Bed capacity in intensive care units remains low in the Cincinnati region as hospitals attempt to recover from the omicron surge that staggered the community just two months ago. 

Area health experts say residual effects of the latest spread such as lingering COVID-19 patients, and the return of many non-COVID patients and procedures, are the main reason why ICU and medical-surgical beds are still stuffed with sick patients even while virus-related hospitalizations continue to plummet. 

A workforce shortage, particularly in the health industry, also persists, limiting the capacity for certain units only to what resources are available on any given day. 

Hospitals were so overwhelmed in January, the systems relied on expanded space and resources, mainly through assistance from the Ohio National Guard in order to meet basic patient needs.

The local systems have enjoyed some relief since then as the omicron variant has deteriorated as rapidly as it rose. But a number of challenges still remain as the hospitals enter what Tiffany Mattingly, vice president of clinical strategies for the Health Collaborative, calls a "recovery phase" of the pandemic. 

According to the latest data from the Health Collaborative's Situational Dashboard, ICU beds in the Cincinnati region are still 94% full and medical-surgical beds are 93% full. 

Both of those numbers are still above pre-pandemic levels, even though only 1 in 20 patients in 40 local hospitals currently has COVID-19. At the height of the omicron surge, as many as 1 in 3 patients at the hospitals had the virus. 

"Some of the capacity limitations are due to staffing, which will continue as we work through these shortages," said Mattingly, who analyzes COVID-19 data trends for the region. "On top of that we have regular patient flow. Many people delayed their care for many reasons. There were concerns about going to the hospital, they were delaying getting their primary or specialty care. Those delays can have an impact on people's health and people are coming in sicker than they were previously." 

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The number of COVID-19 patients in the ICU has significantly dropped since January. In the Cincinnati region. According to the latest data, 92 patients remain hospitalized with COVID-19, while 14 individuals are being treated in the ICU and eight are on ventilators.

In January, hospitals saw upwards of 1,000 patients hospitalized with COVID with more than 200 in the ICU and more than 100 on ventilators. 

The percentage of COVID patients who make up the ICU was over 35% previously and has since dropped to 17%. 

The residual effects of COVID-19, however, directly correlate to the high volume of sick patients in ICUs, said Dr. Stephen Feagins, Mercy Health Cincinnati's chief clinical officer. 

"We call it the surge after the surge if you will," Feagins said, alluding to his hospitals seeing a lot of inpatients whose conditions worsened after they had COVID-19. "Heart attacks or strokes, or other things are essentially made worse by having had COVID within the last two months because of the sort of residual interstitial lung issues."

"COVID is still making its presence known even if it is not a predominant part of the numbers," he added. 

Even as the transmission of COVID-19 subsides, longer hospital visits have been one of the many casualties of the prolonged pandemic, added Dr. Carl Fichtenbaum, a clinical professor of infectious disease at the University of Cincinnati. 

"There's not a lot of new individuals that are being admitted to our hospitals into ICUs," he said. "Many of them are listed as post-COVID, which means they typically are no longer are actively shedding the virus but they're still pretty sick because they suffered a lot of damage to their lungs or other organ systems." 

Fichtenbaum said a clearer picture on what long-term effects of COVID may look like won't come for another few months, but early signs show that some vulnerable groups such as elderly individuals, or those with pre-existing conditions could experience lingering symptoms from catching the disease. 

"They've got brain fog, they've got fatigue, there's some people with heart problems and just no stamina or concentration abilities," he said. "So there's going to be a number of people who suffer from those effects. And because omicron infected almost half of the United States, there's going to be a lot of people suffering from those problems."

The post-omicron challenges come as the United States is still experiencing massive loss – to the tune of nearly 700 deaths per day – from the novel virus. 

The seven-day daily death average, which has dropped significantly from a high of over 2,000 in January, according to data from the Centers for Disease Control and Prevention, stands tall above the number of fatalities that occur from the influenza virus. The CDC estimates from Oct. 1, 2021 to March 19, 2022, deaths from the flu range from 1,800 to 5,200. 

The U.S. is currently less than 24,000 COVID deaths away from reaching 1 million in just a two-year span. 

"In Hamilton County, COVID took 2,166 lives over the last two years, which is something we've never seen with the flu," said Hamilton County Health Commissioner Greg Kesterman. 

With most COVID restrictions lifted in the region, officials are again putting the focus back on vaccinations and boosters. On Tuesday, the Food and Drug Administration approved a second booster shot for individuals aged 50 and older who have had at least four months between their first booster. 

But feelings of an endemic classification regardless of vaccination status have begun to set in among the public. On Thursday, Kansas Gov. Laura Kelly announced she was directing the state to officially transition its response from a pandemic to endemic response. State senators in Kentucky have similarly pushed for endemic language to take place of prior pandemic legislation such as a state of emergency declared by Gov. Andy Beshear. 

Earlier this month, Ohio Department of Health Director Dr. Bruce Vanderhoff, said the state was transitioning from daily COVID reporting to weekly reporting, citing a transition to an endemic 

But as deaths continue and the definition of endemic is debated, some health officials are pumping the brakes on those declarations. 

"We certainly are feeling like it's endemic, it has not been declared that, but we're living with yet another infectious disease that can flare at any time," Feagins said. "But the maximum deaths you will ever see for a flu season is around 100 to 150 deaths per day. We continue to have COVID deaths as a nation and as a region. So, what is endemic? In large part, endemic is something that's more flu-like in terms of deaths per day, and we're still pretty far away from that." 

Fichtenbaum said another six months with little change in transmission is needed to transition to a new classification. The Health Collaborative's Mattingly said the goal is to get to a consistent seasonal classification of the novel virus, allowing it to be better controlled for an extended period of time. 

"COVID is not yet operating or functioning in a seasonality the way the flu does," she said. "The flu has a season. COVID hasn't reached a normalization where it has a season yet. We think maybe we'll see that this year, this fall as we level out from the last major surge, but there's so many variables there."