“On October 15, a key FDA advisory panel voted unanimously to recommend emergency use authorization of a booster dose of Johnson & Johnson’s vaccine for people ages 18 and older, to be administered at least two months after a primary dose. Several panelists said they believe the data suggest the proper course of the vaccine is two doses rather than one.
The FDA will issue a formal ruling on these boosters after weighing the panel’s recommendations. Then the CDC must refine the agency’s recommendations for who should receive the vaccines before rollouts can begin.
The panel is also scheduled to discuss mixing and matching vaccines, following the release of a National Institutes of Health study showing that booster doses of the mRNA vaccines are more effective than a second dose of the Johnson & Johnson shot. FDA officials said that they are not yet ready to put the matter up for a vote.
The Johnson & Johnson news comes a day after the panel voted unanimously to recommend emergency use authorization of booster doses of Moderna’s vaccine for certain populations. This includes all people ages 65 and older as well as those ages 18 to 64 who are at risk of severe COVID-19 because of their underlying conditions. It also includes people ages 18 to 64 who are at high risk of exposure because of where they work or live, such as health-care workers or incarcerated people.” (A)
“While tens of millions of US residents are already eligible for a third jab, Americans across the country remain confused about boosters, who needs them and how they help.
Here’s what we know so far.
What’s the status of each vaccine?
Pfizer
Numbers: To date, more than 103 million US residents have been fully vaccinated with two Pfizer doses, while approximately 7 million have received boosters.
Efficacy: Data shows that a full dosage of the Pfizer vaccine is 88% effective in preventing hospital admission. CDC data released in mid-September shows that the vaccine’s effectiveness falls to 77% after 120 days.
Company Claim About Booster: Pfizer has been supportive of the need for boosters, with CEO Albert Bourla telling reporters that studies have shown that the vaccine’s effectiveness steadily declines to about 84% for vaccinated people four to six months after receiving their second dose.
FDA Ruling: Pfizer boosters have been approved for older adults and 50 to 64 year olds with medical conditions, as well as adults with underlying medical conditions or those who live and work in high-risk settings.
Moderna
Numbers: To date, more than 69 million people have been fully vaccinated with the Moderna vaccine, with about 1.5 million people having received Moderna booster jabs.
Efficacy: New data shows that Moderna’s vaccine was about 93% effective at reducing the risk of being admitted to hospital with Covid-19. It stays about 92% effective after 120 days.
Company Claim About Booster: Last month, Moderna said that a half-dose booster jab would boost antibodies to a higher point than the initial two shots and believes a booster will be necessary “prior to the winter season”. Currently, Moderna boosters have only been approved for certain people with weakened immune systems, such as cancer patients or transplant recipients.
FDA Ruling: On Thursday, a panel of FDA advisers unanimously voted to recommend a single half-dose booster for the elderly, the immunocompromised or those in high-risk jobs or living situations.
The FDA must now make a final decision on whether to authorise Moderna boosters. If authorised by the agency, a panel of CDC advisers will meet to discuss who will receive them.
Johnson & Johnson
Numbers: Nearly 15 million US residents have received a Johnson & Johnson (J&J) vaccine, which is administered in one dose. CDC data shows that only about 9,800 people have so far received J&J boosters.
Efficacy: Research shows that the J&J vaccine is 71% effective in preventing the need for hospital care. After just 28 days, the vaccine’s effectiveness falls to 68%.
Company Claim About Booster: Like Moderna, J&J has submitted a request for emergency use authorisation for its booster jab. In late September, the company said that research shows that a booster provides a nine-fold increase in antibodies. Four weeks later, it had climbed to a 12-fold increase.
FDA Ruling: On Friday, a panel of FDA advisers unanimously voted to recommend boosters for the one-shot J&J vaccine. The panel recommended that boosters be given to anyone over 18, at least two months after the initial dose.
A number of panel members said that J&J should ultimately be considered a two-dose vaccine like Pfizer’s and Moderna’s….”
“Many Americans, however, say they are confused about who can receive the boosters and what the benefits are.
“Of course, I’m confused. On one day the White House said that they’d give boosters to everyone. It turns out only some people can get them. I still don’t know who decides,”… “It seems to me there’s been a lot of contradictions.”.. (B)
”If mix-and-match boosters are authorized, we might find ourselves with a more bewildering decision: Nine different paths will be available in total, depending on where you started. Assuming that every option will soon be on the table, which one should people take?
Booster shot perplexity is like Abbott and Costello’s “who’s on first?”..
https://www.youtube.com/watch?v=sShMA85pv8M (B)
“Can someone get their initial COVID-19 vaccine from one manufacturer and then get a booster from another? The question has intrigued medical professionals since before the first shot went into an arm—and it’s far more than an academic issue. Allowing people to mix and match COVID-19 shots could significantly improve vaccine distribution and may even offer some medical benefits. ..
The NIH embarked on its own mix-and-match research in June, and the interim preliminary results were released online Wednesday. They are now under review by the FDA’s Vaccines and Related Biological Products Advisory Committee…
If the final results of this study, along with others in process worldwide, continue to find advantages, the CDC’s Advisory Committee on Immunization Practices (ACIP) might ultimately green-light a mix-and-match protocol. But it has not done so at this time.
The only combination protocol authorized in the U.S. is for immunocompromised people getting a third mRNA shot to enhance their generally weak response to the first two. The CDC recommends using the same brand throughout, but if that is unavailable, it says a different mRNA vaccine can be used…
Should you try to mix and match?
With the fragmented healthcare system in the U.S., it’s possible that some people here have gotten a second or third dose of a different vaccine through less than legitimate means. You probably know someone who has done this, perhaps swayed by data showing stronger protection for some vaccines or annoyed that boosters for the Moderna and J&J vaccines are not yet approved.
Even though the preliminary NIH results show some advantage, the number of people tested was small. And while no serious adverse events occurred, uncommon reactions wouldn’t be discovered until tens of thousands or more recipients get the combination, Piedra says. It also remains to be seen whether the changes in the immune system seen 15 days after the vaccine ultimately translate into disease protection.
Plus, if you choose your own unauthorized booster shot, what happens if later research proves a different combination is better? That’s why experts say it’s a bad idea to become your own vaccine advisory committee and get a shot out of turn. “Deciding whether to mix,” Javaid says, “should be done in a safe and scientific matter rather than randomly.” (C)
“Here’s what has transpired: On August 18, the CDC and the FDA announced that all Americans who received the two-dose mRNA COVID-19 vaccines should get booster shots eight months after receiving their second dose. That included those who received either the Pfizer-BioNTech or Moderna vaccines, and they were told boosters would be available in September.
But at the time, neither the CDC’s Advisory Committee on Immunization Practices (ACIP) nor the FDA officially authorized booster shots for Americans aged 12 and up. After a recent meeting, the VRBPAC voted that only Americans who are 65 and up, or who have certain underlying health conditions, should get booster shots at this time. The reason, the panel members said, is that there is not yet enough evidence to recommend boosters for younger, healthier people.
Then, the ACIP met on the topic on September 22 and 23, and voted to recommend booster shots of the Pfizer-BioNTech vaccine for people aged 65 and up, along with residents of long-term care settings. Those booster shots should be given at least six months after patients completed their initial two doses of the vaccine, the ACIP said.
This is where things get a little more confusing. Rochelle Walensky, M.D., director of the CDC, overrode the ACIP’s decision and included health care workers, teachers, and others workers in jobs that put them at high risk for COVID-19…
“The final recommendations are “confusing” for people, says William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine…
“At some point, most of us will need a booster,” says Dr. Schaffner. “That happens with a lot of adult immunizations, including the flu vaccine.”
However, COVID-19 vaccines have only been widely available since December 2020 at the earliest, and data is still being collected on how long protection from the vaccines will last.
“There has been a sense that the administration has been very impressed with the data from Israel, which would indicate that immunity is waning,” Dr. Schaffner says. The country has seen preliminary success in giving some of its residents a third dose, which may have provided inspiration for the booster approval by the CDC and the FDA…
“It is true that if you look at antibody levels produced by the vaccine, by eight months, they’re starting to wane,” Dr. Schaffner says. “But antibody levels are an imprecise indicator of protection, and other aspects of protection continue to go on.”.. (D)
The NIH study tested and compared every possible combination, and here’s the gist: If you need a booster, don’t take J&J. Two weeks after boosting, people who had followed a J&J → Moderna regimen registered average antibody levels that were 9.8 times higher than those who had gotten two J&J shots; antibody levels among J&J → Pfizer recipients hovered just behind. Overall, the highest antibody levels were found among people for whom all three doses were Moderna; Pfizer → Moderna produced the second-highest levels, then Moderna → Pfizer…
The best way to determine which of the nine mix-and-match options produces the best protection from disease would be to recruit thousands of volunteers for a randomized controlled trial, and then count how many people on each regimen get sick over an extended period. But short of doing that, antibody levels provide the best and most convenient information that can be garnered quickly from the greatest number of people.
Omer would like to see such long-term data on clinical outcomes, along with more data on mix-and-match strategies’ effects on different age groups and how long booster protection lasts. These sorts of data are missing from plenty of booster studies, not just mix-and-match. Until we get them, we’ll be stuck where we are right now, knowing more than ever about how to boost, but still unsure of when, exactly, it’s most appropriate to do so.” (E)
“When, exactly, should those people get those shots? Is it better to load up on extra antibodies as soon as possible, or should people wait until COVID rates start to rise again?
Here’s a simple starting point: If you’re already eligible for a third shot because you’re immunocompromised, get it on the sooner side…
Things get squishier for vaccinated people with relatively healthy immune systems. They’ll already be flush with newly minted B and T cells, which lie in wait to produce antibodies and attack the coronavirus. Ali Ellebedy, an immunologist at Washington University in St. Louis, told me that the longer those cells mature in the body, the more prepared they are to fight off the invader. Delivered too early, another dose of the vaccine could end up “restarting something that was already working,” he said. Ellebedy recommended delaying any booster shots by at least six months from your initial course of vaccination. Eight months is better; even a year would be fine…
Ultimately, the dynamics of transmission in your area may be more important than the details of your personal vaccine schedule. David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, would rather see boosters distributed sparingly and strategically to communities that show signs of an impending surge. While everyone else waits, vaccine makers could update their formulas to better protect against Delta and set up randomized controlled trials to gather better data on how their original doses and boosters are performing.
On an individual level, Dowdy told me, there’s probably minimal harm in eligible people getting third shots now. But vaccine makers might have a new shot in a few months, designed around circulating variants, or even an intranasal option that can stop infections sooner. Once the government announces that tens of millions of people should get a booster now, persuading them to do so again in a few months, when a better option is available, could be difficult. And those who decide to get a booster now might find they’re ineligible for a fourth shot when that better option comes. Case rates might seem scary now, but this pandemic has proved time and again that things can certainly get worse. “I think it’s important to not just say, Should I get a booster or not?” Dowdy said, “but rather, Would I prefer to have a booster now or save the opportunity for later?”” (F)
“The risk of mRNA Covid booster shots causing heart inflammation in young adults continues to worry top scientists weighing whether to approve third doses for anyone over 12, Dr. Ofer Levy, a voting member of the Food and Drug Administration’s advisory panel, said Friday…
The panel previously recommended the FDA approve boosters from Moderna and Pfizer for all seniors and other high-risk groups. But some committee members have voiced concern about authorizing third mRNA doses for people 12 and up due to the risk of two rare heart inflammation conditions, myocarditis and pericarditis.
