospital. Am I able to go in with my partner? Those are things just to make sure to clarify beforehand.

Sometimes it seems like they're changing every few days, but most hospitals are making exceptions for partners, people that are going in if your wife or your partner is delivering. Just make sure to check that every couple of days, because you're getting close. You're almost there. What I will say is that, if you're vaccinated, if you're wearing a mask, that is the safest that you can possibly be. All of your providers will be doing everything that they can to make it safest for you. There's a lot more protocols that have and put in place for not only for you as patients, but also for your newborn as well to make sure that they're safe--

Brian Lehrer: Michael, congrat--

Dr. Craig Spencer: I understand that there's a lot of trepidation. We went through this a year ago and I had a lot of the same concern, but we're in a much better place now than we were then.

Brian Lehrer: Michael, congratulations to you and your wife and your baby in advance. Dr. Spencer, what's the visitation policy at New York-Presbyterian right now?

Dr. Craig Spencer: That's a good question. I actually need to take a look because I haven't seen it. It seems like it changes every once in a while every couple of days. I know that we're trying to limit obviously the number of people, not just at our hospital, but in really all hospitals the number of people coming into the ER alongside patients. Obviously, there are some folks for whom they need a family member to come in with them to either help out, but every hospital I know is right now trying to figure out how to manage the space crunch with having family there at the bedside which is incredibly important but also represents another risk of spread to patients that are there as well as a potential exposure for them.

Brian Lehrer: Here's Elizabeth, a nurse in Brooklyn, you're on WNYC. Hi, Elizabeth.

Elizabeth: Hi, Brian. I've actually been on the year before, and hi to you, doctor. This is the issue I call about all the time. When you talk about the crisis that you say we are in, I want you to always speak about the condition of the health care workers, not just to say that we have a shortage. What is going on now is unsustainable and I'd like to give you some information. The institution for which you work is treating its workers, from nurses all the way on down to custodians, in a way that I do not believe is humane, and it is making the solutions fall on them and their backs in this way.

Over the weekend, in my community hospital in the emergency room, there was one nurse for 20 to 25 patients. Just imagine what that means. That people who come into the hospital to visit family members have not been tested. Imagine what that means. That nurses have to provide their own tests for COVID. That's crazy. There is not enough staff. They are pulling people from different units, which I understand, but at the same time, they are never consulting the people who work there for what might be the best sustainable practice. I don't mean to use this word facetiously, but I think they're cannibalizing their staff and this cannot go on. I'm asking you--

Brian Lehrer: What would be the most important best practices to you, Elizabeth?

Elizabeth: I am not in a position, I'm a retired nurse, to say what best practices are but I do think what we need, and what management will not do, because I think their bottom line is making money. They have not shut down the money-making practices, which are elective surgery. I think you need to have an immediate emergency, city-wide gathering of elected officials, business officials, and the people who work there. Not the CEOs who have never stepped a foot on a COVID floor. They have COVID floors where COVID patients and non-COVID are not separated from one another. I don't have the solution. I have ideas but the people who work there are best informed to tell you their contribution.

Brian Lehrer: Elizabeth, thank you so much for your contribution. Dr. Spencer, on any of that?

Dr. Craig Spencer: Thanks for putting it out, Elizabeth. I think she's right. It's important to highlight that it's not just that we have staff that are getting sick. We have been doing this for two years. It is incredibly exhausting for those of us who were on the frontline in March and April in 2020 and saw so many people die. So many of us continue to remain even though many have stepped aside and have quit the profession of nursing or medicine altogether because of the mental toll that they've really encountered over the past few years.

It is absolutely an issue right now that staffing is a problem. It has been an issue throughout this pandemic as many people have left their profession. I completely understand what Elizabeth is saying. There's a lot of concerns around having the providers necessary to staff those beds. As I was pointing out earlier, to have providers who themselves are falling ill. This is what concerns me. I'm still concerned about Omicron. It's still bringing sick people to the emergency room, but what concerns me more is that the impact that's having on our healthcare system, on the structures, on the staff is really unsustainable.

