The severe weather threat Tuesday brought Kenton County emergency teams together for a training. “This is very timely training,” Kenton County Homeland Security and Emergency Management director Steve Hensley said. “We spend a great deal of time planning for events we hope never occur, but on occasion, unfortunately, we know that they do.”As the potential for severe weather loomed, agencies from across Kenton County and beyond came together to train including police, fire, environmental agencies and hospital representatives among others.The teams are preparing for disasters such as tornados, floods, chemical spills, terrorist activities and unforeseen problems.“That’s what this is today, bringing everyone together so the first time they meet is not in the event of a real disaster,” Hensley said. “These kinds of exercises help us practice those skills. So, when those unfortunate real-life situations happen, we can hit the ground running,” said Ft. Mitchell police Chief Andrew Schierberg.

Thousands of nurses went on strike Monday at two of New York City's major hospitals after contract negotiations stalled over staffing and salaries nearly three years into the coronavirus pandemic.

The privately owned hospitals were postponing nonemergency surgeries, diverting ambulances to other medical centers, pulling in temporary staffers, and assigning administrators with nursing backgrounds to work in wards to cope with the walkout.

As many as 3,500 nurses at Montefiore Medical Center in the Bronx and about 3,600 at Mount Sinai Hospital in Manhattan were off the job. Hundreds picketed, some singing the chorus from Twisted Sister’s 1984 hit “We’re Not Gonna Take It,” outside Mount Sinai. It was one of many New York hospitals deluged with COVID-19 patients as the virus made the city an epicenter of deaths in spring 2020.

“We were heroes only two years ago,” said Warren Urquhart, a nurse in transplant and oncology units. “We was on the front lines of the city when everything came to a stop. And now we need to come to a stop so they can understand how much we mean to this hospital and to the patients.”

The union for nurses, the New York State Nurses Association, said they had to strike because chronic understaffing leaves them caring for too many patients.

Jed Basubas said he generally attends to eight to 10 patients at a time, twice the ideal number in the units where he works. Nurse practitioner Juliet Escalon said she sometimes skips bathroom breaks to attend to patients. So does Ashleigh Woodside, who said her 12-hour operating-room shifts often stretch to 14 hours because short staffing forces her and others to work overtime.

“We love our job. We want to take care of our patients. But we just want to d it safely and in a humane way, where we feel appreciated,” said Woodside, who has been a nurse for eight years.

The hospitals said they had offered the same raises — totaling 19% over three years — that the union had accepted at several other facilities where contract talks reached tentative agreements in recent days.

Montefiore said it had agreed to add 170 more nurses. Mount Sinai’s administration said the union’s focus on nurse-to-patient ratios “ignores the progress we have made to attract and hire more new nurses, despite a global shortage of healthcare workers that is impacting hospitals across the country.”

The hospitals said Monday that they had prepared for the strike and were working to minimize the disruption.

“We remain committed to seamless and compassionate care, recognizing that the union leadership’s decision will spark fear and uncertainty across our community,” Montefiore said. “This is a sad day for New York City.”

Mount Sinai called the union “reckless.”

Gov. Kathy Hochul urged the union and the hospitals late Sunday to take their dispute to binding arbitration. Montefiore’s administration had said it was willing to let an arbitrator settle the contract “as a means to reaching an equitable outcome.”

The union did not immediately accept the proposal. In a statement, it said Hochul, a Democrat, “should listen to the frontline COVID nurse heroes and respect our federally-protected labor and collective bargaining rights.”

Both hospitals had been getting ready for a walkout by transferring patients, including intensive-care newborns at Mount Sinai.

Montefiore and Mount Sinai are the last of a group of hospitals with contracts with the union that expired simultaneously. The Nurses Association had initially warned that it would strike at all of them at the same time — a potential calamity even in a city with as many hospitals as New York.

But one by one, the other hospitals struck agreements with the union as the deadline approached.

CINCINNATI —

The omicron surge is pushing hospitals to capacity as they struggle to keep up with the highest number of COVID-19 patients on record.

“We’re certainly at our highest water mark to date,” St. Elizabeth Dr. Jim Horn said.

St. Elizabeth surpassed their highest number of COVID-19 patients set last year at 219. The new number set this week is 232.

“It just means that everyone is extremely busy, and everyone is stretched to the max,” Horn said.

Every facet of hospital operations is affected from pharmacy to supply chain to the thin ranks of the staff.

“They’re tired, they’re demoralized, they’re emotionally stretched,” Horn said.

There are so many health care workers out sick, even those who are not normally on the front lines are called into action to help.

“Every, every hospital from our rural hospitals to our urban core hospitals are hit by this,” the Health Collaborative’s Tiffany Mattingly said.

Mattingly said almost every hospital in the region is hitting historic high number of COVID-19 patients.

“Definitely as bad as we’ve seen since the start of the pandemic. They’re operating at a whole new level of surge right now,” Mattingly said.

As a record number of Americans are infected with COVID-19, largely due to the rapidly spreading omicron variant, some states' health care systems are beset with nearly full intensive care units.

Four states have less than 10% remaining capacity in their ICUs, according to data Wednesday from the U.S. Department of Health and Human Services: Kentucky, Alabama, Indiana and New Hampshire.

And as infection spreads, states and health care systems nationwide are handling shortages of available medical workers, who face a greater chance of COVID-19 exposure and must isolate after testing positive.

Members of the National Guard and other federal emergency teams have been deployed to hospitals and long-term care facilities in places such as New Hampshire to alleviate the burden with medical and non-medical tasks.

"This is part of the winter surge, part of the long haul, which is why we put so many of the mitigation strategies and measures in place early on to help provide some flexibility to hospitals and health care systems," New Hampshire Gov. Chris Sununu said Wednesday.

Five other states are very close to just 10% of ICU capacity remaining, according to HHS data: New Mexico, Missouri, Rhode Island, Mississippi and Georgia. Nationally, COVID-19 hospitalizations have reached record highs with at least 151,261 Americans need care as of Wednesday.

Early research indicates the omicron variant may produce less of a chance of needing hospitalization than prior COVID-19 variants. But omicron's increased transmissibility means more people at higher risk for severe disease, such as those who are unvaccinated or immunocompromised, will be infected.

"Omicron continues to burn through the commonwealth, growing at levels we have never seen before. Omicron is significantly more contagious than even the delta variant," said Kentucky Gov. Andy Beshear Monday. "If it spreads at the rate we are seeing, it is certainly going to fill up our hospitals."

While conditions are not as dire as at the start of the pandemic nearly two years ago due to the availability of vaccines and other treatment options, the staffing shortages in hospitals is a real concern during this latest surge, said Dr. Craig Spencer, director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.

"The problem is that right now we have hospitals where there's not enough nurses to take care of the patients who are coming in, the COVID patients and the non-COVID patients," Spencer told CNN Wednesday.

"That's exactly why we need to do everything we can to try to limit the number of people that are infected, not just those that are older or unvaccinated or not boosted, but everyone. Because each infection represents a potential to infect more people. We need to do what we can to slow that spread right now and ease the pressure on our hospitals," Spencer said.

For those who come into emergency rooms for non-COVID reasons yet test positive, hospitals are still having to invoke quarantine protocols for those patients which puts a strain on operations, he said. And that can have an effect on all patients.

"Right now, we're still seeing sick people that need oxygen, the overwhelming majority of which are unvaccinated. But a lot of the patients that we're seeing right now have underlying chronic conditions that are being exacerbated," Spencer said.

Those patients, he said, can include "someone who gets COVID is dehydrated and needs to stay in the hospital, or someone who gets COVID and is too weak and they can't go home because they're a fall risk. Those aren't as bad in one sense as those kind of classic COVID patients we were seeing before. But every single patient that needs to stay in the hospital takes up a bed. And beds and staffing are what's in short supply right now."

