POST 37. July 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.”

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“In late March, as the number of COVID-19 cases was growing exponentially in the state, Cuomo said New York hospitals might need twice as many beds as they normally have. Otherwise there could be no space to treat patients seriously ill with the new coronavirus.

“We have 53,000 hospital beds available,” Cuomo, a Democrat, said at a briefing on March 22. “Right now, the curve suggests we could need 110,000 hospital beds, and that is an obvious problem and that’s what we’re dealing with.”

The governor required all hospitals to submit plans to increase their capacity by at least 50%, with a goal of doubling their bed count. Hospitals converted operating rooms into intensive care units, and at least one replaced the seats in a large auditorium with beds. The state worked with the federal government to open field hospitals around New York City, including a large one at the Jacob K. Javits Convention Center.

But when New York hit its peak in early April, fewer than 19,000 people were hospitalized with COVID-19. Some hospitals ran out of beds and were forced to transfer patients elsewhere. Other hospitals had to care for patients in rooms that had never been used for that purpose before. Supplies, medications and staff ran low…

All told, more than 30,000 New York state residents have died of COVID-19. It’s a toll worse than any scourge in recent memory and way worse than the flu, but, overall, the health care system didn’t run out of beds.

Gov. Andrew Cuomo, at a March 22 briefing, displayed a projection that New York could need 110,000 hospital beds. At the peak, fewer than 19,000 were hospitalized with COVID-19.

“All of those models were based on assumptions, then we were smacked in the face with reality,” said Robyn Gershon, a clinical professor of epidemiology at the NYU School of Global Public Health, who was not involved in the models New York used. “We were working without situational awareness, which is a tenet in disaster preparedness and response. We simply did not have that.”

Cuomo’s office did not return emails seeking comment, but at a press briefing on April 10, the governor defended the models and those who created them. “In fairness to the experts, nobody has been here before. Nobody. So everyone is trying to figure it out the best they can,” he said. “Second, the big variable was, what policies do you put in place? And the bigger variable was, does anybody listen to the policies you put in place?”” (A)

“The government’s top infectious disease expert said on Tuesday that the rate of new coronavirus infections could more than double to 100,000 a day if current outbreaks were not contained, warning that the virus’s march across the South and the West “puts the entire country at risk.”

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, offered the grim prediction while testifying on Capitol Hill, telling senators that no region of the country is safe from the virus’s resurgence. The number of new cases in the United States has shot up by 80 percent in the past two weeks, according to a New York Times database, with new hot spots flaring far from the Sun Belt epicenters.

I can’t make an accurate prediction, but it is going to be very disturbing, I will guarantee you that,” Dr. Fauci said, “because when you have an outbreak in one part of the country, even though in other parts of the country they are doing well, they are vulnerable.”” (B)

“At (Houston’s) Lyndon B. Johnson Hospital on Sunday, the medical staff ran out of both space for new coronavirus patients and a key drug needed to treat them. With no open beds at the public hospital, a dozen COVID-19 patients who were in need of intensive care were stuck in the emergency room, awaiting transfers to other Houston area hospitals, according to a note sent to the staff and shared with reporters.

A day later, the top physician executive at the Houston Methodist hospital system wrote to staff members warning that its coronavirus caseload was surging: “It has become necessary to consider delaying more surgical services to create further capacity for COVID-19 patients,” Dr. Robert Phillips said in the note, an abrupt turn from three days earlier, when the hospital system sent a note to thousands of patients, inviting them to keep their surgical appointments.

And at The University of Texas MD Anderson Cancer Center, staff members were alerted recently that the hospital would soon begin taking in cancer patients with COVID-19 from the city’s overburdened public hospital system, a highly unusual move for the specialty hospital.

These internal messages highlight the growing strain that the coronavirus crisis is putting on hospital systems in the Houston region, where the number of patients hospitalized with COVID-19 has nearly quadrupled since Memorial Day. As of Tuesday, more than 3,000 people were hospitalized for the coronavirus in the region, including nearly 800 in intensive care…

Houston Fire Chief Samuel Peña said his paramedics sometimes have to wait for more than an hour while emergency room workers scramble to find beds and staffers to care for patients brought in by ambulance — a bottleneck that’s tying up emergency medical service resources and slowing emergency response times across the region.

