Nebraska Medicine activated its crisis plan Thursday for the first time in the health system’s history in the face of a growing demand for health care and a shortage of staff to provide it.
Dr. James Linder, Nebraska Medicine’s CEO, said the health system enacted what are known as crisis standards of care to prepare for an anticipated further surge in cases caused by the omicron variant and the need for additional health care expected to come with it.
A number of health systems across the country are enacting crisis plans as they face the dual challenges of rising case counts fueled by omicron and a growing number of health care workers sidelined by their own or their relatives’ infections. About 24% of U.S. hospitals are reporting a “critical staffing shortage,” according to data reported Saturday to the U.S. Department of Health and Human Services.
“We’ve not yet reached the COVID-19 spike in our community, and (the crisis plan) positions us to respond to any spikes in the number of cases we have to care for in the community and do so in a safe manner,” Linder said.
Activating the plan provides the health system with additional flexibility to redeploy staff, limit non-urgent services and modify how resources are distributed.
Dr. Harris Frankel, the health system’s chief medical officer, said patients can still receive care at Nebraska Medicine’s facilities.
But appointments could be delayed or rescheduled, and fewer appointments may be available. Surgeries might be postponed, and clinical trials may be paused. Medical students and other staff may be deployed as support personnel. Classrooms or conference rooms may be used for some patients.
In addition, Frankel said, patient transfers from outside facilities will continue to be limited and the criteria to accept them restricted.
Enacting the plan also helps protect the availability of care for the 70% to 80% of patients who don’t have COVID-19, he said.
In November 2020, health care leaders developed what’s now called a health care crisis protocol for the state. The protocol looked ahead to a time when COVID-19 patients and others needing medical care might overwhelm the state’s health care system and providers would be forced to decide who received care.
Officials with Methodist Health System, CHI Health and Children’s Hospital & Medical Center said they have not activated their crisis plans.
But those health systems are feeling the strain. Jeannette Wojtalewicz, CHI Health’s interim CEO, said the health system is in what it calls contingency care, meaning that it adapts daily to patient numbers, staffing and bed availability.
Wojtalewicz said CHI Health’s patient load and staffing needs have grown exponentially. The health system is currently caring for 223 COVID-19 patients. Of patients on ventilators, she said, 91% are unvaccinated. She said 379 employees have tested positive for COVID-19 or are quarantining.
“We are entering into a critical phase,” Wojtalewicz said in a statement. “We need your help. If you haven’t been vaccinated, please consider doing so and please mask up for your friends and family.”
Officials with Lincoln’s Bryan Health said many of the elements in its plan are in place and have been for some time, including redeploying staff and repurposing clinical space. Like Nebraska Medicine and Methodist, Bryan has been limiting elective procedures and surgeries requiring overnight stays since August. Wojtalewicz said CHI Health also has been delaying cases that can safely wait.
Nebraska is tallying its highest coronavirus case counts of the pandemic. While omicron appears to be less severe than the delta variant of the virus that causes COVID-19, the sheer number of people it is infecting is expected to lead to higher rates of hospitalization. A total of 662 Nebraskans were hospitalized with COVID-19 on Wednesday, fueled by the easily transmitted omicron. By Thursday, 399 COVID-19 patients were hospitalized in the Omaha metro area, a figure approaching the pandemic peak of 445 in November 2020.
Cory Shaw, Nebraska Medicine’s chief operating officer, said the health system has seen a tenfold increase in staff absences because of COVID-19. The health system is dealing with shortages of staff not only in inpatient and outpatient settings but also among technology, facilities and testing staff.
“Without them here,” he said, “the environment can’t be maintained as safe.”
Shaw said calling up the Nebraska National Guard to help with staffing would likely divert members with health care training from the facilities where they work, creating shortages there.
Dr. Kelly Cawcutt, a critical care physician and infectious diseases specialist, said Nebraska Medicine is seeing patients infected with omicron while still dealing with those brought in by the delta wave.
She called on people to get vaccinated, wear masks in indoor public places, avoid crowds and socially distance.
“We need our community to help us to get back to our standard of care that we all have enjoyed up to this point,” she said.
Linder, asked whether Omaha’s mask mandate would help slow transmission, said, “COVID-19 is transmitted through the air. And a mask is the best way to prevent that transmission to other people and to protect ourselves. Wearing masks is a really wise thing to do to flatten the curve.”
Virus Q&A: Answers to common questions about COVID-19 vaccines, travel and more
Do at-home COVID-19 tests detect the omicron variant?
Yes, but U.S. health officials say early data suggests they may be less sensitive at picking it up.
Government recommendations for using at-home tests haven't changed. People should continue to use them when a quick result is important.