“As we go into younger and younger age groups, they’re less and less at personal risk of severe Covid, and on the other hand, somewhat more at risk of this inflammatory heart condition with the mRNA vaccine,” Levy told CNBC’s “Closing Bell.” “So it’s a risk benefit analysis, and that’s why you’re seeing that deliberation.”
Though uncommon, myocarditis has been found mostly in male adolescents and young adults who received a vaccine from Pfizer or Moderna, according to the Centers for Disease Control and Prevention. Cases typically arise within days of vaccination, usually after the second dose, and subside with medicine and rest, the CDC said.
Unlike mRNA vaccines from Pfizer and Moderna, J&J’s Covid shot is not associated with a risk for heart inflammation, the CDC says. Over 15 million Americans have received their primary vaccine dose from J&J.” (G)
“The single-dose Johnson & Johnson vaccine that last week won approval from FDA advisers for a booster shot probably should have been a two-shot vaccine from the start, the nation’s top infectious disease physician said Sunday.
“What the advisers to the FDA felt is that, given the data that they saw, very likely this should have been a two-dose vaccine to begin with,” Dr. Anthony Fauci told ABC’s “This Week.”” (H)
As the greenlight looms for another dose of Johnson & Johnson’s Covid-19 vaccine, experts on Friday urged those who received it to get a booster shot as soon as it’s available because it will provide them with the best protection against the coronavirus.
“J&J is a very good vaccine. I also believe it’s probably a two-shot vaccine,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “It’s really urgent that people get that second shot pretty quickly.
“Probably one is not enough. And everybody who has had one needs a second one two months after the first. They are going to get full protection if they do that,” he said.” (I)
“President Biden announced the donation of 17 million doses of the Johnson & Johnson vaccine to the African Union, a month after President Uhuru Kenyatta of Kenya publicly pleaded for more equitable vaccine distribution around the world.
President Biden on Thursday announced the donation of millions of coronavirus vaccines to a group of African countries during a meeting with President Uhuru Kenyatta of Kenya, which is contending with the pandemic and an unfolding humanitarian disaster in neighboring Ethiopia.” (J)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. 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.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 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.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
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.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
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”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.’” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
POST 148. April 7, 2021. CORONAVIRUS. While the Biden administration accelerates vaccinations to ward off numerous variants and as more young people are being hospitalized, states, even with increasing case rates are on paths to fully reopen. Politics v. public health!
POST 149. April 10, 2021. CORONAVIRIUS. “From Michigan to Massachusetts, COVID-19 cases and hospitalizations are on the rise again. Deaths will soon follow. “ ”.. the Biden administration is facing renewed calls to delay second vaccine doses and blanket more of the U.S. population with an initial shot.”
POST 150. April 10, 2021. CORONAVIRUS. “The use of so-called COVID-19 “vaccine passports” is quickly becoming a divisive issue across the US – with several states, including New York, embracing the idea, while others have already moved to ban them.”
POST 151. April 14, 2021. CORONAVIRUS. the J&J vaccination pause. “ Federal officials are concerned that doctors may not be trained to spot or treat the rare disorder if recipients of the vaccine develop symptoms of it…” “…a standard treatment for blood clots — use of an anticoagulant drug — could be dangerous or even fatal in such cases…”
POST 152. April 15, 2021. CORONAVIRUS. “The Chinese Center for Disease Control and Prevention’s director said Saturday authorities are considering mixing COVID-19 vaccines because the country’s domestically made doses “don’t have very high protection rates,”
POST 153. April 18, 2021. CORONAVIRUS. “At least 35 hospitals across Michigan were listed Thursday as nearing capacity and three were at full capacity for COVID-19 patients..”.. We can manufacture beds. We can open up beds. We can create entire wings of the hospital if we have to, but if we don’t have staff for those beds, we’ve got nothing.”..
POST 154. April 19, 2021. CORONAVIRUS. “Breakthrough infections, which occur when fully vaccinated people are infected by the pathogen that their shots were designed to protect against, are an entirely expected part of any vaccination process.” “Pfizer’s chief executive said that a third dose of the company’s Covid-19 vaccine was “likely” to be needed within a year of the initial two-dose inoculation — followed by annual vaccinations.”
POST 155. April 24, 2021. CORONAVIRUS. As the J&J vaccine pause is ended Senator Johnson said “The science tells us that vaccines are 95% effective. So if you have a vaccine, quite honestly, what do you care if your neighbor has one or not? I mean, what is it to you?”
POST 156. April 28, 2021. CORONAVIRUS. As CDC revises guidance on outdoor masking, Texas Governor Abbott says “the state is “very close” to herd immunity… despite acknowledging that he does not know what the herd immunity threshold is for the virus, an uncertainty echoed by the public health community.”
POST 157. April 25, 2021. CORONAVIRUS. Ohio hospitals; “We agreed in multiple conversations, there’s nothing in fighting a pandemic that creates a competitive advantage.”…
POST 158. May 5, 2021. CORONAVIRUS. . As populations get closer to herd immunity “ it may be helpful to introduce some nuance to what we mean by the term. Nationwide herd immunity. Regional herd immunity. Temporary herd immunity. Endemicity.”
POST 159. May 9, 2021. CORONAVIRUS. “Without deeper sharing of expertise in how to make vaccines…waiving patent obligations is unlikely to be a game-changer… Having access to the “recipe” certainly helps, but understanding how to put it together and produce it at scale is something else.”
POST 160. May 13, 2021.CORONAVIRUS. “The CDC acknowledged Friday that airborne spread of COVID-19 among people more than 6 feet apart “has been repeatedly documented.”” Meanwhile states relax or eliminate indoor dining restrictions. HUH?
POST 161. May 15, 2021. CORONAVIRUS. “Even if the spread of Covid-19 decreases enough to allow a return of most activities, there are some aspects of pandemic life that epidemiologists say will persist much longer. In particular, they say that masks are a norm that should continue, even if that view puts them at odds with the new C.D.C. guidance. More than 80 percent of them say people should continue to wear masks when indoors with strangers for at least another year, and outdoors in crowds.”
POST 162. May 21, 2021. CORONAVIRUS. “New Jersey Gov. Phil Murphy is refusing to lift his indoor mask mandate for vaccinated residents…” “…fully vaccinated residents in New York and Connecticut are no longer required to wear masks..”..” “California says it isn’t ready to follow the federal lead and unmask, at least for another month..”.. “..Texas Gov. Greg Abbott issued an executive order Tuesday prohibiting state governmental entities such as counties, public school districts, public health authorities and government officials from requiring mask wearing.”
POST 163. May 23, 2021. CORONAVIRUS. RWJBarnabas Health in New Jersey announced a mandate…saying supervisors and those of higher rank must get the vaccine by June 30. They will eventually require the system’s 35,000 employees to do the same.
POST 164. May 26, 2021. CORONAVIRUS. On Wednesday, health minister Norihisa Tamura warned Olympic organizers they would have to “secure their own” hospital beds for anyone falling ill at the Games, explaining the government would not release beds set aside for Japanese covid-19 patients.”
POST 165. May 31,2001. CORONAVIRUS. “Like all pandemics, this one will end either with millions — maybe billions — being infected or being vaccinated. This time, world leaders have a choice, but little time to make that choice before it is made for them.”
POST 166. June 3, 2020. CORONAVIRUS. “President Biden said Wednesday that he has asked intelligence agencies to double down on their efforts to investigate whether the coronavirus originated from human contact with an animal or in an laboratory in China, saying there is not “sufficient information” to assess whether one is more likely than the other.”
POST 167. June 9, 2021. CORONAVIRUS. Hospitals prevaricate on mandatory staff vaccinations. Florida’s Governor forbids cruise ship vaccine mandates. Pfizer and Moderna apply for FDA full approval.
POST 168. June 10, 2021. CORONAVIRUS. “Our species has a tendency to get distracted. We have a very strong appetite for distraction, and when something is not in the spotlight, when it’s not a crisis anymore, we tend to forget and move on to something else. So the biggest challenge is going to be maintaining focus on this next step of developing vaccines that anticipate pandemics.”
POST 169. June 14, 2021. CORONAVIRUS. “Hospitals in Washington, D.C…announced a consensus agreement to mandate COVID-19 vaccinations for more than 30,000 workers, 70% of which are already vaccinated. Each of 14 hospitals will set their own deadline…”
POST 170. June 17, 2021. CORONAVIRUS. “Dr. Ashish Jha…is worried about the potential impact the delta variant could have in the United States… “I’m concerned about the Delta variant,”… “Why? Most contagious variant yet. Wreaked havoc in India. Spiking cases in UK. Growing rapidly in the US.”
POST 171. June 19, 2021. “A 34-year-old man (a Covid-19 survivor) has been diagnosed with India’s first known case of “green fungus” infection.”… “Green fungus is the new infection to join the earlier known cases of black, white and yellow fungus.”…”green fungus was earlier seen only as a “junior partner” in other infections… In the current patient, this fungus is acting as the aggressor.”
POST 172. June 23, 2021. CORONAVIRUS. Morgan Stanley chief executive James Gorman said: “If you can go into a restaurant in New York City, you can come into the office.”…”remote work can “dramatically undermine” the character and culture a company is attempting to build; and “virtually eliminates spontaneous learning and creativity.”
POST 173. June 26, 2021. CORONAVIRUS. “The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.”
POST 174. July 1, 2021. CORONAVIRUS. “..while the WHO is encouraging people to keep wearing masks even if they’re vaccinated, Dr. Anthony Fauci says it doesn’t look like the CDC currently plans to change its guidelines.” … health officials in Los Angeles recommended that “everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.”..”
POST 175. July 5, 2021. CORONAVIRUS. “Can a health care worker who is not against vaccines in general still harbor sincere concerns that scientists don’t yet know about all the side effects of these vaccines? Yes, says Ezekiel Emanuel, MD, PhD — but those people should not work in health care.”
