{"id":22572,"date":"2020-11-25T21:27:24","date_gmt":"2020-11-25T21:27:24","guid":{"rendered":"http:\/\/arknews.org\/?p=22572"},"modified":"2021-12-17T12:42:32","modified_gmt":"2021-12-17T18:42:32","slug":"as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/","title":{"rendered":"As COVID hospitalizations top 1K, doctors and nurses say health care system is stretched to its limits"},"content":{"rendered":"<p>As the number of active COVID-19 cases in Arkansas\u00a0<a href=\"https:\/\/www.healthy.arkansas.gov\/programs-services\/topics\/novel-coronavirus\">hits new records on a near daily basis<\/a>, hospitals are feeling the strain.<\/p>\n<p>\"We are overwhelmed,\" said a doctor who works at a large hospital in Central Arkansas, one of eight medical providers the Arkansas Nonprofit News Network interviewed for this story. Most asked to have their names withheld in order to speak candidly. \"We cannot possibly continue at the current rates of exponential growth in the community,\" the doctor said. \"It\u2019s not sustainable. I believe we\u2019re looking at 10 days of wiggle room before there is nowhere to go and we\u2019re looking at those sorts of crazy scenarios where there\u2019s patients lined up in the hallway.\"<\/p>\n<p><span style=\"\">As of Wednesday, more than a thousand people in Arkansas were hospitalized with COVID-19 \u2014 more than double the number two months ago \u2014 and<\/span> <span style=\"\">the state's intensive care units (ICUs) were 93.4% full, leaving just 75 staffed beds available statewide.<\/span><\/p>\n<p><span style=\"\">\"This is like a boulder rolling down a hill,\" Dr. Jos\u00e9 Romero, secretary of the Arkansas Department of Health, said at a press conference on Nov. 17. \"There will come a time when we cannot stop it. It will continue to escalate and it will eventually overwhelm our health care facilities.\"<\/span><\/p>\n<p><span style=\"\">Even as the numbers rise, Governor Hutchinson, the health department and the Arkansas Hospital Association have stressed that hospitals still have plans in place to make adjustments and add capacity as needed. \"I think there\u2019s still wiggle room in the system,\" said Dr. Jerrilyn Jones, the health department\u2019s preparedness medical director.<\/span><\/p>\n<p><span style=\"\">On Nov. 13, Hutchinson announced the creation of a new Winter COVID-19 Task Force that will make recommendations on hospital capacity and other issues. In press conferences Friday and Tuesday, Hutchinson said that the state has not reached a crisis point in terms of ICU occupancy. He said hospitals had experience managing high occupancy in ICUs even before the pandemic and expressed confidence they would be able to handle the increasing volume.<\/span><\/p>\n<p><span style=\"\">\"The fact is, we have adequate ICU space,\" Hutchinson said Friday. \"Because the hospitals are so good about adjusting. And I haven\u2019t gotten to the point that we can say they\u2019ve adjusted their way into a real problem.\"<\/span><\/p>\n<p><span style=\"\">However, some health care providers are beginning to sound the alarm that the system is close to a breaking point. With no end in sight to the rising case numbers, and with Thanksgiving gatherings expected to fuel more community spread, they fear what the coming weeks will bring. If the current trajectory continues, the Central Arkansas doctor said, hospitals simply won\u2019t have enough trained staff and the quality of care will suffer for COVID and non-COVID patients alike: \"We will not be able to provide what we consider the standard of care. Outcomes will change. People will die that wouldn\u2019t normally die.\"<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"\"><span class=\"asterisk-divider\">***<\/span><\/span><\/p>\n<p><span style=\"\">\"We\u2019re managing, but if the volume picks up 10%, 15%, God help us, 20%, it\u2019s not going to be manageable,\" Melissa Brogdon said. Brogdon, a semi-retired ICU nurse, recently finished a nine-week contract at a midsize hospital in Central Arkansas. \"It felt like we\u2019re doing OK right now, but this is about as much as we can handle.\"<\/span><\/p>\n<p><span style=\"\">Most people who contract COVID-19 do not end up in the ICU. The ones who do reach that stage, however, \"are hard to keep alive,\" Brogdon said. \"If they get to a critical point, it takes a huge amount of attention from the nurses and the doctors and the respiratory therapists to keep them alive long enough to recover.