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!

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WEDNESDAY

“Dr. Anthony S. Fauci told Congress on Tuesday that he was seeing a “disturbing surge” of infections in some parts of the country, as Americans ignore social distancing guidelines and states reopen without adequate plans for testing and tracing the contacts of those who get sick…

“The virus is not going to disappear,” said Dr. Fauci, the nation’s top infectious disease expert, who testified that the virus was not yet under control in the United States…

More than three months after Mr. Trump declared an emergency because of the virus, Dr. Fauci said the picture was a “mixed bag,” with some bright spots, but also some dark ones and many unknowns. Some states like New York are “doing very well” in controlling the spread of the virus, but the surge in other states is “very troublesome to me,” he said.

“The next couple of weeks are going to be critical in our ability to address those surges that we are seeing in Florida, in Texas, in Arizona and other states,” Dr. Fauci added…

In somber tones, all four of the doctors testifying on Tuesday made clear that the United States was hardly out of danger. Despite talk of a so-called second wave of the pandemic, Dr. Fauci said the nation was still in the middle of the first wave. Dr. Redfield said the crisis had “brought this nation to its knees,” cautioning that when it coincides with flu season this year, hospitals and health workers would face a tremendous strain. Getting a flu shot, he said, would be imperative.” (A)

“As more and more hospitals publicly report that their ICU beds are full, the state changed its guideline for tracking who is in its ICU beds — a change that will mask the true number of people in Florida’s intensive care units as the state struggles to keep pace with the coronavirus pandemic.

Some hospitals in the state may be using their ICU beds for non-critical-care coronavirus patients — people who need isolation but don’t need the most intensive level of care. And late Tuesday, at least a half-dozen South Florida hospitals had filled their ICU beds.

To ensure hospitals are not overwhelmed, Florida’s Agency for Health Care Administration Secretary Mary Mayhew has repeatedly said the state needs to keep a close eye — in real time — on how many ICU beds are available regardless of how sick the people are in those beds.

But now, instead of reporting the number of COVID-19 patients occupying ICU beds, the Department of Health wants hospitals to report only the number of COVID patients in those beds who are receiving ICU-level of care. The change could reduce the number of occupied ICU beds being reported to the state…

Still, the Department of Health’s change in reporting has some critics skeptical. Santa Rosa Beach attorney Daniel W. Uhlfelder has been keeping a close eye on re-openings, testing and hospitalizations. Uhlfelder has been appearing as the Grim Reaper to discourage continued reopening during the pandemic.

“I don’t believe in the coincidence of the timing,” Uhlfelder said. “Why in the middle of a global pandemic are those guidelines being modified the week when cases are skyrocketing? If we can’t have confidence in the numbers, how are we going to have confidence in the process?” (B)

“Baptist Health confirmed that the ICU at its hospital in Homestead is at capacity.

Baptist Health confirmed that Homestead Hospital’s intensive care unit is at capacity due in part to coronavirus and more patients having elective surgeries, officials said Tuesday.

Baptist Health officials said they are able to transfer patients to other hospitals in their system to manage capacity. Regular beds can also be converted to ICU and acute care beds if needed, they added.

Baptist Health currently has 286 coronavirus-positive patients and persons under investigation at hospitals across its system. Over 1,350 COVID-19 positive patients have been discharged across the system to date.” (C)

“As the number of patients hospitalized (in Houston) with the coronavirus has reached record highs 12 days in a row, Gov. Greg Abbott and other health officials have stressed that the state has “abundant” capacity to care for them.

Statewide, there were 14,260 available hospital beds and nearly 1,500 intensive care unit beds as of Tuesday.

But regionally, some hospital officials are reporting that intensive care units — for seriously ill patients, like those on ventilators — are near or over capacity, and local leaders have warned that hospitals could get overwhelmed if the number of infections keeps climbing…

The governor struck a newly urgent tone Monday in a televised press conference to say COVID-19 was “spreading at an unacceptable rate” and that multiple metrics to gauge the virus’ spread and severity had significantly increased. Epidemiologists have attributed upticks in infections and hospitalizations to changes in behavior, including lax mask use and less social distancing.