POST 176. July 9, 2021. CORONAVIRUS. Mercy Springfield ( Missouri) hospital…” ran out of ventilators for its patients over the Fourth of July weekend…”…“Mercy will require all current and future employees to be fully vaccinated.”…“The US government is deploying a Covid-19 surge team to provide public health support in southwest Missouri
POST 177. July 12, 2021. CORONAVIRUS. the Delta variant is “the 2020 version of Covid-19 on steroids,”… “It is the most hypertransmissible, contagious version of the virus we’ve seen to date…it’s a superspreader strain if there ever was one .” but… now, there’s a Delta Plus variant…
POST 178. July 15, 2021. CORONAVIRUS. “Tennessee’s top vaccine official says she has been fired as punishment for doing her job in the face of political pushback.”..” More than 180 state and local public health leaders…have resigned, retired or been fired since April 1…”“Former President Trump and his GOP allies have stepped up attacks on Anthony Fauci…”
POST 179. July 16, 2021. CORONAVIRUS. “It, therefore, follows that the “harm principle” (“first, do no harm.”) can be used to justify compulsory vaccination programs in specific instances where the community interests or benefits are deemed to be significant.”
POST 180, July 20, 2021. CORONAVIRUS. “Most people will either get vaccinated, or have been previously infected, or they will get this Delta variant,”.. “And for most people who get this Delta variant, it’s going to be the most serious virus that they get in their lifetime in terms of the risk of putting them in the hospital,”
POST 181. July 22, 2021. CORONAVIRUS. “Health experts fear the Tokyo Olympics could become a COVID-19 superspreader event.” “Whatever happens in Japan isn’t likely going to stay in Japan since all of the athletes and accompanying coaches and staff will be returning to their home countries.”
POST 182. July 26, 2021. CORONAVIRUS. Alabama Gov. Kay Ivey (R): “Folks supposed to have common sense.”…“But it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” ““Beginning in mid-September, New York City will require all of its 340,000 municipal workers, including police, firefighters and teachers, to either be vaccinated against COVID-19 or tested weekly.”
POST 183. July 29, 2021. CORONAVIRUS. When I was appointed President and CEO of Jersey City Medical Center in1989 in the peak of the HIV/ AIDS crisis, we had a dedicated, and always full, dedicated 60 bed AIDS unit, staffed by one full time nurse and numerous part-time and per diem nurses. Today, right now, hospitals caught in the Covid-19 surge, are forced to redeploy nursing staff, respiratory therapists and other clinicians, most without prior infectious diseases experience. Why are we tolerating the unvaccinated putting our hospital staffs at risk?
POST 184. August 1, 2021. CORONAVIRUS. “The coronavirus could be “just a few mutations potentially away” from evolving into a variant that can evade existing COVID-19 vaccines, CDC director Rochelle Walensky said..” (A) “The Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox..” (I)
POST 185. August 6, 2021. CORONAVIRUS. ‘If you aren’t going to help, please get out of the way’: Biden turns up the pressure on GOP governors as Delta spreads”
POST 186. August 8, 2021. CORONAVIRUS. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late,” she added, referring to patients who have to be put on a ventilator.” (A) “There is no one definition of what the end of a pandemic means.”.. “The question of when the crisis will be over is a layered one — with different answers from local, national and global perspectives.”
POST 187. August 11, 2021. CORONAVIRUS. “As a result of the increase in COVID-19 cases and hospitalizations, the state of Florida requested 300 ventilators from the federal government.”… “An 11-month-old girl with Covid-19 is stable and no longer intubated one day after she was airlifted to a Texas hospital 150 miles away because of a shortage of pediatric beds in the Houston area.”
POST 188. August 15, 20201. CORONAVIRUS. “According to an internal CDC briefing….an estimated 1.1 million people have already gotten unauthorized booster shots…”….”If it is left up to the honor system, I think many Americans will suddenly wake up and find themselves immunocompromised enough to get a 3rd dose,”
POST 189. August 19,2021. CORONAVIRUS. “There wasn’t a single I.C.U. bed available in Alabama on Wednesday…”…”A triage plan on the Alabama health department’s website suggests that “persons with severe mental retardation” are among those who “may be poor candidates for ventilator support.”
POST 190, August 21, 2021. CORONAVIRUS. “We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,”..“Emergency medical technicians (EMTs) and certified paramedics can now care for patients in Mississippi hospitals and emergency rooms under a new health office order issued by the Mississippi State Department of Health on Wednesday.”
POST 191. August 27, 2021. CORONAVIRUS. “Anthony Fauci, MD, chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases, explained that late September gives the United States time to set up the logistics.” This is not medical science, but perhaps Political Science?
POST 192. August 30, 2021. CORONAVIRUS. Gov. John Bel Edwards on Hurricane Ida – “I hate to say it this way, but we have a lot of people on ventilators today and they don’t work without electricity,” he said.”
POST 193. September 3, 2021. CORONAVIRUS. Nurses are leaving their hospitals and becoming travel nurses at hospitals across town “because they can make $4,000, $5,000, $6,000, $7,000 a week while not having to relocate anywhere..”
POST 194. August 2, 2021. CORONAVIRUS. “Recently-released data is painting a grim picture of the opioid epidemic that has gripped the United States — as the country is still grappling with the coronavirus pandemic that has killed more than half a million Americans. Some people are calling them twin pandemics that have collided”…“Faced with a novel health crisis, researchers are collecting data on the long-term impact of using opioids to treat COVID-19 pain…
POST 195. September 6, 2021. CORONAVIRUS. “…there are “zero ICU beds left for children in Dallas County, Texas,”.,..”That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely if they have Covid and need an ICU bed, we don’t have one. Your child will wait for another child to die… (county judge Clay Jenkins)
POST 196. SEPTEMBER 11, 2001. PART 1. Military helicopters and jets were overhead, as President Bush was getting ready to leave NYC. PART 2. LESSONS LEARNED memorandum by hospital CEO Jonathan Metsch goes “viral”…
POST 197. September 12, 2021. CORONAVIRUS. Idaho officials have instituted “crisis standards of care” to help 10 hospitals and health care systems decide how to allocate personnel and resources to deal with a crush of COVID-19 patients.”… “The Washington Medical Coordination Center oversees facilitating transfers in the state, and it’s warning we could be nearing the point of “Crisis Standards of Care,” just like Idaho.” .. “These crisis models don’t actually save more lives, they just save different lives..”
POST 198. September 15, 2021. CORONAVIRUS. A pundit said “The most elegant policy riposte to the anti-vaxxers… is to refuse to allow Medicare or Medicaid to pay their medical bills in the event they become seriously ill. Private health insurers might also follow suit.” (but is making our hospitals become the bill collectors right?)
POST 199. September 19, 2021. CORONAVIRUS. Crisis Standards of Care. “… to his knowledge, no patient in Idaho has been taken off life-support therapy in order to provide that therapy to another patient who has a better prognosis.” “While that has yet to occur, if we continue on this path, it will,”
POST 200. September 23, 2021. CORONAVIRUS. CDC Director overrides a recommendation of its scientific advisors saying “that people can get a booster if they are ages 18 to 64 years and are health-care workers or have another job that puts them at increased risk of being exposed to the virus.”…“In a pandemic, even with uncertainty, we must take actions that we anticipate will do the greatest good.”
POST 201. September 27, 2021. CORONAVIRUS. “A multibillion-dollar institution in the Seattle area is sitting on nearly $12 billion in cash… received at least $509 million in government funds (from) a federal program that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.”
“Based on our estimates…we find preventable COVID-19 hospitalizations cost $5.7 billion from June to August in 2021.”…
POST 202. September 30, 2021. CORONAVIRUS. “..NY Governor Hochul signed an executive order expanding healthcare worker eligibility requirements…to head off potential staffing shortages fueled by the state’s new COVID-19 vaccination requirements.” “The.. order allows out-of-state/ out-of-country healthcare workers to practice in New York…”..”It allows EMTs graduates to temporarily pitch in at additional healthcare settings; allows various types of healthcare workers to more easily administer and order COVID-19 vaccinations; enables telemedicine physician visits in nursing homes; permits facilities to more quickly discharge, transfer or receive patients…”
POST 203. October 3, 2021. CORONAVIRUS. “.. more than 125,000 laboratory-confirmed COVID-19 cases have been reported in pregnant people, including more than 22,000 hospitalized cases and 161 deaths”…The risk is not just to the mother. Covid-19 in pregnancy can cause preterm birth or babies born so sick they have to go straight to the neonatal intensive care unit, or NICU.”
POST 204. October 5, 2021.CORONAVIRUS. “News that an experimental antiviral drug from Merck appears to halve the risk of hospitalization or death from Covid-19 has bolstered hopes of finding a simple at-home treatment for the virus.”..” A more blunt assessment came from vaccine scientist Dr. Peter Hotez of Baylor College of Medicine’s National School of Tropical Medicine. “It’s not a miracle cure but a companion tool, So get vaccinated.””
POST 205. October 11, 2021. CORONAVIRUS. The AAP reported nearly 226,000 new child cases over the past week ending. “Hospital care for children does not occur in isolation from that of adults. Many of the resources we use are the same—a twenty-pound baby and a two-hundred-pound man might use the same kind of ventilator, for example. Dialysis machines, which could cleanse a seven-year-old’s blood as easily as his grandfather’s, are in high demand. Pediatric resident physicians, nurses, and respiratory therapists get cross-deployed to care for adults during the surges.”
POST 206. October 15, 2021. CORONAVIRUS. to borrow from Winston Churchill about where we are with the pandemic – “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”
POST 207. October 17, 2021. CORONAVIRUS. “…if you choose your own unauthorized booster shot, what happens if later research proves a different combination is better? That’s why experts say it’s a bad idea to become your own vaccine advisory committee and get a shot out of turn.”
“From June through August 2021, preventable COVID-19 hospitalizations among unvaccinated adults cost over $5 Billion.. Over 280,000 COVID-19 hospitalizations could have been prevented by vaccination between June to August 2021.”
for links to POSTS 1-199 in chronological order highlight and click on
“Overwhelmed by a surge in COVID-19 patients, Alaska’s largest hospital on Tuesday implemented crisis standards of care, prioritizing resources and treatments to those patients who have the potential to benefit the most.
“While we are doing our utmost, we are no longer able to provide the standard of care to each and every patient who needs our help,” Dr. Kristen Solana Walkinshaw, chief of staff at Providence Alaska Medical Center, wrote in a letter addressed to Alaskans and distributed Tuesday.
“The acuity and number of patients now exceeds our resources and our ability to staff beds with skilled caregivers, like nurses and respiratory therapists. We have been forced within our hospital to implement crisis standards of care,” Walkinshaw wrote…
Walkinshaw noted that the state’s COVID-19 dashboard, which is routinely updated with numbers related to the virus, “isn’t equipped or designed to demonstrate the intricacies of providing medical care during this unprecedented time.”
At Providence, one of only three hospitals in a city of about 300,000 residents, officials have developed and enacted procedures to ration medical care and treatments, including dialysis and specialized ventilatory support.
The emergency room is overflowing at Providence, and she said patients wait for hours in their cars to see a doctor for emergency care.
Walkinshaw noted that what happens at the Anchorage hospitals affects the entire state since specialty care can often only be provided in the state’s largest city.
“Unfortunately, we are unable to continue to meet this need; we no longer have the staff, the space, or the beds,” Walkinshaw wrote. “Due to this scarcity, we are unable to provide lifesaving care to everyone who needs it.”
