POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”

“Throughout the COVID-19 crisis in Florida, Gov. Ron DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced, a South Florida Sun Sentinel investigation has found.

DeSantis, a Republican who owes his job to early support from President Donald Trump, imposed an approach in line with the views of the president and his powerful base of supporters. The administration suppressed unfavorable facts, dispensed dangerous misinformation, dismissed public health professionals, and promoted the views of scientific dissenters who supported the governor’s approach to the disease.

The DeSantis administration’s approach to managing COVID-19 information carries costs. It supports a climate in which people proudly disdain masks, engage in dangerous group activities that could spread the disease, and brush aside information that conflicts with their political views. With partygoers packing Florida bars and holiday travelers filling hotels and guest rooms, the state faces a few difficult months before the possible relief of vaccines.

These findings are based on interviews with more than 50 people, including scientists, doctors, political leaders, employees of the state health department, and other state officials, as well as more than 4,000 pages of documents.

— The Florida Department of Health’s county-level spokespeople were ordered in September to stop issuing public statements about COVID-19 until after the Nov. 3 election.

— The DeSantis administration refused to reveal details about the first suspected cases in Florida, then denied the virus was spreading from person to person — despite mounting evidence that it was.

— State officials withheld information about infections in schools, prisons, hospitals and nursing homes, relenting only under pressure or legal action from family members, advocacy groups and journalists.

— The DeSantis administration brushed aside scientists and doctors who advocated conventional approaches to fighting the virus, preferring scientists on the fringes who backed the governor’s positions.

— The governor’s spokesman regularly takes to Twitter to spread misinformation about the disease, including the false claim that COVID was less deadly than the flu.

— The governor highlighted statistics that would paint the rosiest picture possible and attempted to cast doubt on the validity of Florida’s rising death toll….

The attempt to deflect attention from negative news is called “blue sky” messaging, and that’s how it was described to local health representatives, according to three health department spokespeople.

“Nothing gets approved without it passing through the governor’s office,” said one county health department spokesperson. “If it’s not blue sky, then it’s held up or we’re told to hold off and it never gets approved.”…

Florida’s wealth of university-affiliated experts on infectious diseases have largely watched from the sidelines as the governor consulted coronavirus advisers who would back his policies.

“We have over 200 affiliated faculty within this institute,” said Dr. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute. “This is what we do for a living. Yet the state has not taken full advantage of that expertise.”

The DeSantis administration’s failure to rely on the institute — established by the state Legislature in 2006 to address disease threats to Florida — is emblematic of its decision to shut out mainstream scientists in favor of a select group who would confirm the less-restrictive COVID-19 policies favored by many Republicans.

“Unfortunately, they’re not drawing on the best science, they’re drawing on political needs,” Morris said. “In many ways, it’s a tragedy.”…

In place of Florida scientists, the governor called on a group of experts and quasi-experts who would tell him what he wanted to hear.

Among them was Dr. Scott Atlas, a radiologist and senior fellow at Stanford University’s conservative Hoover Institution, who served as Trump’s coronavirus adviser despite having a medical specialty that did not involve infectious disease. Atlas won Trump’s favor with optimistic statements on the pandemic, skepticism of masks, advice to limit testing and promotion of an approach that involved reopening the economy.

“Calling people in from out of state to be experts who are of your same mindset, you are controlling the narrative, and it’s politics not science,” said Dr. Jay Wolfson, senior associate dean of the University of South Florida’s Morsani College of Medicine. “Florida is one of the top states in the nation for expertise to draw on. Unfortunately, at the state level, I’m afraid we are not being heard, and evidence-based data is not being used as far decisions being made.”…

At a news conference Monday, the governor said the hard evidence on tactics such as lockdowns and mask mandates shows they simply don’t work.

“At some point you have to look at the observed experience about what’s happening,” he said. “And I think there’s narratives like ‘lockdowns work.’ And they don’t, if you look at the evidence, business closures, all this stuff, look at what just happened in Europe, France locked down Switzerland didn’t — same viral curve, literally, no difference. So you focus on protecting vulnerable people. You provide the resources to our medical and hospitals as they need it.”” (A)

“Last week, Florida became the third state to report more than 1 million cases, following California and Texas. A total of 1,058,074 people in Florida have tested positive since the pandemic began.

In November alone, Florida reported 200,753 cases of COVID-19 — nearly 20 percent of the total number of cases in the state since March…

As for testing, the health department reported 7.86 percent of 118,590 test results returned from labs were positive for COVID-19 through Dec. 5. The median age of Floridians testing positive is 40.

