POST 230. January 20, 2022. CORONAVIRUS. “Dr. Fauci also said that the world is still in the first of what he considered to be the five phases of the pandemic. The first is the “truly pandemic” phase, “where the whole world is really very negatively impacted,” followed by deceleration, control, elimination and eradication.”…to paraphrase Churchill – “This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”..
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The White House chief medical adviser, while speaking at the World Economic Forum’s Davos Agenda online conference, said that “it is an open question whether it will be the live virus vaccination that everyone is hoping for,” according to CNBC.
“I would hope that that’s the case. But that would only be the case if we don’t get another variant that eludes the immune response of the prior variant,” he added…
Fauci’s comments come a week after Europe’s top medical product regulation agency said that the COVID-19 omicron variant may be pushing the pandemic into becoming endemic.
Marco Cavaleri, head of vaccine strategy for the European Medicines Agency (EMA), told reporters on Tuesday that the natural immunity conferred by the highly infectious omicron strain may be fast-tracking the progress towards endemicity.
According to the BBC, epidemiologists would consider a disease endemic when “levels are consistent and predictable — unlike the boom and bust waves so far in the pandemic.”…
However, he added that “we don’t want to get into a whack-a-mole for every variant, where you have to make a booster against a particular variant. You’ll be chasing it forever.”” (A)
“Dr. Fauci also said that the world is still in the first of what he considered to be the five phases of the pandemic. The first is the “truly pandemic” phase, “where the whole world is really very negatively impacted,” followed by deceleration, control, elimination and eradication.
He said that only one infectious human disease has ever been eradicated: smallpox.
“That’s not going to happen with this virus,” he said.
However, once countries reach the “control” phase, when the virus becomes a “non-disruptive presence,” then the virus will be considered endemic, he said. The rhinovirus and some upper respiratory infections are examples of endemic diseases.
As Omicron continues to spread at a breakneck speed, some governments seem resigned to the idea that Covid is already a fixture of daily life. In some European countries, the authorities are pushing a “learn to live with it” approach that includes shorter isolation periods and the elimination of pre-departure tests for travel.” (B)
“Dr. Steven Brown is on the front line of the battle against the surge of COVID-19 cases. But for him, the front line is also the home front.
Working overnights, the 66-year-old critical care specialist manages hundreds of intensive care unit patients in hospitals across the Midwest, more than half of them COVID cases, many on ventilators. And he does it from his living room in suburban St. Louis.
Sitting before an array of four large computer screens and two laptops, he compares his work to that of an air traffic controller. He can read charts, scans, X-rays and even look in on patients with the help of sophisticated cameras in the ICUs.
“Each room has its own camera in it and I’m remotely operating it,” he told ABC News.
So despite being distant from his patients, his care is intimate. “I can look in a throat. I can look at how they’re using their muscles of respiration and whether they have disordered breathing. I’m able to do extreme fine-tuning of the ventilator settings for patients.”
And lately, more and more of his cases are COVID patients on ventilators. On his regular 12-hour shifts, he reports that the “amount of disease I am seeing is amplified. While some critical care doctors on a night shift might be managing eight or 10 patients with COVID-19 who are on ventilators for their shift, I’m managing 10 times as many because I’m managing patients in multiple sites….
Working from home, however, does not mean working less. Brown forecasts that the surge in the disease will mean a surge in his already grueling work schedule, from 10 straight days of 7 p.m. to 7 a.m shifts to 12 days in a row or more…
The eICU program, which began in 2008, is a virtual intense care unit where nurses and doctors provide care to patients at a UW Health office building. Care is provided at seven hospitals and eight ICUs across Wisconsin and northern Illinois 24 hours a day, Lynn Jacobs, a nursing supervisor at UW Health said.
“We’ve partnered with hospitals for many years now, and this program has allowed us to play a pivotal role during this terrible pandemic surge helping rural hospitals that are just not designed to handle this severity and volume of illness,” Jacobs said…
The eICU has helped care for about 1,300 COVID-19 ICU patients since the beginning of 2020, Jacobs said. In 2021, around 25% of the eICU admissions with a COVID-19 diagnosis have occurred in the last six weeks.” (C)
“For several years, Houston Methodist had been planning to spin up a virtual intensive care unit to provide support for community hospitals and widen access to care.
“We had chosen the technology, the cameras were hung, and we had signed contracts for our physicians to work,” explained Roberta Schwartz, executive vice president and chief innovation officer at the health system.
The team used Caregility for their cameras and Medical Informatics Corp.’s Sickbay platform for their artificial intelligence tools. Their intensivists were employed through Equum Medical.
In February 2020, the team hung the final camera on the main campus.
“Our first COVID-19 patient arrived in March,” she said…
“We added the community hospitals as we could get carts, and then, eventually, we added their cameras,” she said.