CDC to update mask guidance

Health experts are reiterating the need to wear quality masks as never-before-seen figures of positive COVID-19 cases strike the country.

The U.S. averaged more than 771,580 new COVID-19 cases daily over the past week, according to Johns Hopkins University data, more than three times that of last winter's peak average.

The U.S. Centers for Disease Control and Prevention plans to update information about mask-wearing, including the different levels of protection that various masks — such as cloth, surgical or N95 — provide against the spread of COVID-19, CDC Director Dr. Rochelle Walensky said during a White House virtual briefing Wednesday.

Overall, it is important for people to wear any face mask that they have access to, "but Omicron has changed things a bit because it is so transmissible that we know that masks are even more important," Lori Tremmel Freeman, chief executive officer of the National Association of County and City Health Officials, told CNN Wednesday.

"And if you have the chance, if you have the opportunity, if you have access to a better mask, then the recommendation would be to wear it," she said, adding that N95 and KN95 masks need to be fitted properly to provide the best protection possible.

Vaccines effective with adolescents, study shows

The rate of deaths in the U.S. has remained lower than during last year's winter surge, which is often credited to around two-thirds of Americans eligible for vaccines being fully inoculated, according to the CDC.

The country has averaged 1,817 COVID-19 deaths a day over the past week, JHU data shows. The peak daily average was 3,402 one year ago on Jan. 13, 2021.

However, the latest CDC ensemble forecast predicts a potential 62,000 new COVID-19 deaths over the next four weeks, meaning preemptive vaccinations are still needed.

The age group of Americans who are the least vaccinated remains those under the age of 18, and a new study of real-world hospital data between July and late October points to the effectiveness of vaccinations even for those who, by being younger, are generally at lesser risk.

The findings, published Wednesday in the New England Journal of Medicine, show that the Pfizer/BioNTech coronavirus vaccine appears to be 94% effective against COVID-19 hospitalization among adolescents ages 12-18 in the U.S.

"Vaccination averted nearly all life-threatening COVID-19 illness in this age group," wrote the researchers from the CDC and a collection of hospitals and universities, who found that far more adolescents hospitalized with COVID-19 were unvaccinated compared with those who were hospitalized for other reasons.

Among the hospitalized adolescents with COVID-19, 4% were fully vaccinated, less than 1% were partially vaccinated, and 96% were unvaccinated. In comparison, of those who did not have COVID-19, 36% were fully vaccinated, 7% were partially vaccinated, and 57% were unvaccinated.

The Biden administration announced Thursday that it will direct $100 million to the National Health Service Corps to help address the health care worker shortage.

Pulled from funding in the American Rescue Plan, the $100 million represents one of the nation’s biggest investments in a program that helps place primary care doctors in communities that have difficulty recruiting and retaining them. It's a five-fold increase from previous years, the Department of Health and Human Services said.

The National Health Service Corps offers loan repayments and scholarships to clinicians in exchange for multiple years of service in areas that have a health care provider shortage.

"Whether you're in rural America, or in a low income part of America, that shouldn't be a reason why you can't access good quality health care," Health Secretary Xavier Becerra said in a phone interview. "And so we want to help states that are going to try to do what they can to keep that public health workforce in those rural communities, those low-income communities, they're where people need them."

The announcement comes after the United States lost 17,500 health care employees in September, according to the Bureau of Labor Statistics. With the industry's employment figures now sitting at just under 16 million, the agency reported the country has lost 524,000 health care employees since the start of the pandemic. Job losses in nursing, hospitals and residential care saw the biggest drops in the industry last month.

Losing employees has in turn increased labor costs. Hospitals and other medical facilities have had to sharply increase spending on recruiting and retaining employees, according to a report published last week by Moody's Investors Services. That has led to boosted benefit options and sign-on bonuses that can go well into five figures since the start of the pandemic.

“Covid has basically caused a laser focus on the glaring gaps and dysfunction across the American health care system,” said Tener Veenema, a scholar focused on workforce issues at Johns Hopkins University's Center for Health Security. “Making investments to redistribute health care providers into rural areas, low-resourced areas, is so important because we know how much they are suffering from a lack of access to good health care.”

States will be able to apply for grants until April and the Department of Health and Human Services predicts it will make up to 50 awards as high as $1 million per year over the course of four years.

Participating states won’t have to match funds or share costs in any way to obtain the grants, and they can use 10 percent of the award for administrative costs.

“With these funds, states can design programs that optimize the selection of disciplines and service locations, and tailor the length of service commitments to address the areas of greatest need in their communities,” said Diana Espinosa, the acting administrator of the Health Resources and Services Administration, which oversees the program. “This investment will make a tremendous impact on access to primary care and addressing health disparities at a critical time.”

The project start date isn't until September 2022, so it won't have an immediate effect on the current labor shortage. It represents, however, the latest push by the Biden administration to address the issue that experts believe will only get worse over the next decade.

President Joe Biden pulled $100 million this year from the American Rescue Plan to support the Medical Reserve Corps, an all-volunteer army of doctors, nurses and medical support teams in hopes of accelerating the pace of Covid-19 vaccinations.

"A hundred-million dollars isn’t going to take care of everybody," Becerra admitted. "But it’s certainly going to go a long way in helping our state partners get resources to those local communities, so they can keep that health care worker there, keep them trained, ready and prepared to keep them healthy."

Rural hospitals across the country are in a difficult spot right now. COVID-19 is hitting them harder than many metropolitan hospitals as they deal with issues of lower staffing.

According to the National Center for Biotechnology Information, about 20% of our nation’s population lives in rural areas, yet less than 9% of our nation’s physicians practice there.

Add on the fact that according to CDC data, COVID is killing rural Americans at a rate 3.5 times higher than those living in metropolitan areas, and this issue is affecting staff and patient care.

“I’m very worried about rural health care because rural health care is teetering on the brink right now,” said Dr. Kurt Papenfus, an ER doctor at Keefe Memorial Hospital in rural Cheyenne Wells, Colorado. “There’s a darkness in this illness that I can’t say I’ve said about any other illness.

In late October, Dr. Papenfus contracted COVID-19 as he was traveling back from the Northeast to visit his daughter.

“I was very cognizant and was wearing a mask at all times, social distancing, and washing my hands,” Papenfus said. “But I remember having this thought on the train that this is a super-spreader event.”

When he got home, Papenfus got tested and was confirmed positive for COVID-19. The diagnosis put Keefe Memorial in a tailspin as he served as the only ER doctor in the small 25-bed hospital.

“We are a trauma level four hospital so keeping that physician on staff 24/7 is what we are required to do,” said Stella Worley, Keefe Memorial’s CEO. “And it is getting to be more of a challenge to have hired physicians out here in rural [America].”

Within minutes of learning of Dr. Papenfus’ COVID-positive diagnosis, Worley was on the phone with several different hospitals working to find a replacement. Within a few hours, they had settled on a former ER doctor who moved to another hospital in Texas a few months prior.

After she agreed, Keefe Memorial paid the doctor to drive 10 hours from Texas to Colorado and fill in immediately as Papenfus recovered at home for the next two weeks.

“Worst-case scenario is you would have to divert patients if there’s no one in the door to care,” said Worley.

Populations in rural America tend to be older, poorer, and less insured than the nation at large, according to the National Conference of State Legislatures.

Since 2010, hospital closures in rural America have been growing as there have been 118, including 17 last year.

The closures only exacerbate a growing lack of health care coverage in rural America, said Dr. Dan Derksen, a rural health care expert and family physician

“Once a critical access hospital (25 beds with a 24/7 emergency department and at least 35 miles from another facility) closes, they almost never come back,” he said.