"The bottom line is the tests still detect COVID-19 whether it is delta or alpha or omicron," says Dr. Emily Volk, president of the College of American Pathologists.
Government scientists have been checking to make sure the rapid tests still work as each new variant comes along. And this week, the Food and Drug Administration said preliminary research indicates they detect omicron, but may have reduced sensitivity. The agency noted it's still studying how the tests perform with the variant, which was first detected in late November.
Dr. Anthony Fauci, the top U.S. infectious disease expert, said the FDA wanted to be "totally transparent" by noting the sensitivity might come down a bit, but that the tests remain important.
There are many good uses for at-home tests, Volk says. Combined with vaccination, they can make you more comfortable about gathering with family and friends.
If you've been exposed to a person who tested positive but you don't have symptoms, a rapid test five days later can give a good indication of whether you caught the virus. It can also help if you're not sure whether your runny nose or sore throat is COVID-19.
But consider the context when looking at results. If you feel sick after going out to a nightclub in an area with high infection rates, for example, you should look at a negative result from an at-home test with a little more skepticism, Volk says.
Following up with a PCR test is a good idea, she says. Those tests are more accurate and are done at testing sites and hospitals.
Can my pet get COVID-19?
Yes, pets and other animals can get the coronavirus that causes COVID-19, but health officials say the risk of them spreading it to people is low.
Dogs, cats, ferrets, rabbits, otters, hyenas and white-tailed deer are among the animals that have tested positive, in most cases after contracting it from infected people.
While you don't have to worry much about getting COVID-19 from your pets, they should worry about getting it from you. People with confirmed or suspected COVID-19 should avoid contact with pets, farm animals and wildlife, as well as with other people, according to the U.S. Centers for Disease Control and Prevention.
"If you wouldn't go near another person because you're sick or you might be exposed, don't go near another animal," says Dr. Scott Weese at Ontario Veterinary College.
Not all infected pets get sick and serious illness is extremely rare. Pets that show symptoms typically get mildly ill, the CDC says.
Some zoos in the U.S. and elsewhere have vaccinated big cats, primates and other animals that are thought to be at risk of getting the virus through contact with people.
This particular coronavirus most likely jumped from animals to humans in the first place, sparking a pandemic because the virus spreads so easily between people. But it does not easily spread from animals to people. Minks are the only known animals to have caught the virus from people and spread it back, according to Weese.
Three countries in northern Europe recorded cases of the virus spreading from people to mink on mink farms. The virus circulated among the animals before being passed back to farmworkers.
How easily animals can get and spread the virus might change with different variants, and the best way to prevent the virus from spreading among animals is to control it among people, Weese says.
Is travel safe during the pandemic?
As the holidays approach, is it safe to travel during the pandemic? (AP Illustration/Peter Hamlin)
It depends. It can be safe if you're fully vaccinated against COVID-19, but officials say people who haven't gotten the shots should delay travel.
Regardless of vaccination status, all travelers should keep taking precautions like avoiding indoor, unmasked crowds, says Dr. Keith Armitage, an infectious disease expert at Case Western Reserve University.
"The delta variant has really brought us back to an earlier time in the pandemic," he says.
The U.S. Centers for Disease Control and Prevention says not to travel if you're sick, or if you tested positive for COVID-19 and your isolation period isn't over yet — even if you're fully vaccinated. Unvaccinated people who decide to travel should get a COVID-19 test one to three days before travel and three to five days after returning.
All travelers must still wear masks on trains, planes and other indoor public transportation areas, the agency says.
Airlines say plane cabins are low risk since they have good air circulation and filtration. However, there is no requirement for vaccination or testing before domestic flights, and passengers can remove their face masks while eating or drinking.
Hotels aren't risky for the vaccinated as long as they wear masks around strangers, Armitage says. More fraught are family gatherings with unvaccinated individuals, particularly for those who are older or have health problems.
Health experts suggest looking at the case levels and masking rules in the place you are visiting before you travel.
Why can't some COVID-19 vaccinated people travel to the US?
Why can't some COVID-19 vaccinated people travel to the US? (AP Illustration/Peter Hamlin)
Because they might not be vaccinated with shots recognized by the U.S. Food and Drug Administration or the World Health Organization.
When lifting overseas travel restrictions in November, the U.S. required adults coming to the country to be fully vaccinated with shots approved or authorized by the FDA or allowed by WHO.
Among the most widely used vaccines that don't meet that criteria are Russia's Sputnik V vaccine and China's CanSino vaccine. Sputnik V is authorized for use in more than 70 countries while CanSino is allowed in at least nine countries. WHO still is awaiting more data about both vaccines before making a decision.
Vaccines recognized by the FDA and WHO undergo rigorous testing and review to determine they're safe and effective. And among the vaccines used internationally, experts say some likely won't be recognized by the agencies.
