POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”

POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”

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“The United States has surpassed 11 million coronavirus cases — that’s 1 million new infections in just one week and 2 million since the beginning of the month. Hospitals are reaching a breaking point as they treat nearly 70,000 COVID-19 patients.

In Utah, records continue being shattered, and cases are skyrocketing. A quarter of new test results are now positive. As intensive care units fill up, health care workers are feeling the strain.

“We’re tired. Mentally, physically, emotionally exhausted,” said nurse Nate Smithson, who works at Intermountain Medical Center — Utah’s largest hospital. For some patients there, the cold COVID-19 reality still isn’t real.

“They deny it. Their family members deny it,” said Smithson.

Janine Roberts is also a nurse at the same hospital. She told CBS News, “We have these patients who literally are on life support. We’re working super hard to get them better, finally helping them to wake up, and then the first thing they’re trying to communicate is that it’s all a hoax.” (A)

“The average Utahn hospitalized with COVID-19 is 54 years old.

Here’s maybe another surprise: Only about half (51.6%) of hospitalized Utahns have one or more confirmed preexisting conditions.

In other words, it’s not all “high-risk” people. Our hospitals are teeming with previously healthy, average people, who were going about their lives one day and ended up in the hospital the next.

I bring this up for obvious reasons: Our hospitals and intensive care units are in the news. The state says that “when 85% capacity is reached, Utah will be functionally out of staffed ICU beds, indicating an overwhelmed hospital system.” As of Friday, 87.4% of our ICU beds at our referral center hospitals are occupied. You don’t have to be a master logician to draw the right conclusion — our hospitals are overwhelmed.” (B)

“As the number of COVID-19 cases and hospitalizations continue to climb in Ohio, Cleveland-area hospital leaders are concerned about the growing number of health care workers who are out sick with the coronavirus. 

According to hospital officials, about 800 Cleveland Clinic employees, 200 at University Hospitals, and 60 MetroHealth staffers are out, making it more difficult to care for the rising number of hospitalized COVID-19 patients in Cuyahoga County. 

“If we have many of our staff out because of exposure, while there’s a large influx of COVID patients, we will not be able to provide the best care to everyone who needs it,” said MetroHealth CEO and President Dr. Akram Boutros.

The health care workers are either diagnosed with COVID-19, in the required 10-day waiting period since symptom onset or are recovering and awaiting symptom clearance to return to work, health officials said.

Contact tracing shows the employees are not contracting the virus at work, but out in the community, Boutros said at a Monday news conference.

“They have contact with family members, they go to church, they go to gatherings… that’s where they get it from,” he said, “a child, a cousin, somebody they went to a restaurant with, somebody they went to the gym with.” 

The area hospitals are anticipating a “greater influx” of COVID-19 patients in the next few weeks, officials said. Currently, there are about 400 patients hospitalized across Cleveland Clinic’s Northeast Ohio locations, said CEO Dr. Tom Mihaljevic.

There are about 200 patients hospitalized with COVID-19 at University Hospitals (UH), and the health system is averaging 25 to 30 new COVID-19 patients per day, said UH president Dr. Cliff Megerian.

If trends do not improve, the hospitals could be nearing capacity by the end of the year, Megerian said.

“If we average the increase over the last month, we could see ourselves, by Christmastime, getting up to 800 patients, a four-fold increase, so obviously we’re hoping that does not happen,” he said.” (C)

“State officials on Monday continued to sound the alarm about rising COVID-19 hospital admissions this month, saying health care workers are being stretched to their limits while hospitals brace for a continued influx of patients.

Illinois had 5,581 people hospitalized for the coronavirus as of Sunday night — a nearly two-thirds increase over the 3,371 reported Nov. 1. The state also has surged past its spring peak set April 28, when 5,037 people were in the hospital for COVID-19.

Gov. J.B. Pritzker said hospitals in the state could encounter difficulty if they seek “reinforcement” health care workers, because Illinois will be competing for workers with surrounding states that are seeing severe coronavirus surges of their own.

“This is a moment when the entire nation is seeing record highs in hospitalizations, more than at any prior time in this pandemic. That fact is more than a frightening backdrop, because it means that there are no health care workers to call in as reinforcements from other states,” Pritzker said at a coronavirus briefing in Chicago on Monday. “It means that out-of-state nurses and nurses’ assistants who signed up to support Illinois in the spring are busy in their own states.”