Part of the problem, Peña said, is that when his 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. That’s a problem that’s likely to deepen as a growing number of medical workers have been testing positive for the virus, according to internal hospital reports. Just as New York hospitals did four months ago, some Houston hospitals have posted on traveling nurse websites seeking nurses for “crisis response jobs.”…

The crisis in Houston has accelerated rapidly in recent weeks, at times resulting in muddled messaging from both hospital leaders and public officials.

On June 24, several hospital executives affiliated with the Texas Medical Center — a sprawling medical campus that’s home to most of Houston’s major hospital systems — issued a statement warning that COVID-19 hospitalizations were growing at an “alarming rate” and could soon put an unsustainable strain on hospital resources.

But the following day, after Abbott issued an executive order directing hospitals to limit elective surgeries — a measure intended to preserve hospital capacity but one that also hurts hospital revenues — the CEOs of four hospitals in the medical center abruptly dialed back their earlier warnings at a hastily organized news conference. They said they hadn’t meant to alarm the public. The hospitals still had room to add ICU beds, they said, both to treat COVID-19 and to continue caring for other patients.

“I think the Texas Medical Center’s purpose was to really urge people to do the right things in the community, and do so by talking about capacity, but really ended up unintentionally sounding an alarm bell too loudly,” Dr. Marc Boom, president and CEO of Houston Methodist, which is part of the Texas Medical Center, said at the news conference. “We clearly do have capacity.”…

Not all hospitals are equally equipped to respond to a surge in COVID-19 demand, accompanied by a loss of more profitable business, Ho said. Hospital systems like Houston Methodist have “the financial resources to sort of convert anything into an ICU just because they have more money, more cash on hand,” she said.

Houston’s public hospitals, Ben Taub and Lyndon B. Johnson, don’t have those same resources.

“The problem is that, of course, there are going to be more patients who are going to be going to Ben Taub” because the virus is disproportionately affecting Black and Latino people in low-income communities, and Ben Taub is traditionally the safety net for those without health insurance, Ho said. “I don’t know to what extent they are able to send patients to the other hospitals.””  (C)

“The trend is worrying: A sharp increase in patients can once again overwhelm hospitals, putting critical resources including staffing, beds and ventilators in short supply.

Already, some hospitals are so swamped they’ve transferred patients elsewhere. Doctors in parts of Texas report waiting lists for their ICU beds, while others have had to decide which patients to admit, incapable of treating all those seeking help. In other parts of the US, health care professionals are seeing younger and sicker patients and making a simple plea: Wear a mask and stay at home.

The increasing infections come weeks after many states began reopening their economies after extended closures intended to stem the spread of coronavirus…

In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Houston Mayor Sylvester Turner said Wednesday.

“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”

“’We are having an explosion of Covid’

Some local officials and public health administrators are already reporting strained hospital capacity with the latest influx of patients.

In Bexar County, home to San Antonio, officials reported this week the number of hospitalizations continues to rise while hospital capacity has shrunk to a little more than 20%, CNN affiliate KSAT reported.

“We are having an explosion of Covid,” says Adam Sahyouni, a Covid ICU nurse manager at San Antonio’s Methodist Hospital. “We aren’t overrun yet, but it’s overwhelming.”

According to data published by the city of San Antonio, at the beginning of June there were 39 coronavirus patients in the ICU and 20 on ventilators. By June 30, 288 coronavirus patients were in ICUs and 158 on ventilators…

At Methodist Hospital in San Antonio, ICU rooms are packed — and some patients are on a waiting list.

“Yesterday was probably one of my worst days that I’ve ever had,” Dellavolpe said. “I got 10 calls, all of whom (were) young people who otherwise would be excellent candidates to be able to put on ECMO (life support). They’re so sick that if they don’t get put on, they don’t get that support, they’re probably going to die. I had three beds.”

