Part 12. 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.”

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“On Friday night, the Uber driver from Queens tested positive, and the case prompted more than 40 doctors, nurses and other workers at a hospital there to go into voluntary self-isolation over fears that they might have been exposed to the coronavirus, officials said on Saturday.” (A)

“Employees of the University of Washington’s UW Medicine system can now get tested for coronavirus without leaving their cars.

The system’s medical center in northwest Seattle has turned a hospital garage lot into a drive-through clinic that can test a person every five minutes. They typically get results within a day or so.

But the idea involves more than convenience. It’s also about safety.

“Because of the way this virus could be spread, we want to make sure there’s good ventilation,” says Dr. Seth Cohen, who runs the infectious disease clinic at UW Medical Center Northwest.

Coronavirus has already caused at least 17 deaths in the Seattle area and infected at least 83 people.

So staff have placed three medical tents on the first floor of the center’s multilevel garage, which is not enclosed. Signs and orange cones funnel vehicles to the testing site…

“We want to make sure that if our staff test negative we get them back to work as soon as we can,” Cohen says. “But if they test positive we want to keep them out of the workforce to make sure they’re not going on to infect other staff or patients.”” (B)

“ “We’re past the point of containment,” Dr. Scott Gottlieb, commissioner of the Food and Drug Administration during the first two years of President Trump’s administration, said on CBS’ “Face the Nation.”

“We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty,” Gottlieb said.

U.S. Surgeon General Jerome Adams said that shifting to a mitigation phase means that communities will see more cases and need to start thinking about whether it makes sense to cancel large gatherings, close schools and make it more feasible for employees to work from home.

That’s what happened Sunday, with more reported school closings, warnings against group gatherings and cancellation of big events, such as the BNP Paribas Open, an Indian Wells tennis tournament scheduled to start this week.

“And that’s going to be different in Seattle than what it’s going to be in Jackson, Miss.,” Adams said on CNN’s “State of the Union.” “But communities need to have that conversation and prepare for more cases so we can prevent more deaths.”…

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that people who are older or have underlying health conditions should also consider avoiding large crowds and travel.

“If you are an elderly person with an underlying condition, if you get infected, the risk of getting into trouble is considerable,” Fauci said on NBC’s “Meet the Press.”

“So it’s our responsibility to protect the vulnerable. When I say protect, I mean right now. Not wait until things get worse. Say no large crowds, no long trips. And above all, don’t get on a cruise ship.”

The comments from current and former officials marked a big shift, acknowledging that the country is past the point of being able to contain the outbreak and needs to pivot to aggressive efforts to mitigate the virus’ spread.” (C)

“Tom Bossert, Donald Trump’s former homeland security advisor, told NBC News on Tuesday that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”

In an op-ed published by The Washington Post on Monday, Bossert also stated, “officials must pull the trigger on aggressive interventions,” later adding, “Aggressive interventions put off and ease the peak burden on hospitals and other health-care infrastructure.”

Bossert specifically suggesting that “School closures, isolation of the sick, home quarantines of those who have come into contact with the sick, social distancing, telework and large-gathering cancellations must be implemented before the spread of the disease in any community reaches 1 percent.”

“If we fail to take action, we will watch our health-care system be overwhelmed,” he warned, “Starting now, public health messaging should be framed in light of this clear objective.”” (D)

““They’re coming in so intensely now that being able to give you a detailed case breakdown, we’re not in that position to do that at this moment because there are so many coming forward,” de Blasio said, speaking at Bellevue Hospital in Manhattan. “As of 12 noon … the number of confirmed cases in New York City is 36. That’s 16 new since yesterday and 11 new even since this morning at 7 a.m. when I last spoke about this.”

Almost 2,000 New York City residents are in voluntary isolation while 30 people are in mandatory quarantine, he said.

Dr. Mitchell Katz, CEO of NYC Health + Hospitals, said local hospitals are bracing for an onslaught of COVID-19 cases, adding that local hospitals are preparing to discharge current patients to handle incoming coronavirus patients.

 “We are prepared at Bellevue and all of our hospitals that were we to have many patients with respiratory distress, we would rapidly discharge those patients who are in the hospital now and do not need to be in the hospital because they can be safely cared for at home,”  Katz said.” (E)

“Schools, temples, churches and other large gathering places within much of the New York City suburb of New Rochelle will be shut down for two weeks as the state battles to contain of one of the nation’s worst coronavirus clusters.

