POST 54. October 22, 2020. CORONAVIRUS. “Hospitals across the USA are starting to buckle from a resurgence of COVID-19 cases…” ““U of Michigan hit with emergency stay-at-home order…. But the football team will play on..” (I)

‘Dr. Scott Gottlieb is warning that the United States is about “a week away from seeing a rapid acceleration in cases” of Covid-19 as the number of coronavirus infections and hospitalizations surge.

In an interview on CNBC’s “The News with Shepard Smith” on Monday evening, the former FDA chief in the Trump administration said the country no longer has any pandemic backstops.

“The summer was a backstop, of sorts, to the spring surge, and we have no therapeutic backstop,” Gottlieb said. “The fall and winter season is when this coronavirus is going to want to spread.”

Echoing similar comments from Dr. Anthony Fauci, the nation’s top infectious disease expert, Gottlieb said the holiday season and family gatherings are especially precarious for the spread of coronavirus because that’s when people let their guard down.” (A)

“Dr. Francis Collins, director of the National Institutes of Health, says “it was all sadly somewhat predictable.”

Hospitalizations are up in more than 40 states. The rising number of cases has not led to a corresponding rise in the number of deaths — yet.

But Collins tells NPR’s Steve Inskeep on Morning Edition that an increase in the number of fatalities will soon follow, as it has previously when cases and hospitalizations went up.

“All of this, I’m afraid, happens because we have not succeeded in this country in introducing really effective public health measures, those simple things that we all could be doing,” he says. “Wear your mask, keep that 6-foot distance and don’t congregate indoors whatever you do, and wash your hands. It’s so simple. And yet people are tired of it. And yet the virus is not tired of us.”” (B)

“U.S. Surgeon General Jerome Adams said Wednesday that a “herd immunity” approach to combating COVID-19 could “lead to many complications/deaths.”

Adams posted the comment on his official Twitter account, along with a link to a recent article from The Journal of the American Medical Association entitled “What is Herd Immunity?”

“The summary: Large numbers of people would need to be infected to achieve herd immunity without a vaccine; this could overwhelm health care systems and lead to many complications/deaths,” Adams tweeted. “So far, there is no example of a large-scale successful intentional infection-based herd immunity strategy.”

Instead, Adams urged people to “wear masks,” “wash hands” and “watch distances.”

The surgeon general’s comments come after the White House embraced a controversial declaration by a group of scientists calling for an approach that relies on “herd immunity.”” (C)

“A frustrated and at times foul-mouthed President Donald Trump claimed on a campaign call that people are tired of hearing about the deadly pandemic which has killed more than 215,000 Americans and trashed Dr. Anthony Fauci as a “disaster” who has been around for “500 years.”

Referring to Fauci and other health officials as “idiots,” Trump declared the country ready to move on from the health disaster, even as cases are again spiking and medical experts warn the worst may be yet to come.

Baselessly claiming that if Fauci was in charge more than half a million people would be dead in the United States, Trump portrayed the recommendations offered by his own administration to mitigate spread of the disease as a burdensome annoyance.

“People are tired of Covid. I have the biggest rallies I’ve ever had, and we have Covid,” Trump said, phoning into a call with campaign staff from his namesake hotel in Las Vegas, where he spent two nights amid a western campaign swing. “People are saying whatever. Just leave us alone. They’re tired of it. People are tired of hearing Fauci and all these idiots.”

“Fauci is a nice guy,” Trump went on. “He’s been here for 500 years.”” (D)

“Hospitals across the United States are starting to buckle from a resurgence of COVID-19 cases, with several states setting records for the number of people hospitalized and leaders scrambling to find extra beds and staff. New highs in cases have been reported in states big and small — from Idaho to Ohio — in recent days.

The rise in cases and hospitalizations was alarming to medical experts.

Around the world, disease trackers have seen a pattern: First, the number of cases rises, then hospitalizations and finally there are increases in deaths. Seeing hospitals struggling is alarming because it may already be too late to stop a crippling surge.

“By the time we see hospitalizations rise, it means we’re really struggling,” said Saskia Popescu, an epidemiologist at George Mason University.”” (E)

“Coronavirus cases in New Jersey, an early epicenter of the pandemic, are on the rise again, doubling over the last month to an average of more than 900 new positive tests a day, a worrisome reversal of fortune for a state that had driven transmission rates to some of the nation’s lowest levels.

After an outbreak several weeks ago in a heavily Orthodox Jewish town near the Jersey Shore, cases are now rising in counties across the state, driven, officials say, by indoor gatherings.

The state’s health commissioner has said there are signs of “widespread community spread” for the first time since New Jersey successfully slowed the spread of a virus that has claimed the lives of more than 16,000 residents. A small, densely packed state, New Jersey has the highest virus fatality rate in the country…/..

State government and hospital officials said they have stockpiled months’ worth of masks, gowns and gloves — the critical personal protective equipment, or PPE, that was in short supply early in the pandemic — and are amassing medications to treat COVID-19 patients. Some acute-care facilities are signing advance contracts with staffing agencies in case they need to supplement their existing workforce…

State Health Commissioner Judy Persichilli said Monday that her team holds daily calls with hospital leaders to check on bed capacity and other resources, including staff — a protocol that has continued, unabated, since the pandemic began.

“We’ve never stopped working with the hospitals. We never considered the (first) wave to be over,” she said. “It’s an everyday event. We’re working with the hospitals and preparing with them every step of the way.”

The state DOH worked with the hospital association to create a database for all providers to report their PPE capacity; the department also requires hospitals to keep 90 days’ worth of surge-level supplies in stock, according to a spokesperson. Persichilli said the state is also stockpiling protective gear and some medicines — in particular Remdesivir, which appears to benefit some patients.

“My anticipation is that our biggest struggle will be staffing as we experience community spread,” Persichilli said Monday as she urged the public to keep up with infection control measures. “People that work in hospitals and in long-term care facilities also are members of a community.”

“These are very valuable individuals that we need, but if they fall ill, backup will be difficult … because every other state in the nation is having the same difficulties we’re having,” she said. In the spring, other states then relatively spared by the pandemic sent backup staff to help New Jersey.” (F)

“It’s no longer just a few hotspot counties causing the virus to spread in New Jersey. The problem is now widespread, from north Jersey to south.

But experts say a second wave is here.

“This is not something we didn’t expect. We expected a second wave to happen in the fall. But the question is how bad it gets. That means peak, and how quickly we get to that peak,” said Dr. Shereef Elnahal, president and CEO of University Hospital, Newark.

Dr. Elnahal says the hospital is already nearly at capacity with non-COVID patients. Now the COVID hospitalizations are increasing again.

“Signs are pointing that this is about to get worse,” Dr. Elnahal told CBS2’s John Dias. “When you start to hit levels of 3 or 4% positivity, you can expect even more admissions. And most concerningly, John, we did have one COVID-19 death last week for the first time in many weeks.”

“The other patients will have to delay their care even more,” Dr. Elnahal added….

New Jersey and Connecticut now technically qualify for the Tri-State travel advisory list, where travelers from states with rising infection rates must quarantine for two weeks.” (G)

“As the coronavirus races across the country, it has reached every corner of a nursing home in Kansas, infecting all 62 residents inside. There are so few hospital beds available in North Dakota that patients sick with the virus are being ferried by ambulance to facilities 100 miles away. And in Ohio, more people are hospitalized with the virus than at any other time during the pandemic.

After weeks of warnings that cases were again on the rise, a third surge of coronavirus infection has firmly taken hold in the United States. The nation is averaging 59,000 new cases a day, the most since the beginning of August, and the country is on pace to record the most new daily cases of the entire pandemic in the coming days.

