Hospital leaders are issuing dire warnings to regions all across the country — from St. Louis to El Paso, Texas — that facilities are full and the increasing COVID-19 case counts threaten to overwhelm their resources.
The problem is compounded by the approaching winter, when traditional respiratory viruses typically rise and can tax a local hospital in a normal year. Add the current pandemic to the mix and it's a recipe for disaster.
Cases are rising rapidly throughout the U.S. The daily case count reported to the Centers for Disease Control and Prevention hit a new high in October and the moving seven-day average of reported cases has reached new heights. The country now has exceed 8.7 million cases and 226,000 deaths.
Residents in El Paso are now under a curfew by an order issued by County Judge Ricardo Samaniego as the region's hospitals are overwhelmed and ICU beds are full as of this past Saturday. (The county judge is an elected position and oversees county government known as the Commissioner's Court.)
"I am left with no choice but to take this next step in hopes of seeing some stability in our community and most importantly to save lives," Samaniego said in a public statement.
Residents will face fines for defying the 10 p.m. to 5 a.m. countywide curfew and for refusing to wear a mask. Fines range from $250 to $500. The curfew will remain in place through Nov. 8.
Texas Gov. Greg Abbott is also deploying resources to help combat the surge of cases and hospitalizations in the border town. The area's convention center is being converted into a makeshift hospital that will house up to 100 beds.
An earlier analysis by Healthcare Dive on hospital capacity found that in the El Paso metro area there are about 445 people per bed. That does not include any additional beds that have been added since the onset of the pandemic.
As facilities are overtaxed and resources become limited, they'll be have to make heart-wrenching decisions.
In Utah, those decisions on crisis standards of care are already being discussed, according to a recent report from the Salt Lake Tribune. Hospital administrators have presented the governor with a set of criteria they will enact when forced to choose between who to care for when supplies and resources are limited.
"That is something that Americans don't fully understand. We're going to be seeing situations where people have to decide, 'well, the younger people get into the ICU, because they have a better chance of surviving than older people,'" Bruce Siegel, CEO of America's Essential Hospitals, said.
He emphasized that Americans still have the ability to change the trajectory by wearing a mask, washing their hands and social distancing. But if if there is continued infection across many regions it risks the personal protective equipment reserves and the availability of labor.
"We're not going to have the ability to shift physicians and nurses and others around because they'll be busy where they are. That could that could be unlike anything we've seen before," Siegel said.
The threat to overwhelm facilities is coming to a head in St. Louis as well.
"We're at an inflection point," Alexander Garza, a physician and leader of St. Louis' regional pandemic taskforce, said during a compelling public address Monday.
"If we continue down the path we're on right now, if we don't start listening to science, wear masks and stop gathering in large crowds, things could potentially get much worse," Garza warned, noting some area hospitals are nearing or have exceeded their capacity.
Patients from more rural areas of the state, places with few hospitals, are now coming to St. Louis area hospitals, in addition to a rise in urban cases, Garza said.
Missouri does not have a statewide mask mandate. However, certain municipalities, including St. Louis and St. Louis County, the state's most populous county, have enacted them.
"We see the news stories coming out of Utah, El Paso ... we do not want to be in that same situation," he added.