Case load or staffing availability?

I keep hearing the mainstream media pumping its Delta variant hysteria.  A couple of days ago I heard an NPR broadcast about how hospitals are being overwhelmed and it all being the fault of the unvaccinated.  However, in the last third of the report, things went a little off-script.  Whoever they were interviewing indicated that the problem was because hospitals were suffering from unavailability of nurses and staff.  That practitioners were burning out and leaving, simply limiting their hours, or were unavailable due to summer holidays.

Hospitals are overtaxed due to surging cases has one set of solutions.  Hospitals overtaxed due to being short handed has a different set of solutions.  Which is it?

I have since seen a couple of fragments of information indicating that at least part of the challenge to hospitals is not the case load per se but the unavailability of staff.  The beds are there for use but not the nurses.  In which case, bed availability is not the issue.  

Looking for some answers this morning, I have not been able to piece together quickly any reliable data sources which could answer the staffing shortage question directly.

However, I am able to look at some additional information sources which call into question the surging cases story.

A few days ago I posted When Mandarin Class behaviors undermine trust.  The catalyst was a veterinarian running for political office and representing herself as a doctor in an ICU unit in order to score partisan points against her opponent, claiming the ICU was overrun when the public data showed otherwise.  

In researching her claims, I found this information.

2017, pre-Covid-19,  average hospital bed utilization was 66%, not materially different from CRMC's current 68%.  Average US ICU occupancy rate just pre-Covid in March, 2020 was 63% compared to CRMC's lower utilization rate of 55% today. 

Average hospital bed utilization rate pre-Covid nationwide was in the vicinity of 66%.  ICU occupancy rate was approximately 63%.

From this handy-dandy NYT dynamic infomatic, we can look at the comparable numbers for today.   National average ICU occupancy rate is 68%, up 5 percentage points from pre-Covid.  That is not a significant issue unless staffing is the critical constraint.  It does not appear as if caseload is the problem. 

Georgia's current ICU occupancy rate is 84%.  Now that is getting up there but certainly not at capacity and should be easily handled under normal circumstances.  Again, unless the constraint is not case load but staffing availability.  

Using the dynamic infomatic from the American Hospital Association, we get a slightly different answer.  These are current (8/11/2021) projections rather than actuals as used above.

Based on the current forecast, Georgia should be at and above capacity for ICU utilization as opposed to the 84% utilization actually reported.  And Georgia is the highest ICU capacity utilization forecasted among all the states.  

Click to enlarge.

As can be seen, only nine states are even 5% or more above the pre-Covid norm of 66% occupancy of all beds.  Only one state is supposed to be overwhelmed, Georgia at 99% capacity, whereas the reality is that we are at 84% capacity.  

Pulling it all together.

ICU occupancy nationwide pre-Covid-19 - 63%

ICU occupancy nationwide as of August 11, 2021 - 68%

Georgia ICU occupancy as of August 11, 2021 - 84%

Georgia all-bed forecast as of August 11, 2021 - 99%

The forecast is dramatically wrong.  The actual is a little tight given normal capacity utilization.  It would only be a problem if indeed the constraint is not bed availability but staffing availability. 

Nationwide we don't have a problem.  Even state wide it appears we do not have a problem.  Obviously though, even within a state, there can be material variance in capacity utilization at an individual hospital level as indicated by the NYT infomatic.

Within five miles of my location in Atlanta, there are ten hospitals.  The free public hospital is at 99% ICU capacity and three others are above 90% capacity.  However, the other six range from 47%-84% capacity.  It is a load sharing issue rather than an overload issue.  Atlanta has 81 ICU beds available.  I.e. 80% capacity on average across the ten hospitals within 30 minutes of one another (most within ten minutes).  

I cannot answer whether this is an issue of too many cases or of too few staff but at only 80% capacity, that seems to me to be a staff availability issue rather than a case load issue.