“It’s a level of decision-making that I don’t think a lot of us are prepared for.”” (D)

“As Texas sets records for new COVID-19 cases and hospitalizations day after day, the state’s hospital capacity — one of the key metrics that Gov. Greg Abbott cited as he allowed businesses to reopen — has become the focus of increased attention and concern.

But the state isn’t releasing the information it collects about how many beds individual hospitals have available. And only a fraction of the state’s hospitals, cities and counties are providing that information to the public on their own…

According to data from DSHS, the state had 1,322 available intensive care unit beds and close to 13,000 available hospital beds Wednesday. But there are important regional disparities. The Northeast Texas Regional Advisory Council reported Wednesday that 43% of its hospital beds are in use with 92 ICU beds available, while the East Texas Gulf Coast Regional Advisory Council, which includes nine counties and more than 1.3 million people, is 83% full with only 10 open ICU beds.

Some of the regional advisory councils provide county-level breakdowns of available hospital beds within their boundaries, including the Southeast Texas Regional Advisory Council, which includes Houston.

Many local government and health authorities have opted not to make hospital capacity information public.

“Publicly, we do not share which hospitals are at capacity, because there is constant shifting and we want the hospitals to have the freedom to move resources as needed,” Mark Escott, Austin’s interim public health authority, said in an email.

Dallas County provides daily briefs that include hospitalizations, ICU admissions and emergency room visits — but doesn’t include available hospital capacity — saying local health experts use these key indicators to determine the COVID-19 risk level and the appropriate response.

The Texas Medical Center in Houston, which includes 21 hospitals, used to update daily a set of “early warnings,” including its base intensive care capacity. On June 24, TMC leaders issued a statement warning that patients with COVID-19 were being admitted at an “alarming rate.” The next day, the medical center reported it had reached 100% of ICU base capacity — and then stopped updating that information for almost three days.

During a joint news conference June 25, Houston Methodist CEO Dr. Marc Boom said officials were concerned that the level of alarm was “unwarranted.”

The Houston Chronicle reported that Abbott had expressed displeasure to hospital executives about headlines related to ICU capacity, but Abbott spokesman John Wittman said any insinuation that the governor suggested the executives publish less data is false.

“We were getting panicked calls from elected officials and members of the media saying, ‘You all are out of ICU beds, what are we going to do?’” David Callender, president and CEO of the Memorial Hermann Hospital, told KHOU-TV. “We were not doing a very good job with our slides and portraying how we manage our capacity.”..

Last week, Sarah Eckhardt, the former Travis County judge serving as an adviser to interim County Judge Sam Biscoe, said she was having trouble obtaining information about capacity at local private hospitals. On Tuesday, she said that the county has since received all the information it needs to plan its response to the recent surge in COVID-19 hospitalizations, which reached 369 in Travis County on Tuesday, including 132 people in ICU.

Travis County has a 22.9% positivity rate, a figure “substantially higher than most of the country,” Escott said in a news conference Wednesday. The positivity rate is the ratio of positive cases to the number of tests conducted, and it can vary depending on who is being tested, health experts say. Public testing in the county is being rationed to only people with symptoms.

“I think that it’s pretty plain that if the chief executives of the county and the city are having a hard time getting information about the occupancy levels in the hospitals, then how would you expect the regular individual to know?” Eckhardt said.” (E)

“Over the past week, Dr. Aric Bakshy, an emergency physician at Houston Methodist, had to decide which coronavirus patients he should admit to the increasingly busy hospital and which he could safely send home.

To discuss questions like these, he has turned to doctors at hospitals where he trained in New York City that were overwhelmed by the coronavirus this spring. Now their situations are reversed.

Thumbing through a dog-eared notebook during a recent shift, Dr. Bakshy counted about a dozen people he had treated for coronavirus symptoms. His colleagues in Houston had attended to many more. Meanwhile, friends at Elmhurst Hospital in Queens told him that their emergency department was seeing only one or two virus patients a day.

