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Nearly 2 years into the pandemic, hospitals in the Midwest are getting hit with a staggering new surge.

Capacity is strained, and so is staff. And no one knows for sure what the Omicron variant will bring.

Hospitals in states like Minnesota, Wisconsin, and Illinois, which have recently seen some of the nation's highest numbers of new COVID-19 cases, are facing dire conditions yet again in the latest wave no one wished they would see. As a result, there is fear about what the coming months may mean for frontline workers and patients, as well as other hospitals across the U.S.

"What we are experiencing is unprecedented," Hsieng Su, MD, senior vice president and chief medical executive at Minneapolis-based Allina Health, told MedPage Today.

There is an increasing number of patients, not just because of COVID, she added. Some of the surge has been caused by care that was delayed due to the pandemic.

"These patients that we are seeing in our hospitals and clinics are extremely sick," she noted. The lengths of stay are longer than before the pandemic, and there is also a staffing shortage. "It is very similar to the 'Great Resignation' that we are facing with other industries as well."

However, the healthcare industry may be the hardest hit, Su pointed out. "This is a very prolonged pandemic, and everyone is working so hard at maximum capacity."

The unique set of circumstances has created "the perfect storm," she said.

As a result, Allina Health has delayed elective surgeries. Unfortunately, the current surge is at a point where there are not many other options, she added.

Allina is also redeploying staff, including nurse anesthetists and anesthesiologists, to intensive care units to help with increased volume, Su said. And it is looking into how primary care physicians may be able to rotate through hospitals.

Additionally, the health system is determining how it can open up beds it is not currently using and other ideas to create capacity, she noted. Having already delayed non-urgent procedures in the hospital, Allina may need to delay outpatient surgeries as well. The difficult task at hand is trying to balance patient needs and the volume the health system is facing.

"It is not something that we want to do," Su said.

In Minnesota and Wisconsin, the Mayo Clinic is also battling the surge.

"Mayo Clinic hospitals have been operating at or near capacity for months, and over the past week, we have seen increases in the number of COVID-19 patients needing care and that number is expected to remain elevated," a spokesperson told MedPage Today in an email. "Mayo Clinic's campus in Rochester has been treating approximately 100 patients with COVID-19 on a daily basis, some of the highest levels of COVID-19 patients we have seen in Rochester throughout the pandemic."

Other Mayo Clinic sites have been hit hard as well, the spokesperson added. Southeast Minnesota has more than 20 COVID patients, and Southwest Minnesota has about 50. Northwest Wisconsin has some 40 patients, and Southwest Wisconsin has about a dozen.

"As with other hospitals, ICUs at Mayo Clinic hospitals continue to be full," the spokesperson continued. "ICU numbers fluctuate from day to day, but there has been an upward trend in the COVID-19 ICU census. Of the patients infected with COVID-19 who have been in the ICU over the past few weeks, the number of unvaccinated patients is five to six times higher than vaccinated patients."

"Widespread vaccination will reduce the spread of variants, as well as prevent mutation of the virus into even more dangerous strains of disease," the spokesperson noted.

The University of Illinois Hospital & Health Sciences System (UI Health) in Chicago is keeping a close eye on volumes as well.

"We are definitely seeing an uptick," Janet Lin, MD, an emergency medicine physician at UI Health, told MedPage Today.

On Thursday, there were 31 COVID patients, up from 29 the day prior. About a third are in the ICU. "These are trending toward numbers we have not seen since 2020," Lin said.

As with other hospitals, what UI Health is seeing in terms of increased capacity is multifactorial, she explained. In some cases, delayed care has led to more acute care needs. And, with the prolonged nature of the pandemic, there is constant evaluation in terms of staying ahead of constraints that may arise in supplies, staffing, medications, and other areas.

A spokesperson for Advocate Aurora Health, which includes a large presence in Illinois, said in an emailed statement that, like other providers nearby, it is seeing COVID-19 hospitalizations steadily rise.

Over the past month, their COVID-19 inpatient census has more than doubled, the spokesperson noted. Currently, there are some 730 COVID patients across the heath system.

"Beds are very tight, and the situation is complicated by workforce shortages impacting many industries across the nation," the spokesperson added. "Despite the challenges, we have the flexibility as an integrated health system to move around resources, including staff, equipment, and supplies, when and where needed."

The best way to prevent COVID-19, as well as serious illness, hospitalization, and death, is to get vaccinated and boosted, the spokesperson said.

Su at Allina Health concurred.

Hospitals and their care teams need a continued commitment and partnership from the public, she said.

The "greatest tool that we have in our toolbox against COVID is vaccination and boosters," she emphasized. Public health practices, such as testing, masking, and social distancing are also critical.

Su also said that, for patients, it is important for them to know that there is awareness by providers of longer wait times in emergency departments and urgent care facilities, and that Allina Health is doing everything it can to optimize processes amid overwhelming volumes.

She further asked that patients show grace and continued gratitude for caregivers, who have continued to step up to the plate during the pandemic to do the best they can for the community.

A colleague recently broke down in tears after receiving a letter of gratitude, she added.

As for what Omicron may bring, all eyes are on the new variant, with scientists seeking to learn more about its transmissibility and potential to cause more or less severe illness than prior strains, according to the hospitals. However, it is not what has caused the current surge in the Midwest, and the messaging from doctors and hospital leaders remains the same.

"We know how to navigate this pandemic," Su said. "We will find out more about Omicron, but we are knee-deep in Delta right now."

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