"They will not all be evaluated in clinical trials with the necessary rigor," said Dr. William Moss, executive director of the Johns Hopkins International Vaccine Access Center.
An exception to the U.S. rule is people who received a full series of the Novavax vaccine in a late-stage study. The U.S. is accepting the participants who received the vaccine, not a placebo, because it was a rigorous study with oversight from an independent monitoring board.
The U.S. also allows entry to people who got two doses of any "mix-and-match" combination of vaccines on the FDA and WHO lists.
Are COVID-19 boosters the same as the original vaccines?
Are COVID-19 boosters the same as the original vaccines? (AP Illustration/Peter Hamlin)
Yes, COVID-19 boosters use the same recipe as the original shots, despite the emergence of the more contagious delta variant. The vaccines weren't tweaked to better match delta because they're still working well.
The vaccines work by training your body to recognize and fight the spike protein that coats the coronavirus and helps it invade the body's cells. Delta's mutations fortunately weren't different enough to escape detection.
The increased protection you might get from a booster adjusted to better match the delta or other variants would be marginal, says Dr. Paul Goepfert, director of the Alabama Vaccine Research Clinic at the University of Alabama at Birmingham.
Manufacturing doses with a new formula would have also delayed the rollout of boosters.
Moderna and Pfizer are studying boosters tweaked for the delta and other variants to be ready if one's ever needed. Health authorities would have to decide if and when a vaccine formula swap would be worthwhile.
"What we don't know," Goepfert noted, "is if you have a delta vaccine compared to the regular vaccine, does it actually work better in preventing transmission or asymptomatic infection?"
The U.S. has authorized booster doses of the Pfizer, Moderna and Johnson & Johnson vaccines for certain people, and a few other countries also are using boosters of those shots or other COVID-19 vaccines.
Can at-home COVID-19 tests make gatherings safer?
Can at-home COVID-19 tests make holiday gatherings safer?(AP Illustration/Peter Hamlin)
Yes, combined with vaccination, home test kits for COVID-19 can add a layer of safety and reassurance by providing on-the-spot results during this second year of pandemic holidays.
"We will be using rapid tests to doublecheck everybody before we gather together," says Dr. Emily Volk, president of the College of American Pathologists, who is planning a holiday meal with six vaccinated family members. "We'll be doing it as they come in the door."
Home kits are not as accurate as the PCR tests done in hospitals and at testing sites, Volk says. But they have the advantage of giving results within minutes instead of days.
Testing kits are available at drugstores without a prescription, and a box with two tests typically costs about $25. Swabs, testing solution and instructions are included.
Adults and teens can test themselves. An adult can test a child as young as 2. How-to videos on product websites can be helpful.
Most tests require swabbing about a half inch inside both nostrils, so it may tickle but doesn't hurt. You will get a positive result if the test detects a viral protein in your sample.
Home tests will miss some infections and in rare cases mistakenly indicate an infection. One popular test misses around 15 out of 100 infections — these are called "false negatives" — and gives a false positive result in about 1 in 100 people who aren't infected.
Test shortages were widely reported during the last COVID-19 surge, but new options have recently hit the market and major manufacturers such as Abbott Laboratories have ramped up production.
The Centers for Disease Control and Prevention offers other tips on ways to enjoy the holidays safely. Vaccination remains the best way to protect against the coronavirus.
How will the world decide when the pandemic is over?
There's no clear-cut definition for when a pandemic starts and ends, and how much of a threat a global outbreak is posing can vary by country.
"It's somewhat a subjective judgment because it's not just about the number of cases. It's about severity and it's about impact," says Dr. Michael Ryan, the World Health Organization's emergencies chief.
In January 2020, WHO designated the virus a global health crisis "of international concern." A couple months later in March, the United Nations health agency described the outbreak as a "pandemic," reflecting the fact that the virus had spread to nearly every continent and numerous other health officials were saying it could be described as such.
The pandemic may be widely considered over when WHO decides the virus is no longer an emergency of international concern, a designation its expert committee has been reassessing every three months. But when the most acute phases of the crisis ease within countries could vary.
"There is not going to be one day when someone says, 'OK, the pandemic is over,'" says Dr. Chris Woods, an infectious disease expert at Duke University. Although there's no universally agreed-upon criteria, he said countries will likely look for sustained reduction in cases over time.
Scientists expect COVID-19 will eventually settle into becoming a more predictable virus like the flu, meaning it will cause seasonal outbreaks but not the huge surges we're seeing right now. But even then, Woods says some habits, such as wearing masks in public places, might continue.
"Even after the pandemic ends, COVID will still be with us," he says.
The AP is answering your questions about the coronavirus in this series. Submit them at: FactCheck@AP.org.