POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”

“Colorado Gov. Jared Polis (D) signed an executive order on Monday that allows hospitals to stop admitting new patients when they reach capacity and transfer patients to other hospitals.

The executive order permits the Colorado Department of Public Health and Environment to direct at-capacity hospitals to transfer patients to other facilities, without first obtaining written permission from the patient.

“Unfortunately, given the increase in infections, the number of persons seeking medical treatment at hospitals may far exceed the capacity of any given hospital,” the order reads.

“Hospitals who have reached capacity may need to cease admitting patients and may also need to transfer such patients to a separate facility without first obtaining the individual’s written or informed consent for such transfer,” the order continues.

The order, which will be in effect for the next 30 days, permits hospitals that are at “capacity to examine and treat patients” to send them to other health care facilities in an effort to prevent the hospitals from becoming overwhelmed.” (A) 

“Your local hospital could soon take on a new policy that aims to clear up any confusion surrounding your ability to visit patients during the coronavirus pandemic.

Hospital leaders in the state, along with the New Jersey Hospital Association, have partnered to develop color codes based on the level of COVID-19 risk, that would ideally be used by medical institutions statewide.

“Our hospitals recognize how difficult it is for patients when they are isolated from their families and support systems,” NJHA President and CEO Cathy Bennett said. “Our goal with this color-level visitation policy is to create transparency and consistency, using a data-driven formula that continues to put the safety of patients and staff first and foremost.”

Determining where hospitals land on the three-level spectrum is based on four key metrics: COVID-19 levels in the community; the level of hospitalized COVID-19 patients; staffing levels; and availability of personal protective equipment.

The codes, though, would not be applied hospital to hospital. To provide greater consistency, color levels would be applied to regions of the Garden State — for example, hospitals in Northeast New Jersey would all be considered to be under the same “threat.”

No matter the color-code at the time, hospitals would not be permitting visitors for COVID-19 patients or those who are immunocompromised, except for circumstances approved by a care team.” (B)

“The Center for Disease Control and Prevention may soon shorten its quarantine guidelines for those who believe they have been exposed to COVID-19, according to a report in the Wall Street Journal. The move, which has been floated in the past, is reportedly aimed at motivating more people to quarantine.

Dr. Henry Walke, the CDC’s director of the division of preparedness and emerging infections, told the Wall Street Journal that an increase in the availability and accuracy of tests are part of what’s driving the change. “We do think that the work that we’ve done, and some of the studies we have and the modeling data that we have, shows that we can with testing shorten quarantines,” Walke said.

According to the WSJ, the new recommendation — which is reportedly in the final stages of approval — would suggest individuals who were exposed to someone with COVID-19 quarantine for between seven and 10 days, and then get tested before seeing other people. So how does that differ from the current guidelines and what do experts think about the possible shift? Here’s what you need to know.

The current CDC guidelines call for a 14-day quarantine

The new guideline would be a significant departure from the CDC’s current quarantine recommendations, which state that “anyone who has had close contact with someone with COVID-19 should stay home for 14 days after their last exposure to that person.” The guidance exempts those who have tested positive for COVID-19 within the last three months — as long as symptoms do not reappear.

The shorter quarantine time is likely a reflection of incubation period

Although the full incubation period for COVID-19 is technically between two and 14 days, the amended guidelines from the CDC would reflect a growing body of evidence showing that the median incubation period from exposure to onset of symptoms is five days. Yes, a positive test can occur after 10 days, but experts say it is extremely rare, which is why the organization may be considering shortening it.” (C)

“A mom of eight boys, Kim Gudgeon was at her wits’ end when she called her family doctor in suburban Chicago to schedule a sick visit for increasingly fussy, 1-year-old Bryce.

He had been up at night and was disrupting his brothers’ e-learning during the day. “He was just miserable,” Gudgeon said. “And the older kids were like, ‘Mom, I can’t hear my teacher.’ There’s only so much room in the house when you have a crying baby.”

She hoped the doctor might just phone in a prescription since Bryce had been seen a few days earlier for a well visit. The doctor had noted redness in one ear but opted to hold off on treatment.

To Gudgeon’s surprise, that’s not what happened. Instead, when she called, her son was referred to urgent care, a practice that has become common for the Edward Medical Group, which included her family doctor and more than 100 other doctors affiliated with local urgent care and hospital facilities. Because of concerns about the transmission of the coronavirus, the group is now generally relying on virtual visits for the sick, but often refers infants and young children to urgent care to be seen in person.