The model allowed the health system to care for the increased volumes of critically ill patients.
Schwartz noted that the project involves “countless” change-management pieces.
“From hiring nurses and contracting physicians, to deciding where buttons go, to deciding when and who should be called on what type of issues – there are so many workflows that need to be identified,” said Schwartz, who also spoke to Healthcare IT News earlier this year about the system’s conversational AI technology.” (D)
“Rural hospitals are getting help from technology during a surge in COVID-19 cases and the need for intensive care treatment.
It allows doctors and nurses to continuously monitor critically ill patients from hundreds of miles away. It’s called eICU, a virtual intensive care unit.
Doctors in a UW Health office building in Madison can provide care to patients in seven hospitals and eight ICUs across the state.
“So we can see all of the patients’ telemetry so their EKG tracings, what their heart rate is, what their blood pressure is doing, how they’re oxygenating. We can also go into all of their health records,” says Lynn Jacobs, Nursing Supervisor, eICU, UW-Health.
The program uses screens and cameras. Doctors can provide expertise to rural hospitals dealing with more critically ill patients due to COVID-19.
“We are seeing a lot more sick patients, a lot of patients that are a lot younger than ones that we’ve cared for, and having the ability to have the intensivists oversight over the care of our patients. give guidance and be a resource has been huge to ensure that the level of care they’re getting here is the same as what they would be getting at UW or at our larger PPS hospital,” says Jessica Faude, interim Vice President of Patient Care Services, Aspirus Medford Hospital.
Faude says eICU is an invaluable tool as rural hospitals lack the number of beds to take care of an influx of critically ill patients and to care for them for a longer period of time.
“We’re keeping vented patients, you know, filling our ICUs with vented patients that we’ve not done for over a while. But we’re comforted in knowing that we’re doing the best care. We have the oversight of UW and their intenseness that are dealing with this every day. So it’s been huge,” says Faude.
Dr. Jeff Wells is the medical director of eICU at UW Health.
“So we see all that information and then information comes into us and we’re able to help them use that to help take care of their patients, to give them the added benefit of experts in critical care that they may not have at the facility or may not have at that time at their facility to help support the care of their patients,” says Wells.
Jacobs explains, “There’s always somebody physically at all of our sites to take care of patients 24/7, but this way, in a small town, physicians are able to get some more rest, and our physicians can kind of take over.”..
While this background assistance helps staff on the ground, it doesn’t give them more hands to get the job done. Through telehealth doctors offsite can make a recommendation, but it still requires that someone on the ground make it happen.
It’s “not quite the same,” Lussier said. But, she added, “without it, we’d have nothing.”” (E)
But expanding telehealth services isn’t easy. Like hospitals providing the direct care, telehealth services also are facing a workforce crunch.
“Telehealth doesn’t necessarily build humans,” Curtis said.
Still, the remote clinicians are doing what they can to help increase capacity at a time when resources are strained.
Lily Powell, director of acute care services for D-H Connected Care, said the program is offering clinicians the flexibility to log on from home for short periods. For example, she said, some of the teleICU nurses have had to be home with their children and aren’t available to work a full shift, but can help out in two-hour increments. That degree of flexibility is uncommon in nursing and it’s been a “big staff satisfier,” she said.
The remote nature of the work also allows clinicians from outside the region to assist, Surgenor said.
In addition to helping other hospitals such as SVMC and Cheshire to care for critical care patients, the teleICU team also has installed hardware necessary to oversee the 60 adult ICU beds at DHMC. Over the holidays, the team installed that equipment on 10 more beds at DHMC in an effort to expand ICU capacity as an increase in demand for the beds is expected due to holiday gatherings and the more transmissible omicron variant of the virus that causes COVID-19.
Without the approximately 30 beds in outside hospitals that D-H Connected Care supports by teleICU, Surgenor said the region’s current bed crunch could be even worse.
“We have built a significant enhanced capacity, which has really paid off in this pandemic,” he said. “We weren’t thinking we’d have a pandemic when we started the program.”” (F)
“With omicron rates soaring, you may find yourself despairingly asking when — or even if — this pandemic is ever going to end.
The good news is that it will end. Experts agree on that. We’re not going to totally eradicate Covid-19, but we will see it move out of the pandemic phase and into the endemic phase.
Endemicity means the virus will keep circulating in parts of the global population for years, but its prevalence and impact will come down to relatively manageable levels, so it ends up more like the flu than a world-stopping disease.
For an infectious disease to be classed in the endemic phase, the rate of infections has to more or less stabilize across years, rather than showing big, unexpected spikes as Covid-19 has been doing. “A disease is endemic if the reproductive number is stably at one,” Boston University epidemiologist Eleanor Murray explained. “That means one infected person, on average, infects one other person.”