As Houston’s hospitals face the worst outbreak of the virus in Texas, now one of the nation’s hot zones, Dr. Bakshy and others are experiencing some of the same challenges that their New York counterparts did just a few months ago and are trying to adapt some lessons from that crisis.

Like New York City in March, the Houston hospitals are experiencing a steep rise in caseloads that is filling their beds, stretching their staffing, creating a backlog in testing and limiting the availability of other medical services. Attempts to buy more supplies — including certain protective gear, vital-sign monitors and testing components — are frustrated by weeks of delays, according to hospital leaders.

Methodist is swiftly expanding capacity and hiring more staff, including local nurses who had left their jobs to work in New York when the city’s hospitals were pummeled. “A bed’s a bed until you have a staff,” said Avery Taylor, the nurse manager of a coronavirus unit created just outside Houston in March.

But with the virus raging across the region, medical workers are falling ill. Dr. Bakshy was one of the first at Methodist to have Covid-19, getting it in early March. As of this past week, the number of nurses being hired to help open new units would only replace those out sick.

Methodist, a top-ranked system of eight hospitals, had nearly 400 coronavirus inpatients last Sunday. A week later — even as physicians tried to be conservative in admitting patients and discharged others as soon as they safely could — the figure was 626. The flagship hospital added 130 inpatient beds in recent days and rapidly filled them. Now, administrators estimate that the number of Covid-19 patients across the system could reach 800 or 900 in coming weeks, and are planning to accommodate up to 1,000.

Other Houston hospitals are seeing similar streams of patients. Inundated public hospitals are sending some patients to private institutions like Methodist while reportedly transferring others to Galveston, 50 miles away.

“What’s been disheartening over the past week or two has been that it feels like we’re back at square one,” Dr. Mir M. Alikhan, a pulmonary and critical care specialist, said to his medical team before rounds. “It’s really a terrible kind of sinking feeling. But we’re not truly back at square one, right? Because we have the last three months of expertise that we’ve developed.”

Houston’s hospitals have some advantages compared with New York’s in the spring. Doctors know more now about how to manage the sickest patients and are more often able to avoid breathing tubes, ventilators and critical care. But one treatment shown to shorten hospital stays, the antiviral drug remdesivir, is being allocated by the state, and hospitals here have repeatedly run out of it.

Methodist’s leaders, who were planning for a surge and had been dealing with a stream of coronavirus patients since March, pointed to the most important difference between Houston now and New York then: the patient mix. The majority of new patients here are younger and healthier and are not as severely ill as many were in New York City, where officials report that over 22,000 are likely to have died from the disease.

But so far, the death toll has not climbed much in Texas and other parts of the South and West seeing a surge.

“We are having to pioneer the way of trying to understand a different curve with some very good characteristics versus the last curve,” said Dr. Marc Boom, Methodist’s president and chief executive.

But he cautioned, “What I’m watching really closely is whether we see a shift back in age — because if the young really get this way out there and then start infecting all of the older, then we may look more like the last wave.”

Dr. Sylvie de Souza, head of the emergency department at Brooklyn Hospital Center, which on Friday reported no new coronavirus admissions and no current inpatient cases, said that she was receiving distressing text messages from doctors elsewhere in the country asking for advice. “It’s disappointing,” she said. “It sort of brings me back to the end of March, and it’s like being there all over again.”..

But doctors in Houston are tightening criteria for admission. Dr. Bakshy, the Methodist emergency room doctor, who worked at Bellevue and Mount Sinai in New York, said that he was conferring with his former colleagues.

“We all have questions about who truly needs to be hospitalized versus not,” he said. “If we had unlimited resources, of course we’d bring people in just to make sure they’re OK.”

Now, he said, a patient has to have low oxygen levels or serious underlying conditions “to really justify coming into the hospital,” although exceptions can be made.

Another challenge in New York and Houston has been determining who is infected and needs to be isolated from others. Nearly 40 percent of all emergency room patients at Methodist are now testing positive; some of them lack symptoms.