The magnitude of COVID-19 patients filling hospital beds is avoidable, doctors say. But in some hospitals, patients with or without coronavirus are paying the price.

"We are at the point where not every patient in need will get the care we might wish we could give," said Dr. Shelly Harkins, chief medical officer of St. Peter's Health in Helena, Montana.

It's one of the latest hospitals to resort to crisis standards of care, meaning emergency medicine personnel must ration care.

In those situations, "people who come in in cardiac arrest may not get CPR, and patients who would otherwise get hospitalized may be sent home with loved ones who are going to be scared and not have full capacity to take care of them," said emergency physician Dr. Megan Ranney, associate dean of the School of Public Health at Brown University.

More than 89,300 people are hospitalized for COVID-19, according to the U.S. Department of Health and Human Services.

And an average of 1,926 people have died from COVID-19 every day this past week, according to Johns Hopkins University. That's the highest rate since early March.

Vaccines are the best way to prevent COVID-19, but millions of teens and adults are not yet fully vaccinated, the Centers for Disease Control and Prevention said.

But there's "exciting news" for families eager to vaccinate their younger children.

Kids as young as 5 might be able to get vaccinated next month

Pfizer will soon ask the Food and Drug Administration to authorize its vaccine for children ages 5 to 11 after clinical trial data showed the vaccine is safe and generates "robust" antibody response among children in that age group, the company announced Monday.

If all goes well, the vaccine could be authorized for children ages 5 to 11 "probably by the end of October, perhaps it slips a little bit into November," former FDA commissioner and current Pfizer board member Dr. Scott Gottlieb told CNBC on Monday.

That would mean another 28 million Americans would be able to get vaccinated, according to a CNN analysis of data from the U.S. Census Bureau.

And that would make 94% of all Americans eligible for vaccination.

"This is exciting news," emergency physician and CNN Medical Analyst Dr. Leana Wen said Monday.

"So many parents are waiting for exactly this news, especially given what's happening now with the delta variant. There have been nearly half a million new cases in children in the last two weeks."

The Pfizer trial included 2,268 participants ages 5 to 11 and used a 10-microgram dose — smaller than the 30-microgram dose that has been used for those 12 and older.

"The 10 microgram dose was carefully selected as the preferred dose for safety, tolerability and immunogenicity in children 5 to 11 years of age," Pfizer said.

What to expect for booster doses

Advisers to the FDA on Friday recommended authorizing a booster dose of Pfizer's vaccine six months after full vaccination — but only for people 65 and older and for those at high risk of severe illness from the virus.

"The reason they made that decision is because of the FDA's judgement that the goal of vaccination is to prevent severe disease, hospitalization and death — and the only people for whom we've seen that two doses don't do that are the age 60 or 65 plus," Ranney said.

"For the rest of us, hold tight and stay tuned."

The CDC is meeting this week with its vaccine advisers, and the agency must give its approval before any booster doses can be officially administered.

The director of the National Institute of Allergy and Infectious Diseases said he believes a booster shot will likely be recommended for more Americans eventually.

"Data will continue to come in, and I believe you're going to see an evolution of this process as we go on in the next several weeks to months," Dr. Anthony Fauci said Sunday.

One evolution could be the evaluation of data for boosters from Moderna and Johnson & Johnson, which Fauci said might come within the next three weeks.

CINCINNATI —

The Health Collaborative's Christa Hyson said Ohio hospitals are doing everything in their power to get shots in arms as quickly as possible.

Right now, their focus is still vaccinating front-line health care workers, making up the very first phase of vaccine rollout.

But Tuesday, Gov. Mike DeWine announced a clear deadline.

"We are telling our hospitals today that they need to finish that up, they need to finish it up by midnight on Sunday," DeWine said.

That deadline is aimed at keeping the process moving as phase 2 is set to begin Monday.

But is it a realistic ask?

"It totally depends on the capacity of that individual hospital, so for some it might be very easy, for others, they have hundreds of staff, maybe even thousands," Hyson said.

UC Health has given the first doses to more than 6,800 employees.

The system employs 12,000 people total.

Hospital officials said they will be giving second doses passed that Sunday deadline, although they don't believe it'll interfere with efforts to begin vaccinating Ohioans ages 80 and older, as part of phase 2.

"As they become vaccine providers, they're hoping we get more regular shipments, current activities shouldn't dictate future deliveries," Hyson said.

We reached out to Tri-Health, The Christ Hospital and Mercy Health for their phase 1 vaccine numbers, but have not received them.

Officials at The Jewish Hospital told us:

"We will continue to offer the vaccine to employees who want it, even if that extends beyond Sunday."

As Louisiana reels from a fourth COVID-19 wave — with the highest single-day cases since the pandemic began — hospitals in the state are preparing for yet another public health crisis with Hurricane Ida battering the coast. The Louisiana governor said this hurricane will be one of the strongest to hit the state in more than 150 years.

Gov. John Bel Edwards said evacuation of hospitals in threatened areas — something that would normally be considered — is impractical with COVID-19 patients.

“That isn’t possible. We don’t have any place to bring those patients. Not in state, not out of state,” Edwards said.

More than 2,600 COVID-19 patients are hospitalized across Louisiana, according to state data. The seven-day average has begun to decline in recent days, having reached nearly 2,700 hospitalizations — the peak from April 2020.

Video above: Louisiana hospitals prepare for Hurricane Ida's arrival

"We have been talking to hospitals to make sure that their generators are working, that they have way more water on hand than normal, that they have PPE on hand," Edwards said.

Officials decided against evacuating New Orleans hospitals. There’s little room for their patients elsewhere, with hospitals from Texas to Florida already dealing with a spike in coronavirus patients, according to Dr. Jennifer Avengo, the city’s health director.

At the state's largest hospital system, Ochsner Health System, officials ordered 10 days worth of fuel, food, drugs and other supplies and have backup fuel contracts for its generators. One positive was that the number of COVID-19 patients had dropped from 988 to 836 over the past week — a 15% decline.

Some hospitals appeared to have evacuated their most critical patients ahead of the storm, as they prepared to lose power. According to The Advocate, the Ochsner Health System evacuated 17 of its most critically ill patients from three hospitals, with 100 patients remaining at those locations.

In Mississippi, workers at Singing River Gulfport expected to have to raise flood gates to keep rising water out of the hospital that is full of COVID-19 patients, the vast majority of whom aren't vaccinated, said facilities director Randall Cobb.

Complicating matters, he said, was that the hospital is short-staffed because of the pandemic and also expects to get a flood of patients suffering from ailments that typically follow any hurricane: broken bones, heart attacks, breathing problems and lacerations.

“It's going to be bad. It's going to be really bad,” Cobb said.

Located a few miles from the coast, the hospital has enough generator fuel, food and other supplies to operate on its own for at least 96 hours, he said, and it will help anyone who has a serious, life-threatening condition. But officials were trying to get the word out that people with less severe medical problems should go to special-needs storm shelters or contact emergency management.

“It’s very stressful because it’s too late if we have not thought of everything. Patients are counting on the medical care but also on the facility to be available,” Cobb said.

President Joe Biden approved a federal emergency declaration for Louisiana ahead of the storm. White House press secretary Jen Psaki said FEMA plans to send nearly 150 medical personnel and almost 50 ambulances to the Gulf Coast to assist strained hospitals.

The Associated Press contributed to this report.

FLORENCE, Ky. —

The commonwealth of Kentucky is putting more pieces in place for large-scale vaccinations.

Health, government and business leaders believe February will be an improvement over this month. But it is tough to tell if that improvement will make much of a difference initially.

