POST 192. August 30, 2021. CORONAVIRUS. Gov. John Bel Edwards on Hurricane Ida – “I hate to say it this way, but we have a lot of people on ventilators today and they don’t work without electricity,”

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“The number of coronavirus patients in U.S. hospitals has breached 100,000, the highest level in eight months, according to the Department of Health and Human Services, as a resurgence of COVID-19 spurred by the highly contagious Delta variant strains the nation’s health care system.

A total of 101,433 COVID patients were hospitalized, according to data published on Friday morning.

U.S. COVID-19 hospitalizations have more than doubled in the past month. Over the past week, more than 500 people with COVID were admitted to hospitals each hour on average, according to data from the Centers for Disease Control and Prevention.

The United States reached its all-time peak for hospitalizations on Jan. 14 when there were over 142,000 coronavirus-infected patients in hospital beds, according to HHS.” (A)

“Southern Louisiana’s hospitals, already packed with coronavirus patients from a fourth surge of the virus, were dealing Sunday with another challenge — the howling Category 4 hurricane pounding the coast.

Lady of the Sea General Hospital in Lafourche Parish, near where Ida made landfall, reported extensive roof damage. “All patients and staff are fine at this time without injury; although, our hospital has sustained significant damage,” hospital CEO Karen Collins said in a message relayed via Facebook. The hospital’s phone system was down.

“Once it is safe to do so they will evacuate their small number of patients,” state health department spokeswoman Aly Neel said in an email. Details on the number of patients involved were not immediately available.

Another Lafourche Parish hospital, Thibodaux Regional Medical Center, reported a partial generator failure to the state. Christina Stephens, a spokesperson for Gov. John Bel Edwards, said the facility “had not lost all critical power.” She said some patients were moved to another part of the facility and the state health department was working with the hospital.

Ida struck as hospitals and their intensive care units were filled with patients from the fourth surge of the COVID-19 pandemic, sparked by the highly contagious delta variant and low vaccination rates across Louisiana.

The governor also said 22 nursing homes and 18 assisted living facilities have been evacuated, though evacuating the largest hospitals was not an option because there simply aren’t other places to send them. Anticipating that power could be out for weeks in places, Edwards said a big focus will be on making sure there is enough generator power and water at hospitals so they can keep up with vital patient needs such as providing oxygen or powering ventilators.

“I hate to say it this way, but we have a lot of people on ventilators today and they don’t work without electricity,” he said.” (B)

“Hospitals in New Orleans are bracing for public health emergencies on two fronts as Hurricane Ida threatens to strike at the same time as Louisiana is experiencing a surge in coronavirus cases.

New Orleans is in the midst of a “severe outbreak” with a seven-day average of 220 new infections, according to the city’s Covid-19 dashboard. Across the state, more than 3,400 new cases were confirmed as of Friday, according to the Louisiana Department of Health. At least 2,684 people are hospitalized in Louisiana with Covid-19.

Last month, Louisiana hit the biggest single-day increase of Covid-19 hospitalizations since the pandemic’s start with 6,800 new cases in a single day, the second-highest single-day case count since Jan. 6, 2021…

Health care systems across New Orleans are already putting contingency plans in place, including beefing up staffing, ordering a surplus of supplies and minimizing the amount of patients who are admitted to hospitals with non-emergencies.

“We definitely were in full disaster mode and getting ready for this storm,” said Warner Thomas, president and CEO of Ochsner Health.

Ochsner has ordered 10 days worth of food, medication and medical supplies, Thomas said…

At LCMC Health, the hospital will enter a “code gray lockdown” early Sunday morning and bring in additional staff to care for patients. Staff and patients will shelter in place but have not been ordered to evacuate yet, said Dr. Jeffrey Elder, medical director for emergency management.

Additionally, doctors and nurses have been told to prepare for a high volume of patients amid the Covid-19 surge.