That has left patients across the state sitting in local hospitals since Providence can’t accept them for transfer.
“If you or your loved one need specialty care at Providence, such as a cardiologist, trauma surgeon, or a neurosurgeon, we sadly may not have room now. There are no more staffed beds left,” she wrote.” (A)
(Helena, Montana) “St. Peter’s Health has announced they are in “crisis care” as their critical care units reach full capacity.
Crisis Care Standards occur when it is no longer possible to deliver the normal standard of care to all persons in need. The need occurs when health care resources are overwhelmed by a disaster or emergency.
Under crisis care, hospital staff may be forced to evaluate patients in terms of which have a better chance of survival. Medication may be rationed and patients may be sent home for recovery that would normally be kept for observation should their condition worsen. St. Peter’s says crisis standards are not a flipped switch situation, but a stepped approached without official levels and different departments may be at different levels depending on the number and severity of patients they are dealing with.
On Thursday, the regional hospital said their Intensive Care Unit and Advanced Medical Unit are at 100% capacity. Their morgue is also full right now, and they’ve requested a refrigeration truck. Not all the deaths or critical care emergencies are related to COVID-19, but the most recent surge is contributing to the situation at the hospital.
“We are giving our staff permission to not do it all. The hardest thing they will do in their careers is not giving the care they are used to giving, but they simply can’t,” said Chief Medical Officer Dr. Shelly Harkins…
St. Peter’s has requested assistance from the Montana National Guard in responding to the crisis. They are unsure if the request will be granted.
On top of the pandemic, St. Peter’s is facing a staffing shortage and burnout of current employees. The health care organization says they have 200 open positions that aren’t filled.” (B)
“Idaho’s Department of Health and Welfare this week activated crisis standards of care across the state for the first time as COVID-19 cases and hospitalizations surge.
Other states facing high numbers of COVID-19 cases are considering rationing care, even if not statewide like Idaho…
The largest hospital in Alaska recently adopted crisis standards, and such Western states as Nevada and New Mexico are expected to ration care in the near future. New Mexico had enacted crisis standards last December, but lifted them once hospitalizations subsided.
Intensive care units across the South are also near 100% capacity in several states, including Texas and Florida, according to data from the New York Times.
However, the Idaho Statesman could not find a state besides Idaho that had implemented crisis standards across all its health systems.
Will vaccination status be considered when care is prioritized?
Vaccination status is not listed as part of the considerations for prioritizing care. It is also against the law and against medical ethics for Idaho’s health care system to triage patients based on politics or whether people wore a mask.
“The goal of providing care quickly and efficiently must be guided by fairness, equality and compassion,” according to Idaho’s crisis standards of care plan. “As such, (this) is grounded in ethical obligations that include the duty to care, duty to steward resources, distributive and procedural justice, and transparency. Its guiding principle is that all lives have value and that no patients will be discriminated against on the basis of disability, race, color, national origin, age, sex, gender, or exercise of conscience and religion.”
Under the plan, people who have a higher likelihood of survival will be given care before those who are more likely to die.
Should there not be enough of a certain resource, care could be prioritized in the following order:
1. Children up through 17 years old.
2. Pregnant women with a viable pregnancy, at more than 28 weeks of gestation.
3. Adults by age, from younger to older: age 18-40, age 41-60, age 61-75 and 76 and older.
4. Patients who “perform tasks that are vital to the public health response of the crisis at hand, including, but not limited to, those whose work directly supports the provision of acute care to others.”
5. A lottery, or “random allocation,” if there is still a tie after going through the first four priority criteria.
Dr. Steven Nemerson from Saint Alphonsus Health System said Thursday that so far, he doesn’t know of a single patient who has been taken off a life-support therapy so that therapy could be given to another patient with a better prognosis.
“While that has yet to occur,” he said, “if we continue on this path, it will.”
What is an example of crisis standards of care?
Under crisis standards of care, the focus is on saving as many lives as possible, according to Health and Welfare. So patients who are more likely to survive could be treated first.
According to the standards, patients could be given a priority score based on a number of factors.
For example, if the demand for ventilators is exceeding supply, hospitals could put into place universal “Do Not Resuscitate” orders. That means if an adult patient goes into cardiac arrest, they could “receive NO attempts at resuscitation,” according to Health and Welfare’s strategies for scarce resource situations.
“The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to health care workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and life-saving medications, with minimal opportunity for benefit.” (C)
“The Idaho Crisis Standards of Care Activation Advisory Committee met Wednesday and determined the influx of COVID patients had severely impacted all of the state’s hospitals to the point of asking the director to expand crisis standards statewide.
The move comes as COVID cases and hospitalizations are at their highest point in the pandemic and show no signs of slowing.
“These are uncharted waters,” said Brian Whitlock, president and CEO of the Idaho Hospital Association. “We’ve never been in this situation before as a state.”
Roth said St. Luke’s has done everything possible over the past 20 months to avoid crisis standards of care.
“This is an incredibly sad day for St. Luke’s and for our community,” he said.
Roth said the overwhelming patient volumes are a result of COVID-19 patients and historic levels of traditional patient care, with the latter largely brought on by a pent-up demand from patients delaying care last year because of COVID-19.
“I’ve never seen any volumes even close to what we’re seeing in my history at St. Luke’s of 14 years,” Roth said.
He said St. Luke’s had a record 173 COVID-positive admissions to its hospital at the end of August, breaking the 172-admissions record back in the December surge. It recently broke the record again with 281 COVID-19 admissions.
“If we continue on this course over the next several weeks, St. Luke’s Health System will become a COVID health system,” said Roth, noting it will consume every resource and bed it has with coronavirus patients.
Roth said the vast majority of patients in St. Luke’s ICU are COVID positive, with 98% of them unvaccinated.
He said the health system has hired more staff and is doing everything it can to provide safe and effective care, “but the standard of care is being eroded.”
“We’ve now stopped surgical procedures that can be reasonably expected to be associated with a significant risk of permanent disability or pathology,” said Dr. Jim Souza, chief physician executive at St. Luke’s.
Souza said certain breast cancers, prostate cancers and bladder tumors, for examples, will be managed “medically” until doctors can get to them.
Sandee Gehrke, chief operating officer at St. Luke’s, said the hospital stretched its nurse-ICU patient ratios. She said a registered nurse in the ICU typically took care of one or two patients but is now tending to about three.
Gehrke said the combination of high patient volumes and 400 employees at home because of COVID-19-related illnesses is stretching St. Luke’s staff thin.
“The strain that we are experiencing from a team member standpoint is heartbreaking,” Gehrke said. “To hear our team talk about the stress that they see and experience, when they are working 10 shifts in a row and they don’t get to see their family and they are seeing the death and the despair that COVID is bringing to us, it’s really taking a toll across the board.”
Nemerson said Saint Alphonsus has 135 COVID-positive patients, which is 35% of its total inpatient volume.
He said Saint Alphonsus is experiencing record numbers of non-COVID and COVID inpatients. Nemerson said COVID inpatients could exceed 210 in the next three to four weeks, at the current rate.
“We, too, are at the maximum capability of providing care without stretching our teams further and further and further,” he said.
Nemerson said Saint Alphonsus is able to continue to deliver a reasonable standard of care, but that will decline simply because caregivers cannot care for patients fast enough.
“I’m scared for all of us,” he said.
Still, Nemerson said people should not avoid emergency care, and if they have medically necessary or time-sensitive procedures, Saint Alphonsus will always be there for them. He said, to his knowledge, no patient in Idaho has been taken off life-support therapy in order to provide that therapy to another patient who has a better prognosis.
“While that has yet to occur, if we continue on this path, it will,” Nemerson said.
As of Tuesday, there were more than 600 Idaho residents hospitalized with the virus as federal contract workers are being dispatched to support understaffed hospitals. There were 173 Idaho COVID patients in intensive care units statewide.
Last winter, hospitals statewide saw just more than 400 COVID patients at once before the surge quelled.
“Our hospitals and health care systems need our help. The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19. In addition, please wear a mask indoors in public and outdoors when it’s crowded to help slow the spread,” Department of Health and Welfare director Dave Jeppesen said in a news release. “The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident.” (D)
.
WHAT ARE ‘CRISIS STANDARDS OF CARE?’
Crisis standards of care give legal and ethical guidelines to health care providers when they have too many patients and not enough resources to care for them all. Essentially, they spell out exactly how health care should be rationed in order to save the most lives possible during a disaster.
Some health care rationing steps have become commonplace during the pandemic, with hospitals postponing elective surgeries and some physicians switching to online visits rather than seeing patients in person. But more serious steps — such as deciding which patients must be treated in a normal hospital room or intensive care unit bed, and which patients can be cared for in a hospital lobby or classroom — have been rare.
At the extreme end of the spectrum, crisis standards of care generally use scoring systems to determine which patients get ventilators or other life-saving medical interventions and which ones are treated with pain medicine and other palliative care until they recover or die.
WHAT’S THE SCORING SYSTEM, AND WHAT ARE ‘TIE-BREAKERS’?
States may use a combination of factors to come up with patient “priority scores.” Idaho’s and Montana ’s system both consider how well a patient’s major organ systems are functioning. Patients with indications of liver or kidney damage, poor oxygen and blood clotting levels and an inability to respond to pain because they are in a coma have higher scores.
Both states also score people based on saving the highest number of “life-years,” so if a person has cancer or another illness that is likely to impact their future survival, they get a higher score.
The lower a patient’s score, the more likely they are to survive, moving them toward the front of the line for ventilators or other resources.
The plans also have “tie-breakers” that come into play if there aren’t enough resources for all of the folks at the front of the line. Youth is the biggest tie-breaker, with children getting top priority.
In Idaho, pregnant women who are at least 28 weeks along with viable pregnancies come next. Both states also give consideration to younger adults ahead of older adults, and Idaho’s fourth tie-breaker is if the patient performs a task that is vital to the public health crisis response. The final tie-breaker is a lottery system.
If someone at the front of the line is given a ventilator and doesn’t show improvement within a set period of time, Idaho says they should be taken off so someone else can have a chance…
DOES VACCINATION STATUS MATTER?
No.
In both Idaho and Montana, the crisis standards of care don’t consider whether a person has been vaccinated against COVID-19. Likewise, patients aren’t denied care if they are injured in a car accident because they failed to wear a seatbelt or drove while intoxicated.
“Vaccination status is not relevant to us when it comes to taking care of patients. We simply do what they need us to do within the constraints and the resources that we have,” said Dr. Shelly Harkins, chief medical officer at St. Peters hospitals in Helena.
WHAT ELSE CHANGES WHEN A HOSPITAL IS OPERATING UNDER CRISIS STANDARDS OF CARE?
Nearly everything.
People will likely wait longer for care, not just in hospitals but at urgent care centers that will likely be dealing with more patients as well. Nurses will care for more patients than they normally would. Instead of hospital beds, some people might be placed on stretchers and cots. Patients will likely be sent home from the hospital as soon as possible, relying on friends, family and prescriptions for in-home medical equipment during their recovery.