As for hospitalizations, 4,400 people in Florida were hospitalized with coronavirus as their primary diagnosis as of Sunday afternoon. Of those, 1,104 patients were in the Tampa Bay area.

Statewide, a total of 56,457 people in Florida have been hospitalized with the virus at some point during the pandemic.” (B)

“Warning that New York had entered a “new phase in the war against Covid,” Gov. Andrew M. Cuomo said on Monday that the state will implement a barrage of new emergency actions, some of which echo the strict measures taken this spring, to stem a rising tide of infections and deaths.

Mr. Cuomo said that the strength of the virus’s second wave has forced the state to rely less on test positivity rates as the determinant for restrictions, and focus more on hospital capacity. On Monday, the governor announced that hospitalizations topped 3,500 over the weekend, a level not seen since May.

The governor said if hospitals become overwhelmed, he could impose a regionally based shutdown, or “pause” order, as he did statewide in the spring. He also asked hospitals to begin identifying retired doctors and nurses to help staff medical facilities, where he said burnout was an increasingly common problem.

The governor said he wanted to prevent the conditions that led to Elmhurst Hospital in Queens being inundated by coronavirus patients this spring, with beds filled, doctors overworked and refrigerated trucks posted outside to hold the dead.

“We are not going to live through the nightmare of overwhelmed hospitals again,” Mr. Cuomo said during a briefing in Manhattan.

Mr. Cuomo said that he would ask hospitals to increase the number of beds by 50 percent, and hospital chains to evaluate where there was capacity inside of those systems, to help redistribute patients where there was availability.

Plans for field hospitals were being dusted off, the governor said, adding that capacity would also be evaluated between hospitals in different parts of the state, an idea known as “surge-and-flex,” another measure the governor implemented in the spring.

Similarly, Mr. Cuomo also announced that he was ordering hospitals to stop elective surgery in Erie County, in Western New York, which is currently enduring the highest weekly positive test rates in the state. The county led the state in number of deaths reported on Monday.

Despite rising rates of infection, Mr. Cuomo has resisted implementing the kind of widespread shutdowns seen in March, when hundreds of New Yorkers began to die every week, and much of New York’s economic activity ground to a complete halt.

Rather, Mr. Cuomo’s strategy has been to utilize targeted restrictions on individual areas — known as his “micro-cluster initiative” — which has now expanded to nearly 30 locations around the state, including in all five boroughs of New York City, its suburban counties, and major upstate population centers.

The announcement on Monday came after weeks of steadily more worrying news in New York. The state’s daily rate of positive tests on Sunday topped 4 percent for the first time since May, and the number of more serious cases continued to grow. The positivity rate was reported to be 4.57 percent on Monday…

On Monday, the governor said new metrics — including hospitalization rates, death and case rates, and available hospital beds — would be used to determine lockdown levels under the “micro-cluster” strategy, the state’s color-coded restriction system. Mr. Cuomo said those new numbers will be set this week, after the state evaluates the effects of people congregating during last week’s Thanksgiving holiday.

“I don’t believe we’ve seen the hit from Thanksgiving,” he said, adding that he believed the increase in cases “will be dramatic.”

It’s still unclear how the governor will reconcile positivity rates and hospital metrics to determine new restrictions, but state officials said homing in on hospitalizations was a useful way to determine the severity of the disease in any given location. There are areas in the state where the number of people testing positive has increased, for example, but hospitalizations have not, lessening the urgency for new restrictions there, officials said.

State officials fear that testing sites will reveal a new surge in virus numbers caused by Thanksgiving gatherings.

With Mr. Cuomo ordering the redistribution of patients across hospitals, the state plans to track hospitalizations by a patient’s home address, not only where the person is hospitalized, to better ascertain which parts of the state are driving hospital admissions….

State officials believe a majority of new cases in the state stem from small gatherings in homes, with people increasingly congregating indoors as temperatures drop, rather than in public settings like bars and restaurants. Changing that behavior, the governor said, would require a robust public messaging campaign similar to the one employed around mask wearing.

“It is all in our control,” Mr. Cuomo said.” (C)

“Massachusetts Gov. Charlie Baker toured the field hospital that’s been rebuilt at Worcester’s DCU Center and announced that a second field hospital will be built in the state soon.

The Worcester field hospital being readied amid a second surge of COVID-19 will have “a lot more capacity” than it did when it was active in the spring, Massachusetts Gov. Charlie Baker said Thursday morning, and it will be ready to take patients Sunday.