\"<\/span><\/p>\n<p><span style=\"\">For hospitals, staffing is the most daunting challenge. There is no shortage of physical space, and an existing room can be converted to a critical care bed. The problem is having enough nurses, physicians and other licensed staff trained to take care of critical patients. The total number of ICU beds in the state tracked by the health department is a moving target, as the number fluctuates with available staff.<\/span><\/p>\n<p><span style=\"\">\"It\u2019s not the equipment or the beds, it\u2019s the staff,\" Brogdon said. Without adequate numbers of highly trained staff to care for the sickest COVID patients, she said, \"a larger number of them are not going to survive.\"<\/span><\/p>\n<p><span style=\"\">An ICU nurse at a large hospital in Central Arkansas said her unit recently had to keep several beds empty because \"we don\u2019t have enough nurses to take care of the patients.\" Another nurse, who works at a step-down unit at a different Central Arkansas hospital, said, \"We don\u2019t have the staff, and then the people that are going to work are going to be burnt out, which is going to affect the care that patients receive in a negative way.\" (Step-down units are an intermediate level between the ICU and general medical floor beds in a hospital.)<\/span><\/p>\n<div class=\"flourish-embed flourish-chart\" data-src=\"visualisation\/4115940\"><script src=\"https:\/\/public.flourish.studio\/resources\/embed.js\"><\/script><\/div>\n<div style=\"text-align: center;\" data-src=\"visualisation\/4115940\"><em>Credit: Abby Zimmardi, <a href=\"https:\/\/arkansascovid.com\/\">Arkansascovid.com<\/a><\/em><\/div>\n<p>&nbsp;<\/p>\n<p><span style=\"\">Arkansas hospitals faced staffing shortages long before COVID-19, but the pandemic has exacerbated the problem. Competition for nurses has become fierce, with hospitals across the country facing potential surges. The cost of hiring traveling fill-in nurses has become exorbitant, said Bo Ryall, president and CEO of the Arkansas Hospital Association. Firms are even offering massive pay bumps to poach nurses on staff in Arkansas hospitals for contract work in other states, he said.<\/span><\/p>\n<p><span style=\"\">\"The system is just not designed for a mass influx of patients,\" said a doctor who works in multiple hospitals in Central Arkansas. \"There aren\u2019t enough nurses, there aren\u2019t enough physicians, there aren\u2019t enough respiratory therapists and physical therapists.\"<\/span><\/p>\n<p><span style=\"\">The doctor expressed frustration at reassuring statements from state and hospital officials about the potential to increase capacity: \"That does not equal safe care. You can convert clinic spaces to hospital space, you can set up a field tent, but ultimately what you\u2019re going to have is health care providers that are seeing more patients than they can safely care for.\"<\/span><\/p>\n<p><span style=\"\">\"What I wish that Arkansans understood,\" the doctor said, \"is that there\u2019s going to come a point, when you come to the hospital for care, whether COVID or not, you\u2019re going to arrive in what is going to be wartime for health care providers. We will give you whatever care we can, but it won\u2019t be what it should be.\"<\/span><\/p>\n<p><span style=\"\"><a href=\"https:\/\/237995-729345-1-raikfcquaxqncofqfm.stackpathdns.com\/wp-content\/uploads\/2020\/11\/Physician-Open-Letter-with-Signatures.18.Nov_.2020-1.pdf\">More than 300 Arkansas doctors signed an open letter<\/a> sent to the governor Nov. 15 warning of \"mass casualties\" if the state doesn\u2019t take further action to slow the spread of the virus. A recent report from the White House Coronavirus Task Force found that \"<\/span><span style=\"\">Arkansas is on the precipice of a rapid, accelerating increase in cases which will be followed with new hospital admissions.\" <\/span><span style=\"\">The report recommended the state consider \"pausing\" extracurricular school activities, limiting bar hours and limiting indoor capacity of restaurants to 25%.\u00a0<\/span><\/p>\n<p><span style=\"\">Hutchinson did modestly restrict bar hours beginning Nov. 20, requiring that they close at 11 p.m. However, he has insisted that most businesses should stay open, noting the economic damage that would be inflicted by a lockdown in the absence of any new federal relief package.\"<\/span><\/p>\n<p><span style=\"\">\"People\u2019s lives are being forfeited over money,\" the doctor who works at multiple hospitals said. \"We feel like the government is setting us up to fail at our job. Ultimately, containing the virus is the only way to truly save lives.