But if earlier surges were defined by acute and concentrated outbreaks — in the Northeast this spring, and in the South during the summer — the virus is now simmering at a worrisome level across nearly the entire country. Colorado, Illinois, Kentucky, Michigan, Montana, New Mexico, North Dakota, Ohio, South Dakota, Utah, Wisconsin and Wyoming each set seven-day case records on Tuesday. Even New Jersey, once a model for bringing the virus under control, has seen cases double over the past month…

The latest wave threatens to be the worst of the pandemic yet, coming as cooler weather is forcing people indoors and as many Americans report feeling exhausted by months of restrictions. Unlike earlier waves, which were met with shutdown orders and mask mandates, the country has shown little appetite for widespread new restrictions…

The newest surge sets the stage for a grueling winter that will test the discipline of many Americans who have spent warmer months gathering in parks and eating outdoors, where the virus is known to spread less easily. At the current rate of growth, new daily confirmed cases could soon surpass 75,687, the record set on July 16.

The rising case count has so far not translated to increased deaths: About 700 people are dying on average each day, a high but steady rate. So far, more than 220,000 Americans have died from the virus.

The latest developments represent a serious new level of spread. Deaths are considered a lagging indicator of new infection, and experts believe the daily toll is likely to rise in the coming months. Nationwide, hospitalizations, the most accurate gauge of how many people are currently sick from the virus, are already trending upward, at a pace slightly lower than new infections.” (H)

“On Tuesday, local health authorities issued an emergency stay-at-home order for the campus in Ann Arbor, Mich., mostly restricting undergraduates to their residences unless they’re getting food, doing an essential job or going to class.

Athletics, though, are exempt — meaning that the Wolverines’ football team will keep preparing for a road game in Minnesota on Saturday and an Oct. 31 home opener against rival Michigan State University. Although the Michigan stadium won’t feature a large crowd, some officials worry that the home game will fuel new cases anyway because of Spartan fans who travel to Ann Arbor and Michigan supporters who gather for watch parties.” (I)

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CORONOVIRUS TRACKING Links to Parts 1-54

CORONOVIRUS TRACKING

 Links to Parts 1-54

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

POST 45. September 9, 2020. CORONAVIRUS.  Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’

POST 46.  September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”

POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

POST 48. October 1, 2020.   “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)

POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).

POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

POST 52. October 18, 2020.  ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”

POST 54. October 22, 2020. CORONAVIRUS. “Hospitals across the USA are starting to buckle from a resurgence of COVID-19 cases…” ““U of Michigan hit with emergency stay-at-home order…. But the football team will play on..” (I)


 [JM1]

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POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”

“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,”…. (Dr. Anthony Fauci)

With “herd immunity” being introduced into the Coronavirus discussion I recalled that as a student in Epidemiology 101 at the UNC School of Public Health back in 1970 this was a descriptive term, and not used operationally.

“Herd immunity” was, and still is, an outcome where enough of the population gains immunity to a virus by vaccination that the viral threat burns itself out by lack of am easily available residual target population.

Now, as the third wave seems to be underway some are suggesting “herd immunity” as a  tamping down strategy – let the young get it, while protecting those at risk, e.g., the elderly and those with pre-existing conditions.

But it doesn’t work that way. The young may get it asymptomatically but will still bring it home to those at risk who will get symptoms requiring treatment, leading to hospitals reaching their limits, not because of unavailability of beds and equipment, but due to staff shortages (health care workers get sick too!)

 So it’s back to basics until there is a vaccine and advanced therapeutics – wearing masks, social distancing, hand hygiene and now “indoor safety”.

Here’s why!

but first….

to read POSTS 1-53 in chronological order, highlight and click on

POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

to read POST 52 highlight and click on

“But “herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy. Herd immunity is an important public-health concept, developed and used to guide vaccination policy. It involves a calculation of the percentage of people in a population who would need to achieve immunity in order to prevent an outbreak. The same concept offers little such guidance during an ongoing pandemic without a vaccine. If it were a military strategy, it would mean letting the enemy tear through you until they stop because there’s no one left to attack.” (L)

“In late September, a Nobel Prize-winning economist emailed Dr. Scott W. Atlas, a White House coronavirus adviser, in what he saw as a last-ditch effort to persuade the Trump administration to embrace a dramatic increase in testing and isolating infected patients. The plan was designed to appeal to President Trump, who has complained that positive tests make his administration look bad and would not “generate any new confirmed cases.”

Dr. Atlas, a radiologist, told the economist, Paul Romer of New York University, that there was no need to do the sort of testing he was proposing.

“That’s not appropriate health care policy,” Dr. Atlas wrote.

Dr. Atlas went on to reference a theory that the virus can be arrested once a small percentage of the United States population contracts it. He said there was a “likelihood that only 25 or 20 percent of people need the infection,” an apparent reference to a threshold for so-called “herd immunity” that has been widely disputed by epidemiologists.

The call for more widespread testing and isolation, Dr. Atlas wrote, “is grossly misguided.”

The exchange highlights the resistance within the White House toward adopting a significantly expanded federal testing program, including efforts to isolate infected patients and track the people they have been in contact with, even as infections and deaths continue to rise nationwide. That resistance has become a sticking point in negotiations over a new economic stimulus package, with the administration and top Democrats disagreeing over the scope and setup of an expanded testing plan.

Many public health experts, and some economists like Mr. Romer, say that a far more sweeping testing program would save lives and boost the economy by helping as many Americans as possible learn quickly if they are sick — and then take steps to avoid spreading the virus.

Dr. Atlas and other administration officials playing influential roles in the government’s virus response effectively say the opposite: that more widespread testing would infringe on Americans’ privacy and hurt the economy, by keeping potentially infected workers who show no symptoms of the virus from reporting to their jobs.” (A)

“In an interview on Thursday, …..Dr Atlas said that the United States had a “massive” testing program over all, but that it should be used strategically to protect vulnerable populations, like nursing home residents — not young, healthy individuals who he said were at low risk of contracting the disease. He said that large-scale government test and isolate programs infringed on civil liberties, and that new research had persuaded him that herd immunity might be achieved once 20 or 40 percent of Americans are infected.

“The overwhelming majority of people who get this infection are not at high risk,” Dr. Atlas said in the interview. “And when you start seeking out and testing asymptomatic people, you are destroying the workforce.”…

Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.

Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.

“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….

In his email, sent to Dr. Atlas’s personal account, Mr. Romer proposed additional testing and isolation efforts that could allow far more Americans to return to work and shopping, generating economic activity that would be 10 or 100 times larger than the cost of the testing program itself.” (B)

“The Great Barrington Declaration – As infectious disease epidemiologists and public health scientists we have grave concerns about the damaging physical and mental health impacts of the prevailing COVID-19 policies, and recommend an approach we call Focused Protection.

Coming from both the left and right, and around the world, we have devoted our careers to protecting people. Current lockdown policies are producing devastating effects on short and long-term public health. The results (to name a few) include lower childhood vaccination rates, worsening cardiovascular disease outcomes, fewer cancer screenings and deteriorating mental health – leading to greater excess mortality in years to come, with the working class and younger members of society carrying the heaviest burden. Keeping students out of school is a grave injustice.

Keeping these measures in place until a vaccine is available will cause irreparable damage, with the underprivileged disproportionately harmed.

Fortunately, our understanding of the virus is growing. We know that vulnerability to death from COVID-19 is more than a thousand-fold higher in the old and infirm than the young. Indeed, for children, COVID-19 is less dangerous than many other harms, including influenza.