As Kentucky Gov. Andy Beshear announced four mass vaccination sites Thursday, Northern Kentucky was all ears.

"We were actually surprised by the governor's announcement yesterday because Northern Kentucky wasn't one of those sites," said Brent Cooper, who heads the Northern Kentucky Chamber of Commerce. "We were thinking that it would be."

Beshear said there would be two mass sites in Paducah, one in Danville and one in Lexington as a start.

Cooper and others in this area expect Beshear will include Northern Kentucky when he makes additional site announcements next week and the following week.

The Chamber was told Northern Kentucky wasn't quite ready even though the 20% positivity rate in Boone, Kenton and Campbell counties dwarfs the statewide rate of just under 12%.

However, there isn't enough supply anyway. And as the St. Elizabeth experience demonstrates, this area of the Bluegrass has administered 98% of what it has.

"We were able to distribute today, even without that site, we're able to distribute what we're getting. We're just hoping that the vaccine dramatically increases," Cooper told us.

Kentucky receives 56,000 doses a week. It could get an additional 8,800 doses per week when the Biden administration releases more to the states.

Kentucky has the capacity to administer 250,000 doses a week. It is ranked in the top 10 for state distribution efficiency. The northern counties lead the way on that. They comprise one of the three most populous areas in Kentucky along with Louisville and Lexington.

We're told 90,000 residents who are 70 and older from the 1B grouping have had their initial COVID-19 vaccine shot. There's another 400,000 of them to go.

When you add a million Kentuckians in 1C to the mix, even the promised increase in doses from the new administration won't cover everybody.

"This is going to be a multi, multi-month process," noted Kris Knochelmann, the Kenton County Judge Executive. "This isn't about just waiting till February and then everybody's available."

There's a push on to move child care providers into the 1B group. But that has yet to happen.

The state's new website provides useful information about what to expect. You should understand it is not a scheduling tool. But you can get alerted for when you're eligible.

"Our advice is to be patient, but stay ready," Cooper stated.

At just under 9,000 additional doses a week, you'll need more patience than readiness.

CINCINNATI —

Hospitals being pushed to the brink of capacity are looking for ways to decompress as the delta-driven COVID-19 surge shows no signs of backing down.

“It's taking a toll, it is causing a lot of strain on the caregivers and the ability to give that care,” said Ohio Hospital Association spokesman John Palmer.

Palmer said physical hospital beds are not the most pressing issue to reducing capacity.

“We have facilities and equipment to help accomplish that, but at the end of the day, the health care is delivered by the caregivers,” Palmer said.

Hospitals are looking for any way to decompress.

“Elective procedures, those surgeries that can be safely moved or rescheduled, whether that’s a couple of days, a couple of weeks, hospitals are starting to look into those opportunities,” Palmer said.

TriHealth is using the method saying it’s “proactively scheduling fewer elective surgeries each day that require inpatient stays.”

St. Elizabeth is among the hospitals now treating some COVID-19 outpatients with monoclonals.

“Because of our ability to treat outpatients with monoclonal antibodies I think we are seeing a decline in terms of our total inpatient escalation,” said St. Elizabeth Dr. John Horn.

A young mother had just celebrated her first wedding anniversary and was one of six members of a Jacksonville church to die over a 10-day span.

Another Florida woman had just given birth to her first child but was only able to hold the newborn girl for a few moments before dying.

A California man died a few weeks shy of his 53rd birthday while his wife was on a ventilator at the same hospital in Oakland, unaware of his passing on Aug. 4.

The COVID-19 death toll has started soaring again as the delta variant tears through the nation's unvaccinated population and fills up hospitals with patients, many of whom are younger than during earlier phases of the pandemic.

The U.S. is now averaging about 650 deaths a day, increasing more than 80% from two weeks ago and going past the 600 mark on Saturday for the first time in three months.

Data on the age and demographics of victims during the delta surge is still limited, but hospitals in virus hotspots say they are clearly seeing more admissions and deaths among people under the age of 65.

Florida hospital officials are seeing an influx of young, healthy adults filling their wards across the state, many requiring oxygen. In the past week in Florida, 36% of the deaths occurred in the under-65 population, compared with 17% in the same week last year when the state was experiencing a similar COVID surge. Florida is the national leader in coronavirus deaths, averaging more than 150 a day in the past week.

The younger patients mark a shift from the elderly and frail, many living in nursing homes, who succumbed to the virus a year ago before states made seniors a priority to get inoculated first. More than 90% of seniors have had at least one shot, compared to about 70% for Americans under 65.

At a predominantly Black church in Jacksonville with a hipster vibe, contemporary music, and a strong social media presence reflective of its young, energetic congregation, six members died over 10 days starting in late July. All were under the age of 35.

They were "all healthy, all unvaccinated," laments Pastor George Davis of Impact Church, who knew each one personally and has struggled with his own grief at the funerals. He's held two vaccination events for his congregation of about 6,000 where over 1,000 received shots.

Among the church members who died were a 24-year-old man Davis watched grow up since he was a toddler and a woman from his worship team who celebrated her first wedding anniversary only weeks before she died. Her husband recovered.

Davis said the young woman was "just the picture of health, vibrant."

"There is a sense among younger people that they are somehow invincible," said Dr. Leana Wen, public health professor at George Washington University and former Baltimore Health Commissioner. "Unfortunately, though, some people who are hospitalized are going to die and that’s going to mean some people who are younger; and as you’ve seen these are people in some cases who are leaving behind young children."

Among those parents are Kristen McMullen, who had decorated her baby’s room with rainbows and suns, fully embracing her favorite season, summer — after which she would name her first child.

The 30-year-old woman fell ill three weeks before her due date and was admitted to a hospital in Melbourne, Florida, with COVID-19.

After an emergency cesarean section, McMullen was able to hold her baby girl for a few moments before being rushed off to an intensive care unit, where she later died.

"She would say that she was scared and that she didn’t want to die," her aunt Melissa Syverson said, struggling to talk in between sobs. "She was fighting to get back to the baby."

McMullen’s aunt said her family did not want to disclose whether McMullen was vaccinated.

Carlos Reyes was skeptical of the vaccine and so was his wife, Maria — until they and their two teenage children had to be rushed to the hospital in Oakland.

Their 14-year-old son, Sergio, did not need to stay after getting oxygen while 19-year-old Emma joined her parents in the intensive care unit. She was released after a few days, and the parents were put on ventilators.

Their 32-year-old daughter who has an auto-immune disease was the only one vaccinated when they fell ill.

"We were all just a little hesitant at the beginning," said the couple's oldest daughter, Jasmine Rivas Fierro, 34.

Their four children didn’t want to break their mother's heart by telling her while she was still in intensive care that Carlos had died a day after their 22nd anniversary.

"She loved him so much," Rivas Fierro said of her mother, who is still in the hospital.

The family is telling people that they must be fully vaccinated to attend Carlos' funeral next week.

Cindy Dawkins also left behind four children, ranging in age from 12 to 24. She died Aug. 7, less than a week after she celebrated her 50th birthday with her family at Universal Studios in Orlando. She had a cough and seemed tired that day before her condition quickly deteriorated and she had to be rushed to the hospital in an ambulance.

Her family believes she contracted the virus at her waitressing job at a bistro in their hometown of Boynton Beach, Fla., where her coworkers have also tested positive. She was healthy and had been getting tested regularly but was still mulling over getting the vaccine.

"Maybe the vaccine would have helped fight it, but I don’t know if it would have completely stopped it," her 20-year-old son, Tre Burrows, said.

As the family wrestles with grief and sorts out guardianship of Dawkins' youngest children, they are also saddened by what could have been. Dawkins came to the U.S. from the Bahamas when she was in high school and her children say she was close to becoming an American citizen, an event the family planned to celebrate with a trip over Thanksgiving.