The National Guard will be called in to help clean facilities and deliver food, Gov. Andrew Cuomo said Tuesday.

Cuomo announced plans to enforce a “containment area” for a 1-mile radius around the center of the cluster, an area of Westchester County that includes much of the city of New Rochelle and stretches into the town of Eastchester. As of Tuesday afternoon, the state had 174 confirmed cases of the coronavirus, second only to Washington state.

“This is literally a matter of life and death,” Cuomo said.” (F)

“California’s Sacramento County is calling off automatic 14-day quarantines that have been implemented for the coronavirus, saying it will focus instead on mitigating the impact of COVID-19.

The change is an acknowledgement that the county cannot effectively manage the quarantines while its health system copes with coronavirus cases. It also reflects problems with the U.S. government’s coronavirus testing program — issues that slowed efforts to identify people with the deadly virus and to contain COVID-19.

“With the shift from containment to mitigation, it is no longer necessary for someone who has been in contact with someone with COVID-19 to quarantine for 14 days,” the county says.

Effective immediately, people in Sacramento County should not quarantine themselves if they’ve been exposed to the COVID-19. Instead, they should go into isolation only if they begin to show symptoms of the respiratory virus, the county’s health department says.

Sacramento County has at least 10 coronavirus cases, including one person who recovered.

Decisions on how to try to contain and control the coronavirus have largely been left to state and local officials, rather than those at the federal level.” (G)

“Nursing homes and assisted living centers should take unprecedented action to curtail most social visits, and should even take steps to keep some employees away, to slow the spread of the new coronavirus, the industry said on Tuesday.

The recommendation follows an outbreak of the virus in the region around Seattle, where five long-term care facilities have been hit with cases, including a facility in Kirkland, Wash., where 18 residents have died. There have now been more than 950 cases of coronavirus in the United States, including 29 deaths.

“The mortality rate is shocking,” said Mark Parkinson, president and chief executive officer of the American Health Care Association. He said that the death rate might well exceed the 15 percent reported in China for people aged 80 and older who were infected.

The challenge of the virus “is one of the most significant, if not the most significant” issues the industry has ever faced, he said.

Industry officials said they are recommending that nursing homes should allow people to enter only if it is essential.

Staff members, contractors and government officials should be asked, “Do you need to be in-building to operate?” said Dr. David Gifford, the health care association’s chief medical officer.

As for family members, he said, “Our recommendation is they should not be visiting.”

Anyone who does visit, he said, should be screened carefully at reception and anyone who has signs of illness should be turned away.” (H)

“N95 masks are essential for protecting health care workers and controlling the epidemic, but some hospitals have been unable to get new shipments as supplies dwindle.

As hospitals around the country prepare for an influx of highly infectious coronavirus cases, their supplies of a crucial type of respirator mask are dwindling fast.

“We’re not willing to run out of N95 masks,” Dr. Susan Ray, an infectious disease specialist at Grady Memorial Hospital in Atlanta, said in a phone interview, referring to the masks by their technical name. “That’s not O.K. at my hospital.”” (I)

“It’s bad enough in ordinary times for a doctor or nurse to work while sick. But as Covid-19 hits hospitals, as it almost certainly will, the tendency of health care professionals to work through illness will present a serious threat to both patient safety and the public’s health…

It is tempting to point the finger at health care professionals who come to work when sick. After all, if their illness is contagious, they pose a threat — in some cases a potentially life-threatening one — to vulnerable patients. But that would be a mistake.

As patient safety expert Paul Batalden has said, “every system is perfectly designed to get the results it gets.” In the case of presenteeism in health care, it is precisely that system — or, more precisely, the lack of a system — that deserves the lion’s share of the blame.” (J)

“As the U.S. battles to limit the spread of the contagious new coronavirus, the number of health care workers ordered to self-quarantine because of potential exposure to an infected patient is rising at a rapid pace. In Vacaville, Calif., alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.

Across California, dozens more health care workers have been ordered home because of possible contagion in response to more than 80 confirmed cases as of Sunday morning. In Kirkland, Wash., more than a quarter of the city’s fire department was quarantined after exposure to a handful of infected patients at the Life Care Center nursing home.

With the number of confirmed COVID-19 cases growing by the day, a continued quarantine response of this magnitude would quickly leave the health care system short-staffed and overwhelmed. The situation has prompted debate in the health care community about just what standards medical facilities should use before ordering workers quarantined — and what safety protocols need to become commonplace in clinics and emergency rooms.