As immunity builds in the population, the risk of infection to all – including the vulnerable – falls. We know that all populations will eventually reach herd immunity – i.e.  the point at which the rate of new infections is stable – and that this can be assisted by (but is not dependent upon) a vaccine. Our goal should therefore be to minimize mortality and social harm until we reach herd immunity.

The most compassionate approach that balances the risks and benefits of reaching herd immunity, is to allow those who are at minimal risk of death to live their lives normally to build up immunity to the virus through natural infection, while better protecting those who are at highest risk. We call this Focused Protection.

Adopting measures to protect the vulnerable should be the central aim of public health responses to COVID-19. By way of example, nursing homes should use staff with acquired immunity and perform frequent PCR testing of other staff and all visitors. Staff rotation should be minimized. Retired people living at home should have groceries and other essentials delivered to their home. When possible, they should meet family members outside rather than inside. A comprehensive and detailed list of measures, including approaches to multi-generational households, can be implemented, and is well within the scope and capability of public health professionals.

Those who are not vulnerable should immediately be allowed to resume life as normal. Simple hygiene measures, such as hand washing and staying home when sick should be practiced by everyone to reduce the herd immunity threshold. Schools and universities should be open for in-person teaching. Extracurricular activities, such as sports, should be resumed. Young low-risk adults should work normally, rather than from home. Restaurants and other businesses should open. Arts, music, sport and other cultural activities should resume. People who are more at risk may participate if they wish, while society as a whole enjoys the protection conferred upon the vulnerable by those who have built up herd immunity.” (C)

“Letting the coronavirus rip through the U.S. population unchecked to infect as many people as possible to achieve so-called herd immunity would cause a lot of unnecessary deaths and the idea is “nonsense” and “dangerous,” the nation’s top infectious disease expert said Thursday.

“I’ll tell you exactly how I feel about that,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said when asked about whether herd immunity is a viable strategy for the U.S. to adopt. “If you let infections rip as it were and say, ‘Let everybody get infected that’s going to be able to get infected and then we’ll have herd immunity.’ Quite frankly that is nonsense, and anybody who knows anything about epidemiology will tell you that that is nonsense and very dangerous,” Fauci told Yahoo News.

Herd immunity happens when enough of the population is immune to a disease, making it unlikely to spread and protecting the rest of the community, the Mayo Clinic says. It can be achieved through natural infection — when enough people are exposed to the disease and develop antibodies against it — and through vaccinations.

Most scientists think 60% to 80% of the population needs to be vaccinated or have natural antibodies to achieve herd immunity, global health experts say. However, the nation’s top health experts have said a majority of Americans remain susceptible to a coronavirus infection.

“With this idea of herd immunity, this is a phrase that’s used when you use vaccination. When you vaccinate a certain amount of the population to be able to protect the rest of the population that isn’t able to get that vaccine,” Maria Van Kerkhove, head of the World Health Organization’s emerging diseases and zoonosis unit, told CNN’s “New Day” on Thursday.

“Herd immunity as an approach by letting the virus circulate is dangerous, it leads to unnecessary cases and it leads to unnecessary deaths,” she said.

Despite those concerns, a senior White House official briefing reporters on a call Monday mentioned an online movement called the “Great Barrington Declaration,” which favors herd immunity, NBC News reported. Health and Human Services Secretary Alex Azar has previously said that herd immunity “is not the strategy of the U.S. government with regard to coronavirus.”..

“By the time you get to herd immunity you will have killed a lot of people that would’ve been avoidable,” he said.”  (D)

“If you just let things rip and let the infection go — no masks, crowd, it doesn’t make any difference — that quite frankly,… is ridiculous because what that will do is that there will be so many people in the community that you can’t shelter, that you can’t protect, who are going to get sick and get serious consequences,” Fauci said. “So this idea that we have the power to protect the vulnerable is total nonsense, because history has shown that that’s not the case. And if you talk to anybody who has any experience in epidemiology and infectious diseases, they will tell you that that is risky and you’ll wind up with many more infections of vulnerable people, which will lead to hospitalizations and deaths. So I think that we just got to look that square in the eye and say it’s nonsense.”

During a briefing Monday, World Health Organization director-general Tedros Adhanom Ghebreyesus called herd immunity “scientifically and ethically problematic.

“Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic,” Tedros said.” (E)

“The authors of the Declaration — a trio of scientists from Harvard, Stanford, and Oxford, whose views, we should say, are outside the mainstream — call their approach “focused prevention.” The big idea is that we could let the virus spread among younger, healthier people, all the while making sure we protect older, more vulnerable people…

And yet there are ample reasons to fear that this “focused prevention” strategy of allowing the young and healthy to get sick to build population immunity to the virus would never work. And it could cause devastating unintended consequences….

Let’s count the reasons why.

1) Even if we could limit exposure to the people least likely to die of Covid-19, this group still can suffer immense consequences from the infection — like hospitalization, long-term symptoms, organ damage, missed work, and high medical bills. The long-term health consequences of the virus have barely been studied. When we expose younger, healthier people to the virus (on purpose!), we don’t know what the consequence of that will be down the road.

2) We have a lonnnnnngggggg way to go. There’s no one, perfect estimate of what percentage of the US population has already been infected by the virus. But, by all accounts, it’s nowhere near the figures needed for herd immunity to kick in. Overall, a new Lancet study — which drew its data from a sample of dialysis patients — suggests that fewer than 10 percent of people nationwide have been exposed to the virus. No one knows the exact threshold percentage for herd immunity to kick in for a meaningful way to help end the pandemic. But common estimates hover around 60 percent.

So far, there have been more than 200,000 deaths in the United States. There’s so much more potential for death if the virus spreads to true herd immunity levels. “The cost of herd immunity [through natural infection] is extraordinarily high,” Hanage says…

3) Scientists don’t know how long naturally acquired immunity to the virus lasts or how common reinfections might be. If immunity wanes and reinfections are common, then it will be all the more difficult to build up herd immunity in the country. In the spring, epidemiologists at Harvard sketched out the scenarios. If immunity lasts a couple of years or more, Covid-19 could fade in a few years’ time, per their analysis published in Science (much too long a time to begin with, if you ask me). If immunity wanes within a year, Covid-19 could make fierce annual comebacks until an effective vaccine is widely available.

At the same time, we don’t know how long immunity delivered via a vaccine would last. But, at least a vaccine would come without the cost of increased illnesses, hospitalizations, and long-term complications.

If immunity doesn’t last, “such a [focused prevention] strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination,” the John Snow Memorandum says.

4) By letting the pandemic rage, we risk overshooting the herd immunity threshold. Once you hit the herd immunity threshold, it doesn’t mean the pandemic is over. After the threshold is reached, “all it means is that, on average, each infection causes less than one ongoing infection,” Hanage says. “That’s of limited use if you’ve already got a million people infected.” If each infection causes, on average, 0.8 new infections, the epidemic will slow. But 0.8 isn’t zero. If a million people are infected at the time herd immunity is reached, per Hanage’s example, those already infected people may infect 800,000 more.

There are a lot of other unknowns here, too. One is the type of immunity conferred by natural infection. “Immunity” is a catchall term that means many different things. It could mean true protection from getting infected with the virus a second time. Or it could mean reinfections are possible but less severe. You could, potentially, get infected a second time, never feel sick at all (thanks to a quick immune response), and still pass on the virus to another person.” (F)

“Experts from a wide range of fields have repeatedly denounced the lack of testing in the United States. Despite Mr. Trump’s repeated affirmations that the country has done more testing than any other nation, researchers have noted that 991,000 or so tests done each day were still not enough to keep in check a virus that has infected more than eight million people nationwide. Tests can individually diagnose people who might unknowingly carrying the virus. At the population level, they can also help health officials monitor any spread and pinpoint and quash outbreaks before they spin out of control.

