Hospital lobbies are being retrofitted to care for patients, recovery wings turned into Intensive Care Units, and elective surgeries are on the chopping block again as COVID-19 cases surge in Chicago and Illinois.

That’s according to doctors and administrators from numerous Chicago-area hospitals who spoke to WBEZ Monday — when 67% of the state’s ICU beds, which go to the sickest patients — were full.

Hospitals are extremely busy, doctors say, mostly with non-COVID patients. But there’s concern that if COVID-19 cases continue to surge at the current rate, people who need acute care due to a heart attack or a stroke, for instance, will be competing for an ICU bed with those who need acute care for COVID-19.

“What nurses and doctors and health care workers are experiencing right now in their hospitals is a crisis as challenging as the one they experienced last spring,” Gov. JB Pritzker said Monday. “… They’re exhausted. Often working overtime, and double shifts.”

What happens when a hospital reaches capacity?

Hospitals cannot turn patients away, under federal law, if someone shows up in need of care. But when a hospital reaches capacity, it can go on something known as “bypass,” which alerts ambulances to bring patients elsewhere.

This is a last resort, but one that some hospitals are already having to face.

“We have a sustained large number of COVID patients,” said Sherri McGinnis Gonzalez, a spokesperson for the University of Illinois Chicago, which operates a 462-bed hospital. “We have had to go on bypass twice in the last week due to unavailable beds.”

Several hospitals within the AMITA Health system, which has 14 hospitals in Illinois, have been on and off bypass for the past week as cases have surged, according to their chief clinical officer, Dr. Stuart Marcus.

“It really does depend on where we are in the course of the day, and how full the hospital is and how busy the emergency room is. That’s also true during normal times as well,” he said, particularly during flu season, which is not yet in full force.

But ultimately, health care workers, who’ve complained of being underpaid and overworked during the pandemic, could be the ones to bear the brunt of overrun hospitals.

“A hospital bed is much more than a physical bed or a space to put the bed, it’s also the nurses and doctors and other staff to care for the patients and all of the equipment that goes with that,” said Seth Trueger, an emergency medicine doctor at Northwestern Medicine. “There’s some things we can do to adapt and improve capacity, but there’s only so much.”

Smaller hospitals, particularly safety net hospitals in communities of color hit hardest by the pandemic, have struggled in the past to be able to transfer COVID-19 patients, facing a lack of coordination among hospitals and a labyrinth of phone calls to find willing facilities. That’s still true for some of those smaller facilities, though larger systems have the ability to transfer patients among their own hospitals.

Putting surge plans into practice

When COVID-19 hit in the spring, hospitals took drastic steps to make space for those patients, including cutting back on elective surgeries.

Dr. Andrew Costello, an emergency room doctor at Swedish Hospital, said ERs also saw a drop off in regular visits, potentially due to March’s stay-at-home order that kept people inside (and out of the hospital), which meant more capacity to treat COVID-19.

“We’ve just gotten back to normal … people are playing sports and injuring themselves, or getting into car accidents,” he said. “So we’re getting back to regular ER volumes. But, we’re having a surge of COVID patients which makes it difficult.”

Hospitals that were able to ramp up elective surgeries over the summer are now quickly scaling back down, though experts are still urging Illinoisans not to delay care on their own.

Cook County Health, the government-run hospital system in Cook County, has suspended elective surgeries that require in-patient stays, and is moving outpatient services to telehealth, according to spokesperson Caryn Stancik.

“This will provide some additional staffing resources for areas of significant need,” she said. “Like other hospitals, our limitations will be related more to the availability of staff [versus] beds.”

Advocate Aurora, one of the largest health systems in Illinois, is reducing elective surgeries by 50% this week, it’s chief medical officer Dr. Jeff Bahr, announced Monday.

Other hospitals, like Rush and AMITA, are evaluating elective surgeries on a day-by-day basis.

Trueger, the doctor from Northwestern, believes that hospitals will try to continue elective surgeries for as long as possible, for several reasons: it’s their mission to continue to provide care to the community, patients are worse-off in the long run by delaying care in the short-term, and elective surgeries are how many hospitals make their money.

“The revenue hit [from the spring] was huge, and it’s going to be hard to do again,” he said, though he predicts elective surgeries will have to start dropping off drastically as COVID-19 cases continue to surge.

Hospitals are also putting other mitigation measures in place, like reimposing limits on visitors.

At Sinai Health, which operates two acute care hospitals, capacity ranges between 75 to 85%. The hospital said it can nearly double its critical care beds if needed — part of its “4-tier surge plan” it will implement once it’s over 90% capacity. Currently, it’s transitioning 75% of its clinic visits to telehealth, and putting other social distancing measures in place.

“We have spaced out furniture in our waiting and cafeteria areas to promote proper social distancing, and have put down floor markers in these areas and other common spaces like elevators and reception areas,” a spokesperson said in a written statement.

Strides in care for COVID-19 patients

Health care workers say the scariest part of the pandemic is not knowing what’s going to happen next or how bad this surge will get. But some add that one hopeful sign is that doctors have gotten better at treating COVID-19 patients in the past eight months, which might translate into fewer visits to the ICU.

“Generally speaking, our length of stay — how long patients are in the hospital — has gone down both in the ICU as well as on the medical surgical units,” Dr. Paul Casey, Chief Medical Officer at Rush University Medical Center said.

He points to how health care workers have learned to use the proning technique, where a patient lays on their stomach to make breathing easier on their lungs. Or, they’ve learned at which point Remdesivir therapy works best for COVID-19 patients.

“That’s allowed us to keep pace a little bit better than we had in the spring, when really, there was this overwhelming surge, but also kind of a lot of learning to be done around COVID patients in general,” he said.

Mariah Woelfel is a general assignment reporter at WBEZ. You can follow her on Twitter @MariahWoelfel.