"Everything was finally going right," her daughter Jenny Burrows said. "And then this happened."

The U.S. remains among nations with the highest rate of new COVID-19 cases, driven mostly by a surge in the South, where many states are lagging in getting people vaccinated against the coronavirus.

"This is starting to look really ominous in the South. ... If you look at rates of transmission in Florida and Louisiana, they're actually probably the highest in the world," Dr. Peter Hotez, the dean of the National School of Tropical Medicine at Baylor College of Medicine, told CNN on Friday.

Infection rates began to plummet in the U.S. in the spring as vaccines became widely available, while the seven-day moving average of daily confirmed cases climbed in other nations, including India and Brazil, according to data from Johns Hopkins University.

In the month of August, the U.S. has so far reported more than 1.5 million new cases of COVID-19, more than three times the numbers for Iran and India — which now hold second and third place, JHU data shows. And the seven-day average has topped more than 135,000 cases, well ahead of other nations.

On a state-by-state comparison, Louisiana has the highest rate of new cases per capita, followed by Florida.

"That's how badly things have gotten out of hand. There is a screaming level of transmission across the southern states right now. And now we're starting to see this happening among younger age groups," Hotez said.

Florida on Friday broke its own record high in COVID-19 cases over the past week, reporting 151,415 new cases — the most infections recorded during a seven-day period since the pandemic upended lives across the globe.

The surge has been fueled by the more transmissible delta variant, overwhelming hospitals across the country.

In Louisiana, Gov. John Bel Edwards said hospitalizations hit a pandemic record high of at least 2,907 patients, up by six people from a day earlier.

"They're not just the highest that they've ever been. They're almost a third higher than at any other point in this pandemic. Our hospitals are struggling. Staff remains the limiting factor on capacity. Our staff at our hospitals, nurses and doctors and respiratory therapists and physician's assistants, you name it, they're maxed out," the governor said Friday.

Edwards said state hospital leaders are worried about the surges.

"I will tell you that I've never heard them express more concern, more alarm, or anxiety than they did this week, because we are rapidly approaching the breaking point," Edwards added.

And in Alabama, there is an alarming uptick of infants as well as teenagers hospitalized with COVID-19, according to Dr. David Kimberlin, the director of the Division of Pediatric Infectious Diseases at the University of Alabama in Birmingham.

"We're seeing a lot of children who are very, very sick admitted to our hospital. We have almost twice as many right now as we did at the previous worst part of this pandemic, which was probably in January," Kimberlin told CNN on Friday.

"These children are coming in fighting for breath, fighting for the ability to basically get through this devastating illness, many of them are on ventilators, maybe a quarter or so on ventilators or heart-lung bypass machines," he said.

He added that as children return to classrooms, "it's critically important that everyone in schools masks, whether you're vaccinated or not."

"I think the most efficient way to do that is to have a mandate, to have a requirement ... that everybody needs to do so. And it saddens me that we seem to be fighting about the way we go about doing it. We all ought to -- and I want to believe that we do -- have our own children's best interest at heart. We got to do this for them."

State and local officials spar over mask and vaccine mandates

But masking children in schools has become increasingly polarizing, especially in states where vaccination rates are lagging and COVID-19 infections, as well as hospitalizations, continue to increase.

Republican Govs. Ron DeSantis of Florida and Greg Abbott of Texas have issued executive orders that ban mask mandates in their states. DeSantis, however, went a step further and threatened to withhold the salaries of superintendents and school board members who disregard his order.

On Friday, the Texas Court of Appeals ruled against Abbott, upholding that mask mandates may remain in Bexar and Dallas counties. Abbott had requested the appeals court to stay rulings from two lower courts that decided mask mandates in those counties can be effective, despite the governor's executive order banning mask mandates.

In Arizona, education groups are suing the state for banning public schools from imposing mask and vaccine mandates.

The Arizona School Boards Association, the Arizona Education Association and other advocacy groups filed the lawsuit Thursday, arguing that the new laws favor private schools over public districts because they don't apply to public schools.

"Students in Arizona's public and charter schools will be less safe in their educational environment than students in private schools," the lawsuit states.

The lawsuit seeks to overturn the bans on mandates. Arizona Gov. Doug Ducey and Attorney General Mark Brnovich did not respond to requests for comment Friday.

"This legislative session was unprecedented. The legislature enacted substantive laws in budget reconciliation bills without notice to the public and on subjects that are completely unrelated to one another," plaintiffs' attorney Roopali H. Desai said in a written statement provided to CNN.

3rd dose for immunocompromised is not a "booster" shot, expert says

Meanwhile, the U.S. Food and Drug Administration on Thursday authorized an additional third dose to be administered to people with compromised immune systems.

And on Friday, vaccine advisers to the CDC voted unanimously to recommend the additional dose for some immunocompromised people. CDC Director Rochelle Walensky quickly endorsed the vote, which means people can begin getting third doses right away.

On Friday, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said it's important not to confuse that third dose with a "booster" shot.

"These are really about finishing a primary series. Think about childhood immunizations. We have vaccines for which we need three of four doses. What we found here is that the immune-compromised often didn't mount an adequate response at all. So we're still trying to build that. That is different than a booster dose where someone did respond and in fact over time that wanes," Osterholm told CNN. "I think it was a great decision."

At a meeting of CDC vaccine advisers, Dr. Heather Scobie said a disproportionate number of vaccine breakthroughs are among immunocompromised people. Almost one-third — 32% — of vaccinated breakthrough cases are among that group, she said.

While immune-compromised people make up about 2.7% of the adult population — about 7 million people — they're more vulnerable to infection, said Dr. Amanda Cohn, the executive secretary of the CDC's Advisory Committee on Immunization Practices.

She said vaccine effectiveness is about 59% to 72% in immunocompromised people, compared to 90% to 94% overall.

"Immunocompromised people are more likely to get severely ill from COVID-19. They are at higher risk for prolonged SARS-CoV-2 infection and shedding and viral evolution during the infection and treatment, particularly amongst hospitalized patients," Cohn said.

Related video above: Louisiana doctors train with nurses to help with staff shortages

With the spread of the more dangerous and transmissible delta variant as well as lagging vaccination rates, states such as Texas are in the midst of a surge in COVID-19 cases that quickly halted a summer of reopenings.

And as Texas faces another rise in hospitalizations approaching a peak witnessed during the 2020 holiday season, officials are concerned over health care worker shortages.

Texas Gov. Greg Abbott announced that more than 2,500 medical personnel will be deployed to hospitals around the state to care for an increasing number of COVID-19 patients.

"The State of Texas is taking action to ensure that our hospitals are properly staffed and supported in the fight against COVID-19," Abbott said in a news release Wednesday. Details on where the additional medical staff were coming from, or where they would be deployed, have yet to be revealed.

There are only 368 ICU beds currently available throughout the state and 10,463 lab-confirmed COVID-19 patients in hospitals across the state, according to state health data Wednesday. Finding people to administer these beds is becoming increasingly difficult.

Dr. Esmaeil Porsa, president and CEO of Harris Health System in Houston, told the Texas Senate Committee on Health & Human Services on Tuesday that health care employees are "tired, overworked and constantly under siege."

Citing long work hours, constant exposure to COVID-19 infection, and yet another surge of patients who are generally sicker and require more attention, Porsa said staffs are reaching critical shortages that are difficult to fill.

"I have lost staff to fatigue and retirement," Porsa said, adding that one area hospital had 25% of its ICU beds unavailable because of staffing issues.

"I always see the silver lining, but I am frightened by what is coming," Porsa said.

It's not just that the hospitals are full, Porsa said Thursday morning.