“It’s just not sustainable to think that every time a health care worker is exposed they have to be quarantined for 14 days. We’d run out of health care workers,” Nuzzo says. Anyone showing signs of infection should stay home, she adds, but providers who may have been exposed but are not symptomatic should not necessarily be excluded from work.

The correct response, she and others say, comes down to a careful balance of the evolving science with the need to maintain a functioning health care system…

As the virus continues to spread, hospitals should be stockpiling such equipment, figuring out how to add beds and planning for staffing shortages, says Dr. Richard Waldhorn, a professor of medicine at Georgetown University and contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a COVID-19 pandemic.

Hospitals should already be training providers to take on expanded duties, Waldhorn says. If a hospital becomes overwhelmed, the Medical Reserve Corps can be mobilized, as can networks of providers who have volunteered to aid in emergency situations. Once workers have been infected and recover, it might make sense to have them treat other coronavirus patients since they likely will have immunity.

Eventually, as a disease becomes widespread, quarantine simply stops being a priority, says Nina Fefferman, a mathematician and epidemiologist at the University of Tennessee-Knoxville.

“There’s a point where we stop trying to quarantine anyone and we just say, OK, we’re going to have more deaths from the fire department not being able to fight fire than from everyone getting the disease.”” (K)

“At the University of Utah Hospital in Salt Lake City, patients who are worried that they may have the coronavirus no longer enter the hospital itself. Instead, they are treated just outside in big tents, where physicians donning protective gear test them and a special air filter whisks germs away.

Two 20-foot-wide tents were put up on Saturday as a way to limit the exposure between individuals suspected of having the coronavirus and patients in other areas of the hospital. A third, smaller tent was erected on Sunday.

As of Monday afternoon, only two Utahns were confirmed to have the coronavirus, including one evacuated from the stricken Diamond Princess cruise ship — but the University of Utah Health, which includes the Salt Lake City hospital, is not taking any chances.

“It’s an all-hands-on-deck situation right now.”

“We’re spending almost all of our time right now at the hospital system educating our staff, educating the public. It’s an all-hands-on-deck situation right now,” Kathy Wilets, spokeswoman for University of Utah Health, said.

Through social media and news conferences, the health care system is urging people to call first if they believe they may have COVID-19, the illness caused by the coronavirus.

Over the phone, the patients will be directed to the tents outside of the hospital, Wilets said, or be told to drive to an urgent care center, where a doctor in personal protective equipment will walk over to their car and test them without them having to get out of the driver’s seat. They will then be instructed to drive home, where they are to remain while they wait for the test results.” (L)

“At the very beginning [of an outbreak] this will happen because you don’t know patients are infected and you only realize later that people were exposed,” said Grzegorz Rempala, a mathematician at the College of Public Health at Ohio State University who models the spread of infectious diseases.

Now that the disease has started to spread through the community, any patient with respiratory symptoms potentially could be infected, though health officials note the likelihood remains low. As providers start routinely wearing protective gear and employing strict safety protocols, accidental exposure should decline…

 “We’re not used to being concerned, before we even do the triage assessment, [about] whether the patient is infectious and could infect hospital workers,” said Dr. Kristi Koenig, the EMS medical director of San Diego County. She said that thinking started to evolve during the 2014 Ebola outbreak. Hospitals should routinely mask patients who come in with respiratory symptoms, she said, given any such patient could have an infectious disease such as tuberculosis.

Yet providers don’t often think in those terms. “In many ways we’re spoiled because we’ve gone from a society 50 or 100 years ago where the major killers were infectious disease,” said Dr. Michael Wilkes, a professor at UC Davis School of Medicine. “Now we’ve become complacent because the major killers are heart disease and diabetes.”

Faced with this new infection risk, many hospitals are scrambling to retrain workers in safety precautions, such as how to correctly don and doff personal protective equipment.

Sutter Health, which has 24 hospitals in Northern California, started ramping up its emergency management system five weeks ago in preparation for COVID-19. Before coming to the emergency room, Sutter patients are asked to call a hotline to be assessed by a nurse or an automated system designed to screen for symptoms of the virus. Those with likely symptoms are guided to a telemedicine appointment unless they need to be admitted to a hospital…

As the virus continues to spread, hospitals should be stockpiling such equipment, figuring out how to add beds and planning for staffing shortages, said Dr. Richard Waldhorn, a professor of medicine at Georgetown University and contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a COVID-19 pandemic.