\"<\/span><\/p>\n<p style=\"text-align: center;\"><span class=\"asterisk-divider\">***<\/span><\/p>\n<p><span style=\"\">Jones, the health department\u2019s preparedness medical director, expressed confidence that the statewide health care system still has room in terms of staffed ICU capacity to handle the influx of patients. \"There is not a specific number that represents a quote-unquote tipping point,\" she said. \"Hospitals are very adept at being able to flex with respect to ICU beds.\"<\/span><\/p>\n<p><span style=\"\">The Arkansas Hospital Association\u2019s Ryall agreed that wiggle room remains. Over the last two months, Ryall said, hospitals across the state have added 122 ICU beds, 174 ventilators and 452 beds in negative pressure rooms designed to keep COVID patients quarantined. \"Certainly they have surge plans to add even more beds as needed, as we move forward,\" Ryall said. \"There\u2019s still capacity there, but we\u2019re concerned about it \u2014 not as much what we\u2019re seeing today, but knowing what\u2019s coming in two to three weeks.\"<\/span><\/p>\n<p><span style=\"\">As the number of cases has increased, the state\u2019s total number of staffed ICU beds has been around 90 percent occupied in recent weeks; last week it ticked up to 94 percent.\u00a0<\/span><\/p>\n<p><span style=\"\">\"I know that makes folks a little alarmed,\" Jones said. \"Sometimes I feel like stats like this become more alarming as we are tracking them second to second.\" But ICU bed capacity, she said, \"is extremely fluid\" and can change by the hour. \"You start off the shift and there\u2019s no ICU beds and then suddenly four hours later we get six beds and we can move patients upstairs,\" she said.<\/span><\/p>\n<p><span style=\"\">Jones pointed out that even in normal times, prior to the pandemic, some of the state\u2019s larger hospitals operated with ICUs at or near capacity.<\/span><\/p>\n<p><span style=\"\">\"It\u2019s not unusual for us to be at capacity in the ICU,\" said Troy Wells, CEO at Baptist Health, the largest hospital system in Arkansas, with 11 facilities statewide. \"The Little Rock campus is a transfer destination all over the state for the sickest patients in Arkansas, so we manage the ICU day to day. That\u2019s no different right now. We have ways of adapting day to day, and levers we can pull to slow things down or speed things up to create capacity.\" Baptist began hiring additional traveling nurses last summer in preparation for higher volume this fall and has added 33 ICU beds since the pandemic began, in Little Rock, North Little Rock and Fort Smith, with another 16 in Little Rock slated for January.<\/span><\/p>\n<p><span style=\"\">Jones acknowledged that the state\u2019s critical care resources are not unlimited. \"I think the discomfort that many are feeling is because there are so many hospitals that are running with these margins,\" she said. \"If all of our facilities are truly running at these very razor thin margins with no room to move, that is concerning. I\u2019m not necessarily convinced that we are at the point where there\u2019s no room to move.\"<\/span><\/p>\n<p><span style=\"\">Some providers interviewed for this story expressed the concern that COVID patients stay in the ICU for a significantly longer period of time than other patients, which means that beds turn over less frequently and could create a backlog even if hospitals are efficient at managing their ICUs.<\/span><\/p>\n<p><span style=\"\">Brogdon said that she found the length of time that patients were in the ICU to be the most surprising part of working a COVID unit. \"A typical critical care patient will come in and either recover or die within a couple of weeks, whereas a huge percentage of the COVID patients come to the hospital and are there for a couple of months,\" she said.<\/span><\/p>\n<p><span style=\"\">Jones said one possibility for increasing capacity would be identifying patients currently in the ICU who could potentially be treated in step-down beds or on the general floor. Such transfers would only be made if the patient was stable and the transfer could be done safely and without sacrificing quality of care, she said. Certain hospitals are better equipped to handle such patients outside of the ICU, she said, so the health care system could free up more space with more efficient statewide management of resources.<\/span><\/p>\n<p><span style=\"\">\"I think we have room in terms of being able to drill down and say who truly needs an ICU bed,\" she said. \"Those are some of the things we\u2019re going to look at with the task force.