“Field hospitals play a critical role in our preparedness strategy that helps us alleviate pressure on the health care system generally and enables hospitals to focus on non-COVID patients,” Baker said after touring the field hospital that the National Guard is establishing at the DCU Center in Worcester. At full capacity, it is expected to be able to accommodate 220 patients.”” (D)

“Rhode Island has opened two field hospitals that combined have more than 900 beds as the number of people hospitalized with COVID-19 in the state reached a new high….

Care New England opened a field hospital with more than 300 beds in Cranston on Monday, the same day the state sent an emergency alert saying conventional hospitals had reached their coronavirus capacity.

A facility with nearly 600 beds opened Tuesday at the Rhode Island Convention Center in Providence. It is run by Lifespan, the state’s largest hospital group.

The Lifespan facility expects to admit 24 to 48 patients on Tuesday, but may need more staff, Chief Nursing Executive Cathy Duquette said.

“We are prepared to take up to 100 patients with the staff we have been able to get. If we see demand increasing, we will certainly reach out to get more from our agency partners,” she said.

Both field hospitals will take patients who are not critically ill.” (E)

“COVID-19 deaths and hospitalizations are at record levels, and the rising case toll from Americans’ holiday travel has created an unprecedented surge with no relief in sight.

The problem is especially ominous in the nation’s intensive care units – specialized units crowded with a record number of critically ill Americans as the nation struggles through the most dangerous phase of the pandemic….

Hospitals already are employing strategies to stretch resources. Utah hospitals have canceled surgeries and shifted staff to makeshift ICU units to care for the growing number of COVID-19 patients. North Dakota’s rural hospitals, short on available beds and expertise, in recent weeks transferred patients to surrounding states. And in Colorado, Gov. Jared Polis signed an executive order authorizing the state health department to order at-capacity hospitals to halt admissions and transfer patients…

New Mexico’s ICU beds were at 103% capacity as of Thursday, the highest rate in the nation, according to U.S. Department of Health and Human Services figures.

Space also is tight at the state’s medical-surgical units in Albuquerque, Las Cruces and Farmington, and rural hospitals are quickly filling, too, according to Troy Clark, president and CEO of New Mexico Hospital Association.

Hospitals used extra space in emergency departments and operating rooms not licensed for beds to accommodate patients, but Clark said the major bottleneck is finding enough doctors, nurses and respiratory therapists to care for them.

COVID-19’s effect on health care workers is far greater now than during the spring or summer. Hospital workers can be infected at home or in their communities. Even if they are not sick, workers exposed to the virus often wait up to four days for test results, Clark said.

“That’s where we’re stressed across the state of New Mexico right now,” he said. “While there may be physical beds, there is not a nurse, a nurse tech or respiratory therapist to care for those patients.”

In North Dakota, Gov. Doug Burgum issued an order last month allowing staff who test positive for the virus but show no symptoms to keep caring for COVID-19 patients….

But hospitals will continue to seek ways to stretch resources under crisis-care scenarios, experts say.

Nursing home residents who need to be hospitalized might find such stays are shortened, Orlowski said.

And when things get really tight, hospitals need to choose who gets life-sustaining therapies. A person with minor ailments might get treatment while a person with several preexisting conditions and low oxygen might not.

If doctors determine a person’s chances of death are significantly high, “they may say, you know what, we are going to use our resources not to do this miraculous save, but we’re going to concentrate our resources on people we know who will be improved by our care,” Orlowski said.

New York hospitals struggled with similar decisions when allocating ventilators and kidney dialysis for lifesaving care during the worst days this spring.

According to the Johns Hopkins report, some hospitals did not have clear written guidelines on ventilators when “capacity became limited.” Doctors had to decide whether to intubate, or insert breathing tubes into people, and which type of ventilator to use. In some cases, hospitals had the equipment but not enough staff.

The same was true for COVID-19 patients suffering kidney failure. Therapy was in short supply for these patients, so doctors had to triage, or choose whether kidney failure patients would get two or three days of dialysis, according to the Johns Hopkins report.

During the summer surge, Banner Health in Arizona faced a shortage of ECMO machines. Extracorporeal membrane oxygenation machines are a last-ditch therapy for those whose lungs are damaged and they can no longer effectively breathe with a ventilator. The machine pumps blood to an artificial lung, adds oxygen and returns the blood to the patient…

Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, said hospital administrators face tough choices.

