The Covid Screwtape Letters — Part 11: The Great Hospital Overload Mirage

Part 1 (origins), Part 2 (masks), Part 3 (lockdowns), Part 4 (the new normal), Part 5 (plexiglass), Part 6 (quarantines), Part 7 (social distancing), Part 8 (swabs), Part 9 (essential workers), Part 10 (hypocrisy), Part 11 (Inflated Deaths)

My Dear Dr. F,

How exquisitely you have furnished our age with pageantry! The ancients managed only famine processions and plague carts, but you have given us the Empty Overflowing Hospital: corridors taped like crime scenes, quiet wings darkened for “capacity control,” and a single, loudly lit ICU alcove prepared as a stage set for visiting cameras. It is Potemkin in scrubs; Versailles with ventilators.

You have rediscovered one of my favorite laws: theater beats truth. The first rule is to announce scarcity, then create it. Declare every bed “full” by decree—relabel, reserve, reclassify. Convert “available beds” into “licensed beds,” then into the ever rarer “staffed beds,” then dismiss the staff. Close elective surgeries (for safety!), throttle routine screenings (for prudence!), furlough nurses (for efficiency!), and—when the halls grow eerily still—proclaim the silence proof of crisis. It takes a special genius to make a half‐empty building feel like a flood.

And how splendidly the priesthood kept spirits high—with choreographed TikTok liturgies and montage merriment, jazz hands in nitrile gloves! “Solidarity,” they called it, a unifying ballet in the time of plague, filmed in gleaming corridors where floor arrows outnumbered patients. The dance said, “We are overwhelmed,” even as the music whispered the truth: one only perfects a chorus line when the pews are empty.

The second rule: make the tour. Mark a meandering path with yellow tape and decals so the media must follow your choreography past the beeping monitors, the plastic hoods, the solemn sentinel in a face shield. Never mind the shuttered ER annex or the field hospital that never saw a soul; never mind the hospital ships idling like white elephants in the harbor, polished and purposeless—their emptiness is an inconvenient truth. All this can be redeemed if you guide the lens to the corner that looks convincingly apocalyptic.

The third rule is purely sacerdotal: transubstantiate “with” into “from.” A positive swab anywhere in the past season makes a case; a case in a bed makes a hospitalization; a hospitalization makes a headline. Whisper the catechism of “associated,” “related,” “involving,” and watch the flock genuflect before the daily census. Do ensure the auditors arrive after the definitional footnotes, not before.

Your greatest flourish—bravo!—was to supplement theater with indulgences. You learned from the cloistered accountants of old that piety improves when it pays. Issue a bonus for this diagnosis, a premium for that device, a multiplier for a particular drug, and soon the ledger will sing hallelujah in chorus with the dashboard. The parish will grow rich on sacraments; the sacraments will multiply to sustain the parish. (Do keep the hymnals locked—too many can spoil the tune.)

And when any whisper that the worst of the overflow was the underflow of judgment—that the collateral queues for tumors, hearts, and children lengthened unseen—answer them with a ritual sigh: “We flattened the curve.” Leave the rest unspoken. The curve of what, and at what cost, are questions for provinces that still worship reason.

Press on, dear nephew. Keep the spotlights bright, the wings taped, the interviews brisk, and the sums generous. The public asks only two things of a miracle: that it be televised, and that someone else pays for it.

Yours in white-coat dramaturgy,
Screwtape

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My Dearest Uncle Screwtape,

Your benedictions fall like confetti over my command center! You will be pleased to know that we have perfected capacity by proclamation. With a stroke, “beds” became “staffed beds,” and “staffed beds” dwindled as mandates and furloughs did their sanctifying work. Thus did absence masquerade as overload. The beauty is that the remedy to the shortage (rebuilding the staff) looks impious compared to the virtue of declaring an emergency.

The tour, as you advise, remains our liturgy. We escort the cameras through a curated gauntlet—machines humming, alarms chirping, a nurse in papal PPE—and then usher them swiftly past the unlit unit labeled “nonessential.” We have learned to say “overflow tent” with such gravity that no one asks why it stands like a wedding canopy awaiting a bride who never arrives.

For the numbers, we use your sacrament of elastic counting. A child admitted for a broken arm but with a positive test becomes an emblem of pediatric catastrophe; a grandfather admitted for heart failure but with a lingering PCR becomes a Covid Bed. We do not lie—we define. Definitions are holier than facts, for they do not change under examination, only under authority.

The incentives hymnbook you approved has kept the choir in time. “Guardrails,” we call them. If an admission brings a stipend, and a particular pharmaceutical a bonus, and a certain device a bounty, why, it simply affirms our commitment to standardized care. The more standardized, the more committed. When critics mutter that we created a protocol economy, we remind them solemnly that equity requires uniformity. (They nod. They always nod.)

There is, admittedly, a delicate dissonance forming in the orchestra. Some now notice that while we cried “overflow,” millions missed screenings; while we reserved wards, ambulances circled; while we counted “beds,” we lost hands. Others whisper about the field sites unused, the ships unmanned, and the many quiet hours in the temple of triage. A few even dare the heresy that a large share of our “Covid hospitalizations” were with, not for.

How shall I sustain the trance, Uncle? A fresh refrain? A new metric? I was considering a solemn index—Hospital Strain Factor—that merges staffing ratios, occupancy definitions, and discretionary closures into one unassailable number. It will glow red on command.

Your acolyte in administered awe,
Dr. F

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My Dear Dr. F,

The Hospital Strain Factor—sublime! Nothing befuddles like a composite. Put three definitions inside one number and it becomes theology. Do not publish its recipe; merely publish its righteousness.

As for the murmurs, you must treat them as you treated the wards: tape off, dim, redirect. When they mention missed screenings, lament “delayed care” in a tone that blames the laity’s hesitancy, not your decrees. When they cite “with, not for,” answer with a sigh and say, “In a pandemic, all care intersects.” When they speak of staffing loss, elevate “burnout” to doctrine and excommunicate the possibility that your own edicts drove the exodus. Above all, keep the camera moving.

Do not waste crisis on events. Institutionalize it. Convert the temporary tour into permanent signage. Keep the floor arrows long after the parade has ended; keep the capacity dashboard glowing after the peak has passed; keep the bonus codes and emergency forms laminated and ready for the next revelation. Rituals, once ingrained, outlive their gods.

And never apologize for the ships or the tents. Call them “visible readiness.” The public loves insurance it never uses. In time they will remember the silhouette more than the census.

We kept the ships—those alabaster angels—polished for the press; their few patients were treated in the foreground, the vacancy behind them framed like a sacrament. When asked about underuse, we called it “preventative success.” The field hospitals and ice‑rink wards did splendid duty as photo backdrops, and when they quietly closed, we declared their temporary nature a sign of prudent stewardship.

During their deployment, the USNS Mercy and USNS Comfort treated a combined total of approximately 182 patients, with 70% of them being COVID-19 positive.

Finally, sprinkle a few small truths like rosewater: acknowledge an outlier here, a nuance there. It perfumes the incense and convinces the pews that frankness reigns. Then return at once to the chorus: “We were at the brink. We saved you from the brink. The brink will return if you look away.”

Do this, and the Empty Overflowing Hospital will remain our most enduring miracle: a cathedral that proves its holiness by how often its doors must close.

Do not let them learn the difference between a scarcity of beds and a scarcity of permission.

Your affectionate uncle,
Screwtape