“We’ve trained for this,” Elder said. “We’ve prepared for it.” (C)

“As Louisiana reels from a fourth COVID-19 wave — with the highest single-day cases since the pandemic began — hospitals in the state are preparing for yet another public health crisis with Hurricane Ida battering the coast. The Louisiana governor said this hurricane will be one of the strongest to hit the state in more than 150 years.

Gov. John Bel Edwards said evacuation of hospitals in threatened areas — something that would normally be considered — is impractical with COVID-19 patients.

“That isn’t possible. We don’t have any place to bring those patients. Not in state, not out of state,” Edwards said.

More than 2,600 COVID-19 patients are hospitalized across Louisiana, according to state data. The seven-day average has begun to decline in recent days, having reached nearly 2,700 hospitalizations — the peak from April 2020.

“We have been talking to hospitals to make sure that their generators are working, that they have way more water on hand than normal, that they have PPE on hand,” Edwards said.

Officials decided against evacuating New Orleans hospitals. There’s little room for their patients elsewhere, with hospitals from Texas to Florida already dealing with a spike in coronavirus patients, according to Dr. Jennifer Avengo, the city’s health director…

Some hospitals appeared to have evacuated their most critical patients ahead of the storm, as they prepared to lose power. According to The Advocate, the Ochsner Health System evacuated 17 of its most critically ill patients from three hospitals, with 100 patients remaining at those locations.” (D)

“Daily tallies of new cases in Louisiana went from a few hundred a day through much of the spring and early summer to thousands a day by late July. Gov. John Bel Edwards told The Associated Press on Sunday that more than 2,400 COVID-19 patients are in Louisiana hospitals, saying the state was in a “very dangerous place with our hospitals.” (E)

“Several hospitals in Florida, South Carolina, Texas and Louisiana are struggling with oxygen scarcity. Some are at risk of having to use their reserve supply or risk running out of oxygen imminently, according to state health officials and hospital consultants.

With the continued uptick in Covid-19 cases, there has been more demand on the oxygen supply, and hospitals cannot keep up the pace to meet those needs, Donna Cross, senior director of facilities and construction at Premier — a health care performance improvement company — told CNN.

‘There is no room to put these bodies,’ Alabama health official says as Covid-19 deaths climb

“Normally, an oxygen tank would be about 90% full, and the suppliers would let them get down to a refill level of 30-40% left in their tank, giving them a three- to five-day cushion of supply,” said Cross. “What’s happening now is that hospitals are running down to about 10-20%, which is a one- to two-day supply on hand, before they’re getting backfilled.”

Even when they’re getting backfill, it’s only a partial supply of about 50%, Cross said. “It is very critical situation.”” (F)

“The Florida story is a cautionary tale for dealing with the current incarnation of the coronavirus. The United States has used the vaccines as its primary pandemic weapon. But Florida shows that even a state that made a major push for vaccinations — Florida ranks 21st among states and Washington, D.C., in giving people of all ages at least one shot — can be crushed by the Delta variant, reaching frightening levels of hospitalizations and deaths…

The best explanation of what has happened is that Florida’s vaccination rates were good, but not good enough for its demographics. It has so many older people that even vaccinating a vast majority of them left more than 800,000 unprotected. Vaccination rates among younger people were uneven, so clusters of people remained at risk. Previous virus waves, which were milder than in some other states, conferred only some natural immunity.

And Florida is Florida: People have enjoyed many months of barhopping, party-going and traveling, all activities conducive to swift virus spread.”  (G)

“On the ground floor of a parking garage at the University of Mississippi Medical Center, there are coronavirus patients where the cars should be — about 20 of them on any given day, laid up in air-conditioned tents and cared for by a team of medical personnel from a Christian charity group. Another garage nearby has been transformed into a staging area for a monoclonal antibody clinic for Covid-19 patients.

These scenes, unfolding in the heart of Mississippi’s capital city, are a clear indication that the health care system in the nation’s poorest state is close to buckling under the latest avalanche of cases triggered by the highly contagious Delta variant of the virus.