\"<\/span><\/p>\n<p><span style=\"\">Some providers told the Arkansas Nonprofit News Network that their hospitals are already being more aggressive about moving patients out of the ICU.<\/span><\/p>\n<p><span style=\"\">\"We\u2019re putting sicker and sicker people on the [general] floor,\" the ICU nurse in the large Central Arkansas hospital said. Under normal circumstances, she said, the hospital will place some people in the ICU out of an abundance of caution, even though they may not strictly need that level of care. \"We just don\u2019t have space for that precaution anymore,\" she said.<\/span><\/p>\n<p><span style=\"\">The nurse in the step-down unit said she is seeing a number of patients, both COVID and non-COVID, who would normally be receiving intensive care. Often, she said, patients are transferred back to the ICU when space clears up. \"When we get these patients that should be in the ICU in our unit, we tend to send them back in a couple of days,\" she said.<\/span><\/p>\n<p><span style=\"\">The chronic shortage of staffed beds means patients are moved more frequently between departments, the nurse said. The hospital typically never moves very sick patients at night, when staffing levels are generally lower. \"Within the past two weeks \u2026 we\u2019re moving patients in the middle of the night,\" she said.<\/span><\/p>\n<p><span style=\"\">Governor Hutchinson and the task force announced several policy changes on Friday aimed at helping hospitals with capacity. The governor said the Arkansas State Board of Nursing will expedite licensure and waive application fees for 1,104 nursing students expected to graduate in the coming weeks. The task force is also exploring the possibility of using the state\u2019s Trauma System to coordinate the placement and transfer of COVID-19 patients to hospitals that have the capacity to treat them.<\/span><\/p>\n<p><span style=\"\">Another new policy relaxes the health department\u2019s guidelines on when medical staff must quarantine, shortening the period before essential health care workers exposed to the virus can return to work if they test negative. The new policy also says hospitals facing extreme staffing shortages may, \"as a last resort,\" allow asymptomatic COVID-positive health care workers to return to work, so long as they only treat COVID patients and remain segregated from other staff.<\/span><\/p>\n<figure id=\"attachment_22573\" aria-describedby=\"caption-attachment-22573\" style=\"width: 640px\" class=\"wp-caption alignnone\"><img loading=\"lazy\" decoding=\"async\" class=\"size-large wp-image-22573\" src=\"http:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/Asa-Nov-2020-1170x731.jpg\" alt=\"Governor Asa Hutchinson\" width=\"640\" height=\"400\" srcset=\"https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/Asa-Nov-2020-1170x731.jpg 1170w, https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/Asa-Nov-2020-700x438.jpg 700w, https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/Asa-Nov-2020-768x480.jpg 768w, https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/Asa-Nov-2020.jpg 1400w\" sizes=\"auto, (max-width: 640px) 100vw, 640px\" \/><figcaption id=\"caption-attachment-22573\" class=\"wp-caption-text\"><em>STAYING THE COURSE: Governor Hutchinson has rejected calls for major new restrictions on businesses, despite the rising case numbers. (Photo credit: Brian Chilson)<\/em><\/figcaption><\/figure>\n<p><span style=\"\">The new guidelines \"will definitely help the situation,\" Ryall said. \"We\u2019ve got a significant number of health care workers who are in quarantine now at some point.\" As of last week, almost 400 University of Arkansas for Medical Sciences employees were quarantined due to exposure to the coronavirus or a positive test. Baptist Health had more than 200 out across the system. At Baxter Regional Medical Center, a 211-bed hospital in Mountain Home, 55 staff members were sick with COVID-19 as of Nov. 14, <a href=\"https:\/\/www.ky3.com\/2020\/11\/15\/mountain-home-ark-hospital-reports-55-staff-infected-with-covid-19-icu-near-capacity\/\">according to a local TV news report<\/a>, including 25 nurses, forcing the hospital to delay elective surgeries that require an overnight stay.<\/span><\/p>\n<p><span style=\"\">But the idea of keeping asymptomatic COVID-positive health care workers on the job sets off alarm bells for some providers.<\/span><\/p>\n<p><span style=\"\">\"To me that is an act of desperation,\" said the doctor who works at multiple hospitals. Even if they are not yet showing symptoms, the doctor said, health care workers should be home resting and recovering \u2014 and breaking quarantine risks exposing more people in the community to the virus.