Abbott spokesperson John Wittman said hospitals in Houston and Austin have been “emphatic” that beds will be available for coronavirus patients. He also said the governor has made clear that “he will utilize tools as necessary to ensure hospitals will provide beds for anyone who tests positive for COVID-19.”

“To be clear, in Houston, the percentage of beds occupied by COVID patients is currently 12.9%. In Austin, the percentage of beds occupied by COVID patients is 10.2%,” Wittman said…

Abbott said he “was assured and reassured consistently” by hospital executives across the state that “they had the capability and the flexibility” to treat all coronavirus patients. “They know how to ratchet back on the number of people who are being admitted for nonessential surgical procedures, to make sure that beds are going to be available for anybody who tests positive for COVID-19.”

Texas officials said Monday that all hospitals are in a “pre-surge state” — still using their staffed beds and not yet turning to emergency expansion plans — and that the state stands ready to assist them. A plan categorizing how hospitals will respond to shrinking capacity shows them doubling up patients in rooms, using nontraditional care areas to treat coronavirus patients and then expanding to nearby buildings. In the most extreme circumstances, they may stand up alternate care sites, like pop-up hospitals.” (D)

“Almost all intensive care unit beds at Houston hospitals were occupied on Wednesday as Texas reported a record number of statewide patient admissions related to the novel coronavirus.

During a City Council meeting Wednesday morning, Houston Mayor Sylvester Turner said 97 percent of the city’s ICU beds were filled. A report from the Texas Medical Center (TMC) said 27 percent of those beds were occupied by COVID-19 patients.

According to data published earlier this week by the TMC, a network of health care and research institutions based in Houston, 90 percent of the city’s ICU beds were filled as of Monday. Virus patients accounted for more than one-quarter of those occupancies.

The TMC’s latest report incorporated ICU admission numbers from seven affiliate hospitals in the Houston area: CHI St. Luke’s Health, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital and University of Texas Medical Branch. The hospitals can collectively admit 1,330 ICU patients at regular capacity, when 70 to 80 percent of total beds are typically occupied, according to the TMC.

The TMC’s Monday report noted that an additional 373 beds could become available under its “sustainable surge” plan, a procedure that would indefinitely increase ICU capacities as needed during the pandemic. Another 504 beds could be added to Houston ICUs under an emergency “unsustainable surge” plan, which the TMC would implement to address a “significant, temporary” influx of patients, according to its report…

On Monday, the Houston Health Department said hospitalizations due to the virus had increased 177 percent throughout the surrounding county since May 31. It also noted a 64 percent increase in ICU patients who had tested positive for the virus.”  (E)

“Texas Children’s Hospital is now admitting adult patients, to help other Houston hospital ICUs and acute care units that have reached patient capacity amid the COVID-19 surge, the hospital said in a statement.

“Yes, Texas Children’s is admitting adult patients,” the statement read. “We are committed to doing our part to assist the city as the number of COVID-19 cases continues to rise…

The measure marks the first time during the pandemic that Texas Children’s has accommodated a COVID-19 surge plan that was prepared in April.”  (F)

“Dr. Marc Boom, the CEO of Houston Methodist, which has over 3,000 beds across eight medical centers including 907 beds at its flagship hospital, said his facilities are not at the tipping point but all hospitals in the city have seen cases triple over the last few weeks. Harris County, Texas, which includes Houston, has seen 8,324 new COVID-19 cases since the beginning of June, averaging about 362 new cases a day, according to data from the county health department.

“I think what’s happened and watching it around our community people have completely let their guard down,” Boom told “GMA.”

Boom said it’s been frustrating seeing people ignore medical professionals calls for social distancing, face coverings and other precautions over the last few weeks. Texas lifted its stay at home order on April 30.

