Hidalgo County Health Authority Ivan Melendez says coming into COVID-19 units nowadays feels like going through a nonlinear version of the five stages of grief: denial, anger, bargaining, depression and acceptance.

      “You cry,” he told the Tribune. “There’s a lady that I’m taking care of that I’ve known since I was a child. … We grew up together, and I know she’s going to die. … It’s the same thing: ‘We got together for Christmas.’ Now we’re seeing the ramification of it.”

      Across Texas, hospital intensive care units are being battered as COVID-19 cases continue to rise in a post-holiday surge. Dozens of facilities have reported that their ICUs have been at or above 100% capacity for weeks, leaving staff overworked and stretched thin.

      More than 50 Texas hospitals are currently reporting that their ICUs are 100% full or higher, and a dozen of them have been full for more than half of the 24 weeks since hospitals began reporting that information in July, according to a Texas Tribune analysis of data released by the U.S. Department of Health and Human Services.

      For example, Rio Grande Regional Hospital in McAllen and HCA Houston Healthcare Medical Center in Houston have been over 100% for 23 and 22 weeks, respectively.

      Though statewide hospitalizations due to COVID-19 seem to be stabilizing, there is still cause for concern, said Chris Van Deusen, a spokesperson for the Texas Department of State Health Services. Across Texas, there are around 600 available ICU beds — a fraction of the couple of thousand that were open in the spring as the pandemic began.

      Van Deusen said the pandemic has seemed to hit different regions in waves. Currently, the Dallas-Fort Worth, Houston and San Antonio areas are seeing significant spikes in COVID-19 cases, according to DSHS data.

      Health officials in Laredo have sent emergency alerts pleading with residents to stay home because local ICUs have reached capacity within the past month. Currently, COVID-19 patients take up almost half of that region’s hospital capacity, according to DSHS data — the highest percentage in the state.

      Many cities have had to divert patients to other hospitals as their local ICUs overflow, in addition to expanding and converting available beds to treat ICU patients.

      Melendez said counting available ICU beds doesn’t give the full picture at Texas hospitals because they are constantly adjusting to accommodate more patients. If an ICU is technically full, he said, many hospitals can still convert some available beds or units outside of that ward to give patients ICU care.

      Hendrick Health Chief of Staff Stephen Lowry said his hospital in Abilene has used both diversion and bed conversion. Currently, the facility is operating at 160% capacity, which is down from a peak of 180%, he said.

      Hendrick Health is the regional referral center for 24 surrounding counties, but Lowry said the hospital hasn’t been able to meet the area’s needs because they don’t have any more space for new patients; they created all the new space they could in the spring before the pandemic struck.

      “It’s really frustrating,” Lowry said. “You hear stories from out in the community, or family members that may have relatives in one of these outlying cities, and they’re having trouble getting their loved ones into a higher level of care because not just Hendrick, but a lot of other facilities around the state are full and unable to accept the transfers.”

      Texas Health Fort Worth, one of Tarrant County’s busiest hospitals, reported hitting 100% ICU capacity on Jan. 8, according to HHS data. The hospital’s president, Joseph DeLeon, said like many other medical centers, the Texas Health Resources network has tried to relieve the pressure by canceling non-critical outpatient procedures.

      But so far, measures that helped during the summer COVID-19 surge haven’t worked as well in the winter, DeLeon said.

      “We thought, ‘Well, OK, now we have some experience from back in July, we kind of know what it’s going to look like.’ But the second surge was different. There were many more critically ill patients this time around,” DeLeon told the Tribune. “This time, we have had much more stress on the staff, much more stress on the physicians … it was just a test of endurance.”

      Cynthia Simmons is Arlington’s public health authority and an emergency room physician at Medical City of Arlington, which has been at or near 100% capacity for weeks. She said Texans should understand that if they get into car accidents, have heart attacks or face other non-COVID-19 emergencies, a full ICU at the nearest hospital could mean there may not be enough resources available.

      “We’re at a point now where we have so much COVID in our community, it’s so easily spread, that the same things we’ve been talking about from public health measures from day one are really important now,” Simmons said. “I’m aware that people are tired of that. But it’s really, really important at this juncture at this time, that we continue those measures to help save the capacity in our hospitals.”

      Simmons added that people should not delay care if they need it because emergency rooms are adept at managing both COVID-19 and non-COVID-19 patients, even when they’re full.

      Simmons and other Texas health care workers have expressed hope for the future after Texas’ vaccination process began on Dec. 14. Tens of thousands have gotten a second dose already, though millions of people who are now eligible are still waiting for Texas to receive enough doses to vaccinate the health care workers, long term care residents, people over 65 and those with certain health conditions who comprise groups 1A and 1B.

      But the ICU bed crunch is far from over. Though hospitalizations are not currently increasing at December’s higher rates, a more contagious COVID-19 variant, identified in Harris County on Jan. 7, could cause hospitalizations to rise more sharply as it spreads. While it may not make people sicker or affect the death rate, the mutation means the virus could spread faster and infect more people, said Stephen Love, president and CEO of the Dallas-Fort Worth Hospital Council.

      “As a result, more hospitalizations, more capacity issues,” Love said. “For the next three to four weeks, [it’s] absolutely critical for us to monitor and try to get the word out to people to please do what they need to do to tamp down the spiral.”