Hospitals are returning to spring strategies, including limiting elective surgeries and adding more beds. On Monday, one of the state’s largest hospital systems, Advocate Aurora Health, said it plans to delay half of its inpatient elective surgeries as the number of COVID-19 patients across Illinois skyrockets.” (D)

Massachusetts. “The Baker-Polito Administration today announced that the first field hospital will be stood up at the DCU Center in Worcester as the Commonwealth prepares additional capacity for COVID-19 patients. This site will be built by the National Guard and is the first field hospital to re-open in the state since June…

The plan to re-establish the field hospital in Worcester was activated this week. The site is expected to be available for patients in the first week of December if needed and additional locations will be added in other regions if necessary. No further changes or restrictions to regular hospital services in Massachusetts are being implemented at this time.

“Since Day One of our response to this crisis, we have worked to ensure that our hospitals and health care providers have the resources they need to meet the acute care health needs of our residents,” said EOHHS Secretary Marylou Sudders, the COVID-19 Command Center Director. “We are in a much better position to respond to what will be a difficult next few months, and the early re-opening of this field hospital is based on the data we see is the right action to take at this time.”

State officials have closely monitored several metrics and note that hospitalizations since Labor Day have increased from 178 to 661. While the hospital system manages the current demand for COVID and non-COVID care, the DCU site will provide approximately 240 additional beds to care for lower-acuity COVID-19 patients, helping preserve hospital system capacity for higher-risk patients diagnosed with COVID-19 or other serious health conditions.

The Massachusetts Emergency Management Agency (MEMA) will coordinate the logistics of the DCU Center field hospital, in close collaboration with the Command Center, City of Worcester, and UMass Memorial Health Care, which will again lead all clinical, day-to-day, operations.

“The Commonwealth’s forward planning and ability to stand up this Alternate Care Site with our partners is a direct result of lessons learned and our experience during the first wave of the pandemic,” said MEMA Director Samantha Phillips. “We hope that we won’t need all of these overflow beds, but if we do, they’ll be ready.”

The DCU Center was the first of five field hospitals constructed by the Commonwealth during the response to the springtime surge of COVID-19 cases. From early April until late May, when it was de-mobilized, the DCU site served 161 patients. In total, the DCU and the Boston Hope field hospitals cared for more than 570 hospital patients during the first pandemic surge.    

“This is the right thing to do and at the right time. The field hospital was an enormous asset for Central Massachusetts hospitals during the spring surge. I believe it can serve an even greater purpose today because we have learned so much more about the virus and caring for COVID-19 patients since then. Our team is ready to deploy and to assist the state’s hospitals,” said Eric W. Dickson, MD, President and CEO of UMass Memorial Health Care.

Alternate Care Sites are designed as clinical spaces for lower acuity patients. These sites provide a relief valve for hospitals, allowing them to manage or reconfigure their facilities to care for more seriously ill patients. Each site is built to safely accommodate the beds, equipment, and medical supplies needed to appropriately care for COVID-19 patients.” (E)

“But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.

Soon, health officials warned, that means hospitals will be at full capacity, too.

“Make no mistake, we are at war and our enemy knows exactly how to kill us,” said Dr. Jay Wolfson, senior associate dean of the University of South Florida’s Morsani College of Medicine. “It thrives on our complacency, it thrives on those of us who are medically at risk and it thrives on people who continue to spend time in groups. And unless people take responsibility, it will win.”

Florida’s Department of Health reported more than 10,100 infections in a single day Sunday – the highest daily caseload since the height of the summer surge in mid-July. Since March 1, 889,864 people in Florida have tested positive for the virus, roughly one in every 23 Floridians.

A new concern is the positivity rate among children tested for the virus — 31 percent, according to recent data from the state Department Health, far above the national average of 11 percent.

The only states with higher caseloads are Texas, with 1.027 million infections, and California, with 1.029 million. The numbers align with the three states’ status as the most populous in the U.S. — California No. 1, Texas No. 2 and Florida No. 3.

A number of states have begun reinstating COVID-19 restrictions ahead of a holiday season that’s expected to make a dire situation worse. Among them are California, Pennsylvania, New Jersey, New Mexico, Illinois, Michigan and Washington.