“Somewhere around Memorial Day people just sort of sighed a breath of relief and said, ‘Hey, I’m going to act like it’s summer. I’m going to act like this thing was never here,’ and we’re paying the price for that now,” he said…

Boom said the increase in coronavirus patients hasn’t yet led to a peak in ICU beds at Houston Methodist’s facilities.” (G)

“Arizona reported another record day for COVID-19 hospitalizations along with another big increase in new cases Monday, as the virus continues its rapid spread through the state ahead of President Donald Trump’s visit Tuesday.

Inpatient beds, ICU beds, ventilators in use and emergency department visits for suspected and confirmed COVID-19 patients all hit their highest-ever numbers Sunday, according to hospital data released by the Arizona Department of Health Services Monday.

The highest jump came in inpatient beds, with 1,992 beds occupied by suspected and confirmed COVID-19 patients Sunday, compared with 1,942 Saturday.

As of Sunday, 82% of current inpatient beds and 84% of ICU beds were in use for COVID-19 and other patients.

More than 1,000 new cases have been reported on each of the past 13 days, with more than 2,000 new cases reported on each of the past five days, according to state data. While increased testing over the past month has contributed to an increase in numbers, the percentage of those tests coming back positive has spiked sharply since mid-May, indicating a sharp increase in community spread.”  (H)

“Meanwhile, 84 percent of intensive care unit beds were in use at Arizona hospitals and 83 percent of inpatient beds were in use as of Monday, according to the data.

“Each day I’ve been going into work over the last month is worse, and what I mean by worse is … just overwhelmed with COVID patients,” said Dr. Frank LoVecchio, who works in several Arizona hospitals in emergency medicine and public health…

LoVecchio said they had their highest number of intubations last week and based on what medical professionals have learned from colleagues in New York and around the country and from medical journals, “the last thing you want to do is put these patients on a ventilator, but you can’t just let them die if they can’t get enough oxygen in them.”

“We don’t want to do that but despite that we have our highest number of patients on ventilators, our highest numbers of patients who are intubated this last week or so,” he said. “We have the highest number of patients in the intensive care unit.”

LoVecchio said facilities were also beginning to fall short in staffing of nurses and respiratory technicians, who help manage the ventilators.” (I)

THURSDAY

“The News Service of Florida reported Friday that during a June 16 call, state Surgeon General Scott Rivkees asked hospital officials to change how they were reporting available ICU beds in the state’s “Emergency Status System” and to only include patients who required what he described as an “intensive level of care.”..

The change in reporting switches the emphasis from the number of available beds to the acuity and illnesses of the patients in the beds, a move DeSantis spokeswoman Helen Aguirre Ferre defended on Twitter.

“There is a difference between the number of critical care patients needing an ICU bed as opposed to those occupying an ICU bed for COVID quarantining which is why @GovRonDeSantis is ensuring the data accurately reflects that difference. Smart!” she tweeted.

If hospitals are using ICU beds for patients who aren’t in critical care, it could at least partly be because of state decisions.

To abate the spread of COVID-19 in nursing homes and slow the death rate among long-term care residents, Florida regulators in May required nursing homes that did not have advanced health-care capabilities to transfer residents with COVID-19 to hospitals.

It also required nursing homes that could not properly isolate residents to transfer them to hospitals or to one of seven state-designated COVID-19 long-term care facilities. Those seven facilities can hold a maximum of 529 residents.

According to state data, 2,640 residents have been transferred, which means the majority of them have been transferred to hospitals.

At a news conference Tuesday in Orlando, DeSantis defended Rivkees’ decision to switch reporting requirements, saying hospitals that told his administration “they were just using their ICU wing as their COVID wing.” (J)

“On MSNBC’s Morning Joe Tuesday morning, Dr. Vin Gupta, a pulmonologist who treats COVID patients in Washington state, said it was stunning and puzzling what Rivkees had ordered.

“That’s data manipulation. Let’s be clear on that,” he said. “That’s fudging the data so they can report better numbers.”

Some hospitals, such as Palm Beach Gardens and JFK medical centers, have recently reported having no open ICU beds in general as COVID cases have surged in the past week. The number of ICU beds with COVID patients is not released to the public.

Palm Beach County hospitals Tuesday afternoon had 23% of adult ICU beds available after dipping as low as 18% last week.

