Hospitals across much of Pennsylvania are at capacity, health-care workers are exhausted and stretched thin, and about 100 people a day are dying from the coronavirus as the winter surge worsens.

A quarter of the state had no or few ICU beds available by week’s end, and about two-thirds of counties were down to their last available hospital beds. Over the last few weeks, average new infections and hospitalizations have climbed, particularly in central and western parts of the state, making Pennsylvania among the worst-hit states this winter.

“We’re really facing a crisis,” said Timothy Friel, chair of Lehigh Valley Health Network’s department of medicine. Its hospitals now have about the same number of COVID-19 patients as they did in December 2020, he said. “I don’t think any of us ever thought one year ago we would be in the same position. … It’s been very, very depressing [and] we don’t see an end coming.”

More than 4,600 people were hospitalized in Pennsylvania on Friday with the virus. The state’s death rate has crept up to a daily average above 100, according to New York Times data tracking. While the Philadelphia region and New Jersey are not as hard-hit, across much of Pennsylvania, emergency-room wait times are long and hospitals are implementing the stopgap measures they now know too well. For instance:

  • At Geisinger Health, headquartered in Montour County, people with COVID-19 now take up a third of regular beds and half of ICU beds. The post-anesthesia recovery unit was turned into a temporary ICU, and most nonemergency surgeries have been canceled.

  • At Mount Nittany Medical Center in the shadow of Penn State, all elective procedures that require overnight stays have been postponed as the hospital treats more COVID-19 patients than at any other point in the pandemic.

  • At Lehigh Valley Health Network hospitals, workers have created makeshift ICUs and more staff are getting trained to care for the sickest patients.

  • At the University of Pittsburgh Medical Center, administrators are hoping to draw 800 new nurses through an in-house program — an attempt at competing with outside agencies that have drawn nurses away from hospitals with better-paying traveling jobs.

At UPMC Altoona, Leigh Straw said he is one of five full-time nurses in a unit that had 30 before the pandemic. Last Thursday, his team had three coronavirus patients who needed to be revived within a half-hour period, Straw said.

“We can see tears in each other’s eyes,” he said of his colleagues. “Seeing the tears in their eyes makes it so much worse. … It kind of crushes you emotionally.”

What’s going on inside the hospitals is a sharp contrast to how the pandemic-weary public behaves outside of them. Gerald Maloney, Geisinger’s chief medical officer for hospital services, said one emergency department doctor had recently described it as feeling like living in a parallel universe.

”Every day when she comes to work, she knows it’s going to be bad,” he said, recounting her description. “But then when she leaves, she steps out into a world where COVID doesn’t seem to exist, where everybody seems to be in denial. Where people are gathering and shopping and nobody has a mask on.”

Geisinger hit the highest-ever number of COVID-19 patients in its nine hospitals last week. The volume at UPMC, which has hospitals across the state, is second only to last December.

They’re contending with a high number of patients with other conditions, including many who need care they put off last year and some who have the flu. That added demand strains on the shrunken workforce, said Donald Yealy, chief medical officer at the University of Pittsburgh Medical Center.

That causes more delays, including for patients with non-coronavirus ailments. Without COVID-19, hospitals would be busy but not maxed out.

“I want them to realize what it’s like inside the hospitals,” Maloney said of the public and the coronavirus’ effect on care for patients with other conditions. “People who haven’t been in ... don’t have any idea that if their father has a heart attack today, his care is going to be impacted by COVID.”

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With a week until Christmas, the whole country was seeing increases in hospitalizations. Public health officials expect indoor holiday gatherings to cause a further spike post-Christmas. On Friday, the White House warned unvaccinated people that they could get sick and overwhelm hospitals.

“This is real, even if you don’t think you’re seeing it,” Yealy said. “And if you don’t think it’s right nearby you, it will be very, very soon.”

Echoes of 2020

Pennsylvania’s average number of new infections a day topped 8,000 this week while the daily hospitalization average topped 5,000, the highest in the United States, according to the New York Times.

The commonwealth also has the fourth-highest hospitalization rate in the country.

New Jersey officials, too, have been warning of increasing spread. Though not in the same position as Pennsylvania, the state had one of the top increases in hospitalization rates this week. There were 1,756 hospitalized COVID-19 patients Wednesday; a month earlier, the number was 733.

In Pennsylvania, Susquehanna, Fulton, and Sullivan Counties had the highest case rates as of Friday, with Northampton, Schuylkill, Lehigh, and Berks Counties not far behind.

For some of the hardest-hit hospitals, the surge — primarily among unvaccinated patients who have caught the delta variant — is about as bad or even worse than this time last year. It’s frustrating health-care workers, confusing a public that had hoped the pandemic was receding, and sickening thousands.

ICUs are full and waiting rooms are backed up with people hoping for beds to open up or delayed test results to come in. Beds are in hallways. Hospital leaders are meeting multiple times a day, making decisions about who gets care and who gets delayed.

» READ MORE: How many Philadelphians need boosters? Vaccine-tracking challenges make it ‘impossible to say.’

Doctors and nurses are also contending with patients’ family members who demand sham remedies like ivermectin or refuse to believe their loved one’s COVID-19 test results. And staffing shortages continue exacerbating the turmoil, from causing nurses to care for too many patients to cutting hours at hospital cafeterias where workers could normally find coffee at all hours.

The situation has gotten so dire that Gov. Tom Wolf this week asked the Federal Emergency Management Agency to send health-care workers to help the state. Hospitals are hoping for their arrival; a plan is expected by next week, a Department of Health spokesperson said.

Experts fear the omicron variant’s arrival could quickly push the country into a new wave of infections. Between the elevated case spread and the possibility that omicron could evade vaccine protection better than previous strains, signs of renewed caution were already emerging, from Sunday’s canceled Eagles game to universities calling off in-person finals.

And while hospitals are managing the surge and have never been fully incapacitated by the pandemic’s peaks, some are worried about what could come next.

“We are getting closer and closer to the proverbial straw that breaks the camel’s back,” said Friel, of Lehigh Valley Health Network.

Avoiding ‘last winter again’

Though cases and hospitalizations are rising — and Philadelphia officials have advised against indoor Christmas gatherings — Southeastern Pennsylvania has so far experienced a less severe surge.

About 350 people were hospitalized in Philadelphia this week — hospitals are “holding their own,” said Philadelphia Health Commissioner Cheryl Bettigole.

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Hospitals in Roxborough, Bristol, and Norristown run by Prime Healthcare were seeing only a handful of coronavirus patients, a spokesperson said. Lankenau, Bryn Mawr, Riddle, and Paoli Hospitals are seeing the surge, but not the worst they’ve seen, said William Surkis, Main Line Health’s vice president for medical education.

“If things keep increasing, it’ll start feeling like last winter again,” he said. “All of us are hoping that won’t happen,” given the region’s relatively high vaccination rates.

Still, people report sometimes-long waits at local emergency rooms, and last week, some hospital administrators around the Philadelphia region said space was tight.

Bettigole said she was hearing “real concern” from the chief medical officers at hospitals in the region, “especially when they look around the state at what’s happening in other places where they’re truly overwhelmed.”

For now, doctors statewide implored residents to get immunized: Those who are getting severely ill or dying are mainly unvaccinated.

“Most of the ones who require hospitalization with COVID are unvaccinated, and it’s frustrating to know that it could have been prevented,” said UPMC’s Yealy. “It’s not a judgmental thing, but it’s frustrating to watch someone struggle to breathe and know that it all could’ve been averted.”