And in some cases, physicians may not attempt to save a patient’s life at all. Idaho’s crisis standards of care plan calls for a “Universal Do Not Resuscitate Order” for all adults once the state has reached the point where there aren’t enough ventilators to go around.
That means if a patient experiences cardiac arrest — where the heart stops suddenly — there will be no chest compressions, no attempts to shock the heart back into a normal rhythm, no chance at hooking them up to life support. That’s partly because resuscitation requires a bunch of hospital staffers, a lot of time, and is frequently unsuccessful. It’s also because if the patient has COVID-19, the process of attempting to revive sends aerosolized virus particles into the air, putting staffers at risk.
Montana’s plan is a bit different, in that it allows individual doctors to decide whether or not to resuscitate patients on a case-by-case basis.” (E)
“As of Monday morning, more than 96,000 hospital beds are filled with Covid-19 patients nationwide — contributing to the 77% of all hospital beds across the country being currently in use, according to data from the US Department of Health and Human Services. About 80% of intensive care unit beds are in use.
Hospitals in some places are closer to capacity than in others.
In Arkansas, Gov. Asa Hutchinson said in a briefing last week that there were only 23 ICU beds available statewide. “That’s closer than we’d like, but it is better than what it has been. And so we continue to monitor that,” Hutchinson said, adding that 27 new ICU beds will be coming online this month.
A heart patient died after he couldn’t get a cardiac ICU bed in 43 hospitals. Now his family is pleading for people to get vaccinated
In Kentucky, Gov. Andy Beshear laid out the severity of the Covid-19 spread in his state on CNN last week, saying that while hospitals are not yet at the point of needing to make tough choices about rationing care, “we are right at” or “quickly approaching that point.”
“We are in a really tough place, Kate,” he told CNN’s Kate Bolduan. “We’ve called in FEMA strike teams, the National Guard, we’ve deployed nursing students all over the state, we’ve taken over testing from hospitals just to free up additional people.”
And In Alabama, a mourning family has issued a plea to others to get vaccinated after Ray DeMonia, a Cullman, Alabama resident, died about 200 miles from his home, in a Mississippi hospital, because there were no cardiac ICU beds nearby. His daughter Raven DeMonia told his story to The Washington Post on Sunday.
‘Rationing health care is not new’
When hospitals run out of beds or when staffing is low, tough decisions must be made on which patients get to be first in line for care. Overall, hospitals and health systems have plans on the table to address an overflow of patients and making such difficult decisions.
Hospitals scrambling for incentives to retain nurses amid shortage
“All hospitals and health systems have plans in place to deal with a surge in patients. These plans can include actions like adding beds, including in non-traditional areas of care in a hospital like a cafeteria or parking lot, shifting patients between hospitals, and working with their local and state health departments to find other sites of care,” Akin Demehin, director of policy at the American Hospital Association (AHA), wrote in an email to CNN on Friday.
“Sometimes this includes sending patients to hospitals in nearby states that may have the capacity to treat them,” Demehin wrote. “One other option that some hospitals have taken is to scale back, or put a pause, on so-called elective procedures that are non-emergent and can be safely delayed for a period of time.”
Yet for the most part, hospital capacity is not only about how many beds are filled — a hospital can usually add beds — but many facilities are much more concerned about enough staffing to care for patients, according to Demehin.
“Hospitals and health systems entered the COVID-19 pandemic already facing a shortage of skilled caregivers, and the last 18 months have exacerbated that,” Demehin wrote, adding that AHA has called on the Biden administration to work as a partner in developing strategies to address the shortage of health care staff.
‘This pandemic is our World War II.’ An up-close look at how a Florida hospital fights to save Covid-19 patients
Overall, decision-making around rationing care can look different depending on the type of medical facility — a hospital or private doctor’s office.
“There are different decisions whether it’s a doctor’s office or an emergency room,” Art Caplan, professor of bioethics at NYU Langone Health in New York, told CNN.
“You have no right to be taken care of by a primary care doctor. There’s still no right to health care that way — the doctor has the ability to decline,” Caplan said, adding for instance, that some doctors might decline to take Medicaid as a patient’s insurance or might decline to treat patients who haven’t received certain vaccines because that patient could pose a risk to the doctor or the health of other patients.
Yet “in the ER, there’s a federal law that says you have to accept anybody, even if they have no money, and stabilize them. It’s called EMTALA, and it’s been around for a while,” Caplan said.
“Rationing health care is not new in the American health care system,” he added. “It’s just Covid that’s new, but not rationing.”
Who receives an ICU bed?
The Emergency Medical Treatment and Labor Act or EMTALA requires hospitals with emergency departments to provide a medical screening exam to any person who comes to the emergency department and requests care. The law also prohibits hospitals with emergency departments from refusing to examine or treat people with emergency medical conditions.
Now, during the pandemic, many of the Covid-19 patients filling hospital beds are unvaccinated. EMTALA obligations remain in place.
As Covid-19 hospitalizations spike, some overwhelmed hospitals are rationing care
“Hospitals generally do not take into account why a gravely ill patient is there,” Caplan said. “The way in which it might become relevant is if you thought it was a predictor of a bad outcome.”
For instance, if a hospital is short on beds or mechanical ventilators, they can prioritize care for patients who are seen as more likely to respond to the care and survive — meaning a 26-year-old Covid-19 patient with no underlying health conditions could be prioritized for care over a 90-year-old patient with lung failure and other medical problems, Caplan said.
“Or, if being unvaccinated and having lung failure puts you at a worse chance of survival versus someone who just comes in with asthma and lung problems but are vaccinated,” Caplan said. “Many places would give priority to the vaccinated asthma patient as opposed to the unvaccinated lung failure patient. What they’re watching is outcome and likelihood of success.”
My son was lucky to get a pediatric ICU bed when he needed one. He shouldn't have needed luck
In hospitals that are so overwhelmed that they have to ration care, those decisions should not be based on whether or not a person chose to get vaccinated against Covid-19, Dr. Anthony Fauci said Thursday.
“If you’re asking, should you preference it for a vaccinated person versus an unvaccinated person, that is something that is always widely discussed, but in medicine I know that you don’t prejudice against someone because of their behavior,” Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN’s Anderson Cooper.
“You just don’t do that in medicine,” Fauci said.
Fauci added that the decision about where to direct “scarce resources” must be based on a “medically sound” reason, “not in a punitive way for someone’s behavior.”
‘We’re in a situation of limited resources’
Throughout the pandemic, Covid-19 has strained the US health care system — and hospitals continue to face difficult decisions on which patient takes priority when staffing is low and beds are full.
“We’re already making those choices and they’re very difficult choices. I work in the intensive care unit. Many people have serious illnesses but not illnesses where they’re going to die immediately, but serious illnesses where they need an operation and some of these operations are so serious that after surgery, they need to be in the intensive care unit for a day or two — replacement of a heart valve, surgery for serious cancers like pancreatic cancer,” Dr. Steven Brown, a critical care pulmonologist at Mercy Virtual Care Center in St. Louis, told CNN’s Ana Cabrera on Thursday.
“If the intensive care unit beds are all filled up with patients who are on ventilators because of their pneumonia, surgeries have to be postponed,” Brown said. “We have situations where people may come into the hospital with a heart attack, and they have to stay in the emergency room for extended periods of time while waiting for a bed to open up.”
Unfortunately, in some cases, for a bed to become available means a patient has died.
“It’s a sad situation that we really haven’t seen in American history in a very, very long time.” Brown said. “We’re in a situation of limited resources now, and when you have limited resources, we are in triage situations — and some people may die as a consequence of this.” (F)
“Some hospitals in Central California are still so overwhelmed with COVID-19 patients that some critically ill people are waiting days to be transferred into the intensive care unit from the emergency room, officials said.
One Fresno area hospital had nine critically ill patients who were unable to get into the intensive care unit for more than three days, interim health officer Dr. Rais Vohra said at a news conference this week. This forces emergency room staff to treat patients needing ICU care, disrupting the healthcare of other patients with less severe illness.
“We’re basically really straining what the emergency department has to do,” Vohra said. “We still anticipate at least a few more weeks of thoroughly impacted operations” in ICUs and emergency rooms.
Hospitals in Fresno County are teetering on the need to ration healthcare and implement “crisis standards of care,” Vohra said. In these situations, hospitals conclude that they can no longer provide the same standard of healthcare to everyone, and must choose whose lives to prioritize to keep as many patients alive as possible.
“We’re still just right there where we’re looking at things on a day-by-day — and even hour-by-hour — basis to see how we can match the resources with the needs,” Vohra said.
In Fresno County and the greater San Joaquin Valley, hospitals remain extremely busy, said Dan Lynch, director of the Central California Emergency Medical Services Agency. Most of Fresno County’s hospitals are running at 108% to 110% of standard capacity, while Clovis Community Medical Center near Fresno has been running at 130% of capacity.
“It just means that they’ve got patients in nooks and crannies throughout that hospital. And they’re taking advantage of every, every place they can to place patients safely,” Lynch said of the Clovis hospital. “We’re providing them with as much staff, and they’re finding staff from outside the state and other areas of the state of California to help them staff those beds.”
Officials have been forced to extend the policy by which not all patients calling 911 will be transported to emergency rooms if they don’t meet certain criteria to be transported. EMS officials had been hoping to relax that policy, but emergency rooms remain overwhelmed.
Lynch said he’s been pleading with federal officials to bring in additional staffing to support the hospitals.
Some help has arrived, in the form of several National Guard teams in the region, comprised of nurses and emergency medical technicians who can help aid emergency rooms.
But Lynch is still seeking federal medical teams who can provide the kind of care needed in intensive care units, “which is really what’s needed so we can expand our ICU surge beds. We have the capability of adding ICU beds to some of our hospitals — we just don’t have a staffing to do it. And that’s what those federal teams would do.” “(G)
With COVID cases surging in Idaho’s panhandle and hospitals there exceeding capacity, the state of Idaho recently activated its crisis standards of care. That means care is not guaranteed for everyone. Instead, doctors are advised to treat patients who are most likely to survive — not necessarily those whose conditions are most critical. The goal by doing that is saving as many lives as possible while space is limited.
But in Oregon, such crisis care standards no longer exist.
“A pandemic is the time when you absolutely need crisis standards of care in place,” said Becky Hultberg, president and CEO of the Oregon Association of Hospitals and Health Systems. “So for us to not have them right now is really troubling.”
Hultberg said having a crisis standards of care document is important for healthcare workers in Oregon as well as patients. She believes everyone should understand how care will always be delivered when resources can no longer meet demand.
“We’re not having to allocate a scarce resource like a ventilator at this point, but having the guidance in place gives clinicians the path forward to making these really tough decisions.”
Oregon had a crisis standards of care document with that guidance in 2018. But last year, the state said the document was discriminatory.