Gupta said that with Palm Beach County and other places opening up more rapidly, officials now don’t know what surge capacity they have in local hospitals.

“This has huge implications and is really concerning,” Gupta said.

Dr. Larry Bush, an infectious disease specialist at Wellington Regional Medical Center, said the state, in changing ICU reporting requirements, is “trying to make it look less severe.”

But he said that there are patients in ICU beds who are not required to be there because immediate-care beds are filled up with COVID patients.

He said at Wellington Regional there are two or three people in ICU who, if they could, would be transferred to the immediate-care floor.

Bush said hospitals can’t send seniors from nursing homes back until they test negative twice even if they show no signs of illness.

Inversely, those COVID patients on ventilators are staying in ICU beds for weeks.

“You are not opening up beds,” he said. “Usually, it’s an in-and-out situation but the ‘out’ has slowed down because they are lingering.”…

DeSantis, at his news conference in Orlando on Tuesday, said the state just wanted to get a truer picture of serious COVID cases in the hospital ICUs.

“Some of the hospitals had told us they were just using their ICU wing as their COVID wing,” he said. “The surgeon general just wanted to know, ’OK, if you are doing that, how many (serious cases) are actually there or not?”” (K)

“Gino Santorio, CEO of Broward Health, said the new guidelines for reporting will affect smaller hospitals, rather than the bigger health systems in South Florida that have isolated areas for general and intensive-care COVID patients.

“What is happening is a couple of hospitals in the state have made their ICUs the dedicated COVID-19 units to isolate the patients. In those scenarios, the positive patients would be sent to the dedicated unit in the ICU whether they needed intensive care or not,” Santorio said.

He said the state and individual hospitals still need to track how many ICU beds are filled, regardless of why, to know whether the spike in cases is followed by more hospitalizations. Hospitals like Broward Health are able to add ICU beds if needed by converting general beds, he said.

On Tuesday, a half-dozen South Florida hospitals had completely filled their ICU beds, according to information the hospitals report into the Emergency Surveillance System managed by the Agency for Health Care Administration. Those hospitals include Coral Gables Hospital and Homestead Hospital in Miami-Dade County; Broward Health North in Broward County; and St. Mary’s Medical Center, Lakeside Medical Center and Bethesda Medical Center West in Palm Beach County.

Some counties, like Miami-Dade, have required their hospitals to report their daily COVID-19 hospitalizations and discharges to the mayor. On Tuesday, Miami-Dade hospitals reported admitting 103 new patients and discharging 92.

At Tuesday’s news briefing in Orlando, doctors from Orlando Health said patients coming to the hospital with COVID-19 are not as sick as they were earlier in the pandemic and less likely to need ICU care.

“Not only do we have the capacity to take care of all our community, we haven’t tapped into our surge capability,” said Dr. George Ralls, a vice president of Orlando Health.

Still, the Department of Health’s change in reporting has some critics skeptical. Santa Rosa Beach attorney Daniel W. Uhlfelder has been keeping a close eye on re-openings, testing and hospitalizations. Uhlfelder has been appearing as the Grim Reaper to discourage continued reopening during the pandemic.

“I don’t believe in the coincidence of the timing,” Uhlfelder said. “Why in the middle of a global pandemic are those guidelines being modified the week when cases are skyrocketing? If we can’t have confidence in the numbers, how are we going to have confidence in the process?”” (L)

“Texas recorded an all-time daily high of 5,489 new Covid-19 cases on Tuesday as hospitals neared capacity in Houston…

Houston’s Texas medical center, often referred to as the largest medical center in the world, showed its ICU beds were at 97% of normal capacity. The hospital has maximum capacity for nearly 1,000 more ICU beds if it activates its plans for public health emergencies.

The surge in cases in Texas and increase in hospitalizations has been accompanied by a higher rate of positive tests. These are indicators cases are not increasing just because more people are being tested.

The head of the Houston Methodist hospital system, Dr Marc Boom, wrote in an email to employees on Friday: “We appear to be nearing the tipping point.”