"What is concerning is the rate by which our COVID-positive patients are increasing," Porsa told CNN's Brianna Keilar. It took only five weeks for the hospital system to go from a baseline of 11 patients to its peak recently, compared to the three months it took during the winter surge, he said.

"If this continues to go at the rate that it is right now — and again, I emphasize that I don't see any intervention, any mitigating interventions being put in place to try to slow this down — this would be a disaster."

Health care systems strained

Because hospitals are filling up and there is less staff available to intake patients, a bottleneck effect is compounding ambulance availability, creating "risks for delays in emergency response to the next call in our community," Houston Fire Chief Samuel Peña said.

"In an EMS system as busy as Houston's, detention of EMS crews at the hospitals will result in increased response times for the entire system," Peña told CNN on Wednesday, noting that ambulance crews are waiting more than an hour at hospitals in some instances.

The fire chief said strategies such as utilizing COVID-19 tents would be beneficial in relieving the bottleneck at hospital emergency departments.

The Lyndon B. Johnson Hospital that set up tents to handle the overflow of patients recently had 130 patients in its waiting room, which is designed to hold at most 70, Porsa said.

"The idea of the tent is that as people screen positive for COVID-19, we can send them to the tent for them to continue their diagnostics and treatments until they figure out what to do with them," he said.

When asked about comments he made to CNN affiliate KTRK regarding a patient left on a stretcher inside an ambulance for five and a half hours waiting for a hospital bed, Peña said the patient was a man in his 60s who was in stable condition.

"He was evaluated at the hospital by medical staff, including blood lab tests and X-rays, all while on our ambulance stretcher because there was no room available for the patient to be transferred to. The patient's symptoms/chief complaint resolved sometime after the physical assessment at the hospital. So for many hours he was stable and symptom-free, but still on an emergency ambulance stretcher," he said.

"Keeping a patient on an ambulance stretcher and an ambulance unit out of service for this long is not acceptable. This is not good for the patient, it is not good for our ambulance crews and it is not good for our community," he said.

Peña says his message to the community is that anyone who can get the COVID-19 vaccine should do so immediately.

"The vaccine will help protect the recipient and help reduce the stress on local hospitals. People who are hesitant to get the vaccine due to any comorbidities should consult their primary care physicians for advice," the fire chief said.

But because it takes weeks after inoculations to gain full immunity, Porsa said in his Senate testimony that even in the rosiest of scenarios, the surge is likely to continue in the near future and immediate measures must be taken.

"Even if the entire population of Texas got vaccinated today, we do not really, logically expect any impact on the numbers a month from now," Porsa said. "There is no way my hospital is going to be able to handle this. There is no way the region is going to be able to handle this."

State vs. local control over masks intensifies

While experts say that vaccinations are the key to controlling the pandemic and lessening hospitalizations over time, other mitigating actions such as widespread mask-wearing can help stop the spread of COVID-19. Yet mandates have been fiercely rejected by Texas state leaders opposing local control and decision-making.

Gov. Abbott and state Attorney General Ken Paxton filed a petition on Wednesday attempting to block a Dallas County mask mandate issued for schools and businesses.

Judge Clay Jenkins' emergency order, Abbott and Paxton say, violates the governor's latest executive order on COVID-19 which says that no governmental entity, including school districts, could require mask-wearing.

"Attention-grabbing judges and mayors have defied executive orders before when the pandemic first started, and the courts ruled on our side — the law. I'm confident the outcomes to any suits will side with liberty and individual choice, not mandates and government overreach," Paxton said.

Abbott and Paxton's statement doesn't mention San Antonio and Bexar County, who have been granted a temporary restraining order against the governor's mask order and announced their own mask mandate, or Houston's Fort Bend County, which announced Wednesday a temporary restraining order of their own.

"The virus is not a political issue, and it's not an issue that we can resolve by way of ignoring it, and following GA 38 (Abbott's mask order) would have had the local officials here in Fort Bend County ignoring the virus," Fort Bend County Attorney Bridgette Smith-Lawson said after a judge granted their emergency health directive request.

Video above: Do's and Don'ts for people looking to dodge delta COVID-19 variant

COVID-19 hospitalizations are reaching all-time highs in parts of the South, with some patients unable to get the care they would normally receive.

Susan Walker has been calling out-of-state hospitals trying to get help for her husband, who did not get vaccinated against COVID-19 and is now in a medically induced coma.

"He is on a ventilator and in dire need of an ECMO treatment, which is not available at the hospital that he is in," the Florida mother said Sunday.

"All the beds are taken up by COVID victims also getting ECMO."

An ECMO treatment uses external machinery that can function as the heart and lungs. It's been used with some severely ill COVID-19 patients, including young adults.

"We have searched every hospital from the south of Florida to the north part of Florida" trying to find availability, Walker said.

"To transfer him to a hospital in Florida is next to impossible."

Across the country, states are struggling to fend off the delta variant — the most contagious strain of coronavirus yet.

But the situation in particularly worrisome in several Southern states.

Louisiana set a new record for COVID-19 hospitalizations last week.

Florida's hospitalizations recently jumped 13% above the state's previous peak on July 23, 2020, according to a survey by the Florida Hospital Association.

The FHA said it expects 60% of the state's hospitals to face a "critical staffing shortage" by this week.

And at Houston's United Memorial Medical Center, "We have no beds. The emergency department is full of patients just waiting to be able to get into the hospital," Chief of Staff Dr. Joseph Varon said Sunday morning.

"Over the last 12 hours, we have lost more patients than ... in the last five to six weeks."

According to data published Sunday by the U.S. Centers for Disease Control and Prevention, 50.1% of the total U.S. population is now fully vaccinated — more than 166 million people.

As of Sunday, Mississippi has fully vaccinated 35.2% of its residents. That makes Alabama — with 34.8% of its residents fully vaccinated — the only state in the U.S. to have fully vaccinated less than 35% of its residents.

The seven-day average of doses administered each day is now 706,323 doses, per the CDC data, and an average of 449,000 people are initiating vaccination each day.

More hospitalizations and deaths expected

The U.S. now is averaging more than 100,000 new COVID-19 cases every day — the highest in almost six months, according to data from Johns Hopkins University.

Because it can take days or weeks for some COVID-19 cases to lead to hospitalization or death, doctors are bracing for an ugly repeat of scenes from 2020.

"It's bad. For me, this is a deja vu of what we had last year," Varon said.

"And the worst part about this is this was foreseeable. And this was preventable. So not only are (we) exhausted, we're annoyed. And we're annoyed because people are not doing the right thing."

The vast majority of those getting hospitalized with or dying from COVID-19 are not fully vaccinated, Dr. Rochelle Walensky, the director of the CDC, said last week.

And Americans who have already had COVID-19 shouldn't assume they don't need a shot.

For adults previously infected with COVID-19, vaccines give better protection against reinfection than natural immunity on its own, according to a CDC study published Friday.

The study suggests people who got COVID-19 in 2020 and didn't get vaccinated were more than twice as likely to be reinfected in May or June 2021, compared with people who also had COVID-19 but were later fully vaccinated.

"If you have had COVID-19 before, please still get vaccinated," Walensky said Friday.

There is no minimum time to wait between recovering from COVID-19 and getting vaccinated, the CDC said.

"Getting the vaccine is the best way to protect yourself and others around you," Walensky said, "especially as the more contagious delta variant spreads around the country."

Dr. Raul Magadia and his team all gathered in the basement of their Anniston, Alabama, hospital last month for a big announcement he was preparing to make through the intercom system.

That system is usually reserved for emergency codes.

But Magadia, an infectious disease specialist at the Northeast Alabama Regional Medical Center, had other plans on May 25.