<\/span><\/p>\n<p><span style=\"\">The doctor also questioned whether it would be logistically possible to safely quarantine a COVID-positive staffer from the rest of the hospital. \"If we had enough health care workers, the governor wouldn\u2019t be willing to assume the risk of having asymptomatic COVID workers in the workplace,\" the doctor said.<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"\"><span class=\"asterisk-divider\">***<\/span><\/span><\/p>\n<p><span style=\"\">Many of the providers interviewed by the Arkansas Nonprofit News Network fear that stretching hospital capacity will lead to worse quality of care for patients and worse health outcomes: longer wait times, less attention from providers, less access to specialized care such as physical therapists, less communication with families and an increased chance of errors.<\/span><\/p>\n<p><span style=\"\">\"It\u2019s not just for COVID patients,\" said the doctor who practices at multiple hospitals. \"The people who come in for a heart attack are going to have a doctor who is seeing too many patients, a nurse that has too many patients. \u2026 When you get to a sustained level of overburden, then you can never focus on anyone well.\"<\/span><\/p>\n<p><span style=\"\">The doctor said that the number of total beds touted by the governor paints a misleading picture. \"Everything looks good on this piece of paper,\" the doctor said. \"But if you really walked in and saw how strained the system was, the number of beds is a moot point. The number matters less than the landscape of the care being provided.\"<\/span><\/p>\n<p><span style=\"\">\"We won\u2019t have enough health care providers to safely treat the patients,\" the doctor said, \"and they\u2019re going to die.\"<\/span><\/p>\n<p><span style=\"\">\"I don\u2019t believe that quality of care is suffering at this point,\" said Jones, who also works as an emergency medicine physician at UAMS. \"We\u2019re not there. But certainly if people are not taking this more seriously and not abiding by the things we need to do to try to mitigate the spread of the disease in the community, it could get to be that way.\"<\/span><\/p>\n<p><span style=\"\">One of the providers\u2019 biggest concerns is that if the numbers keep rising, hospitals will have no choice but to change staffing ratios.<\/span><\/p>\n<p><span style=\"\">Typically, one ICU nurse is assigned to just one or two patients because their needs are so extensive. If that ratio increases, said Brogdon, that would mean \"less time and concentration you have for your patient load.\" Intensive care would become less intensive and could become unsafe, she said.<\/span><\/p>\n<p><span style=\"\">At the hospital where she just completed her contract, Brogdon said, \"there was a discussion among the nurse managers and the critical care nurses as to what is the next step. Are we going to accept that we\u2019re going to be taking three critical patients sometimes instead of two? Or is everybody going to work mandatory overtime every week? Because very soon we\u2019re going to have to do one or the other.\"<\/span><\/p>\n<p><span style=\"\">Asked about hospitals potentially changing staff ratios, Ryall said, \"I do not think we\u2019re at the point where we\u2019re even thinking that way yet. If it reached [high enough] levels, that certainly would be a consideration, but those levels are way out in front of us.\"<\/span><\/p>\n<p><span style=\"\">For many of the providers interviewed for this story, the disconnect they feel with state officials and hospital administrators is less about the current situation and more about the days to come. For now, they said, they are managing an extremely challenging ordeal. But while officials continue to project relative calm and confidence, hospitals are reaching a tipping point, they said, and will run out of resources if community spread continues at its current pace.<\/span><\/p>\n<p><span style=\"\">\"On the one hand, they\u2019re not lying,\" said the doctor at the large Central Arkansas hospital. \"Our nursing ratios are still normal. But there\u2019s less and less wiggle room. We are used to surging, and we can handle linear growth. We can staff up and stretch and bend \u2014 that is what we do every day throughout the year. This is different.\"<\/span><\/p>\n<p><span style=\"\">The ideas to increase capacity presented by state officials, the doctor said, might help at the margins, but it is like \"pissing on a wildfire.