Others have cautioned against an overreliance on testing as a preventive measure, noting that, in the absence of standards like physical distancing and mask wearing, testing alone cannot fully contain a virus that spreads wherever people tend to gather, regardless of whether those infected are exhibiting symptoms.

“No testing scheme, no test is perfect. There will always be people who go undetected,” said Dr. David Dowdy, an infectious disease epidemiologist at Johns Hopkins University who has researched and written about herd immunity. “The best way to protect the most vulnerable is to reduce the amount of virus that’s in the population that can get through all of those testing schemes and cause destruction.”

Dr. Atlas’s position has been challenged by medical advisers around him who have backgrounds in infectious disease response, revealing a significant rift in the White House over the right approach. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, has pushed for aggressive, broad testing even among young and healthy people, often clashing with Dr. Atlas in meetings.

“I would always be happy if we had 100 percent of students tested weekly,” Dr. Birx said on Wednesday in an appearance at Penn State University, “because I think testing changes behavior.”

Dr. Atlas at one point influenced the administration’s efforts to install new Centers for Disease Control and Prevention guidance that said it was not necessary to test people without symptoms of Covid-19 even if they had been exposed to the virus, upsetting Dr. Birx and Dr. Robert R. Redfield, the C.D.C. director….

Mr. Romer said… “Atlas just responded in a way that just honestly made it seem like he was in over his head,” … (G)

“A group of 80 researchers warn that a so-called herd immunity approach to managing COVID-19 by allowing immunity to develop in low-risk populations while protecting the most vulnerable is “a dangerous fallacy unsupported by the scientific evidence”…

The open letter, referred to by its authors as the John Snow Memorandum, is published today by The Lancet. It is signed by 80 international researchers (as of publication) with expertise spanning public health, epidemiology, medicine, paediatrics, sociology, virology, infectious disease, health systems, psychology, psychiatry, health policy, and mathematical modelling [1]. The letter will also be launched during the 16th World Congress on Public Health programme 2020.

They state: “It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic.”

“Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.”…

They explain that uncontrolled transmission in younger people risks significant ill-health and death across the whole population – with real-world evidence from many countries showing that it is not possible to restrict uncontrolled outbreaks to certain sections of society, and it being practically impossible and highly unethical to isolate large swathes of the population. Instead, they say that special efforts to protect the most vulnerable are essential, but must go hand-in-hand with multi-pronged population-level strategies…

The authors also warn that natural infection-based herd immunity approaches risk impacting the workforce as a whole and overwhelming the ability of healthcare systems to provide acute and routine care. They note that we still do not understand who might suffer from ‘long COVID’, and that herd immunity approaches place an unacceptable burden on healthcare workers, many of whom have died from COVID-19 or experienced trauma as a result of having to practise disaster medicine.

The letter concludes: “The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months. We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (H)

“THE JOHN SNOW MEMORANDUM

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by the World Health Organization as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19….

In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality(6),(7) prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown. Although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems. In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.

This has understandably led to widespread demoralisation and diminishing trust. The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence….

We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.” (I)

Showdown: Great Barrington Declaration v John Snow Memorandum (J)

“The United States came into this crisis with enormous advantages. Along with tremendous manufacturing capacity, we have a biomedical research system that is the envy of the world. We have enormous expertise in public health, health policy, and basic biology and have consistently been able to turn that expertise into new therapies and preventive measures. And much of that national expertise resides in government institutions. Yet our leaders have largely chosen to ignore and even denigrate experts.

The response of our nation’s leaders has been consistently inadequate. The federal government has largely abandoned disease control to the states. Governors have varied in their responses, not so much by party as by competence. But whatever their competence, governors do not have the tools that Washington controls. Instead of using those tools, the federal government has undermined them. The Centers for Disease Control and Prevention, which was the world’s leading disease response organization, has been eviscerated and has suffered dramatic testing and policy failures. The National Institutes of Health have played a key role in vaccine development but have been excluded from much crucial government decision making. And the Food and Drug Administration has been shamefully politicized,3 appearing to respond to pressure from the administration rather than scientific evidence. Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.” (K)

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CORONOVIRUS TRACKING Links to Parts 1-52/53

CORONOVIRUS TRACKING

 Links to Parts 1-52/53

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

POST 45. September 9, 2020. CORONAVIRUS.  Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’

POST 46.  September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”

POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

POST 48. October 1, 2020.   “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)

POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).

POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

POST 52. October 18, 2020.  ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

POST 53. October 20, 2020. CORONAVIRUS. “a…“herd-immunity strategy” is a contradiction in terms, in that herd immunity is the absence of a strategy.”


 [JM1]

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POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018

1.Former hospital prez says: Designate local Zika centers now. Medical experts do not know if, or where, or how much, or on what trajectory the Zika virus may spread across the United States.

2.The ER clerk asked me “How do you spell Zika?

3.With little guidance about caring for Zika patients, hospitals are planning on their own

4.Hospitals are developing their own Zika preparedness models. Compare the Central Florida and Johns Hopkins approaches! Which template makes more sense?

5.All pregnant women with Zika diagnosed at community hospitals must be referred to academic medical centers for prenatal care!

6.EBOLA is back in Africa. Is ZIKA next? Are we prepared?

7.Study Findings: Five percent of pregnant women with a confirmed Zika infection.. went on to have a baby with a related birth defect

8.In June WEST NILE was identified nationwide. Today it’s POWASSAN VIRUS. – ARE WE PREPARED FOR A SURGE OF EMERGING MOSQUITO AND TICK BORNE VIRUSES?

9.“Houston Braces for Another Brush With the Peril of Zika” *. But they are doing passive not active surveillance. IS YOU AREA’S HEALTH CARE SYSTEM PREPARED FOR A SURGE OF AN EMERGING VIRUS LIKE ZIKA?

10.Locally transmitted ZIKA case in Texas! Are we ready?

11.CDC deactivated its emergency response center for Zika.. The first probable locally acquired Zika case in 2017 has been confirmed in Texas….

12.“We are arguably as vulnerable—or more vulnerable—to another (flu) pandemic as we were in 1918.”

13.The CDC postponed its briefing on preparation for nuclear war and will focus on responding to severe influenza (A)

14.“Think hospitals are under a strain now, from a slightly bad flu season? Wait until a really bad one hits.”

15.Government Shutdown. “The CDC would furlough key staff amid one of the most severe flu seasons in recent memory….”

16.“..in a severe (flu) pandemic, the U.S. healthcare system could be overwhelmed in just weeks.

17.“we are not finished with Zika… It very well could come back.” Are we ready?

18.New Ebola outbreak declared in Democratic Republic of the Congo

19.As ZIKA and EBOLA reemerge, Trump administration cuts funding to halt international epidemics

20.“With an outbreak like this, it’s a race against time, as one Ebola patient with symptoms can infect several people every day.”

21.EBOLA, ZIKA. EMERGING VIRUSES. “ All too often with infectious diseases, it is only when people start to die that necessary action is taken.”

22.PANDEMIC PREPAREDNESS. “It’s like a chain—one weak link and the whole thing falls apart. You need no weak links.”

23.Democratic Republic of Congo’s Ebola outbreak has been “largely contained”…

24.“Slightly over a month into the response, further spread of [Ebola Virus Disease] has largely been contained,” WHO announced on June 20.

25.“… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days….Boy, do we not have our act together.” — Bill Gates”.