Because test results are sometimes delayed by more than a day, Dr. Bakshy and his colleagues have had to make their best guesses as to whether someone should be admitted to a ward for coronavirus patients.

Hospitals in New York tended to move patients within their own systems to level loads. In Houston, the wealthier institutions have joined together to aid those least able to expand capacity.

This past week, Methodist sent a team to a nearby public hospital to accept transfer patients. Top officials from Methodist and the other flagship hospitals that make up the Texas Medical Center, normally competitors, consult regularly by phone. They have been coordinating for days with the county’s already overwhelmed safety-net system, Harris Health, taking in its patients. The private institutions have also agreed to take turns, with others in the state, accepting patients from rural hospitals.”..

But doctors, based on the experiences of physicians in New York and elsewhere, are avoiding ventilators when possible and are maintaining Ms. Hernandez on a high flow of oxygen through a nasal tube. She is on the maximum setting, but can talk to the clinical team and exchange text messages with her daughter, who is also a Methodist inpatient with the coronavirus…

Methodist was part of two remdesivir trials. But because the research has ended, it and other hospitals now depend on allotments of the drug from the state. As virus cases increased, the supplies ran short, said Katherine Perez, an infectious-disease specialist at the hospital. “In Houston, every hospital that’s gotten the drug, everyone’s just kind of used it up,” she said.

The hospital received 1,000 vials, its largest batch ever, a little over a week ago. Within four days, all the patients who could be treated with it had been selected, and pharmacists were awaiting another shipment.

A new chance to test remdesivir in a clinical trial in combination with another drug may provide some relief. As cases rise, Methodist researchers are being flooded with offers to participate in studies, with about 10 to 12 new opportunities a week being vetted centrally. Without solid research, “your option is to do a bunch of unproven, potentially harmful, potentially futile, interventions to very sick people who are depending on you,” said Dr. H. Dirk Sostman, president of Methodist’s academic medicine institute.

Dr. Boom, the Methodist chief executive, said if he could preserve one thing from the New York experience in March, it would be how the country came together as it had in previous disasters.” (F)

“Houston Health Department Health Authority Dr. David Persse said the city had reached a 25% positivity rate.

“The virus is very prevalent in the community,” Persse said, adding that there were more than 1,200 people in Houston hospitals with more than 500 of them in the ICU due to complications from the coronavirus. “The virus is very much out there,” Persse said, “It’s very much actively spreading.”

Texas is expected to see nearly 2,000 new hospitalizations per day by mid-July, according to forecasts published by the Centers for Disease Control and Prevention.

In Harris County, which encompasses Houston and is the most populous county in Texas, at least two hospitals are “pretty much at maximum capacity,” Turner said Wednesday.

“The threat … Covid-19 poses to our community right now is higher than it has been. There is a severe and uncontrolled spread between our families, friends, and communities,” Turner said. “And we need to slow it down, so that it doesn’t overwhelm our health care delivery system.”

On Friday, Texas reported a third day of new Covid-19 cases topping 7,000, according to state health department data.

It reported 7,555 cases Friday, continuing the trend of sharp growth of the disease in the state, with a record 8,076 new cases on Wednesday and 7,915 new cases Thursday, according to state data.

Texas also reported 50 new deaths from Covid-19 Friday. John Hopkins data puts the number of confirmed cases in the state at 185,591, with 2,592 deaths.

The virus has killed more than 129,000 people and infected over 2.7 million in the US since the pandemic started, according to Johns Hopkins University.” (G)

“For one brief, delusional moment in early April, I felt a smidgen of support for my governor, Greg Abbott. Sure, part of me thought his plan to reopen the state after just a few weeks of lockdown was cuckoo. Medical experts warned of a surge in coronavirus cases if Texas did just that…

But while New York and Washington were in crisis, the number of cases and deaths here remained remarkably low. Maybe Texas was being spared because of a lack of density in our cities or because people drove alone in their cars instead of cramming into subways. Maybe our already rising temperatures were killing off the virus.

