Health care staff shortages and near-capacity COVID-19 units are straining Philadelphia area hospitals even as they prepare for a bigger wave of cases following the holiday season.

Some hospitals have begun canceling non-urgent procedures to reserve their depleted staff for critically ill patients, while others have tightened visiting policies that had loosened during the summer.

Inside hospitals, workers described scenes dramatically different from just a few weeks ago. Most hospitalized patients are unvaccinated. But workers are also seeing people who were vaccinated against COVID-19 — but not boosted — filling beds faster than the hospital can discharge patients who’ve recovered.

While the vaccines and a variant that seems to make people less sick offer some hope, hospital workers said they are bracing for things to get worse before they get better.

Last week, Temple University Hospital began reviewing its upcoming planned surgeries and rescheduling some, “if the case is one that can be safely postponed and frees up necessary resources for a burgeoning inpatient population,” said Tony Reed, executive vice president and chief medical officer at Temple University Health System.

“I anticipate we’re going to be having the conversation about electives for the next few weeks,” he said.

Temple is currently rescheduling no more than five procedures a day. Meanwhile, Main Line Health announced Sunday that it is “pausing” all elective surgeries for the next two weeks.

Temple’s emergency department -- already one of the busiest in Philadelphia -- has been especially hectic with the influx of COVID-19 patients.

“We’re in a crisis within the crisis,” said Carlos Aviles, a pharmacy technician and the president of the union representing technicians at Temple University Hospital. “We weren’t ready for the first wave of COVID, and we’re dealing with a dam with a lot of cracks and leaks right now. If this dam bursts through, how many lives are we going to lose?”

Aviles and his colleague, nurse Mary Adamson, the president of the Pennsylvania Association of Staff Nurses and Allied Professionals chapter at Temple, say staff shortages have demoralized nurses and spurred worries that they can’t care appropriately for the number of patients they’re being assigned. Adamson, an ICU nurse, said the hospital had about 150 to 200 COVID-positive patients on campus.

“The industry standard is two ICU patients to one nurse, unless the patient has a more serious condition” -- like many COVID patients, Adamson said. “Now we’re at three patients to one nurse, and patients that should require a single nurse are being paired up. In the medical-surgical units, nurses are taking five, six, seven patients apiece.”

“The thing about nursing is,” she continued, “it’s all about surveillance. It may not look like you’re busy, but you’re watching everything. When someone has a heart attack or a blood clot, it happens fast, but the symptoms leading up to that are there. They’re subtle, but they’re there. And that’s what we’re missing in health care right now. Those subtle signs that prevent those bad outcomes.”

At Suburban Community Hospital in Norristown, Shannan Giambrone, an ICU nurse and the head of the PASNAP local chapter there, said nurses are also feeling the strain.

“There are some elderly patients who are vaccinated but still susceptible to a virus,” said Giambrone, who estimates the hospital’s COVID-19 census has doubled in the past two weeks. “The younger patients have been unvaccinated, and they’re not doing well. That’s one of the things that’s making nurses struggle -- it’s not a statement on your personal belief on why you did or didn’t choose to vaccinate. I don’t care. But it’s hard to take care of people who didn’t have to be this sick.”

Prime Healthcare, the health system that oversees Suburban and two other area hospitals, is allowing visitors into the hospital only on a case-by-case basis, and is closely monitoring its patient census and preparing to allocate resources accordingly in the event of rising COVID numbers, said Michelle Aliprantis, a spokesperson for the health system.

Hospitals in the Penn Medicine health systems have also seen a COVID surge in recent weeks, particularly in under-vaccinated areas, PJ Brennan, Penn’s chief medical officer, said in a statement.

Some health care services -- Brennan did not specify which -- that can be “safely postponed” are being “curtailed as appropriate,” he said. Visiting hours have also been limited; visitors must show proof of vaccination or a negative COVID test; and everyone visiting facilities is now required to wear a surgical mask, KN-95, or N-95 mask.

Tower Health is not currently restricting elective procedures, even as COVID-19 cases continue to rise, said Richard Wells, a spokesperson for Tower. As of Jan. 2, there were 263 COVID-19 patients across the four-hospital system, 80% of whom were unvaccinated.

The number of COVID patients at Cooper University Health Care is at the highest it’s ever been, said Joseph M. Montella, Cooper’s chief medical officer, and the “vast majority” are unvaccinated.

All five of Virtua Health’s New Jersey hospitals are near capacity, with cases ramping up dramatically in the past 10 days, said Reg Blaber, chief clinical officer and executive vice president for Virtua Health. As of Jan. 3, Virtua had more than 300 COVID-19 patients — more than this time last year and up from 100 at the beginning of December.

Most of Virtua’s COVID-19 patients are unvaccinated. Those few who are vaccinated did not receive a booster and are experiencing less severe illness, compared to the unvaccinated.

“The rate of people being admitted to Virtua hospitals with COVID is greater than the rate of people being discharged with COVID,” Blaber said. Virtua is preparing for another surge by evaluating how to reconfigure space to safely accommodate more patients. It is also addressing staff shortages by offering flexible schedules, reassigning staff within departments, bringing in temporary staff, and offering overtime or bonuses to employees to volunteer for extra shifts.

Hospital staffing in general in South Jersey has suffered during this surge, Gov. Phil Murphy said at a press conference Monday. “The staffing challenges are, to use a technical term -- bad. It’s bad in both hospitals and long-term care. There’s just no other way around it,” Murphy said. ”Staffing is going to be the constraining factor here [in this surge], rather than beds or PPE or ventilators.”

Main Line Health Chief Medical Officer Jon Stallkamp said the decision to pause non-urgent procedures has eased the pressure.

“We’ve postponed surgeries, so now we have staff I can reassign, and beds open that I can reassign to a COVID patient,” he said. “And non-clinical staff are picking up time to help with the staff on the floor -- delivering trays, moving a patient, just answering the phone helps.”

He and other physicians from around the region urged people to get vaccinated and boosted -- and to avoid the ER for anything that’s not an emergency, including COVID testing.

Staff writer Justine McDaniel contributed.