26.After Ebola scare, Denver Health wishes it notified public of potential deadly virus sooner

27.At least 10 health-care workers have been infected with the deadly Ebola virus as they battle an outbreak in an eastern province of Congo

28.“…(WHO) reports the next seven to 10 days are critical in controlling the spread of the Ebola virus in eastern Democratic Republic of Congo.”

29. Candida Auris. Is it ethical for the public not be notified about new “super bugs” in hospitals so they can decide whether or not to go to affected hospital

30. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…

31. CANDIDA AURIS. “Antibiotic-resistant superbugs are everywhere. If your hospital claims it doesn’t have them, it isn’t looking hard enough.” (D)

32.EBOLA. June17, 2019. “Three cases of EBOLA have emerged in Uganda, a neighboring country to the Democratic Republic of the Congo.”

33. CANDIDA AURIS. “.. nursing facilities, and long-term hospitals, are…continuously cycling infected patients, or those who carry the germ, into hospitals and back again.”

34.EBOLA. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.

October 18, 2020

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POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals, maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

“Doctor” previously tracked Ebola and Zika. With Coronavirus it’s, as Yogi Berra said, “déjà vu all over again” without any  thoughtful differentiation about hospital capacity/ capability matched to patient severity. It seems, for the most part, whichever hospital you are taken to or go to for Coved-19 is where you stay. We don’t default like that for other “critical care” services such as cardiology/ cardiac surgery,  trauma, high risk obstetrics, maternal-fetal medicine, and neonatology.

Since we need to be prepared for future pandemics it’s timely to consider levels of care and hospital designations for “emerging viruses.” Back in the day of Certificate of Need this might have already been done. With years of deregulation it’s off the radar.

Here’s one way to look at it in Rapid Response mode.

‘When the first wave of coronavirus patients flooded New Jersey hospitals earlier this year, clinicians were heavily focused on ventilators. At the apex of the pandemic, one in four people hospitalized for COVID-19 needed these machines to breathe, and the state’s supplies were running short.

Six months later, the picture has changed dramatically. Ventilators are still critical for some patients — 10% of those hospitalized earlier this week depended on artificial respiration, according to state data — but clinicians now try to employ less invasive protocols first, like high-flow oxygen or repositioning patients to ease breathing, called “proning.”

“When the pandemic started, we intubated you at the drop of a hat,” said Dr. Lewis Nelson, who leads the emergency department at University Hospital in Newark, which was at the heart of the outbreak. Intubation generally requires the patient to be heavily sedated as a tube is then inserted into the windpipe and connected to the ventilator, which is calibrated to provide a specific oxygen concentration. The patient often requires a catheter to collect urine as well.

“There’s a sweet spot” in balancing who needs to be intubated and who could benefit more from other treatments, said Nelson, who also chairs the emergency medicine department at Rutgers New Jersey Medical School. “You have to use a good amount of clinical judgment.”

The shift in pulmonary treatment is just one example of how inpatient care for COVID-19 has evolved in New Jersey since the virus first emerged publicly in March and began spreading, sickening tens of thousands. Nearly 210,000 residents have tested positive for the virus, including more than 14,400 who have died.

While clinical research remains limited, physicians said some evidence is beginning to emerge about what treatments work best for coronavirus patients. There are a few medications that appear to reduce the related symptoms, they said, and medical providers are better able to identify problems and predict the course of the disease. There is no cure for COVID-19 and the quest for a vaccine continues.

“We’re still not making decisions based on high-quality evidence,” Nelson said. “It’s much better than it was before, but it’s still limited.”

Perhaps the biggest change in New Jersey is in the volume of COVID-19 patients at the state’s 71 acute-care hospitals. State statistics show that as the initial outbreak peaked in mid-April, more than 6,000 people were receiving inpatient treatment; one-third of these patients were in critical-care rooms and more than one in four were on a ventilator. As of Monday, hospitals were treating 445 coronavirus patients, with 29% in critical care and 10% on ventilators…

At times during the surge, multiple hospitals would be forced to temporarily suspend new admissions and divert ambulances to neighboring emergency departments, as coronavirus patients overwhelmed their bed or staff capacity. Several times officials shuttled ventilators from one facility to another to meet demand, and state and hospital leaders worked together to create a strategy to ration these machines and other scarce resources, should there not be enough for all patients. Shortages of nursing staff and personal protective equipment, or PPE — the masks, gowns and gloves designed to help stop the spread — were common in the early months.

While greater knowledge and treatment options have improved patient outcomes, health officials agree more research is needed to confirm the best-practice protocols for treating COVID-19 patients. They are also learning more about the long-term impacts of coronavirus infection, which can involve weeks or months of recovery at home. “It’s not a quick, rapid illness. It takes time,” Breen said.

At the same time, they are bracing for a second wave of the virus. “We do believe we’re going to have a resurgence. COVID has not just disappeared,” Nelson said.” (A)

“How do you choose a hospital?

Doctors at smaller community hospitals, regional medical centers, and the largest academic medical centers described the same general approach to care. This raises the question: Does it matter where you go?

Many doctors said probably not. “A lot of the management around COVID really involves a lot of things that we all have at our disposal in any health-care facility,” Hamilton said.

Some at larger hospitals, though, said that experience with complex intensive-care patients and more extensive resources may make larger health systems the better choice.

“The larger academic medical centers are probably better versed on how to take care of really sick patients,” Powell said.

Others, though, said there are advantages to community hospitals. Ronak Bhimeni, chief medical officer for Prime’s Lower Bucks Hospital, said his patients avoided the crush some larger hospitals experienced. Lower Bucks always had adequate supplies. “There was never a time when we felt that we couldn’t manage this,” he said.

One clear difference is that academic medical centers are far more likely to offer clinical trials. You can search clinicaltrials.gov to see what centers near you offer. If you’re the kind of person who wants to help make scientific progress and have early access to new — unproven — treatments, this may be important to you. Temple has a notably long list of trials, and Criner said more than half of the hospital’s coronavirus patients have joined one. “We try to have multiple options open so we can offer multiple things to people,” he said.

In general, current trials are looking at drugs with tongue-twisting names that might reduce inflammation, improve immune response, or combat cytokine storm…

Wayne Psek, a health-care quality expert at George Washington University’s Milken Institute School of Public Health, says there are not enough data available now to know which types of hospitals are doing a better job. Experience usually is helpful, but, in this case, “we just don’t know how to treat [coronavirus] well enough.” Some hospitals, he said, may be better staffed and better equipped to evaluate new information, but most are sharing now. He said he would make sure hospitals had beds available.

Albert Wu, director of the Johns Hopkins Center for Health Services and Outcomes, said coronavirus patients may benefit from the extra resources and research at larger facilities. Bigger places have more people to monitor and share study results. Practice often improves care. “In general, there is a volume-outcome relationship in almost anything that’s complicated,” he said. Treating HIV patients reinforced the value of clinical trials for him. “Access to clinical trials is an important element of quality care when there’s no agreed consensus treatment,” he said. Still, he said, many smaller hospitals now have easy access to advice from academic medical centers in their networks.

You can expect treatments to continue changing as doctors wade through what Hamilton says is already an “absolutely staggering” amount of research on COVID-19.” (B)

“El Centro Regional Medical Center was overrun with dozens of Covid-19 patients in May, with nowhere to send the critically ill. The only other hospital in Imperial County, Calif., also was swamped.

Chief Executive Adolphe Edward called the state’s emergency medical services director, asking him to intervene. “Please, please help us,” he pleaded.

Doctors and nurses at El Centro swapped text messages and made phone calls, blindly searching for openings at other hospitals.