Still, Republican U.S. Sen. Rick Scott, appearing Tuesday on the Fox Business Network, delivered assurances that Florida would remain “open for business.”

Gov. Ron DeSantis has remained largely silent on whether the state is headed toward new coronavirus restrictions. The last ones were lifted Sept. 25 when Republican DeSantis issued an executive order prohibiting any local ordinances that restrict commerce and require that Florida remain fully open. The order also barred local governments from enforcing mask mandates or social distancing rules.

If anything can change that, Wolfson said — as it has in hard-hit states such as South Dakota, with the nation’s highest positivity rate — it will be the situation in Florida’s medical centers.

“The only thing that will cause, I think, political decisions in certain states to move toward at least partial lockdowns and mask mandates is the hospitals begin to get so full that they can no longer take in new patients,” he said. “And our ICU beds are already very, very full.”..

Epidemiologists and biostatisticians have paid close attention to the virus’ hold on Florida because of the high volume of travel in, out and across the state, Wolfson said.

About 1.5 million out-of-state visitors came to Florida over Memorial Day weekend, Wolfson said, and Florida’s unusually warm winter has continued to draw crowds to the beaches.

That could be why this latest national surge no longer seems so confined to specific states or regions as the summer’s surge was. This time, the nation is facing the wave together.

After eight months of observation, researchers have made a grim prediction for Florida, Wolfson said: By the second week of January, the Tampa Bay region will be reporting upwards of 15,000 coronavirus cases every day. That compares with 1,373 reported in the region Sunday.” (F)

“Many other doctors are also calling it quits. Thousands of medical practices have closed during the pandemic, according to a July survey of 3,500 doctors by the Physicians Foundation, a nonprofit group. About 8 percent of the doctors reported closing their offices in recent months, which the foundation estimated could equal some 16,000 practices. Another 4 percent said they planned to shutter within the next year.

Other doctors and nurses are retiring early or leaving their jobs. Some worry about their own health because of age or a medical condition that puts them at high risk. Others stopped practicing during the worst of the outbreaks and don’t have the energy to start again. Some simply need a break from the toll that the pandemic has taken among their ranks and their patients.

Another analysis, from the Larry A. Green Center with the Primary Care Collaborative, a nonprofit group, found similar patterns. Nearly a fifth of primary care clinicians surveyed in September say someone in their practice plans to retire early or has already retired because of Covid-19, and 15 percent say someone has left or plans to leave the practice.

The clinicians also painted a grim picture of their lives, as the pandemic enters a newly robust phase with record case counts in the United States. About half already said their mental exhaustion was at an all-time high. Many worried about keeping their doors open: about 7 percent said they were not sure they could remain open past December without financial help.” (G)

(A)Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week, https://www.cbsnews.com/news/covid-usa-hospitals-overrun-1-million-cases-week/

(B) Who is in Utah’s hospitals with coronavirus — and what’s likely to happen to them, By Andy Larsen, https://www.sltrib.com/news/2020/11/14/who-is-utahs-hospitals/

(C) Cleveland Hospitals Say Rise In Health Workers With COVID Could Impact Care, By ANNA HUNTSMAN, https://radio.wosu.org/post/cleveland-hospitals-say-rise-health-workers-covid-could-impact-care#stream/0

(D)Illinois sounds warning again as hospitals pass spring highs for COVID-19 patients, By JAMIE MUNKS,

https://www.chicagotribune.com/coronavirus/ct-coronavirus-illinois-hospitalizations-20201117-ebil2cizdjhpdko6f3rpdin6vm-story.html

(E) Baker-Polito Administration Announces Re-establishment of a Field Hospital at the DCU Center in Worcester, https://www.tampabay.com/news/health/2020/11/17/with-no-restrictions-dire-coronavirus-warning-for-florida-hospitals-at-capacity/

(F) Hospitals at capacity? With no restrictions, dire coronavirus warning for Florida, By Anastasia Dawson, https://www.tampabay.com/news/health/2020/11/17/with-no-restrictions-dire-coronavirus-warning-for-florida-hospitals-at-capacity/

(G)Doctors Are Calling It Quits Under Stress of the Pandemic, by Reed Abelson, https://www.nytimes.com/2020/11/15/health/Covid-doctors-nurses-quitting.html?referringSource=articleShare

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