As COVID-19 becomes a staple winter virus alongside influenza and respiratory syncytial virus (RSV), hospitals are struggling to provide timely care amid an onslaught of sicker patients—a situation health experts say is likely "only going to get worse" over time.

What COVID-19 has been like so far this winter

Compared to past pandemic winters, which saw heavy surges in both COVID-19 cases and hospitalizations, this year has so far seen a much smaller increase in both. As of Jan. 12, there was a daily average of 45,600 COVID-19 hospitalizations in the United States—much lower than the 159,510 seen roughly a year prior.

According to the New York Times, high levels of population immunity likely helped stem the impact of another COVID-19 surge. Although there may still be a large number of new cases, hospitalizations and deaths have not yet risen significantly—suggesting that vaccines and past infections continue to offer protection from the virus's worst outcomes.

"What you're seeing is a transition to ongoing transmission but much milder infections," said Céline Gounder, a senior fellow at the Kaiser Family Foundation.

However, the new, highly-transmissible omicron subvariant XBB.1.5 has rapidly risen in prevalence over the last few weeks, and health experts have expressed concerns that it will lead to a new winter surge. Currently, CDC data shows XBB.1.5 makes up 43% of all new COVID-19 cases in the country.

XBB.1.5 "has displaced other variants in a way that we've never seen before. That's kind of alarming," said Sam Scarpino, who tracks new COVID-19 variants at Northeastern University. "The question is not whether it's going to cause a surge. It almost certainly will. The question is: How big is the surge going to be?"

Hospitals are still struggling to provide timely care

Although COVID-19 hospitalizations have not yet spiked, hospitals are still struggling to provide timely care for all their patients. Aside from the coronavirus, other respiratory viruses, such as RSV and the flu, have also strained hospitals' staff and resources.

Going forward, Ashish Jha, the White House COVID-19 response coordinator, said he's not sure whether the U.S. healthcare system will be able to handle a continued onslaught of respiratory viruses during the wintertime, especially now that the coronavirus seems to be a permanent fixture. Over time, this will lead to increased strain and impact hospitals' ability to treat other serious illnesses.

"I am worried that we are going to have, for years, our health system being pretty dysfunctional, not being able to take care of heart attack patients, not being able to take care of cancer patients, not being able to take care of the kid who's got appendicitis because we're going to be so overwhelmed with respiratory viruses for … three or four months a year," Jha said.

"I just think people have not appreciated the chronic cost, because we have seen this as an acute problem," he added. "We have no idea how hard this is going to make life for everybody, for long periods of time."

According to Jha, the healthcare system is like a sea wall that can hold back a certain level of water. With COVID-19, water is now flowing over the wall, and "the flood of patients has cascading effects on other types of medical care," the Washington Post writes.

Anne Zink, CMO for the Alaska Department of Health and president of the Association of State and Territorial Health Officials, said Jha's sea wall analogy is an accurate description of how the pandemic has affected America's health system over the last few years.

"The sea wall was crumbling before the pandemic, and the waves of the pandemic created great holes, and that continual onslaught will degrade the wall and make it worse," Zink said.

Aside from large numbers of sick patients, hospitals are also dealing with medical supply chain uncertainties, worsening staff shortages, and financial challenges—all of which significantly impact their ability to provide quality care.

Although hospitals had some flexibility to manage their shortage of acute care beds before the pandemic, "that flexibility is now gone," said James Jarvis, a senior executive at Northern Light Health. "There is no wiggle room or expansion room that we would have for anything in reserve."

Health experts have also expressed concerns that, going forward, people with illnesses will delay care, be less likely to go to the hospital because of infection concerns, and ultimately end up waiting hours for necessary care.

"Delays of care will result in people having either more severe disease or, unfortunately, dying, and there's little that we can do to prevent that," Jarvis said. "You know, that has always happened, but never to the extent that it's happening now."

And in the future, "it's only going to get worse," Jarvis said. (Sun/Achenbach, Washington Post, 1/17; Lopez, New York Times, 1/17)