In the emergency room, coronavirus patient Jose Manuel Abundis Gomez waited. It took 20 hours to find another hospital with a bed for the 71-year-old retired state administrator, said Alidad Zadeh, his primary care physician.

By the time Mr. Abundis was finally transferred, his oxygen levels had dropped. He later died.

During a pandemic, hospitals and local, state and federal agencies rely on a range of real-time metrics to respond to emergencies quickly. They need to know how many beds are available at each facility, whether hospitals need more nurses and the available number of ventilators and other critical supplies. That way, patients can get transferred quickly and medicine distributed to those in most need.

The U.S. has tried—and failed—over the past 15 years to build a system to share such information in a crisis. When the pandemic started, nothing like it existed. The limited and inconsistent access to data has been a major impediment to providing hospital care during the pandemic, according to interviews with industry and government officials and thousands of internal documents and emails.

Weeks after the coronavirus surfaced, administration officials began putting together a solution. It was riddled with mistakes and slowed by competing agency attempts to solve the problem, the interviews and documents show. Today, with some U.S. cities bracing for more cases, there is still no viable way to broadly track what’s happening inside hospitals.

“It’s staggering to most people how little visibility there is outside of a particular health system,” said Gregg Margolis, a former U.S. Department of Health and Human Services emergency health planning official. “Every time these things happen everybody throws their hands up and says, ‘I can’t believe these things don’t work more closely together.’ ”

At hospitals like El Centro, the data gaps meant patients couldn’t be moved to another facility quickly for treatment. Between May and August, hospital, county and California state administrators scrambled to transfer nearly 500 patients to about 90 hospitals outside Imperial County, transfer data and emails show. Some were moved as far as 600 miles…

Lawmakers and federal officials have warned for years that up-to-the-minute hospital data would be essential in emergencies. More than $100 million for the technology was cited in legislation but never formally appropriated. Resistance from hospitals and medical-record software companies to report the data has exacerbated the issue, former federal health officials and other experts say.

A spokeswoman for HHS defended the data-reporting system the Trump administration put in place as comprehensive and unprecedented, and said the government is “poised to go even further by making this system fully automated.”…

El Centro Chief Executive Adolphe Edward called the California Emergency Medical Services Authority director to intervene. ‘Please, please, help us,’ he said.

Transferring patients is a labor-and time-intensive process. Hospitals broker patient exchanges through a transfer center, a unit similar to air traffic control in an airport. Transfer centers rely on repeated phone calls to locate a bed. ‘Sometimes we’re out blind shopping,’ said Tara Mitchell, head of the case managers who coordinate transfers at El Centro.

Between May and August, nearly 500 patients from Imperial County were transferred by ambulance and helicopter to about 90 hospitals outside the county. Some were transferred as far as 600 miles. The helipad was quiet at El Centro Regional on Sept. 1.

Slow U.S. response

When the pandemic hit, government officials raced to put a makeshift system in place to track hospital data, including the number of beds occupied to ventilator inventory and Covid-19 admissions. From the start, there were competing efforts overseen by HHS.

The Centers for Disease Control and Prevention, an HHS agency, moved quickly to add Covid-19 questions to an existing hospital-disease surveillance system. Known as the National Healthcare Safety Network, the CDC system was used by about 6,000 hospitals to routinely report infection data to the agency…

In late June, White House coronavirus coordinator Deborah Birx admonished health-care industry executives on a call as Covid-19 cases surged across the South and West.

It is easier to get data from HIV clinics in Africa than U.S. hospital data, said Dr. Birx, a former ambassador for global AIDS coordination, according to people familiar with the call. Dr. Birx declined to comment through a spokesman.” (C)

“Older New Jerseyans are still wary of going to the hospital for non-COVID-related treatments despite a steep decline in patients with the virus and numerous health and safety measures in place, the New Jersey Hospital Association found in a survey released Thursday.

Hospitals statewide continue to care for approximately 350,000 non-COVID-19 cases, such as life-saving surgeries, births, trauma services and emergency care. And COVID-19 admissions represented less than 5% of total patients in the state’s medical facilities as of September, down from an April peak that had 20% of the hospital beds filled up with COVID patients.

The NJHA‘s Health Attitudes survey was initiated as part of the “Get Care Now NJ” consumer awareness campaign, which educates residents on the safety and security of hospitals.

The survey found that 84% of New Jersey adults are either “extremely concerned” (23%), “very concerned” (27%), or “somewhat concerned” (34%) about the risk of contracting COVID-19 if they need to visit a hospital.

Elective surgeries for June and July were down 24% year over year…

“These findings confirm our concerns: that our state’s older residents have been delaying surgical procedures and potentially putting their health at risk,” noted NJHA President and CEO Cathy Bennett.

“New Jersey’s hospitals are ranked the eighth safest in the nation and we’re committed to educating our residents through Get Care Now NJ that our hospitals are safe and secure, with compassionate care delivered by our health care teams,” she said.”  (D)

PRESS RELEASE from BRIGHAM AND WOMEN’S HOSPITAL

On Sept. 22, our Infection Control team identified a COVID-19 cluster involving Braunwald Tower 16A and 14CD.

To date, 41 employees and 15 patients related to the cluster have tested positive for a total of 56.

All current inpatients are being tested for COVID-19, and this will be repeated every three days. This is in addition to the current hospital policy which requires testing for all patients upon admission and daily screening for symptoms. The Brigham has reached out to all staff members potentially exposed to the cluster, has facilitated testing for them and will continue to test those in the highest risk groups every three days.

Since Friday, Sept. 25, we have performed 10,213 tests on 7,751 unique employees and received 9,560 results. Of these results, 51 were positive. Of these 51 positive results, 41 are associated with the cluster, seven are not associated with the cluster and three are being investigated further.

We expect that as we continue to test, we will continue to identify a handful of positive employees. To this point, the overall prevalence rate of our non-cluster community is 0.1 percent, a fraction of the community, city and state rates.

As we continue to respond to this cluster, testing for asymptomatic employees will be available through Sunday, Oct. 18 or as long as necessary to support our testing needs. The primary focus of our testing is to ensure that those asymptomatic staff identified as needing ongoing testing can be tested as efficiently as possible.

It is important to stress that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower).

If you are testing all admitted patients and screening all staff and visitors, how did this happen?

Our Infection Control team has investigated the source of the cluster through intensive contact tracing, testing, and staff interviews. Based on the information that we currently have, our Infection Control team is unable to determine whether the source of the cluster was a staff member or patient.

What did you do to stop the spread of this cluster?

There are a number of things we’ve done to address this issue.

We have reached out to all potentially exposed staff members, arranged testing for them, and will continue to test those in the highest risk groups every three days

We offered voluntary testing to all staff members working on the main campus since Sept. 14

Staff who are symptomatic and/or have tested positive have been sent home immediately and are not permitted to return to work until they meet our system’s return-to-work criteria

We are testing patients in the hospital every three days

We have run whole genome sequencing of all isolates in order to confirm the infections are related

We are reaching out to all patients discharged from the affected units to check on their health and to arrange testing for them

Environmental Services has performed a thorough cleaning of the affected areas

How did this spread? Was there a potential breach in infection control measures?

Our Infection Control team is conducting an ongoing investigation and has identified possible factors that may have contributed to the outbreak:

Many involved were very early in their infectious period, a time when they are most contagious

Many patients were not masked during clinical care/interactions with staff

Some patients had multiple risk factors for transmission, such as coughing, shortness of breath or use of nebulizers

Some providers were inconsistent in their use of eye protection during patient encounters

Lack of physical distancing of at least six feet among some staff while unmasked for purposes of eating…

How can you prevent this from happening again?

