Amid the beeping of machines and chatter between nurses and patients at Seattle’s Harborview Medical Center, a quiet drilling noise filled the brightly lit hallway as one of the hospital’s carpenters fastened brackets to the ceiling.

He’s preparing to slide curtains onto a track, transforming part of the hallway into a space for more patient beds. Normal rooms, hospital leaders say, are full. And staffers hardly bat an eye anymore when the curtains go up.

“This right here, getting ready to move in three or four hallway patients, is telling,” said registered nurse Scott McGieson, pausing to watch the work unfold as he carried a tray of food to a patient’s room.

For months Seattle and Washington state virologists and physicians have tracked record numbers of COVID-19 cases due to the highly transmissible omicron variant, now dominant in the U.S. — but haven’t been able to analyze the variant’s impact on hospitalizations until recently.

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At UW Medicine, one of the state’s largest health care systems, hospitalizations have “exploded” over the past three weeks, Dr. John Lynch, Harborview’s medical director of infection control, said.

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In December 2020, UW Medicine was caring for 124 COVID-19 patients across its four hospitals, 90 of which were in the acute-care unit. As of last week, the health care system counted a new high of 194, and on Wednesday had 190, with about 151 in acute care. Meanwhile, the proportion of COVID patients in the ICU has declined about 25% from a previous peak.

The omicron surge has largely hit hospital acute-care units, which generally treat less-severe illness, harder than ICUs — a difference from previous waves, Lynch said.

“We’re still seeing people with pneumonia, we’re definitely seeing people with trouble breathing, or who require oxygen supplementation, but they’re not so severe that they’re in the ICU,” Lynch said.

The new pattern of disease has marked a “big switch,” he said.

The same is true on a state level, Dr. Tao Sheng Kwan-Gett, the state’s chief science officer, said in a Wednesday news briefing.

The proportion of COVID patients hospitalized has fallen “dramatically” with the omicron variant, compared to the previous wave of delta, Kwan-Gett said. But because of the variant’s rapid rise in cases, statewide hospitalizations have continued to increase.

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In Seattle, Harborview is seeing a mix of COVID patients. Some are still coming to the hospital with pneumonialike symptoms or other respiratory problems, similar to the beginning of the pandemic, but many arrive needing treatment for something else — like a car wreck — and later test positive for the coronavirus, Lynch said.

“[The virus] may not be causing a problem for you at all,” he said.

Whether a patient shows symptoms sometimes doesn’t matter in health care facilities.

“We still have to put you into a situation where you’re safe and all the people around you are safe,” Lynch said. “So the impact on the health care facilities still is very, very high.”

Health care systems strained

Over the past few weeks, Jason Naki, a registered nurse at Harborview, has watched the patient numbers shoot up in the acute-care unit where he works.

He just returned from vacation — his first since becoming a nurse over a year ago — but the exhaustion is already creeping back, he said on a recent weekday.

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“Not only do we have a surge of patients giving us that burden on the health care system, we also have this compassion fatigue and burnout,” Naki said. “A lot of this probably could have been prevented.”

Most of Harborview’s asymptomatic COVID patients have been vaccinated and don’t need critical care, Lynch said. Unvaccinated people continue to make up the largest proportion of the hospital’s sickest patients, he said.

In addition to converting hallways into spaces for patient beds, UW Medicine is also looking at using other “unconventional” spaces for patients, like outpatient clinics, Lynch said.

“That’s something we’ve never had to do,” he said. “We’ve planned for it, but it’s something we’re doing now actively to accommodate this enormous number of patients. … That’s a big deal.”

To date, UW Medicine has seen about 11,900 ICU COVID patients, compared to the roughly 21,900 acute-care COVID patients it has treated, Harborview spokesperson Susan Gregg said Wednesday.

The recent hospitalization trends concern Lynch, given how close the state is to “crisis standards of care,” a term hospitals use when they have to deny lifesaving treatment to one patient in order to give it to another.

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“It is an incredibly high risk,” he said.

He and other hospital leaders have long had a close eye on two factors that could push the state’s health care systems over the edge — patient loads and staff availability. And omicron, he says, is threatening both.

Infections begin to drop

While the number of confirmed COVID infections remains high — a figure that’s likely a “substantial” undercount because of limited data — there have been some signs of slowing rates in Western Washington, Kwan-Gett, the state’s science officer, said Wednesday.

In King County, where cases began skyrocketing to record levels in mid-December, there’s been a 27% decrease in reported infections this week compared to the week before, according to the county’s COVID-19 data dashboard.

“Very good to see several days of decreasing cases,” King County health officer Dr. Jeff Duchin said on Twitter this week, adding that the county could also see COVID hospitalizations start to plateau.

Even so, the county was still averaging more than 4,500 cases per day as of Wednesday — more than five times the county’s winter 2020 average.

Deaths have gradually increased over the past few weeks — with the county averaging at five per day — but are still at a “relatively low level [compared with] past surges,” Duchin wrote.

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Duchin has also predicted that because the rise in omicron infections was so rapid, its rate of decline could also be steep.

The Institute of Health Metrics and Evaluation, a global research facility based at the University of Washington, also projects a sharp decrease in cases and predicts daily cases could dip back to pre-delta levels by early April.

In Eastern Washington, however, omicron infection levels have lagged a bit behind those in the Seattle area and are just now starting to pick up, Kwan-Gett said.

“The real challenge is that we’re not going to be out of our part of the surge when it hits Eastern Washington,” Lynch said, noting that when smaller, rural critical access hospitals fill up, they often transfer patients to larger Seattle-area facilities.

“Anecdotally, [patients] are doing better” than in past COVID-19 surges, Isabelle Norville, charge nurse of Harborview’s acute-care unit, said. “As health care workers, it’s getting harder.”

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