In December of 2020, the Oregon Health Authority (OHA) replaced the crisis care standards document with four “crisis care principles,” which they developed with community input. Those principles are non-discrimination, health equity, patient-led decision making and transparent communications.
An Oregon Health Authority spokesperson told KGW that no new crisis guidelines are in development and that they expect health care providers to apply the principles. OHA also shared the following statement:
“Oregon has developed a set of crisis care principles to help guide health care providers in the event that they have to make heart-wrenching, life-and-death decisions if hospitals reach the point where they are overwhelmed with more patients than they can treat. OHA worked closely with community voices from across Oregon to ensure these difficult decisions are made in a way that is transparent, is not discriminatory and fully involves patients and families.
Hospitals can implement crisis care standards on their own — and triage decisions are just one step Oregon empowers hospitals to take to respond to a public health crisis. They can suspend elective procedures, alter staffing and take other steps that can help prevent hospitals from reaching a point where they are forced to ration care. They do not need to rely on a declaration from state health officials.
We can save lives and we can stem the crisis facing hospitals if more Oregonians get vaccinated against COVID-19 and wear masks when they’re in public places. However, if any Oregon hospitals have to make these difficult decisions, state health officials will work with providers to keep the public informed. We want patients and families to be fully informed about the principles health care providers are expected to apply, the rights of patients and the avenues families can use to report their concerns to state regulators and independent advocacy organizations.”
While Hultberg agrees that the 2018 guidance needed revision, she believes the state still needs actual crisis care standards both for now and in the future. She does not believe the list of principles on its own, provides the kind of detailed information that would help clinicians during a crisis.
“These are wrenching choices to make but avoiding the conversation does not solve the problem,” said Hultberg. “We have to be prepared for our hospitals to respond if we see another surge or if we see an earthquake or some other kind of natural disaster.”” (H)
“The state’s plan on how to allocate medical care during times of a crisis was made available for the public to read on Wednesday, Sept. 15.
The Hawaii Department of Health (DOH) said its Crisis Standards of Care Triage Allocation Framework was created in 2020. It included input from healthcare providers across the state, and it was done in preparation for if the state ever found itself in a serious COVID situation.
“It’s something that I reject out of hand, the process to discuss and think about is ok, but Hawaii should never ration care, and of course it created a lot of fear,” said Lt. Gov. Josh Green, who is also an emergency room physician.
“So I thought that someone had to speak up. It created fear amongst our kupuna because in the plan, there was consideration for rationing care under certain circumstances, severe shortages to the elderly, and that’s not anything we could accept,” he continued.
The 36-page public document laid out a scoring system that healthcare facilities would use if they were ever faced with a triage situation.
According to the document:
Advanced age was rejected as a primary triage criterion because it discriminates against the elderly. Age already factors indirectly into any criteria that assess the overall health of an individual because the likelihood of having chronic medical conditions increases with age and there are many instances where an older person could have a better clinical outlook than a younger person. Thus, clinical factors (with the exception of the COVID-19 disease-specific age criterion based upon the known poor prognosis with older age) will be used to evaluate a patient’s likelihood of survival and to determine the patient’s triage priority unless there is a case of equal priority and can be a factor in as a “tie-breaker.”
The document also added that age would only be used if a situation resulted in the need for a tie-breaker.
“Age is used only in a tie-breaking situation. Evidence from multiple countries including the U.S. shows that age >65 yo is an indicator for poor prognosis in COVID-19 patients. If the triage score is equal between two individuals, the Triage Officer/Review Committee should use the consideration that a patient >65 yo who is also COVID-positive is less likely to benefit from the scarce resource.”
Green said he received dozens of phone calls from kupuna after the document was released.
“When a 75-year-old woman reaches out to you, and she’s afraid that if she gets sick, she won’t be able to go to the hospital for life-saving care, that’s when you know you’ve made a mistake,” Green said of the document’s release.
Two weeks ago, Oahu hospitals were at a critical state when there were nearly 450 COVID-patients hospitalized, and triage tents were set up at most major hospitals to handle any overflow.
Hawaii reports 569 COVID cases, 8 new deaths
Hospitalizations have dropped 30% since then.
“I think that it’s important that everyone realizes we will not need to ration care, I will fight against it,” Green said. “It was terrible, it’s a terrible idea in Hawaii to ever rationed care because, as I said several times, we should move heaven and earth before we ever tell someone they can’t get care.”
Green suggested using other facilities by bringing in hundreds of additional federal care nurses and physicians, using monoclonal antibody treatment and utilizing long-term care facilities before considering rationing care.
“All of those are possible solutions before we’d ever tell someone your mom or dad, or your elderly grandfather, does not qualify for care, we should never do that,” he continued. “ (I)
“During the current delta-driven Covid-19 wave, Americans are being transported hundreds of miles from their homes because no nearby hospital has room for them. Some of them have even died waiting for medical attention.
In other words, US hospitals are being forced — in the middle of a public health emergency — to ration health care for their patients.
Rationing has long been a dirty word in US health policy, used as an attack on any socialized health program that more centrally determines which medical services will be covered and for whom. The US health system has always rationed care through cost: It’s de facto rationing when a patient doesn’t get the medical care they need because they can’t pay out-of-pocket costs or because they live in a rural community without a facility nearby.
“We’re so used to rationing by ability-to-pay in this country that classic capacity rationing feels a bit foreign,” Hannah Neprash, a health economist at the University of Minnesota, said in an email.
The delta variant, more contagious and virulent than its predecessors, and America’s lagging vaccination rates are driving the current crisis.
The states with the worst outbreaks in confirmed cases per capita right now — Tennessee, Kentucky, Alaska, Wyoming, and West Virginia, according to the New York Times’s tracker — have either set new hospitalization records in the last several weeks or are near their previous highs from the winter wave. All of them have vaccination rates below the national average. Throughout the South, hospitals are reporting they have more patients in need of ICU care than ICU beds available, as the Times reported on Tuesday.
America, the richest country in the world, is not supposed to be a place where patients are left at the door to die. Yet that is exactly what’s happening now — 18 months into the pandemic.
The US health system wasn’t built to withstand a pandemic
Many parts of the American health system have struggled to handle the pandemic. The current hospitalization crisis is just the latest iteration of an institutional failure.
The United States still has a lot of unvaccinated people who are fully vulnerable to the delta variant of the novel coronavirus, which is more transmissible and may cause more virulent disease. One in four people over 18 still haven’t received any dose of a Covid-19 vaccine, and younger age cohorts have lower vaccination rates than their elders. As a result, there has been a shift in who’s being hospitalized: People over 65 made up more than half of hospitalizations in December and January; now they are about a third. Children under 12 still are not eligible for the vaccines, and pediatric hospitals are seeing their highest number of Covid-19 patients ever.
But while the demographics of the people being hospitalized may have shifted, the sheer number of people getting severely ill with Covid-19 and ending up in the hospital is almost as high as it has ever been.
Texas, to give one example, has nearly matched its winter peak with more than 14,200 people currently hospitalized with Covid-19. More than 90 percent of the state’s ICU beds are occupied, according to Covid Act Now. In Idaho, with about 88 percent of ICU beds in use, hospitals had to activate what is known as “crisis” standards of care. That gives them more discretion to prioritize the patients most likely to survive for ICU beds and other treatment.
In Bellville, Texas, 46-year-old military veteran Daniel Wilkinson was rushed to the emergency room. He was diagnosed with gallstone pancreatitis, which is treatable but which his local hospital was not equipped to treat, according to KPRC. The doctor called all over the region — to hospitals in Texas, Oklahoma, and Arkansas, among others — but could not find a hospital that would take him. Those states currently have some of the highest Covid-19 hospitalization rates in the country.
An ICU bed was eventually located at a Houston Veterans Administration hospital, more than an hour away from Bellville. But Wilkinson’s organs started failing on the helicopter ride there and he died. It had been more than seven hours since his mother first brought him to the local ER.
There are more stories like Wilkinson’s across the United States. On Monday, the Washington Post reported that a 73-year-old Alabama man died of a cardiac emergency after being turned away from more than 40 hospitals. The closest hospital that would take him was 200 miles away in Mississippi. Alabama is currently experiencing the second-most Covid-19 hospitalizations per capita in the nation.
Hospitals are trying to balance handling a new Covid-19 surge with providing medical care to all of the other patients who need their attention. But that has required them to make some hard choices.
Karen Joynt Maddox, a practicing physician and health policy researcher at Washington University in St. Louis, said her local hospital was instructed during the pandemic not to take patients from small rural facilities unless absolutely medically necessary, which at times has meant rejecting transfer requests made by family members.
The US does not have a lot of hospital beds compared to many other wealthy countries; about 2.9 per 1,000 people compared to the average of 4.6, according to the Peterson-Kaiser Health System Tracker.
There are some good reasons for that: Over the decades, more medical services have been shifted from inpatient to outpatient settings in order to save costs. But that still ended up shrinking the number of hospital beds available in a once-in-a-lifetime emergency.
We wouldn’t necessarily want the US health system to always be flush with excess hospital capacity, some experts contend. It would cost substantial funding to maintain. But even in normal times, urban hospitals will operate at near 100 percent capacity while rural hospitals sit with half their beds open.
“We have beds, just not in the right places,” Joynt Maddox said, “and with no system to try to use the available beds as rationally as possible.”
The current crisis has revealed how disorganized the US health system truly is. American hospitals don’t have a reliable revenue stream, as hospitals do in countries with budgets that pay providers a predictable amount of money every year.
And there is no central authority to help manage the patient load when US hospitals are overwhelmed; Daniel Wilkinson’s doctor made those calls on his own. As NPR reported, local hospital leaders across the country have been left making desperate pleas to other facilities hundreds of miles away.
Other wealthy nations were better equipped to handle their Covid-19 surges
That disorganization is what distinguishes the US from other wealthy countries with different health systems — and arguably contributed to some of these terrible outcomes.
America is not alone in being tested by the coronavirus. Other wealthy nations saw their hospitals strained in the pandemic, especially early on, when countries like Italy endured some of the worst initial coronavirus outbreaks.
But a year and a half into the pandemic, those other countries appear better equipped to handle the load, aided by both higher vaccination rates and more cohesive health systems.
The US is mediocre in terms of hospital capacity, but it’s not at the bottom among its economic peers. Both Canada and the United Kingdom, with government-run health programs for every citizen, actually have slightly fewer hospital beds per capita.
And they neared their limits during the worst waves of the pandemic. The UK’s National Health Service was forced to transfer ICU patients to less congested areas during the fall and winter surges. In Ontario, more than 2,500 patients have been moved to other cities in order to receive lifesaving care. Even in France, which has significantly more hospital beds per capita than the US, more than 100 Covid-19 patients had to be evacuated as Paris hospitals ran low on beds.
These are not quite the same horror stories as we are seeing in the US, however, because there was a stronger level of coordination among the hospitals. In all of these international cases, either the national or local government managed the movement of patients.