Our experience over the past few months demonstrates that we can create and maintain a safe environment by adhering to all of the elements of our Safe Care Commitment and our infection control policies. This includes:

Universal masking of both providers and patients

Frequent hand hygiene

Enhanced distribution of eye protection

Daily attestations of health for employees and visitors

Testing all patients on admission, rescreening all patients daily for new symptoms of COVID-19, and retesting if the screen is positive

Requiring patients admitted to the hospital to mask when staff enter the room

Practicing appropriate physical distancing, particularly when eating or drinking

Creating space optimization and seating capacities in all workrooms and breakrooms and enforcing this with increased monitoring measures

Opening up additional, safe eating areas

Is it safe to visit the hospital?

Yes. The Brigham is committed to creating and maintaining a safe care environment by testing all patients admitted to the hospital, requiring staff to attest to their health daily before working, requiring all staff, patients and visitors to wear hospital-issued masks while on campus, insisting on frequent hand hygiene, frequently cleaning the environment, and enforcing appropriate physical distancing.

It is important to note that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower). This cluster is not impacting any other areas of the hospital or our outpatient clinics.

How is the hospital tracing those who might have been exposed?

Our Infection Control team is conducting intensive contact tracing using the electronic health record and staff interviews. Those individuals who have been exposed have been contacted directly and we have facilitated testing for them.

What is being done to address patients or visitors who had previously left the hospital and the potential for them exposing others to the virus?

Our Infection Control team is reaching out directly to patients and staff who have been exposed (including those patients who have been discharged) to facilitate testing. Each person will be individually advised by a member of our Infection Control team…

Will the hospital provide a free test for those who believe they were exposed?

Yes.” (E)

“Employees at Brigham and Women’s Hospital have sounded the alarm. The facility has a COVID-19 cluster of more than 40 positive cases. Now, a patient in a different part of the hospital has tested positive.

Brigham nurse Kerry Noonan says the virus “is clearly coming back with force in the hospital as well as in the community.”

Noonan also told WBZ-TV, “The hospital stepped up and did a universal testing for everyone. One time. Unfortunately, we know as soon as the test is done, and you walk out the building and go back into the community or you go back home, you could very well come in contact with it again.”..

Noonan says the hospital needs to continue to test routinely, or randomly, people in the building who are providing direct case, and he says those people should have “N95s and face shields.”

“I don’t know why we still have visitors,” Noonan said. “We need to restrict access to essential personnel only.”..

The hospital says with testing, it is likely there will be more positive cases connected to the cluster. So far, researchers have not identified the source of the infection. At this point, doctors do not believe the new case is related to the others.” (F)

“Boston area hospitals say they are preparing for a long winter as COVID-19 cases continue to spike in Massachusetts and across the globe

Over the past week alone, more than 4,000 new coronavirus cases have been reported in the state, including 1,226 over the weekend. The percentage of coronavirus tests coming back positive, on average, is at 1.1%, compared to the 0.8% it had been at in previous weeks.

Boston entered the highest-risk, category on the state’s COVID map last week, even as Gov. Charlie Baker is allowing Massachusetts to move ahead with the latest step in the reopening of its economy.

Those numbers are still not as high as what the state experienced in the spring, but health officials say they are concerned.

Lowell General Hospital told The Boston Globe they are seeing three times the number of coronavirus patients as they were as recently as a month ago. Lowell is one of the 23 communities currently included in the red, or highest-risk, categories on the state’s COVID map.

Southcoast Health said its hospitals have seen COVID-19 cases double in the last two weeks. And UMass Memorial Medical Center in Worcester has also seen a steady increase.

The number of patients hospitalized for COVID-19 in the state is now up to 438. Of that number, 83 were listed as being in intensive care units and 27 are intubated, according to the Department of Public Health.

The three-day average number of coronavirus patients in the hospital is up 41% from the lowest observed value.” (G)

“Wisconsin health officials announced Wednesday that a field hospital will open next week at the state fairgrounds near Milwaukee as a surge in COVID-19 cases threatens to overwhelm hospitals.

Wisconsin has become a hot spot for the disease over the last month, ranking third nationwide this week in daily new cases per capita. Health experts have attributed the spike to the reopening of colleges and K-12 schools as well as general fatigue over wearing masks and socially distancing.

“We hoped this day wouldn’t come, but unfortunately, Wisconsin is in a much different, more dire place today and our healthcare systems are beginning to become overwhelmed by the surge of COVID-19 cases,” Democratic Gov. Tony Evers said in a statement. “This alternative care facility will take some of the pressure off our healthcare facilities while expanding the continuum of care for folks who have COVID-19.” (H)

When Tammy Gimbel called to check on her 86-year-old father two weeks ago, he sounded weak. He was rushed to Sanford Medical Center in North Dakota’s capital, where doctors said he had the coronavirus. But all the hospital beds in Bismarck were full, his relatives were told, and the only options were to send him to a hospital hours away in Fargo, or to release him to be monitored by his daughter, who was herself sick with the virus.

Ms. Gimbel and her father hunkered down in a 40-foot camping trailer in her backyard to try to recover. He only got worse.

“There I sat in my camper, watching my dad shake profusely, have a 102 temperature with an oxygen level of 86,” Ms. Gimbel recalled. “I am sicker than I had been the whole time, and I wanted to cry. What was I going to do? Was I going to watch my dad die?”..

On Monday, hospitals in Bismarck reported that only six inpatient beds were open and just one intensive care unit bed. Across the entire state, 39 staffed I.C.U. beds were available…

Miles from Bismarck, smaller communities have long turned to city hospitals to handle cases they do not have capacity to manage, but that is shifting.

“In the past two weeks, my ability to send people to Fargo or to Bismarck has been nonexistent,” Dr. Sarah Newton of Linton Hospital, a facility in Emmons County, told her City Council last week.

Emmons County is dealing with the state’s worst level of infections per capita, and Linton Hospital has been completely full. Dr. Newton described spending hours calling around the state for a patient who needed emergency heart surgery. A bed finally opened in Fargo.

“We’ve had to scramble, and I think a lot of the other hospitals have had to scramble as well,” Robert Black, the chief executive of Linton Hospital, said…

In earlier months, some nursing homes with outbreaks had often sent residents with Covid-19 to a hospital for treatment and to help slow the spread of the virus inside the nursing home, according to Sandy Gerving, an administrator at Marian Manor Healthcare Center, a nursing facility an hour west of Bismarck. In the past month, though, she said, nursing homes have been turned away from some hospitals…

“We got to the point where we knew there was no one that would take them,” Ms. Gerving said of patients who were sick but not critically ill. “So then we started keeping them in our building. And then we started having an outbreak internally.”..

Public health officials say they have struggled to press for county-level masking mandates in the state. There is no state-level mask rule.” (I)

“Hospital administrators in Montana say the recent rise in COVID-19 infections statewide could strain the health care system in coming weeks as patients become more ill and cold and flu season picks up. Health experts are making a plea for Montanans to “do their part” after more than 700 people have been hospitalized with the virus since it arrived in the state…

Dr. Shelly Harkins, Chief Medical Officer at St. Peter’s Health in Helena, says while hospitalization rates may seem low now, she’s anticipating an increase soon that could max out St. Peter’s capacity.

“Typically it’s a few weeks following an increase in reported cases that we would see hospitalizations,” Harkins said during a press conference Wednesday, where state health officials, the governor and hospital administrators urged Montanans to take the virus seriously.

State data show 500 more cases were reported last week than the week prior, building on a curve that’s been trending upward since Labor Day.

