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U.S. Hospitals Try To Bend But Not Break As They Wait For COVID-19 Vaccine To Kick In

MARY LOUISE KELLY, HOST:

Hospitals across the nation have improvised to handle a crush of COVID cases. The Thanksgiving surge has not helped. In hard-hit Tennessee, health officials are warning that if the surge after Christmas and New Year's is anything like Thanksgiving, health systems will break. Blake Farmer of member station WPLN in Nashville reports on the struggle within hospitals to bend but not break.

BLAKE FARMER, BYLINE: One of the largest hospitals in the South, Vanderbilt University Medical Center, drew a line. This is all we can handle. Then a couple of weeks ago, they crossed it, says Robin Steaban. She's the chief nursing officer.

ROBIN STEABAN: There is a breaking point - we have not discovered that yet, but we know that there is one - when it's going to be impossible to do the kind of care we want to do for patients.

FARMER: That's not to say it's been pretty here at Vanderbilt. Dr. Todd Rice has been getting calls from as far away as Missouri and Virginia - hospitals with no room or no capabilities for complex COVID patients. Rice leads Vanderbilt's COVID ICU and has to tell them there's no room here either, at least not for their patient. And that feels wrong for a major medical center.

TODD RICE: We don't say that. We say, yes, bring them. We want to help them. You know, and here, we're having to really triage our resources and say, this person is, you know, a person who's sicker. And I can help, and I'm going to have to hold on you for right now.

FARMER: So a strange thing is happening. Even smaller hospitals that would usually refer critical cases to urban medical centers can't do that and are actually having to accept overflow from out of state.

MATT KING: It's pretty unusual for us to get patients, or it was unusual. Now we're getting them fairly regularly.

FARMER: Dr. Matt King is a pulmonary critical care physician at Sumner Regional Medical Center in Gallatin, Tenn. He had one patient flown in the other day from Kentucky who had looked for a bed from Ohio to Alabama, and this wasn't even a COVID patient. But COVID is what's causing the capacity issues. King says patients are hospitalized for weeks.

KING: It doesn't take very many patients staying for a week or two weeks for us to fill up. The hospital really relies on being able to get people in, get them well and get them home quickly so that we can take care of the next person that's sick.

FARMER: So doctors are doing things that feel risky, like sending patients home earlier than they typically would.

KING: Actually, right now I'm signing some paperwork to get a patient home with oxygen.

FARMER: Hospitals are also telling more people who show up to come back only if things get worse. Dr. James Parnell leads Tennessee's chapter of the American Academy of Emergency Medicine.

JAMES PARNELL: You've got to meet some pretty strict criteria to get admitted to the hospital for COVID-19 now.

FARMER: From outside the walls of these hospitals, most people wouldn't even notice how serious the situation is. Visitors are largely kept out. Patients aren't spilling into the street. Ambulances don't line up around the block. But inside, hospitals are constructing new COVID units. In an effort to avoid treating patients in hallways, emergency departments are doing flash renovations.

DUANE HARRISON: Just two days ago, we took down our lobby, and we made it a patient care area.

FARMER: Dr. Duane Harrison leads HCA's emergency department in Hendersonville, Tenn. He says a small cafe is now the waiting room, and it's working but on a hope and a prayer.

HARRISON: It is daunting to walk into the emergency room at 6 a.m. and see 13 people and know that there are no beds upstairs. And you're waiting for discharges and, unfortunately, deaths. But we keep making a place.

FARMER: Harrison says it's not comfortable, but it's better than the alternative. And hospitals will have to make even more space because they know additional cases are coming on account of all the holiday gatherings.

For NPR News, I'm Blake Farmer in Nashville.

KELLY: And this story comes from NPR's partnership with Nashville Public Radio and Kaiser Health News. Transcript provided by NPR, Copyright NPR.