In the email, seen by the Texas Tribune, Boom continued: “Should the number of new cases grow too rapidly, it will eventually challenge our ability to treat both Covid-19 and non-Covid-19 patients.””  (M)

Anxiety is setting in for Texas hospital officials as the number of coronavirus patients has surged in the last few days.

“Currently we have room, but things have to change. This is not good,” said Dr. Faisal Masud, medical director of critical care medicine at the Houston Methodist hospital system. “The explosion of patients all across, that explosion has to slow down.”…

“I think we can manage right now, but if this trajectory is what it was the last 10 days,” said Masud, “when we literally had almost a tripling of our cases — we can’t do that for a couple of weeks at all.”…

In a statement Wednesday, the Texas Hospital Association said that hospitals are reserving 15 percent of bed capacity for COVID-19 patients and could slow or pause non-COVID-related procedures to increase capacity.

But they also warned in a statement that “if this trend continues, it is not sustainable.”

‘Tremendous stress’ of balancing coronavirus, other patients..

Masud, who oversees eight hospitals in the Houston Methodist system, said facilities are under “tremendous stress” as they try to deal with the jump in cases, while trying to treat patients who have been waiting for procedures they should have had three months ago.

“We owe it to the non-COVID patient also,” he said. “To me a patient is a patient. If you have a person or a loved one who has a heart attack, am I not supposed to provide care to them?”

While capacity is often discussed in terms of beds, Masud said more COVID-19 patients mean more strain on personnel and equipment. The hospital system also is helping out county hospitals…

Treating COVID-19 does not just involve finding an available bed, he said, noting that “you can have a bed in the Marriott.” Providing care to pandemic patents requires nurses, therapies, critical care physicians and other people and equipment.

Adding to the strain, some hospitals have furloughed personnel because of the stop or slowdown of elective procedures, which generate revenue.

“A lot of the personnel that are needed now are having to be hired back or find more people — that means more of the PPE, we need more of that coming in,” said Diana Fite, president of the Texas Medical Association and an emergency care physician…

The medical personnel interviewed Wednesday were eager to make public pleas for people to return to more cautious mindsets about coronavirus…

“If we don’t do something different today, we won’t have a choice,” Masud said.” (N)

“As the number of patients hospitalized with the coronavirus has reached record highs 12 days in a row, Gov. Greg Abbott and other health officials have stressed that the state has “abundant” capacity to care for them…

The governor struck a newly urgent tone Monday in a televised press conference to say COVID-19 was “spreading at an unacceptable rate” and that multiple metrics to gauge the virus’ spread and severity had significantly increased. Epidemiologists have attributed upticks in infections and hospitalizations to changes in behavior, including lax mask use and less social distancing.

Abbott spokesperson John Wittman said hospitals in Houston and Austin have been “emphatic” that beds will be available for coronavirus patients. He also said the governor has made clear that “he will utilize tools as necessary to ensure hospitals will provide beds for anyone who tests positive for COVID-19.”..

While large swaths of the state are not reporting surges in hospitalized coronavirus patients, health experts and local officials predict a coming crush in some urban areas if the growth in cases doesn’t slow down.

“What we had before was a ripple compared to what we’re about to experience,” said Dr. David Persse, health authority for the Houston Health Department…

Abbott said he “was assured and reassured consistently” by hospital executives across the state that “they had the capability and the flexibility” to treat all coronavirus patients. “They know how to ratchet back on the number of people who are being admitted for nonessential surgical procedures, to make sure that beds are going to be available for anybody who tests positive for COVID-19.”

Texas officials said Monday that all hospitals are in a “pre-surge state” — still using their staffed beds and not yet turning to emergency expansion plans — and that the state stands ready to assist them. A plan categorizing how hospitals will respond to shrinking capacity shows them doubling up patients in rooms, using nontraditional care areas to treat coronavirus patients and then expanding to nearby buildings. In the most extreme circumstances, they may stand up alternate care sites, like pop-up hospitals.