No such system exists in the US; it is largely done informally. I spoke with a California hospital executive last summer who had to call a nearby hospital himself, looking for a ventilator when his facility was running low on those lifesaving machines.
Other countries appear to have avoided unnecessary deaths because they have a real system to coordinate care. In Britain, hospitals are currently able to handle more emergency care than the average volume prior to the pandemic, according to recent research by the Nuffield Trust, though elective surgeries are still sometimes being canceled.
“Hospitals have been incredibly stretched but have always been able to offer urgent and emergency care,” Nick Scriven, a UK doctor and past president of the Society of Acute Medicine, told me. “People were not turned away if they needed a hospital bed.”
The pandemic laid bare how disastrously disorganized the US health system is. But that’s always been true. It just usually reveals itself in more subtle ways.
An overwhelmed ER in a downtown urban setting might lead to some patients leaving without being seen. Low staffing at certain times — US hospitals stand out from their international peers because they have more administrative staff and less medical staff — appears to lead to worse outcomes. And then you have the higher out-of-pocket costs borne by Americans, which have been shown to lead to people skipping or postponing necessary medical care.
As Ezra Klein wrote for Vox last year, in covering the UK’s National Health Service, every health system rations care. There are not unlimited resources. But while in the US that rationing occurs in subtle and haphazard ways, other countries have tried to build a more rational system for managing their medical capacity.
That left them better positioned to handle surges of sick patients during the pandemic. America is paying the price for its failure to do the same thing.” (J)
“On Sept. 7, the country’s leading COVID-19 doctor issued a dire warning about the growing number of pandemic cases in the country, and the shrinking number of ICU beds available to care for the sickest people. Speaking on CNN, Dr. Anthony Fauci, the chief White House medical advisor, said we are “perilously close in certain areas of the country of getting so close to having full occupancy that you’re going to be in a situation where you’re going to have to make some tough choices.”
Those tough choices, he admitted, include discussions about whether scarce resources should go to people who haven’t been vaccinated, and the difficult ethical questions about personal choice that rationing crises raise. Doctors and hospital administrators are making heart-breaking decisions about who gets access to the increasingly few ICU beds. Should vaccinated people take precedence? Should people who followed mask and social distancing recommendations be prioritized over people who flouted these public health guidelines? While Fauci said such factors should not factor into a person’s care, he acknowledged that faced with such difficult choices, inevitably, “there’s talk of that.”
In some states, hospitals have already descended into the negative numbers for ICU beds, meaning they have more patients than beds available. In the U.S., as of Sept. 9, 80% of ICU beds are occupied, with 31% of them filled by patients with COVID-19, according to data collected by the Department of Health and Human Services. Those data also show that 100% of ICU beds in Alabama are occupied, but Dr. Karen Landers, assistant state health officer at the Alabama Department of Public Health, said to TIME in an email that the situation is actually worse. The state “reports that Alabama hospitals are in the negative zone in terms of ICU beds,” she writes. “Alabama hospitals have more ICU patients than ICU beds. Alabama has asked for and received Federal assets for care teams in Southwest and Southeast Alabama in the last two weeks.”
In the vast majority of states, at least 60% or more of those beds are filled with patients, most of them battling COVID-19. As of Sept. 9, more than half a dozen states reported that 90% or more of its ICU beds were occupied.
The strain pushes hospital directors into an ethical corner: how to decide which of the extremely limited beds and staff should go to which patients. In Idaho, where 90% of ICU beds in the state are full, the governor on Sept. 7 declared, for the first time in the state’s history, that the northern regions would now operate under “crisis standards of care,” which means normal standards of care that hospitals provide are preempted by other pressing factors, most notably the scarcity of equipment, beds, and health care staff. The declaration minimizes liability for doctors, nurses, health care workers and hospitals if they can’t respond with the same level of care and resources as they normally would. “Crisis standards of care is a last resort,” said Dave Jeppesen, director of the Idaho Department of Health and Welfare, which made the decision, in a statement.
Because it’s the first time that the emergency standard is being applied, “things are pretty fluid as we are still figuring out what it all means for us,” says Kimberly Johnson, director of communications and marketing for St. Mary’s Health, a 23-bed community hospital in Cottonwood, Idaho. Any decision about allocating limited medical equipment or services to patients goes to the hospital’s triage team, which involves an ethics committee that applies an intricate algorithm that takes into account the patient’s age, health status, family situation and more. It’s not perfect by any means, but gives doctors some foundation on which they can make those seemingly impossible decisions about who receives care and when.
“We are robbing Peter to pay Paul,” says Johnson. “We are wheeling and dealing to find beds, asking other hospitals to take our very acute patients if we can take their less acute ones.” Johnson says doctors have called facilities as far as Utah and San Francisco to find beds for their critical care patients when none were available in the northern part of Idaho last week.
Meanwhile, hospitals need to find ways to free up room for those less acute cases. At Kootenai Health, one of the Idaho hospitals affected by the new standards, officials turned the hospital’s health resource center into a temporary patient care unit to absorb those with less urgent needs. Hospitals in Florida were forced to do the same, converting cafeterias into patient wards to accommodate less urgent cases.
But what if there are no such valves to reduce the pressure on the critical care system? In those situations, says David Magnus, director of the Center for Biomedical Ethics at Stanford University, long-standing principles of utilitarianism, prioritization and egalitarianism apply. Different institutes may come up with varying algorithms that balance these concepts in different ways, with some preferring to focus on addressing social and cultural discrimination while others prioritize life years that a younger, healthy person may have yet to live over absolute number of lives saved. These principles have guided medical decision making of scarce resources, most notably in distributing organs for transplantation, for decades. That doesn’t make allocation decisions any easier, he notes, and rationing may grow more necessary in coming weeks and months as COVID-19 continues to spread.
Should vaccinated patients get priority?
The shadow that hovers over the current threat of rationing is the fact that this blow to the health care system was essentially avoidable and solvable. “We are having the same conversation that we had in April 2020. It’s disheartening; we are back where we were a year and a half ago,” says Jeffrey Kahn, director of the Johns Hopkins Berman Institute of Bioethics. “It didn’t have to be this way.”
Unlike during the previous crush on the health care system during the first and second COVID-19 waves, one of the factors driving the flood of ICU cases this time around are people who have not been vaccinated against COVID-19. It’s no coincidence that the states with the highest ICU bed occupancies are also those with relatively low vaccination coverage; in Georgia, where 99% of ICU beds are now full, 42% of the population is fully vaccinated, and in Alabama, where hospitals can no longer find beds for patients who need ICU care, 39% of the residents are vaccinated; Wyoming has a similar vaccination rate, which is the lowest in the country. In a plea on the state’s department of public health website, Alabama’s Landers noted that “given the shortage of ICU beds in Alabama, Alabama Department of Public Health continues to remind the general public of mitigation standards to reduce COVID-19 as well as the need for all persons ages 12 and above to be vaccinated.”
Still, ethicists and medical professionals agree that people’s behavior is not an acceptable factor to consider in making rationing decisions, as emotionally difficult as that may be to implement. “It’s understandable why physicians, nurses, respiratory therapists, social workers, food service and environmental workers and everybody who works in a health system are frustrated and angry toward the unvaccinated,” says Magnus. “They are facing another surge, and have had a miserable year and a half. And instead of being over, we’re back to square one. There is a sense that this time, we didn’t have to have this, and yet here we are again. So, the emotions are very understandable. But the mere fact that their behavior may have contributed to why people are sick and needing access to critical care resources is not a reason to discriminate [against] them by itself.”
Inevitably, patients who flouted public health guidelines to wear masks, avoid indoor public gatherings, and maintain social distancing will be vying for the same ICU beds as patients who followed them faithfully; but adherence to these guidelines should not play any role in determining who gets care. “The truth is that we provide care to diabetics who are non-compliant [with their dietary advice] and medication, and we provide critical care to smokers who develop heart disease,” says Johnson from St. Mary’s in Idaho. “Not having a vaccination is not a reason to not provide care; it’s not a consideration in our algorithms for how we provide care.”
The chokepoints on the horizon
Those algorithms will be tested to their limits in coming weeks. Even more urgent than the dwindling number of ICU beds is the shortage of ECMO units. For patients who can’t breathe well, extracorporeal membrane oxygen machines act as a mechanical set of heart and lungs to pump oxygenated blood through the body, similar to the heart-lung bypass machines surgeons use during heart bypass surgery. Many of the younger patients now affected by COVID-19 aren’t improving on ventilators—which only provide mechanical breathing assistance but still rely on patients’ lungs to do most of the work—and often require an ECMO. But even before the pandemic, ECMO machines were not widely available. In northern California, where about 7 million people live, there are 40 ECMO beds; Kaiser Permanente’s six beds are already full, and Stanford receives four to five requests for ECMO daily. “There is just not anywhere near enough of this resource to go around,” Magnus says.
In addition, ECMO was first used primarily in treating pediatric patients, and only recently became an option for adults, which means that fewer machines calibrated for adults, as well as fewer specially trained nurses, are available to treat adult ECMO patients—a single patient on ECMO requires a team of three specially trained nurses on duty 24 hours a day. That means that guidelines for helping doctors navigate who should receive ECMO when supply is scarce aren’t as robust as they are for rationing ventilators or ICU beds. “We have similar principles, but I don’t think the processes are as well developed for making decisions in a transparent way and with any type of community engagement,” says Magnus.
Staffing in ICU units is becoming another choke point on the already strained critical care system. Even if ICUs beds are available, the trained staff to care for patients occupying them may not be.
In Florida, when hospitalizations during this latest surge hit their peak in late August, hospitals scrambled to find doctors and nurses to staff the overflowing ICUs. It’s a catch-as-catch-can system that needs better coordination, says Mary Mayhew, president and CEO of the Florida Hospital Association. Having a database of health care professionals from neighboring states who are licensed and ready to fill in during emergency shortages would be a useful lesson learned from the pandemic experience. Already, many states participate in nursing compacts that enable nurses to work outside of the state in which they’re licensed. “We need better information about the number of individuals who have those compact licenses, and a repository that is regularly updated of individuals who have indicated an interest or willingness to support whatever current or future needs may be,” Mayhew says. “It points to an opportunity post-pandemic to evaluate where there are still unnecessary barriers to timely access to staff.”
In the meantime, Fauci stressed that getting vaccinated could help to alleviate some of the burden on ICU wards, as well as avoid those wrenching rationing decisions, as we enter the fall and winter, when students are back in school and colder weather means more people will be spending time indoors where not just SARS-CoV-2, but other respiratory viruses like influenza can take hold and spread. Studies show that fully vaccinated people are better protected against COVID-19, and far less likely than unvaccinated people to develop severe disease that requires ICU or even hospital care. But if the numbers of unvaccinated people remain high, the reality is that the fast-spreading Delta variant will find a way to bury deeper in communities not just in the U.S. but around the world. And with finite medical resources available to care for the sickest patients, rationing will become a hard truth. “Everybody who talks about this really hopes we never have to do this,” says Kahn.” (K)
“From April through June 2020, New York City hospitals were overwhelmed by COVID-19 patients, and now, a working group of 15 hospital intensive care unit directors and the Johns Hopkins Center for Health Security have reported on the successes and failures of that time.