He was about to share that in a few minutes the hospital would discharge the last Covid-19 patient from their COVID-19 unit. It was a surreal milestone, he later told CNN, for staff who have been on the front lines of the battle against the virus for more than a year.

"We were really aiming for some good news after 13, 14 months of horrible news," Magadia said. "That moment ... that we had zero (patients), it's an unbelievable feeling."

On the other side of the country, inside the Zuckerberg San Francisco General Hospital, similar celebrations took place in late May after hospital staff announced they had no COVID-19 patients — for the first time since March 2020.

"It's incredibly hopeful for us," said Dr. Susan Ehrlich, the hospital's CEO. "It was a very fatiguing year and a half, very stressful."

Both facilities say they have since seen several COVID-19 patients — but numbers remain so low they don't compare to the harsh peaks they experienced over the winter.

Across the United States, other hospitals have welcomed similar milestones in recent weeks, which health experts largely credit to COVID-19 vaccinations.

A Utah hospital said in mid-May they had no COVID-19 patients for the first time in more than 430 days, calling the news a "welcomed light." Shortly after, a Minnesota hospital said it was shutting down its COVID-19 unit following a gradual decrease of patients. In Connecticut, one hospital recently saw its COVID-19 patients drop to one.

More than 22,400 Americans are hospitalized with COVID-19 nationwide, according to data from the Department of Health & Human Services. That's more than an 83% decrease from the country's peak in early January, when more than 136,000 Americans were hospitalized with the virus.

But with uneven vaccination rates across the U.S., some hospitals are still struggling amid recent upticks in COVID-19 patients — almost all of whom are unvaccinated — and worry about another surge fueled by summer gatherings.

It's what concerns Magadia as well.

"It's really looking good. We're seeing the light at the end of this long, long tunnel, but we're not quite out of the woods yet," he said.

Some hospitals still see surge of patients

Late last month, the University of Kansas Health System recorded several days with only one or two COVID-19 patients. That's a far cry from early December, when staff were treating more than 200 COVID-19 patients, according to Dr. Steven Stites, the chief medical officer.

"We had COVID-19 patients everywhere," he said. "That was clearly the worst, darkest days of the pandemic for us."

Now, those who are getting hospitalized because of the virus have not been vaccinated, Stites says.

"If you're here sick with Covid, you've not been vaccinated," he said. "We've had one person who had been vaccinated that I can think of off the top of my head."

It's a pattern other hospitals have noted, too. In Alabama, Magadia said close to 95% of patients hospitalized because of COVID-19 since vaccinations began have been unvaccinated.

"It's really a compelling point that vaccines work," Magadia said.

In central Oregon, Dr. Jeff Absalon, the chief physician executive for the St. Charles Health System, said they are still "in the middle of a surge of Covid patients." Roughly 98% of hospitalized COCID-19 patients since March have been unvaccinated.

"We have spent a few weeks near our highest point recently," he said. "We're still in the thick of the pandemic."

Absalon is not sure why the numbers remain high.

Local leaders have continued to push vaccination efforts, but Absalon suspects the recent uptick may be due to increased community transmission among unvaccinated crowds as the weather warms up as well as due to the frequent tourists traveling to the area.

He says they are also testing current COVID-19 patients for variants of the virus.

"Our vaccination rates in our county are quite good but, with all that being said, we're clearly not at a herd immunity level," he said.

Younger Americans hospitalized

Wyoming, which has one of the lowest COVID-19 vaccination rates in the U.S., recently saw hospitalization numbers climb again, state data shows.

Dr. Jeffrey Chapman, chief medical officer at the Cheyenne Regional Medical Center in the southeastern part of the state, says he and staff members are worried over a recent rise in COVID-19 patients.

"When we see literally numbers doubling and tripling in a week, we get scared," he said.

With lower age groups lagging in vaccination numbers, the hospital's COVID-19 patient demographics have shifted younger.

"Two-thirds of the people we have in the intensive care unit ... are 50-60, whereas in the past, it was almost all 70s and 80s," Chapman said. "And we've actually seen a small number of pediatric patients, which we haven't seen for quite some time."

"So I think one can postulate that, because younger age groups are vaccinated at a lower frequency ... we're seeing more people at a younger age that are requiring hospitalization," Chapman said. "Can I say association? Yes. Can I say causation? I don't have absolute data to back that up, but I don't think it's unreasonable to say that."

Older Americans, who were prioritized for shots, have some of the highest COVID-19 vaccination coverage numbers. As a result, parts of the country have reported their COVID-19 patients have skewed younger, to crowds that aren't vaccinated.

But now that vaccines are widely available, U.S. officials have stressed the importance of younger groups getting their shots, too — both for their own safety and to help their communities suppress the spread of the virus.

And a recent increase in COVID-19 hospitalizations among people 12 to 17 reinforced the importance of vaccinations as well as prevention measures against the virus, according to a study released Friday by the Centers for Disease Control and Prevention.

"In the month leading up to the recommendations of the Pfizer COCID-19 vaccine for teens and adolescents 12 and older, CDC observed troubling data regarding the hospitalizations of adolescents with Covid-19," CDC Director Dr. Rochelle Walensky said during a White House COVID-19 briefing.

"More concerning were the number of adolescents admitted to the hospital who required treatment in the intensive care unit with mechanical ventilation," Walensky said, adding the data "force us to redouble our motivation to get our adolescents and young adults vaccinated."

'Post-Covid stress disorder'

As hospitals continue to treat COVID-19 patients, one of the biggest challenges they're facing is exhausted, emotionally overwhelmed staff.

In Kansas, Stites said there is underlying fatigue and mental and physical exhaustion.

"There's just been a lot of pain and suffering amongst healthcare personnel" who often were the last ones to see a COVID-19 patient alive and had to communicate the bad news to families, he said. "I think that there is a scar, there is a wound that is deep in your mental psyche about what this disease really means."

It's somewhat of a "post-Covid stress disorder," he said.

"This is having a personal toll on the people that are committed to helping others," Absalon, in Oregon, said. "One of the things that's particularly difficult right now is that they're taking care of people that have chosen not to be vaccinated. And it's very heartbreaking to see that at this point in the pandemic a lot of what we're seeing in the hospital is preventable."

In Wyoming, Chapman looks at the hospital's COVID-19 patients every morning and every night to ensure they're prepared for another surge.

"I don't want to see people get sick, and I don't want to see people die, so that's part of my anxiety. What can I do to stop this?" he said. "I personally believe the vaccine is the answer to that."

ANKENY, Iowa —

An Ankeny, Iowa, man spent 144 days in the hospital battling COVID-19.

It started Nov. 1 with a visit to the doctor. Days later, on Nov. 6, Paul Carpenter passed out at home and was told by his doctor to go to the ER.

That led to the lengthy hospital stay. At least 100 days on a ventilator and 40 days on the ECMO, a machine that replaces the function of the heart and lungs.

The ECMO machine turned out to be a lifesaver.

There were many days his wife, Amy, thought she was going to lose the man she loves.

"Every day, every day got worse," Amy said.

Paul was not ready to die.

"I couldn't let my son be without a father," Paul said. "It was tough but I fought for 144 days."

Paul didn't fight alone.

He has fond feelings and thanks for his care team.

"If it wasn't for them I wouldn't be here," Paul said.

His physical therapist says she knows how difficult COVID-19 has been for everyone.

But it is nice to hear a thank you.

"To hear positive things makes it all worth it," said Megan Thompson, the physical therapist at UnityPoint Health.

Paul has gone back to visit a few times since he was released March 30.

After almost 5 months in the hospital, he is still fighting every day.

Every day he is able to keep fighting he says is owed to his care team.

GAZA STRIP —

Related video above: Middle East on the brink?

