As people gather for Thanksgiving this week, hospital workers in St. Louis are on high alert. Emergency rooms are crowded with people sick with respiratory illnesses, and doctors are worried that more people will get sick as people mix during the holidays.
The St. Louis region, along with the rest of the country, is experiencing an early, gnarly flu season. Childhood respiratory illnesses are also on the rise. The increase in patients is coming as more health care employees leave their jobs, putting more strain on the workforce that remains.
COVID-19 hospitalizations aren’t as high as in the past
Earlier this year, the Centers for Disease Control and Prevention introduced new metrics to measure the spread of the coronavirus. The federal agency reports St. Louis and St. Louis County have a “medium” COVID-19 risk. The agency takes case numbers and hospitalizations into account to calculate this measurement.
However, the CDC also reports the level of community transmission in the region is high. That means even if people aren’t hospitalized, the virus is being spread widely. Doctors say people in the region should take both metrics into account before visiting elderly or immunocompromised family members for the holidays.
According to the St. Louis Metropolitan Pandemic Task Force, about 250 people are hospitalized with COVID-19 in the region's hospitals. That’s fewer than at this time in 2021 and 2020.
During last year’s omicron variant-fueled surge in late December, there were nearly 1,500 people in the hospital with COVID-19. However, the region did not see a dramatic rise in such cases until after Thanksgiving, indicating that holiday gatherings fueled the huge spike.
Other respiratory illnesses also worry health workers
Doctors say fewer coronavirus-related hospitalizations — even with high transmission levels — mean that many people have stronger immune systems because they have received the COVID-19 vaccine or been exposed to the virus.
But other illnesses, including RSV, a childhood virus; the flu and the common cold, are spreading at a high rate this year.
“We are seeing some unusual patterns in the respiratory viruses that we've seen every year for, you know, 100-plus years,” said Dr. Steve Lawrence, an infectious diseases specialist at Barnes-Jewish Hospital and Washington University.
The viruses usually follow a set pattern — they start around Halloween, and then peak around the Super Bowl, said Dr. Saba Bajwa, a pediatrician at HSHS Medical Group Pediatrics in O’Fallon, Illinois.
But those viruses started spreading early this fall, Bajwa said.
“This round of flu was a little bit sooner than expected,” she said. “And then on top of that, there's a strain of RSV going around that’s causing more severe symptoms than we've seen previously. We just haven't seen it flooding hospitals this much since before the pandemic.”
The pandemic could cause severe respiratory illnesses
During the first two years of the pandemic, the public lost a certain amount of immunity, said Dr. Howie Mell, an emergency physician at HSHS St. Elizabeth’s Hospital in O’Fallon, Illinois. People weren’t going into work as much, and kids weren’t in school.
For example, he said, most kids get RSV when they’re young. But now, many children of many ages are contracting it at the same time, because for the past few years, there wasn't much opportunity to catch it.
“We're absolutely crushed,” he said. “And I think the general consensus is that this is three years all brought into one, right? Because we for so long had social distancing, we had masking, we had all of these things, which protected kids from being affected.”
The increase in sick people could strain hospitals
If trends continue, patients could overwhelm workers, Lawrence said.
“If this continues to increase at the rate that we're seeing for another, say two, three, four weeks, that could really put some hospitals in a more serious situation of having that strain and capacity of the ER being full, or having hospital beds that are filling up,” he said. “We are watching carefully and certainly keeping our fingers crossed that it doesn't continue at this pace.”
Hospitals dealing with more patients already were facing a lot of health workers leaving the profession.
Earlier this year, the Missouri Hospital Association reported that nearly 20% of nursing positions in the state’s hospital were vacant, the highest since the survey began and up from 12% in 2021.
Staff turnover for other positions, including respiratory therapists, also is high, the report found.
Health workers have dealt with an increased workload since the pandemic started, said Sarah Dewilde, a nurse at St. Louis University Hospital who is a steward for the nurse's union there. Many workers feel they weren’t getting paid enough to keep them at such a demanding job, she said.
“Nurses have finally given their notice,” she said. “They’re like, ‘Look, we're not willing to put up with this. We deserve to make more money for what we're doing.’ Because in every job, if you were to take on more responsibilities, you would take on more money, right?”
Staff members who haven’t left are absorbing this year’s big increase in patients with respiratory illnesses.
“If something doesn't get done … it's inevitably put onto the nurse, because the nurse is the one that has to ensure that it gets done,” DeWilde said. “So we're getting calls from doctors asking ‘Hey, why isn't this done?’ It’s like, ‘We know there’s no lab techs this evening. I can't draw labs on five patients, as well as take care and clean all of them up.'”