“We have reached a failure point,” LouAnn Woodward, the medical center’s top executive, said late last week. “The demand has exceeded our resources.”

The current coronavirus spike has hit the South hard, but a combination of poverty and politics made Mississippi uniquely unprepared to handle what is now the worst coronavirus outbreak in the nation. The state has fewer active physicians per capita than any other. Five rural hospitals have closed in the past decade, and 35 more are at imminent risk of closing, according to an assessment from a nonprofit health care quality agency. There are 2,000 fewer nurses in Mississippi today than there were at the beginning of the year, according to the state hospital association.

“If you look around, the state’s hospitals were in bad shape before there was such a thing as Covid,” said Marty Wiseman, an emeritus political science professor at Mississippi State University. “It was not a good time to layer a pandemic on top of that.” (H)

“Florida’s new weekly COVID-19 report is out, and kids are the only age group where cases are still increasing…

According to the data, coronavirus cases in kids 12-years-old and younger went up 30% more than the week before. Meanwhile, cases among 12-year-old to 19-year-olds were up 26%.

The same is true of hospitalizations with COVID-19. According to data, adult hospitalizations went slightly down while COVID-19 hospitalizations for children went up.” (I)

“At Children’s Hospital New Orleans, where the intensive care unit has been jammed with Covid-19 patients, scenes like this have played out unrelentingly over the past month. Nurses raced around monitoring one gut-wrenching case after another. One child was getting a complicated breathing treatment known as ECMO, a last resort after ventilators fail, which nurses said was almost unheard-of for pediatric cases. About a half-dozen others were in various stages of distress.

“We all thought, ‘Well, thankfully it’s not happening to the kids; none of us would be able to stomach that,’” said Mark Melancon, a longtime nurse at the hospital, recalling previous stages of the coronavirus pandemic. “Fast forward to now, and it’s happening with the kids.”

Mr. Melancon said that until this summer, the hospital had treated only one or two Covid-19 patients at a time. Now, a procession of patients require constant attention, their oxygen levels often dipping precariously low without maximum intervention.

As children’s hospitals in many parts of the United States admit more Covid-19 patients, a result of the highly contagious Delta variant, federal and state health officials are grappling with a sharp new concern: children not yet eligible for vaccination in places with substantial viral spread, now at higher risk of being infected than at any other time in the pandemic. Nowhere is that worry greater than in Louisiana, which has among the highest new daily case rates in the country and only 40 percent of people are fully vaccinated, putting children at particular risk as they return to school.

Most children with Covid-19 have only mild symptoms, and there is not enough evidence to conclude that Delta makes some of them sicker than other variants do, scientists say. Doctors and nurses at Children’s Hospital agreed with that assessment.

Theresa Sokol, Louisiana’s top epidemiologist, said that people younger than 18 had among the highest test positivity rates in the state and were responsible for a significant share of transmission, with many cases most likely undetected.

“So many days are filled with this puzzle of: We don’t have enough beds for this patient who wants to come, so how are we going to shuffle our children around to accommodate one more?” said Devon H. Relle, a pediatric nurse practitioner at Children’s Hospital New Orleans, where she worked the front desk of the 17-bed I.C.U. The hospital was also seeing an early, worrisome wave of respiratory syncytial virus, known as R.S.V., which can cause some of the same symptoms and was contributing to the overflow conditions.

The crush of Covid-19 at Children’s Hospital grew so intense this month that the state called in a federal “surge team” of emergency responders from the Department of Health and Human Services’s National Disaster Medical System. The group of about 14 included a physician, a nurse practitioner, nurses, paramedics, a respiratory therapist and a pharmacist.

The team was the first assigned to a children’s hospital during the pandemic.

“Covid-19 right now down here is so endemic that you don’t have to have a specific exposure, because it’s just out there,” said Anne Barylick, a nurse practitioner on the surge team who handled patient intake in the emergency department and Covid-19 units. “Statistically, you’re going to run into it.”” (J)

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