Just weeks ago, the Gaza Strip's feeble health system was struggling with a runaway surge of coronavirus cases. Authorities cleared out hospital operating rooms, suspended nonessential care and redeployed doctors to patients having difficulty breathing.

Then, the bombs began to fall.

This week's violence between Israel and Gaza's Hamas rulers has killed 103 Palestinians, including 27 children, and wounded 530 people in the impoverished territory. Israeli airstrikes have pounded apartments, blown up cars and toppled buildings.

Doctors across the crowded coastal enclave are now reallocating intensive care unit beds and scrambling to keep up with a very different health crisis: treating blast and shrapnel wounds, bandaging cuts and performing amputations.

Distraught relatives didn't wait for ambulances, rushing the wounded by car or on foot to Shifa Hospital, the territory's largest. Exhausted doctors hurried from patient to patient, frantically bandaging shrapnel wounds to stop the bleeding. Others gathered at the hospital morgue, waiting with stretchers to remove the bodies for burial.

At the Indonesia Hospital in the northern town of Jabaliya, the clinic overflowed after bombs fell nearby. Blood was everywhere, with victims lying on the floors of hallways. Relatives crowded the ER, crying out for loved ones and cursing Israel.

"Before the military attacks, we had major shortages and could barely manage with the second (virus) wave," said Gaza Health Ministry official Abdelatif al-Hajj by phone as bombs thundered in the background. "Now casualties are coming from all directions, really critical casualties. I fear a total collapse."

Gutted by years of conflict, the impoverished health care system in the territory of more than 2 million people has always been vulnerable. Bitter division between Hamas and the West Bank-based Palestinian Authority and a nearly 14-year blockade imposed by Israel with Egypt's help also has strangled the infrastructure. There are shortages of equipment and supplies such as blood bags, surgical lamps, anesthesia and antibiotics. Personal protection gear, breathing machines and oxygen tanks remain even scarcer.

Last month, Gaza's daily coronavirus cases and deaths hit record highs, fueled by the spread of a variant that first appeared in Britain, relaxation of movement restrictions during Ramadan, and deepening public apathy and intransigence.

In the bomb-scarred territory where the unemployment rate is 50%, the need for personal survival often trumps the pleas of public health experts. While virus testing remains limited, the outbreak has infected more than 105,700 people, according to health authorities, and killed 976.

As cases climbed last year, stirring fears of a health care catastrophe, authorities set aside clinics just for COVID-19 patients. But that changed as airstrikes pummeled the territory.

Nurses at the European Hospital in the town of Khan Younis, frantically needing room for the wounded, moved dozens of virus patients in the middle of the night to a different building, said hospital director Yousef al-Akkad. Its surgeons and specialists, who had deployed elsewhere for the virus, rushed back to treat head injuries, fractures and abdominal wounds.

If the conflict intensifies, the hospital won't be able to care for the virus patients, al-Akkad said.

"We have only 15 intensive care beds, and all I can do is pray," he said, adding that because the hospital lacks surgical supplies and expertise, he's already arranged to send one child to Egypt for reconstructive shoulder surgery. "I pray these airstrikes will stop soon."

At Shifa, authorities also moved the wounded into its 30 beds that had been set aside for virus patients. Thursday night was the quietest this week for the ICU, as bombs had largely fallen elsewhere in Gaza. Patients with broken bones and other wounds lay amid the din of beeping monitors, intercoms and occasional shouts by doctors. A few relatives huddled around them, recounting the chaotic barrage.

"About 12 people down in one airstrike. It was 6 p.m. in the street. Some were killed, including my two cousins and young sister. It's like this every day," said 22-year-old Atallah al-Masri, sitting beside his wounded brother, Ghassan.

Hospital director Mohammed Abu Selmia lamented the latest series of blows to Gaza's health system.

"The Gaza Strip is under siege for 14 years, and the health sector is exhausted. Then comes the coronavirus pandemic," he said, adding that most of the equipment is as old as the blockade and can't be sent out for repairs.

Now, his teams already strained by virus cases are treating bombing victims, more than half of whom are critical cases needing surgery.

"They work relentlessly," he added

To make matters worse, Israeli airstrikes hit two health clinics north of Gaza City on Tuesday. The strikes wreaked havoc on Hala al-Shawa Health Center, forcing employees to evacuate, and damaged the Indonesian Hospital, according to the World Health Organization. Israel, already under pressure from an International Criminal court investigation into possible war crimes during the 2014 war, reiterated this week that it warns people living in targeted areas to flee. The airstrikes nonetheless have killed civilians and inflicted damage on Gaza's infrastructure.

The violence also has closed a few dozen health centers conducting coronavirus tests, said Sacha Bootsma, director of WHO's Gaza office. This week, authorities conducted some 300 tests a day, compared with 3,000 before the fighting began.

The U.N. Relief and Works Agency, or UNRWA, ordered staff to stay home from its 22 clinics for their safety. Those now-closed centers had also administered coronavirus vaccines, a precious resource in a place that waited months to receive a limited shipment from the U.N.-backed COVAX program. Those doses will expire in just a few weeks and get thrown away, with "huge implications for authorities' ability to mobilize additional vaccines in the future," Bootsma said.

For the newly wounded, however, the virus remains an afterthought.

The last thing that Mohammad Nassar remembers before an airstrike hit was walking home with a friend on a street. When he came to, he said, "we found ourselves lying on the ground."

Now the 31-year-old is hooked up to a tangle of tubes and monitors in the Shifa Hospital surgical ward, with a broken right arm and a shrapnel wound in his stomach.

The United States is ranked number one in the world for pandemic preparedness, according to the Global Health Security Index. Still, hospitals and medical professionals are in dire need of personal protective gear, ventilators and beds as a looming surge in patients draws near.

Some hospitals are as ready as possible, but it’s unclear if even the best can handle what’s to come.

In the nation’s third largest city, Rush University Medical Center is one hospital tower built to handle disaster.

“That includes infectious disease pandemics, like we're experiencing now. So, not just did we build the tower, but we also routinely drill on these different scenarios,” says Paul Casey, Rush’s chief medical officer.

Constructed after 9/11, Rush’s CEO, Dr. Omar Lateef, says the facility was designed to handle mass casualty incidents, and now, it could be a model for epidemic response.

“Many of the same features of the building make it a building structured to treat highly contagious infections,” says Lateef.

The hospital has the ability to quickly ramp up to 130 percent capacity. Intake and extra beds can be added within minutes and are already on deck.

“We are essentially extending our emergency department into our ground floor pavilion area,” says capital projects construction manager Angela Tosic.

The ambulance bay area has been transformed into a triage area. They are converting spaces into what are known as “negative pressure” units that help to prevent cross-contamination.

“We can take entire quadrants of the building flip switches and make them negative pressure,” explains Lateef. “We can take massive areas of the building that when we built them are nice hallways but secretly inside the columns are oxygen dispensers.”

The incident command center is at the heart of the operation.

“We closely monitor both the activity of coronavirus locally, as well as our testing of coronavirus,” says Casey. “And then, we look at what's the next step that we need to be prepared to take.”

Keeping staff safe and preventing the spread of the virus is a top priority. Employees are being asked to self-monitor and check their temperature at home twice a day.

Once at work, facial recognition scanners not only confirm their identities but also take real-time temperature readings to ensure they do not have fevers.

Should staffer’s exhibit symptoms, a drive through COVID-19 testing area is already up and running.

Patients exhibiting COVID-19-like symptoms enter and are housed in a completely separate unit.

Rush says it will max out its bed capacity as much as possible but has to balance that with not running out of available staff.

“The number we have is when patients stop coming in we'll figure out a way to not turn people away,” says Lateef.