I know that it looks like this wave will be fast on and, hopefully, fast off, but it's coming with such a big tsunami of cases. So many people are coming to the emergency room and staying in the hospital. That a lot of those other conditions that Elizabeth are pointing out having very few nurses, having very few staff, having patients who ultimately test positive that may be around other patients who may not yet test positive or haven't been exposed. These are huge concerns that we're trying to deal with but this has been tough before, it's even harder now by the sheer volume of patients, the number of staff that are out, and just the limitations we have on space. That's why I wrote that piece in The New York Times. Omicron might be milder but it is not mild, especially its impact on our healthcare system.

Brian Lehrer: Since the headline of your piece, and I realized the op-ed writers don't always write the headlines, but it's so alarming. As an ER doctor, I fear healthcare collapse more than Omicron. What's the vision of healthcare collapse, if you would use that phrase, and do you have policies to stave it off?

Dr. Craig Spencer: Yes. Healthcare collapse to me would be taking much longer for you to be seen in the emergency department because you're forced to wait in the waiting room three to four times longer. Either for non-COVID illness or maybe you have COVID. All the treatments and therapeutics that we have right now aren't much benefit if we don't get them to you. Healthcare collapse to me is meaning that you call 911 and there's not enough ambulances to come in an acceptable period of time because they're dealing with a high volume of other cases or the number of EMS drivers is out because they're sick.

Healthcare collapse to me is not having enough staff beds to put patients, and so they sit longer in the emergency department, making it even riskier for others that are coming in for non-COVID illness and getting infected themselves. A healthcare collapse for me is this issue of not having enough providers or losing more providers who feel they just had two years of this physical toll and now this mental toll of dealing with this pandemic. That, for me, is the concern. Getting the care that you need is going to be delayed, or possibly, there's just not going to be a provider at your bedside because there's not enough of them today.

This is something that we're starting to see in places like Rhode Island and in California, where they've said that COVID positive providers under crisis guidelines can come back to work. We know that multiple states over the past few days, including Maryland, Colorado, and many others have launched crisis standards of care. Meaning that the normal rules don't apply. We have to do everything we can to keep the ship together. It's only a matter of time if we allow this to continue until we have negative and untoward impacts of a system and staff that is already overloaded. It's unsustainable.

Brian Lehrer: Last question. To that point, what do you think about these recently relaxed standards for essential workers going back to work after being COVID positive from the CDC that has drawn so much dissent? 5 days of isolation instead of 10 days after a positive test if they no longer have symptoms, but they don't have to test negative to go back to work after just 5 days. Is that a safe standard in a hospital like yours or is that a troubling but necessary balancing of risks between the possibility of exposing someone to still contagious COVID versus the possibility of dire staffing shortages?

Dr. Craig Spencer: What it is is a horrible decision to have to make two years into this pandemic. Look, it's ultimately a question of, would you have a provider who is at your bedside that has been outside that period and is likely not contagious and is wearing a mask versus not having a provider or waiting twice as long for care? I don't think it is a perfect scenario by any means. We're seeing this, as I've said, in places already where they're being forced to send people that have had COVID back to the frontlines in some cases in crisis standards of care not even waiting that five days.

This is tough. My general preference would be that you have providers going back that are asymptomatic. They primarily are working with known COVID-positive patients, and they should have a negative test if possible before they go back to work. We know that that is a challenge and we're going to have to do what we need to do to take care of patients, which is our first priority. Sometimes, unfortunately, that's going to be putting people back on the frontlines maybe before they're ready.

Brian Lehrer: Emergency Medicine Physician and Director of Global Emergency Medicine at New York-Presbyterian and author of the article in The New York Times: As an ER Doctor, I Fear Healthcare Collapse More Than Omicron, Dr. Craig Spencer. Dr. Spencer, we really, really appreciate it. Thank you.

Dr. Craig Spencer: Thanks for having me again, Brian.

Brian Lehrer: Brian Lehrer on WNYC. Much more to come.

 

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