As @ChiTownDoc said, we did have capacity in March and April due to the cancellation of elective procedures, the lockdown, and people's general fear of catching the virus by coming to the hospital. This also coincided with a severe drought in appropriate PPE.
Both are no longer the case.
I don't have any statistics to show you to back this up, but from my years in trauma, I can tell you that traumatic surgical patients tend to come in waves. There is nothing obvious connecting them; there no reason for why they should all be happening at the same time, but they come and go in clusters with some staying longer than others. Elective procedures are generally a steady stream of patients for us: we always have a few. So when we're in the middle of a trauma peak, we're either close or at capacity (thirty beds in my home unit). Our medical ICU, where non-traumatic head bleeds, DKA, sepsis, drownings, people swimming in comorbidities, et al go, is also thirty beds. When COVID started, they designated half of those to be the COVID ICU. We were able to make it through April and May with just those fifteen beds because Austinites did an excellent job in flattening the curve compared to many other places in the country. Bit by bit, we got better, though still not wholly acceptable, PPE. (Example: when I was last in the COVID ICU a few weeks ago for a stretch of shifts, I brought my personal respirator from home so as to not have to reuse N95s, which is what got me my first confirmed exposure to SARS-CoV-2 on the first time I was sent to the COVID ICU. And to further clarify the ridiculousness, if a manager had caught me doing that, I probably would have been sent home without pay for violating their policy against using personal PPE. Another reason I work nights)
Sounds like things are/were well in hand, right? Wellllll...Austinites are no longer doing a good job at wearing masks, socially distancing, or socially isolating among ourselves. We are in a trauma peak. We have elective surgeries occurring. Our COVID ICU has expanded to past twenty of the thirty beds in the medical ICU, which means that the trauma ICU now has to take the standard MICU patient population that overflows due to a lack of beds on that floor. We. Are. Full. Our med/surg COVID floor, once kept to a single floor, has expanded to a floor and a half now. We have hemorrhaged ICU nursing staff since the middle of April, and the nurses that have stayed are burnt out with incredibly low morale. The gallows humor that exists among ICU nurses, especially on nights, is a lot more gallows than it is humor now. There is a mental health crisis occurring among nurses and the response of administration is buy boxes of doughnuts, hand out t-shirts, encourage us to do yoga, and then to make sure the public knows that they [the administration] consider us heroes.
To anyone who says we've got plenty of doctors and nurses ready to jump in...uh what? There has been a nationwide nursing shortage for the past thirty-plus years, and Texas is no exception. Furthermore, cross-training to a new specialty of nursing takes a lot time plus supervised experience. You can't just jump into it.
An OR nurse cannot just start taking ICU-level patients. OR nurses barely do any patient care. That is not a knock on them; it's just the reality of that type of nursing.
A PACU nurse cannot just start taking ICU-level patients or med/surg patients. They see patients for thirty minutes-to-an-hour, tops, and their patients are always stable, hence why the patient went to PACU from the OR to begin with.
An ED nurse cannot just start taking ICU-level patients. They have the skills to stabilize and acutely manage critically-ill patients, but they don't have the research skills, practical skills, or intuition an ICU nurse has. Not to mention, I'm not sure I've ever met an ED nurse that knows how to actually document care.. (I kid, a little)
A med/surg nurse cannot just start taking ICU-level patients. They do not have the knowledge or experience to titrate critical vasoactive, inotropic, paralytic, or sedating medications (all of which are currently used on ICU-level COVIDs). They can't assist with line placement or intubation. They can't make more than a couple of critical decisions in a life-threatening moment because they are never really in those situations. When a code happens, you what occurs? An ICU nurse runs up to the floor to manage the code until doctors can get there because we know what the fuck we're doing in a code and they don't. Like OR nurses, this is not a knock on them. It's just a different type of nursing.
A med/surg nurse cannot just start taking an even heavier assignment. M/S nurses at night already have five-to-six patients every shift, which isn't exactly super safe (but safe enough for the state of Texas, I guess). That is a struggle, even for very experienced RNs. Can we really ask them to start taking eight-to-ten patients per shift? And if they're COVID+ on top of everything else?
An outpatient dialysis nurse (tons of them here in Texas/the south) can't just start taking hospitalized patients. It's entirely different! I don't know what the fuck they do, but it certainly isn't hospital patient care.
And before you just think I'm jerking off to myself about how awesome, smart, talented, beautiful, and fabulous my fellow ICU nurses and I are—though it's true, we are all of those things—no ICU nurse could just flip a switch become a med/surg nurse. On rare occasions when we are floated to help on a M/S floor, they are only allowed to give us three patients in a shift because our brains are educated and wired to handle two (three max) critical patients at a time, not five-to-six not very sick patients, and not very sick patients require a different type of care. A type of care we don't really know how to provide very well. Nor could we do any of the other types of nursing right away. It's literally impossible. If things get truly desperate, people will die due to nursing shortages.
I can't speak to or for doctors, but if there are any that want to start training to help out in the ICU as ancillary nursing staff, we haven't been told about it.
Stay at home as much as you can. Wash your hands as often as you can. When you do go out, wear a fucking mask and stay the fuck away from other people and don't bitch about it.
One more fun anecdote: so we are testing everyone who is admitted to the hospital now (with bullshit exceptions for external tests, even ones a week old). We had two elective surgical patients come in a bit ago, and both were swabbed when they came in. Both negative. A few days later, some suspicious symptoms, and they were retested and came back positive. Oops! Did they have it when they came in and we had a bum first test? Did they get it from us? Did they spread it to any of us while we were doing our jobs and being all up in their business? We'll never know because administration won't tell us shit. Nevermind the fact that we are starting to have nurses test positive as well, and admin's response is that we probably got it at the grocery store, so we can't blame them. Lol okay.