Hospitals should already be training providers to take on expanded duties, Waldhorn said. If a hospital becomes overwhelmed, the Medical Reserve Corps can be mobilized, as can networks of providers who have volunteered to aid in emergency situations. Once workers have been infected and recover, it might make sense to have them treat other coronavirus patients since they will have immunity.”  (M)

“In this California epicenter of the coronavirus outbreak, officials say they are trying to be as transparent as possible. They’re keeping a cruise ship out at sea, updating citizens on new cases and providing emergency resources to battle the epidemic.

But on one matter there remains absolute silence: the names of those who have died after being exposed to COVID-19. One California patient and at least 13  Seattle-area residents have died from the illness.

Experts in public health and bioethics say that far from helping society, a decision to reveal the identities of people – dead or alive – who have contracted the coronavirus would be a disaster with far-reaching ramifications.

“Doctors don’t out people,” says Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics in Maryland, which focuses on the ethical implications of scientific advancement. “Whether it’s HIV, syphilis, coronavirus or anything else, people simply won’t show up to their doctor if they feel they might be outed for a condition.”

Kahn pointed to the Hippocratic Oath, which explicitly states that a physician will “respect the privacy of my patients, for their problems are not disclosed to me that the world may know.”

What’s more, laws laid down in 1996 by the Health Insurance Portability and Accountability Act (HIPAA) ensure that a person’s  health records remain undisclosed to the general public long after their death. That means releasing names of anyone with COVID-19 would violate HIPAA. There have been 51 confirmed COVID-19 cases in California…

What officials are duty-bound to do in any sort of infectious case – whether it’s a sexually transmitted disease or tuberculosis – is referred to as “contact tracing” investigation. This piece of detective work involves finding out anyone who has been in contact with the infected patient and advising them of best next steps…

 “HIPAA requires us to protect confidentiality, and we are only releasing as much information as is necessary to protect public health,” says Combs Prichard, adding that officials did disclose that the one COVID-19 victim in the county – described as an older adult with underlying conditions – was from the city of Rocklin.

“We are absolutely 100% doing a thorough contact investigation, that’s why we don’t feel there is a public health reason to release more identifying information,” she says. “We’ve been able to develop a thorough list of close contacts and are contacting them directly and placing them in quarantine.”

Placer County’s approach represents “a constant discussion in public health, as we’re walking a fine line between causing harm and getting people unnecessarily frightened versus making sure they adopt the right precautions,” says Claire Wheeler, professor of Public Health at Portland State University.

Wheeler points out that while medical officials may be following protocol by not releasing the names of COVID-19 victims or those who have the virus, that doesn’t stop those contacted by health workers from sharing details, including a name, with friends or through social media.

Should such personal information be leaked to the media or online, “it could be very bad for those individuals,” Wheeler says. “What if they lost their jobs? In these situations, people become hysterical. That’s the most dangerous piece of this.”” (N)

“Bridgeport Hospital President Anne Diamond addressed the media Saturday afternoon. Diamond said the doctor who tested positive for coronavirus did not expose patients to the illness because he was exhibiting no symptoms when he made rounds at the hospital.

A doctor who works in Connecticut and recently made rounds at Bridgeport Hospital has tested positive for the coronavirus, the governor announced Saturday.

This is the second New York state resident who works in a Connecticut hospital to test positive for the virus, also known as COVID-19. State officials announced Friday night that an employee who works at both Danbury and Norwalk hospitals has tested positive for the coronavirus.

The doctor in Bridgeport did not shows symptoms of coronavirus while working with patients, the governor’s office said, and “stayed home to self monitor.” Officials said he was not an employee of the hospital, but rather a community doctor who made rounds there.

“This physician saw a limited number of patients at Bridgeport Hospital. At that time, the physician displayed no symptoms associated with COVID-19,” said Anne Diamond, president of the hospital. “As a result, the physician contact here during that time does not constitute an exposure.”

Hospital staff were notified and the “very small number of patients” who came into contact with the doctor were isolated, she said. The Centers for Disease Control and Prevention has since told them that isolation is not necessary.

“The CDC has advised us that our staff will not require isolation or furlough given the nature of the encounter, but we are asking that all staff self monitor for symptoms in the future,” Diamond said.” (O)


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