Harkins says St. Peter’s is also facing staffing shortages as health care workers themselves are quarantined due to exposure or fall ill.

“When resources are strained at the local health system, all the patients, even those with non-covid medical conditions like heart disease, lung disease, kidney disease, many others, they become at risk of being left without adequate services to stay well. It is the morbidity and mortality from all the non-covid related diseases that we are concerned about, too,” Harkins says.

Harkins says four people with COVID-19 are hospitalized at St. Peter’s, more than their typical case load since the virus arrived in state.

Ellner says Billings Clinic’s capacity is a fluid number. He said 13 COVID patients are filling half of the downtown hospital’s intensive care unit beds. A total of 48 COVID patients from as far as Wyoming are hospitalized there.

Michael Skehan, St. Vincent Healthcare chief operating officer, said Wednesday the Billings-based hospital is treating 41 COVID-19 patients, with eight in critical care. Skehan says St. Vincent recently pulled in dozens of nurses, technicials and respiratory therapists from sister hospitals in Colorado.

State health officials said Wednesday that Benefis Hospital in Great Falls is at 115 percent capacity, with 37 COVID-19 patients, seven of whom are in intensive care units.

“There’s concern that those systems are going to be even further stressed,” Jim Murphy, the state’s chief epidemiologist, said.

Hospital administrators say they’re building out additional capacity, bringing in nurses and respiratory therapists, and transferring patients to regional partners as needed. Gov. Steve Bullock says the state has a 90-day supply of personal protective equipment available for hospitals and local agencies as needed, and testing is available for people with symptoms, known exposures and congregate care residents.

But Harkins at St. Peter’s in Helena says Montana is only headed into halftime of the pandemic bowl. She says everyone needs to double down on the basics: wash your hands, keep your distance, wear a mask.” (J)

“Nurses at Alta Bates Summit Medical Center in Oakland, Calif., were on edge as early as March, when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.

The Centers for Disease Control and Prevention had advised hospitals to isolate COVID-19 patients to limit staff’s exposure and help conserve high-level personal protective equipment that’s been in short supply.

Yet COVID-19 patients continued to be scattered throughout the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.

Patients on that floor who had the coronavirus were not staying in their rooms, either because they were confused or disinterested in the rules. Hospital employees were not provided highly protective N95 respirators, says Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator.

“It was just a matter of time before one of the nurses died on one of these floors,” Hill says.

Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from COVID-19 on July 17.

California Nurses Association members had complained to Cal/OSHA about COVID-19 patients being spread throughout the hospital where registered nurse Janine Paiste-Ponder worked. Colleagues say they suspect the practice was a factor in her illness and death.

The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A Kaiser Health News investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID-19 patients from those not infected with the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead…

Our investigation discovered that patients with COVID-19 have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.” (K)

POSTED ON May 15, 2017 (L) – perhaps this needs to be modified for Coronavirus and implemented?

Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).

1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.

2. REVRCs should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and emerging viruses “reading” expertise).

3. National leadership in clinical trials.

4. A track record of successful, large scale clinical Rapid Response.

5. Organizational wherewithal to address intensive resource absorption.

(A)‘A complete shift’: Not just ventilators, doctors now use a range of COVID-19 treatments, LILO H. STAINTON, https://www.njspotlight.com/2020/10/covid-19-new-treatment-options-medications-steroids-recovery-rate-ventilators/

(B) Hospital coronavirus treatment has changed. Here’s what it looks like now in Philadelphia., by Stacey Burling, https://www.inquirer.com/health/coronavirus/coronavirus-treatment-changes-hospitals-philadelphia-20201003.html

(C) Why Hospitals Can’t Handle Covid Surges: They’re Flying Blind, By Melanie Evans and Alexandra Berzon, https://www.wsj.com/articles/hospitals-covid-surge-data-11601478409

(D) NJHA: Older folks still wary of going to the hospital for non-COVID-19 treatment, By Gabrielle Saulsbery, https://njbiz.com/njha-older-folks-still-wary-going-hospital-non-covid-19-treatment/

(E) Statement for Media Regarding COVID-19 Cluster, https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3684

(F) I-Team: Brigham And Women’s Employees Push For More Testing After Covid-19 Outbreak, By Cheryl Fiandaca, https://boston.cbslocal.com/2020/10/01/i-team-brigham-and-womens-employees-urge-hospital-covid-tests-covid-outbreak/

(G) Mass. Hospitals Preparing for Long Winter Amid Spike in COVID Cases, https://www.nbcboston.com/news/local/mass-hospitals-preparing-for-long-winter-amid-spike-in-covid-cases/2206798/

(H) Wisconsin activates field hospital as coronavirus keeps surging, https://www.foxnews.com/health/wisconsin-field-hospital-coronavirus-surging

(I) The Virus Surges in North Dakota, Filling Hospitals and Testing Attitudes, By Lucy Tompkins, https://www.nytimes.com/2020/10/07/us/coronavirus-north-dakota.html?referringSource=articleShare

(J) Coronavirus Strains Montana Hospitals Heading Into Flu Season, By NICKY OUELLET, https://www.mtpr.org/post/coronavirus-strains-montana-hospitals-heading-flu-season

(K) Some Hospitals Fail To Separate COVID-19 Patients, Putting Others At Risk, by CHRISTINA JEWETT, https://www.npr.org/sections/health-shots/2020/09/10/911165550/some-hospitals-fail-to-set-covid-19-patients-apart-putting-others-at-risk

(L) EBOLA is back in Africa. Is ZIKA next? Are we prepared?, http://doctordidyouwashyourhands.com/2017/05/ebola-is-back-in-africa-is-zika-next-are-we-prepared/

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CORONOVIRUS TRACKING Links to POSTS 1-51

CORONOVIRUS TRACKING

 Links to Parts 1-51

Doctor, Did You Wash Your Hands?®

http://doctordidyouwashyourhands.com/

Curated Contemporaneous Case Study Methodology

Jonathan M. Metsch, Dr.P.H.

https://www.mountsinai.org/profiles/jonathan-m-metsch

PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”

PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”

PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)

PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….

PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”

POST 6. February 18, 2020.  Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””

PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.

PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”

PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”

Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.

PART 11. March 5, 2020.  CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”

Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”

PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”

PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.

PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT

PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.”  “New York’s private and public hospitals unite to manage patient load and share resources.

PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.

PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”

PART 20. April 20, 2020. CORONAVIRUS. “…nothing is mentioned in the “Opening Up America Again” plan about how states should handle a resurgence.”

PART 21. April 23, 2020. CORONAVIRUS. “We need to ask, are we using ventilators in a way that makes sense for other diseases but not this one?”

POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”

POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)

POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.

POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”

POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”

POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…

POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.

PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!

POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”?  “ If Fauci didn’t exist, we’d have to invent him.”

POST 33. June 21, 2002. CORONAVIRUS….. Smashing (lowering the daily number of cases) v. flattening the curve (maintaining a plateau)

POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!

POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..”  While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”

POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..

POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”

POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)

POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)

POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”

POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”

POST 42. August 11, 2020. CORONAVIRUS. “I think that if future historians look back on this period, what they will see is a tragedy of denial….

POST 43. August 22, 2020. CORONAVIRUS.”  “we’ve achieved something great as a nation. We’ve created an unyielding market for FAUCI BOBBLEHEADS”!! (W)

POST 44.  September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”

POST 45. September 9, 2020. CORONAVIRUS.  Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’

POST 46.  September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”

POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”

POST 48. October 1, 2020.   “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)

POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”

POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).

POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).


 [JM1]

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