Maybe, in contrast to the yahoo stereotype, most Texans were wearing masks, socially distancing and washing their hands and so had actually headed the virus off at the pass, or dodged the bullet, or whatever people think we like to say down here.

And maybe for those reasons, Mr. Abbott became infatuated with the idea that Texas would be among the first states to reopen. As he said, Texans needed to get back to work. That was indisputable. The food bank near my house was already overwhelmed with the unemployed and hungry.

Yes, Dr. Peter Hotez, Houston’s internationally known virus expert, warned of the dangers of opening early, but what did he know? The guy wears a bow tie…

On Memorial Day, the Galveston beaches were packed like Carnival in Rio. And out in rural Texas, folks who had no choice were working away in meat-processing plants. Businesses like Target and Wal-Mart welcomed shoppers without masks as if it were Black Friday.

As we now know, that was then. “Ten days away,” a friend who works for Judge Hidalgo told me the night before the June 2 march for George Floyd downtown, when police helicopters were circling over our socially distanced dinner party — 10 days before we would start to see the cases really spike.

That date coincided with the arrival of Mr. Abbott’s Phase 3, which allowed many businesses to reopen at 75 percent capacity on June 12. Shortly after that, the numbers exploded.

The governor knew better than to blame better testing for the increase, because we don’t have enough testing. Instead, he blamed those rowdy millennials: “There are certain counties where a majority of the people who are tested positive in that county are under the age of 30, and this typically results from people going to bars,” he said.

But, no worries, the governor added; Texas still has plenty of hospital beds. And today, we have more than 130,000 cases, up from over 60,000 at the end of May.

And so, here we are, with a jittery populace and the Texas Medical Center’s coronavirus website competing with TikTok. I.C.U.s in Houston are at 97 percent capacity, with “unsustainable surge capacity” predicted for hospital beds in late July. If “this trajectory persists,” Dr. Hotez tweeted, “Houston would become the worst-affected city in the U.S.” He added that it would “maybe rival what we’re seeing now in Brazil.”..

Now with the numbers climbing, Mr. Abbott has taken the bold step of hitting the pause button on future reopenings, allowing local officials to limit outdoor events to 100 people (down from 500), closing bars and suspending elective surgeries in some counties to save potentially needed bed space. But mainly his advice is just to stay put, which has become easier since New York, New Jersey and Connecticut are now requiring Texans to quarantine for 14 days upon arrival.

“We want to make sure that everyone reinforces the best safe practices of wearing a mask, hand sanitization, maintaining safe distance, but importantly, because the spread is so rampant right now, there’s never a reason for you to have to leave your home,” Mr. Abbott said in a recent interview. Unless you do need to go out, the safest place for you is at your home.”

In other words, we are all in this together. But we are also completely and totally on our own.” (H)

“In Queens, the borough with the most coronavirus cases and the fewest hospital beds per capita, hundreds of patients languished in understaffed wards, often unwatched by nurses or doctors. Some died after removing oxygen masks to go to the bathroom.

In hospitals in impoverished neighborhoods around the boroughs, some critically ill patients were put on ventilator machines lacking key settings, and others pleaded for experimental drugs, only to be told that there were none available.

It was another story at the private medical centers in Manhattan, which have billions of dollars in endowments and cater largely to wealthy people with insurance. Patients there got access to heart-lung bypass machines and specialized drugs like remdesivir, even as those in the city’s community hospitals were denied more basic treatments like continuous dialysis.

In its first four months in New York, the coronavirus tore through low-income neighborhoods, infected immigrants and essential workers unable to stay home and disproportionately killed Black and Latino people, especially those with underlying health conditions.

Now, evidence is emerging of another inequality affecting low-income city residents: disparities in hospital care.

While the pandemic continues, it is not possible to determine exactly how much the gaps in hospital care have hurt patients. Many factors affect who recovers from the coronavirus and who does not. Hospitals treat vastly different patient populations, and experts have hesitated to criticize any hospital while workers valiantly fight the outbreak.