\"<\/span><\/p>\n<p><span style=\"\">\"We\u2019re beyond the point where we can increase capacity,\" the doctor said. \"There\u2019s no more. You can\u2019t grow new nurses nearly as fast as you can grow new infected patients. The only math left is to decrease the spread in the community.\"<\/span><\/p>\n<p><i><span style=\"\">This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans. Data visualization by <em>Abby Zimmardi, c<\/em>ourtesy of <em><a href=\"https:\/\/arkansascovid.com\/\">Arkansascovid.com<\/a><\/em><\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u201cWe cannot possibly continue at the current rates of exponential growth in the community,\u201d the doctor said. \u201cIt\u2019s not sustainable. I believe we\u2019re looking at 10 days of wiggle room before there is nowhere to go and we\u2019re looking at those sorts of crazy scenarios where there\u2019s patients lined up in the hallway.\u201d<\/p>\n","protected":false},"author":6,"featured_media":22574,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[155,111],"tags":[213,279,280,281,283,284,282],"class_list":["post-22572","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-coronavirus","category-health-care","tag-arkansas-department-of-health","tag-arkansas-hospital-association","tag-jerrilyn-jones","tag-jose-romero","tag-melissa-brogdon","tag-troy-wells","tag-winter-covid-19-task-force"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v17.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>As COVID hospitalizations top 1K, doctors and nurses say health care system is stretched to its limits - Arkansas Nonprofit News Network<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"As COVID hospitalizations top 1K, doctors and nurses say health care system is stretched to its limits - Arkansas Nonprofit News Network\" \/>\n<meta property=\"og:description\" content=\"\u201cWe cannot possibly continue at the current rates of exponential growth in the community,\u201d the doctor said. \u201cIt\u2019s not sustainable. I believe we\u2019re looking at 10 days of wiggle room before there is nowhere to go and we\u2019re looking at those sorts of crazy scenarios where there\u2019s patients lined up in the hallway.\u201d\" \/>\n<meta property=\"og:url\" content=\"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/\" \/>\n<meta property=\"og:site_name\" content=\"Arkansas Nonprofit News Network\" \/>\n<meta property=\"article:published_time\" content=\"2020-11-25T21:27:24+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2021-12-17T18:42:32+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/M.-Brogdon-2-crop.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1675\" \/>\n\t<meta property=\"og:image:height\" content=\"942\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"David Ramsey\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"15 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Organization\",\"@id\":\"https:\/\/arknews.org\/#organization\",\"name\":\"Arkansas Nonprofit News Network\",\"url\":\"https:\/\/arknews.org\/\",\"sameAs\":[],\"logo\":{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/arknews.org\/#logo\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/04\/annn_logo.png\",\"contentUrl\":\"https:\/\/arknews.org\/wp-content\/uploads\/2021\/04\/annn_logo.png\",\"width\":1200,\"height\":900,\"caption\":\"Arkansas Nonprofit News Network\"},\"image\":{\"@id\":\"https:\/\/arknews.org\/#logo\"}},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/arknews.org\/#website\",\"url\":\"https:\/\/arknews.org\/\",\"name\":\"Arkansas Nonprofit News Network\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/arknews.org\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/arknews.org\/?s={search_term_string}\"},\"query-input\":\"required name=search_term_string\"}],\"inLanguage\":\"en-US\"},{\"@type\":\"ImageObject\",\"@id\":\"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/#primaryimage\",\"inLanguage\":\"en-US\",\"url\":\"https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/M.-Brogdon-2-crop.jpg\",\"contentUrl\":\"https:\/\/arknews.org\/wp-content\/uploads\/2020\/11\/M.-Brogdon-2-crop.jpg\",\"width\":1675,\"height\":942,\"caption\":\"ON THE FRONT LINES: Melissa Brogdon, a retired nurse who recently finished a contract in an ICU, said hospital are stretched thin.\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/#webpage\",\"url\":\"https:\/\/arknews.org\/index.php\/2020\/11\/25\/as-covid-hospitalizations-top-1k-doctors-and-nurses-say-health-care-system-is-stretched-to-its-limits\/\",\"name\":\"As COVID hospitalizations top 1K, doctors and nurses say health care system is stretched to its limits - 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