As omicron spreads, filling hospital beds and flooding emergency rooms and urgent cares with anxious patients, the employee hotline at Lehigh Valley Health Network has been ringing nonstop: Doctors, nurses, and other workers are calling out sick because of COVID-19. One day last week, the line was averaging more than one call a minute — and some of the people who would usually be taking the calls were out sick, too.

In the last week, the unprecedented number of infections has sidelined teachers, bus drivers, trash collectors, and others in significant numbers, in some cases disrupting services and schools. The omicron variant is more transmissible and can evade vaccine protection; as health-care workers also catch the fast-spreading virus, it has added a new challenge for hospitals already strained by the worsening surge.

“This particular wave has been intensified and has been magnified by the superimposed staffing crisis,” said Timothy Friel, the chair of the department of medicine at Lehigh Valley Health Network. “That has just made it even tougher.”

Geisinger Health, which operates nine hospitals in northeastern and central Pennsylvania, had more than 10% of its staff in quarantine or isolation. About 270 Penn State Health employees — a larger than usual number, but just over 1% of its staff — were out of work Thursday.

“Right now it seems like everybody knows many people who are infected,” said Gerald Maloney, chief medical officer for health services at Geisinger. “The number of people sick is crazy.”

Some hospital leaders said their contact-tracing efforts showed workers generally catch the virus while out in the community, like everybody else, rather than at work.

» READ MORE: Pa. nurses after 22 months of COVID-19 and a new surge: ‘It is so defeating’

Last month, several Pennsylvania hospitals, mainly in the western and central parts of the state, were already at capacity.

Since, the number of new infections has skyrocketed and the crisis has worsened — hospitalizations, mainly of unvaccinated people, have increased from about 4,700 to more than 6,400 statewide just since Christmas — causing even facilities in the Philadelphia region to cancel elective surgeries or tighten visitation policies.

“Every day feels like a crisis,” Friel said. ”The challenge is not knowing where the crisis is going to be — what practice, what locations” are going to have the most employees out sick.

Pivoting to fill gaps

In Pennsylvania, nearly a quarter of all COVID-19 tests are coming back positive, up from 15% last week. New Jersey officials said hospitals were preparing to see up to 30% of staff out because of COVID-19 exposure based on the state’s positivity rate.

Other places were reporting even higher numbers: Philadelphia, for example, had a nearly 40% positivity this week. And officials believe the number of cases is being undercounted because many people are testing at home or unable to find tests.

At hospitals, “staffing was already a challenge,” said Donald Yealy, chief medical officer at University of Pittsburgh Medical Center. “Now you add on this short-term threat.”

Gov. Tom Wolf on Friday announced the Department of Health and Pennsylvania Emergency Management Agency would set up overflow sites and send medical staff, a signal of how critical the situation has become.

The regional sites will not open until February, however, and it was unclear when support staff would arrive. A spokesperson for the governor said the administration had not yet identified where the sites would open or which staffing agencies they would use. The office did not answer other questions about the plan. A few hospitals said they were waiting to learn more.

» READ MORE: Why is it so hard to find a COVID-19 test? Sites are short-staffed, and rapid supply is low.

In York and Scranton, Department of Defense medics sent by the Federal Emergency Management Agency arrived at two hospitals this week and are set to stay 30 days. New Jersey has also requested FEMA help, while the state National Guard will assist long-term care facilities, officials said.

The virus-related absences mean some are now having to move workers to different jobs or ask employees to pick up extra work. It also contributes to longer waits and backlogs, already a problem due to the high volume of patients and existing staffing shortages.

Geisinger has been recruiting staff to do additional jobs for extra pay, Maloney said — for example, a pathologist whose workload is lighter than normal because the hospital has postponed many surgeries could pick up shifts giving vaccinations.

WellSpan Health’s York Hospital has opened nearly 200 extra beds and converted spaces into patient wards and was so short on staff that it received the military medics from FEMA.

They’re expecting those numbers to keep rising, which could put the hospitals’ ability to deliver care “in jeopardy,” CEO Roxanna Gapstur said Thursday.

No hospital is yet at a point where administrators say they are unable to provide acute care. But existing fatigue and burnout are compounding for employees at work.

“I don’t want anyone to think we are compromising on care,” said Deborah Addo, Penn State Health’s executive vice president and chief operating officer. “But it might mean we are compromising on the livelihood of a caregiver.”

In Philadelphia region

As the United States continues to see a sharp, steady climb in the numbers of people infected and hospitalized, hospital rates in Pennsylvania and New Jersey were higher than the national average, according to federal data analyzed by the New York Times.

New Jersey had more than 5,600 people hospitalized on Friday, the highest number since the state’s spring 2020 peak. Pennsylvania had more than 6,400, its average number of daily hospitalizations climbing toward the winter 2020 peak.

ICU beds have steadily filled over the last few weeks. On Friday, the percentage of available beds ranged from 14% in northwest Pennsylvania to just under 10% in the northeast.

Hospitals in Bucks, Chester, and Montgomery Counties still had capacity this week.

But the strain was intensifying in Philadelphia and Delaware County. Health Commissioner Cheryl Bettigole said the city’s hospitals were “extremely stressed” on Tuesday, and the city on Thursday reported 1,162 COVID-19 patients in hospitals.

» READ MORE: About 90% of COVID-19 patients in some of Pa.’s hardest-hit hospitals are unvaccinated

“We are getting close to the kind of dire situation we all dread in which treatable conditions can be fatal,” she said, “because our hospitals simply don’t have room.”

Delaware County medical adviser Lisa O’Mahony said medical reserve corps workers are being called in to fill staffing gaps, while all of the county’s six hospitals were at capacity.

Some of the Pennsylvania hospitals that were overwhelmed a few weeks ago with COVID-19 patients say they are doing even worse now, and they expect it to get tougher before the surge abates. Geisinger was above capacity systemwide, and all UPMC facilities were at or near capacity.

If the situation worsens at Guthrie, it may have to designate one hospital for COVID-19 patients and others for non-virus-related care, said Michael Scalzone, chief quality officer.

South Jersey’s hospitals are fuller than in April 2020, and more children are currently hospitalized for COVID-19 in New Jersey than at any point during the pandemic, Health Commissioner Judith Persichilli said.

Exhausted hospital workers are hoping models predicting that the omicron surge could soon peak — New Jersey officials said that could be as soon as Jan. 14 for hospitalizations — prove accurate.

“One hope that we cling to is [given] how quickly omicron has driven up numbers, we will see a rapid decline,” said Friel, of Lehigh Valley Health. “We keep telling each other, ‘One more week, two more weeks, we can keep doing it.’”