The number of available beds statewide, which is updated daily by the Department of State Health Services, included on Monday 1,303 pediatric beds and 380 psychiatric beds housed in general hospitals, said agency spokesperson Chris Van Deusen. The available bed numbers don’t include beds at psychiatric facilities, alternate care sites or those that “could be brought online but aren’t actually staffed yet,” he said….

Facilities treating coronavirus patients could face challenges that go beyond bed space — like staffing shortages.

Some hospitals have already turned to contract nurses or extended employees’ hours, in part because of a rising number of staff members in quarantine after possible exposure to the virus, said Maureen Milligan, president and chief executive officer of the Teaching Hospitals of Texas. There’s burnout among some employees, including medical staff, she said.” (O)

“Gov. Greg Abbott issued two executive orders mandating that the state’s health care facilities postpone elective medical procedures and suspending regulations to allow hospitals to treat two patients in one room in an effort to combat the spread of Covid-19.

He also announced the creation of a “strike force” to help Texas procure medical supplies and said that he was deploying the National Guard to help providers organize testing areas and assist hospitals in creating more bed space.

Abbott has grown increasingly aggressive in responding to the pandemic, following the lead of Texas cities and counties and other states around the country. Texas, however, still lags in testing capabilities.

State officials said at Sunday’s news conference that Texas was in the early stages of the outbreak and that the measures were intended to help boost hospital capacity, supplies and medical staff as more people fall critically ill.

Hospitals could face fines and providers could face jail if they don’t comply with the order postponing elective procedures. The “strike force” includes former Republican state Rep. John Zerwas, an anesthesiologist, as well as an executive from Austin-based Dell Technologies. Abbott added that the state had funds to pay for protective equipment and other supplies needed to help treat patients, but couldn’t find supplies.

The governor said that the state wasn’t prepared to strengthen restrictions on people’s movement and issue shelter-in-place rules, but added that he would consider stricter measures if people don’t follow his earlier order banning gatherings of more than 10 people. Several cities and counties already have imposed stricter bans on gatherings.

“The only thing that matters right now is public health and safety,” said Abbott. (P)

“There are more than three times as many confirmed COVID-19 cases in Arizona today as there were one month ago. Public health experts say the virus isn’t slowing down.

The state reports about 88% of Arizona’s hospital ICU beds are in use as of Tuesday. Joshua LeBaer with the Biodesign Institute at ASU warns that at the rate cases are rising, some Arizona hospitals will reach capacity within the next few weeks.

“It’s important to remember that what we’re looking at here is an exponential curve, so things can go up very quickly,” LeBaer said in a call with reporters.

LeBaer said the state needs to consider every possible tool to slow the spread, including expanding contact tracing and increasing compliance with mask mandates. He also said the state should be testing more than just the people who show symptoms.

“We should be testing many more asymptomatic individuals, because we know that people without symptoms can still spread this virus, and we need to get results back to those people very quickly,” LeBaer said.

LeBaer said many tests take up to a week for results. So people may be spreading the disease before they know they’re positive.” (Q)

“As the spread of the coronavirus in Arizona reaches unprecedented levels, nurses and hospital workers have shared on social media how the COVID-19 pandemic is stretching them thin. While Gov. Doug Ducey has focused on increasing hospital beds and recently allowing for local mask-wearing regulations, hospital workers shared that their trained staff is already overworked. 

Tucson nurse Ben Gerkin wrote on Facebook on June 14 that he works at a COVID-19 Intensive Care Unit. What he has seen is unlike anything in nearly 10 years as a registered nurse.

“I have never looked around my 100% full ICU and genuinely thought that there is the possibility of NO survivors,” Gerkin wrote. “Hospitals are at the point where we can’t accept all patients and are making decisions based on if they have the chance of survival. We are also not able to provide all treatment modalities such as dialysis on all patients based on futility of the situation.” (R)

“CDC Director Robert Redfield on Thursday said the number of coronavirus infections in the U.S. could be 10 times higher than the confirmed case count — meaning a total of more than 20 million.

“Our best estimate right now is for every case reported there were actually 10 other infections,” Redfield said during a call with reporters, referencing data from antibody tests that show who has been exposed to the virus.” (S)

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