Still, mortality data from three dozen hospitals obtained by The New York Times indicates that the likelihood of survival may depend in part on where a patient is treated. At the peak of the pandemic in April, the data suggests, patients at some community hospitals were three times more likely to die as patients at medical centers in the wealthiest parts of the city…

Inequality did not arrive with the virus; the divide between the haves and the have-nots has long been a part of the web of hospitals in the city.

Manhattan is home to several of the world’s most prestigious medical centers, a constellation of academic institutions that attract wealthy residents with private health insurance. The other boroughs are served by a patchwork of satellite campuses, city-run public hospitals and independent facilities, all of which treat more residents on Medicaid or Medicare, or without insurance.

The pandemic exposed and amplified the inequities, especially during the peak, according to doctors, nurses and other workers.” (I)

“Dr. Anthony S. Fauci, the nation’s top infectious disease expert, warned on Monday that the country was still “knee-deep in the first wave” of the pandemic, as U.S. deaths passed 130,000 and cases neared three million, while Texas and Idaho set daily records for new cases, according to a New York Times database.

Dr. Fauci said that the more than 50,000 new cases a day recorded several times in the past week were “a serious situation that we have to address immediately.”..

“I would say this would not be considered a wave,” Dr. Fauci said. “It was a surge, or a resurgence of infections superimposed upon a baseline that really never got down to where we wanted to go.”..

Dr. Fauci compared the United States unfavorably with Europe, which he said was now merely handling “blips” as countries move to reopen. “We went up, never came down to baseline, and now it’s surging back up,” Dr. Fauci said.”  (J)

• A.How America’s Hospitals Survived the First Wave of the Coronavirus, by Charles Ornstein, https://www.propublica.org/article/how-americas-hospitals-survived-the-first-wave-of-the-coronavirus
• B.‘I Am Very Concerned,’ Fauci Tells Senators About Coronavirus Spread, By Sheryl Gay Stolberg and Noah Weiland, https://www.nytimes.com/2020/06/30/us/politics/fauci-coronavirus.html?referringSource=articleShare
• C.Internal messages reveal crisis at Houston hospitals as coronavirus cases surge, BY CHARLES ORNSTEIN and MIKE HIXENBAUGH, https://www.texastribune.org/2020/07/01/coronavirus-texas-houston-hospitals-cases-surge/
• D.Hospitals face ‘an explosion of Covid’ and signs of another surge as coronavirus case numbers climb, By Christina Maxouris, https://www.cnn.com/2020/07/02/health/coronavirus-hospitalizations-rates-rise/index.html
• E.Texas won’t specify where hospital beds are available as coronavirus cases hit record highs, BY SARAH R. CHAMPAGNE, https://www.texastribune.org/2020/07/02/texas-hospital-capacity-coronavirus/
• F.As Coronavirus Slams Houston Hospitals, It’s Like New York ‘All Over Again’, By Sheri Fink, https://www.nytimes.com/2020/07/04/us/coronavirus-houston-new-york.html?referringSource=articleShare
• G.2 Texas counties urge residents to shelter in place as hospitals reach capacity, By Alta Spells and Susannah Cullinane, https://www.cnn.com/2020/07/04/us/texas-hospitals-coronavirus/index.html
• H.How Texas Swaggered Into a Coronavirus Disaster, By Mimi Swartz, https://www.nytimes.com/2020/06/28/opinion/texas-coronavirus.html?referringSource=articleShare
• I.Why Surviving the Virus Might Come Down to Which Hospital Admits You, By Brian M. Rosenthal, Joseph Goldstein, Sharon Otterman and Sheri Fink, https://www.nytimes.com/2020/07/01/nyregion/Coronavirus-hospitals.html?referringSource=articleShare
• J.Fauci Says Virus Cases ‘Never Got Down to Where We Wanted to Go’ as Deaths Pass 130,000, https://www.nytimes.com/2020/07/06/world/coronavirus-updates.html?referringSource=articleShare