“You have to think about capacity on a day by day basis, because we don’t see this surge ebbing any time soon.”” (G)

“New Mexico hospitals may soon move to “crisis standards of care,” allowing providers to ration care depending on a patient’s likelihood of survival, Gov. Michelle Lujan Grisham (D) said in a Washington Post interview.

The state of play: “New Mexico has consistently won praise among public health experts for its aggressive approach to combating the virus,” the Post writes. But hospitals across the state have been operating at or near capacity recently, with many close to running out of ICU and regular beds, the Santa Fe New Mexican reports.

By the numbers: On Friday, the state saw 2,073 new COVID-19 cases, and had a 14.2% case count increase over the past week, according to the COVID Tracking Project. Currently 934 people are being hospitalized.

The big picture: Lujan Grisham imposed a two-week shutdown ahead of Thanksgiving to mitigate the risk of a rise in cases. The latest restrictions were the strictest in the state since the stay-at-home order issued in March, according to the Santa Fe New Mexican.

Although the governor told WaPo that positivity and infection rates dropped, she said she would likely allow hospitals to move to “crisis standards of care” this Monday.

Of note: Each hospital will decide on its own whether that step is necessary.” (H)

“President-elect Joe Biden picked California Attorney General Xavier Becerra for secretary of health and human services on Monday as one of his administration’s top officials to fight the raging coronavirus pandemic.

Biden, who takes office on Jan. 20, also chose Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital in Boston, to run the U.S. Centers for Disease Control and Prevention (CDC). Biden formally tapped Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, as his chief medical adviser on the virus.

Biden named Jeff Zients, an economic adviser known for his managerial skills, as a coronavirus “czar” to oversee the response that will soon include an unprecedented operation to distribute hundreds of millions of doses of a new vaccine, coordinating efforts across multiple federal agencies.

“This team of world-class medical experts and public servants will be ready on Day One to mobilize every resource of the federal government to expand testing and masking,” Biden said in a statement, adding that they would “oversee the safe, equitable, and free distribution of treatments and vaccines.”…

Biden also picked Vivek Murthy, a physician and former surgeon general, to return for a second term as surgeon general. He chose Dr. Marcella Nunez-Smith, a professor at the Yale School of Medicine, to lead a group to deal with addressing the disproportionate impact of COVID-19 on Black and Latino Americans.” (F)

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(A)Secrecy and spin: How Florida’s governor misled public on COVID-19 pandemic, By Mario Ariza, David Fleshler and Cindy Krischer Goodman Sun Sentinel https://www.newburyportnews.com/news/national_news/secrecy-and-spin-how-floridas-governor-misled-public-on-covid-19-pandemic/article_32237e88-27c5-5a8f-ae8d-af9a6dc2e139.html

(B) Coronavirus in Florida: State reports another 8,436 Floridians test positive for COVID-19, https://www.11alive.com/article/news/health/coronavirus/coronavirus-numbers/florida-coronavirus-report-sunday-december-6-2020/67-b69d496b-8f6c-4c0c-9c68-e28e8596ba7e

(C) Cuomo Fears ‘Nightmare of Overwhelmed Hospitals’ as Virus Cases Spike, By Jesse McKinley and Luis Ferré-Sadurní, https://www.nytimes.com/2020/11/30/nyregion/coronavirus-hospitalization-ny.html?referringSource=articleShare

(D) Second Mass. COVID Field Hospital Planned for Lowell, Baker Says, https://www.nbcboston.com/news/local/mass-gov-baker-to-tour-field-hospital-as-coronavirus-cases-soar/2247078/

(E)Rhode Island opens field hospitals as hospitalizations surge, https://apnews.com/article/health-rhode-island-coronavirus-pandemic-providence-210c8519938dd7c68cfe667dc8e13fc3

(F) Biden Names Health Team to Fight Pandemic, California’s Becerra in Leading Post, BY TREVOR HUNNICUTT, https://apnews.com/article/health-rhode-island-coronavirus-pandemic-providence-210c8519938dd7c68cfe667dc8e13fc3

(G) ‘A very, very dark place’: Hospitals brace for crisis-care mode with too many patients, not enough staff, Ken Alltucker, https://www.usatoday.com/story/news/health/2020/12/05/hospitals-crisis-care-mode-coronavirus-hospitalizations-increase/3820852001/

(H) New Mexico to allow hospitals to ration coronavirus medical care, by Oriana Gonzalez, https://www.axios.com/new-mexico-hospitals-ration-coronavirus-care-2870a519-ae95-43cd-8065-d52cd00a8251.html

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