We’re nowhere near that right now. The highly contagious omicron variant means each infected person is infecting more than one other person, with the result that cases are exploding across the globe. Nobody can look at the following chart and reasonably conclude that we’re in endemic territory.
Looking at this data might make you wonder about some of the predictions that were floating around before omicron came on the scene. In the fall, some health experts were saying that they thought the delta variant might represent the last big act for this pandemic, and that we could reach endemicity in 2022.
The outlook is more uncertain now. So how should you be thinking about the trajectory and timeline of the pandemic going into the new year? And how should omicron be shaping your everyday decision-making and risk calculus?
Here’s one big question you’d probably like the answer to: Does omicron push endemicity farther off into the future? Or could it actually speed up our path to endemicity by infecting so much of the population so swiftly that we more quickly develop a layer of natural immunity?
“That is really the million-dollar question,” Angela Rasmussen, a virologist at the University of Saskatchewan in Canada, told me. “It’s really hard to say right now.”
That’s partly because endemicity isn’t just about getting the virus’s reproductive number down to one. That’s the bare minimum for earning the endemic classification, but there are other factors that come into play, too: What’s the rate of hospitalizations and deaths? Is the health care system overburdened to the point that there’s a precipitous space or staffing shortage? Are there treatments available to reduce how many people are getting seriously ill?..
…This is why Ramussen says “the key determinant” of when the pandemic ends is how long it will take to make vaccines accessible around the world (and to combat ongoing vaccine hesitancy). Currently, we’re not vaccinating the globe fast enough to starve the virus of opportunities to mutate into something new and serious. “If only a very small proportion of people are getting access to vaccines, we’re just going to keep playing variant whack-a-mole indefinitely,” Rasmussen said.” (G)
“At this difficult moment of the pandemic, a great deal of distress is the result of a basic disconnect. Even as Americans hear frightening news about record numbers of infections and hospitalizations, there is growing confusion about testing, booster doses and medications — the very tools we use to protect ourselves from Covid-19.
Closing this gap isn’t the job of one federal agency, it’s the job of two. The pandemic has pushed the Centers for Disease Control and Prevention and the Food and Drug Administration to the front lines of the nation’s response. Scientists at the C.D.C. are tracking every twist and turn in the pandemic, while their counterparts at F.D.A. oversee the technologies that keep us safe. Among the agencies’ major challenges, however, has been working together…
The usual division of labor, however, has not worked well during the pandemic. The public has been confused by the lack of clarity around how recommendations are made for vaccines and by the finger-pointing when problems arise. At one low point in February 2020, C.D.C. leaders blocked the access of F.D.A. inspectors to its Covid-19 laboratory — an immediate problem for the review of C.D.C. tests, and perhaps also a reflection of the agencies’ arm’s-length relationship.
It does not have to be this way. Both the C.D.C. and the F.D.A. share the mission of protecting and advancing public health. Greater cooperation would improve the nation’s response to Covid…
In addition to the immediate benefits of better collaboration between the C.D.C. and F.D.A., there is an indirect value: trust. The agencies are full of experts working incredible hours during the pandemic to save lives. The public will be reassured to see them together, connecting the latest information about the pandemic to the most effective use of tests, medications and vaccines.” (H)
(A)Fauci: Too soon to say if omicron is final wave of pandemic, BY SARAKSHI RAI, https://thehill.com/policy/healthcare/public-global-health/590052-fauci-too-soon-to-say-if-omicron-is-final-wave-of
(B)Covid News: Omicron’s Role in Ending Pandemic Still Unknown, Fauci Says, https://www.nytimes.com/live/2022/01/17/world/omicron-covid-vaccine-tests?referringSource=articleShare
(C)ICU doctor battles COVID-19 from home, By Andy Fies, https://abcnews.go.com/US/icu-doctor-battles-covid-19-home/story?id=79645516
(D)How a Texas health system spun up a virtual ICU – just in time for COVID-19, Kat Jercich, https://www.healthcareitnews.com/news/how-texas-health-system-spun-virtual-icu-just-time-covid-19
(E)Virtual ICU helps rural hospitals as COVID-19 cases surge,
https://www.wiproud.com/news/local-news/virtual-icu-helps-rural-hospitals-as-covid-19-cases-surge/
(F)Strained hospitals get ICU help through telehealth, but it’s no substitute for staffing, capacity in COVID surge, By NORA DOYLE-BURR, https://www.concordmonitor.com/How-teleICU-is-helping-hospitals-to-address-current-COVID-19-surge-44485369
(G)Despite omicron, Covid-19 will become endemic. Here’s how., By Sigal Samuel, https://www.vox.com/future-perfect/22849891/omicron-pandemic-endemic
(H)The C.D.C. and F.D.A. Can Work Better Together, By Joshua M. Sharfstein, https://www.nytimes.com/2022/01/18/opinion/cdc-fda-covid.html?referringSource=articleShare