“We have to take into consideration the risk of exposing chronically ill and well patients, staff and visitors in offices, waiting areas or public spaces,” said Adam Schriedel, chief medical officer and a practicing internist with the group.

Gudgeon’s experience is not unusual. As doctors and medical practices nationwide navigate a new normal with COVID-19 again surging, some are relying on urgent care sites and emergency departments to care for sick patients, even those with minor ailments.

That policy is troubling to Dr. Arthur “Tim” Garson Jr., a clinical professor in the College of Medicine at the University of Houston who studies community health and medical management issues. “It’s a practice’s responsibility to take care of patients,” Garson said. He worries about patients who can’t do video visits if they don’t have a smartphone or access to the internet or simply aren’t comfortable using that technology.

Garson supports protocols to protect staff and patients, including in some instances referrals to urgent care. In those cases, practices should be making sure their patients are referred to good providers, he said. For instance, children should be seen by urgent care facilities with pediatric specialists.” (D)

“As the crush of new COVID-19 hospitalizations stretches hospitals around the state to their limits, the Mayo Clinic Health System is taking unprecedented steps to expand capacity at its northwestern Wisconsin locations. Those include moving beds into waiting rooms, surgical spaces and even a parking garage.

It’s been just more than a week since the Mayo Clinic announced 100 percent of its hospital beds in Northwestern Wisconsin were full. That number fluctuates by the hour, but emergency room physician Paul Horvath said hospitals and emergency rooms have been forced into what is known as “diversion status.”

“I worked a shift in one of the emergency departments the other evening,” Horvath said, “and literally every bed in northwest Wisconsin was full, and hospitals just weren’t able to admit new patients. Which means that I had the challenge of managing ICU level care in my ER for hours, which is obviously not routine.”

A recent surge of 20 patients at Mayo’s hospital in Barron forced staff to move some patients into a room designated for preparing people for surgery, said Horvath. He said when emergency departments fill up, paramedics have to find new places to bring patients that are further away and may not have the same level of staff or equipment to treat the critically ill.

Horvath said from a patient’s perspective, the team of doctors and nurses all look the same in their layers of personal protective equipment. Beeping monitors and the hurried, labored breathing of paitients makes communication more difficult too. Horvath said he sometimes feels like he’s yelling at patients and staff to cut through the noise.

Sue Cullinan is an emergency room doctor at Mayo Clinic’s Eau Claire hospital. On Oct. 12, she recorded video diary entries detailing how the hospital was preparing for the ongoing surge of new admissions.

“Our surge plan expands into the garage, it opens up more beds, we’re expanding into lobbies, we’re putting people where we wouldn’t normally put patients,” said Cullinan.

“Not where I’d want to put my grandfather or my grandmother,” she said, though it “may have to happen.” (E)

“Wealthy New Yorkers are shelling out big bucks to professional line-waiters so they won’t have to sit in hours-long COVID-19 testing queues ahead of Thanksgiving.

Cash-strapped locals who offer their line-sitting services on freelance marketplace TaskRabbit told The Post they’ve been charging up to $80 an hour for the service — and people are paying.

“I’ve already done this about five times already,” said one out-of-work writer as she waited in a CityMD line in Soho for someone else.” (F)

• A.Colorado order allows hospitals to stop admitting, transfer patients when at capacity due to COVID-19, BY JUSTINE COLEMAN, https://thehill.com/homenews/state-watch/527295-colorado-order-allows-hospitals-to-stop-admitting-transfer-patients-when
• B.NJ HOSPITALS TAKING ON COVID-19 COLOR CODES FOR VISITORS, DINO FLAMMIA, https://nj1015.com/nj-hospitals-taking-on-covid-19-color-codes-for-visitors/
• C.Experts encourage CDC to shorten COVID-19 quarantine: ’14 …
• D.Parents Complain That Pediatricians, Wary of COVID, Shift Sick Kids to Urgent Care, By Kristy P. Kennedy, https://khn.org/news/parents-complain-that-pediatricians-wary-of-covid-shift-sick-kids-to-urgent-care/
• E.Mayo Clinic Puts Hospital Beds In Ambulance Garage, Lobbies As COVID-19 Surges, By Rich Kremer, https://www.wpr.org/mayo-clinic-puts-hospital-beds-ambulance-garage-lobbies-covid-19-surges
• F.Rich New Yorkers are hiring line-waiters to sit in COVID-19 testing queues, By Gabrielle Fonrouge, https://nypost.com/2020/11/23/new-yorkers-are-hiring-line-waiters-to-sit-in-covid-19-test-lines/?utm_medium=browser_notifications&utm_source=pushly&utm_campaign=719994