“Crisis Standards of Care: Lessons from New York City Hospitals’ COVID-19 Experience” determined that crisis standards of care (CSC) planning did not always match actual clinical needs during the pandemic, and though the response to surging COVID-19 cases was effective, it was often chaotic. Notably, this was the first time CSC measures were implemented by hospitals on a large and prolonged scale since their development by the National Academy of Medicine 11 years ago.
As hospitals shifted from conventional standards of care, inter-hospital collaboration proved successful even as situational awareness stumbled. Decision-making for triage and allocation of life-sustaining care proved difficult for many to process, and healthcare workers themselves proved very susceptible to and affected by the psychological strain of dealing with CSC issues as the surge continued.
The researchers determined that the lessons from this time could help other hospital systems, however, as COVID-19 hospitalizations rapidly rise again across the country. They believe that CSC planning needs to be more operational, with greater involvement from clinicians, who need to be shown that the process is not limited to things like ventilator triage. The researchers stated that it is essentially about making the best decision when in an unfamiliar situation involving risk to a patient or provider.
A formal declaration is needed for crises — one that clearly lays out guidance about the scope of the declaration and the researchers or processes to which it applies. Better situational awareness of patient load, resources, and changing guidance is necessary, and so are ways of inter-staff communication. Speed is key, and as such, triage decisions should be taken out of committee hands and instead involve the treating physician and others. Emotional support for healthcare workers is needed, but so is planning for staff shortages as the pandemic wreaks its toll.” (L)
“Our analysis of HHS and CDC data indicates there were 32,000 preventable COVID-19 hospitalizations in June, 68,000 preventable COVID-19 hospitalizations in July, and another 187,000 preventable COVID-19 hospitalizations among unvaccinated adults in the U.S. in August, for a total of 287,000 across the three months. We explain more on how we arrived at these numbers below.
If each of these preventable hospitalizations cost roughly $20,000, on average, that would mean these largely avoidable hospitalizations have already cost billions of dollars since the beginning of June.
From June through August 2021, preventable COVID-19 hospitalizations among unvaccinated adults cost over $5 Billion
Based on our estimates, described below, we find preventable COVID-19 hospitalizations cost $5.7 billion from June to August in 2021.
We used counts of adult hospitalizations with confirmed COVID-19 in recent months reported to HHS to estimate preventable hospitalization costs for unvaccinated adults. We focus on hospitalizations of adults (ages 18+) with COVID-19 because many children are still ineligible for the COVID-19 vaccine, and even those minors who are eligible may need parental consent to get the vaccine. We made assumptions that result in a conservative estimate of costs attributable to preventable, unvaccinated hospitalizations.
Over 280,000 COVID-19 hospitalizations could have been prevented by vaccination between June to August 2021…” (M)
PREQUELS
POST 187. August 11, 2021. CORONAVIRUS. “As a result of the increase in COVID-19 cases and hospitalizations, the state of Florida requested 300 ventilators from the federal government.”… “An 11-month-old girl with Covid-19 is stable and no longer intubated one day after she was airlifted to a Texas hospital 150 miles away because of a shortage of pediatric beds in the Houston area.”
POST 189. August 19,2021. CORONAVIRUS. “There wasn’t a single I.C.U. bed available in Alabama on Wednesday…”…”A triage plan on the Alabama health department’s website suggests that “persons with severe mental retardation” are among those who “may be poor candidates for ventilator support.”
POST 190, August 21, 2021. CORONAVIRUS. “We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,”..“Emergency medical technicians (EMTs) and certified paramedics can now care for patients in Mississippi hospitals and emergency rooms under a new health office order issued by the Mississippi State Department of Health on Wednesday.”
POST 195. September 6, 2021. CORONAVIRUS. “…there are “zero ICU beds left for children in Dallas County, Texas,”.,..”That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely if they have Covid and need an ICU bed, we don’t have one. Your child will wait for another child to die… (county judge Clay Jenkins)
POST 197. September 12, 2021. CORONAVIRUS. Idaho officials have instituted “crisis standards of care” to help 10 hospitals and health care systems decide how to allocate personnel and resources to deal with a crush of COVID-19 patients.”… “The Washington Medical Coordination Center oversees facilitating transfers in the state, and it’s warning we could be nearing the point of “Crisis Standards of Care,” just like Idaho.” .. “These crisis models don’t actually save more lives, they just save different lives..”
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. 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.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 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.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
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.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
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”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.’” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
POST 148. April 7, 2021. CORONAVIRUS. While the Biden administration accelerates vaccinations to ward off numerous variants and as more young people are being hospitalized, states, even with increasing case rates are on paths to fully reopen. Politics v. public health!
POST 149. April 10, 2021. CORONAVIRIUS. “From Michigan to Massachusetts, COVID-19 cases and hospitalizations are on the rise again. Deaths will soon follow. “ ”.. the Biden administration is facing renewed calls to delay second vaccine doses and blanket more of the U.S. population with an initial shot.”
POST 150. April 10, 2021. CORONAVIRUS. “The use of so-called COVID-19 “vaccine passports” is quickly becoming a divisive issue across the US – with several states, including New York, embracing the idea, while others have already moved to ban them.”
POST 151. April 14, 2021. CORONAVIRUS. the J&J vaccination pause. “ Federal officials are concerned that doctors may not be trained to spot or treat the rare disorder if recipients of the vaccine develop symptoms of it…” “…a standard treatment for blood clots — use of an anticoagulant drug — could be dangerous or even fatal in such cases…”
POST 152. April 15, 2021. CORONAVIRUS. “The Chinese Center for Disease Control and Prevention’s director said Saturday authorities are considering mixing COVID-19 vaccines because the country’s domestically made doses “don’t have very high protection rates,”
POST 153. April 18, 2021. CORONAVIRUS. “At least 35 hospitals across Michigan were listed Thursday as nearing capacity and three were at full capacity for COVID-19 patients..”.. We can manufacture beds. We can open up beds. We can create entire wings of the hospital if we have to, but if we don’t have staff for those beds, we’ve got nothing.”..
POST 154. April 19, 2021. CORONAVIRUS. “Breakthrough infections, which occur when fully vaccinated people are infected by the pathogen that their shots were designed to protect against, are an entirely expected part of any vaccination process.” “Pfizer’s chief executive said that a third dose of the company’s Covid-19 vaccine was “likely” to be needed within a year of the initial two-dose inoculation — followed by annual vaccinations.”
POST 155. April 24, 2021. CORONAVIRUS. As the J&J vaccine pause is ended Senator Johnson said “The science tells us that vaccines are 95% effective. So if you have a vaccine, quite honestly, what do you care if your neighbor has one or not? I mean, what is it to you?”
POST 156. April 28, 2021. CORONAVIRUS. As CDC revises guidance on outdoor masking, Texas Governor Abbott says “the state is “very close” to herd immunity… despite acknowledging that he does not know what the herd immunity threshold is for the virus, an uncertainty echoed by the public health community.”
POST 157. April 25, 2021. CORONAVIRUS. Ohio hospitals; “We agreed in multiple conversations, there’s nothing in fighting a pandemic that creates a competitive advantage.”…
POST 158. May 5, 2021. CORONAVIRUS. . As populations get closer to herd immunity “ it may be helpful to introduce some nuance to what we mean by the term. Nationwide herd immunity. Regional herd immunity. Temporary herd immunity. Endemicity.”
POST 159. May 9, 2021. CORONAVIRUS. “Without deeper sharing of expertise in how to make vaccines…waiving patent obligations is unlikely to be a game-changer… Having access to the “recipe” certainly helps, but understanding how to put it together and produce it at scale is something else.”
POST 160. May 13, 2021.CORONAVIRUS. “The CDC acknowledged Friday that airborne spread of COVID-19 among people more than 6 feet apart “has been repeatedly documented.”” Meanwhile states relax or eliminate indoor dining restrictions. HUH?
POST 161. May 15, 2021. CORONAVIRUS. “Even if the spread of Covid-19 decreases enough to allow a return of most activities, there are some aspects of pandemic life that epidemiologists say will persist much longer. In particular, they say that masks are a norm that should continue, even if that view puts them at odds with the new C.D.C. guidance. More than 80 percent of them say people should continue to wear masks when indoors with strangers for at least another year, and outdoors in crowds.”
POST 162. May 21, 2021. CORONAVIRUS. “New Jersey Gov. Phil Murphy is refusing to lift his indoor mask mandate for vaccinated residents…” “…fully vaccinated residents in New York and Connecticut are no longer required to wear masks..”..” “California says it isn’t ready to follow the federal lead and unmask, at least for another month..”.. “..Texas Gov. Greg Abbott issued an executive order Tuesday prohibiting state governmental entities such as counties, public school districts, public health authorities and government officials from requiring mask wearing.”
POST 163. May 23, 2021. CORONAVIRUS. RWJBarnabas Health in New Jersey announced a mandate…saying supervisors and those of higher rank must get the vaccine by June 30. They will eventually require the system’s 35,000 employees to do the same.
POST 164. May 26, 2021. CORONAVIRUS. On Wednesday, health minister Norihisa Tamura warned Olympic organizers they would have to “secure their own” hospital beds for anyone falling ill at the Games, explaining the government would not release beds set aside for Japanese covid-19 patients.”
POST 165. May 31,2001. CORONAVIRUS. “Like all pandemics, this one will end either with millions — maybe billions — being infected or being vaccinated. This time, world leaders have a choice, but little time to make that choice before it is made for them.”
POST 166. June 3, 2020. CORONAVIRUS. “President Biden said Wednesday that he has asked intelligence agencies to double down on their efforts to investigate whether the coronavirus originated from human contact with an animal or in an laboratory in China, saying there is not “sufficient information” to assess whether one is more likely than the other.”
POST 167. June 9, 2021. CORONAVIRUS. Hospitals prevaricate on mandatory staff vaccinations. Florida’s Governor forbids cruise ship vaccine mandates. Pfizer and Moderna apply for FDA full approval.
POST 168. June 10, 2021. CORONAVIRUS. “Our species has a tendency to get distracted. We have a very strong appetite for distraction, and when something is not in the spotlight, when it’s not a crisis anymore, we tend to forget and move on to something else. So the biggest challenge is going to be maintaining focus on this next step of developing vaccines that anticipate pandemics.”
POST 169. June 14, 2021. CORONAVIRUS. “Hospitals in Washington, D.C…announced a consensus agreement to mandate COVID-19 vaccinations for more than 30,000 workers, 70% of which are already vaccinated. Each of 14 hospitals will set their own deadline…”
POST 170. June 17, 2021. CORONAVIRUS. “Dr. Ashish Jha…is worried about the potential impact the delta variant could have in the United States… “I’m concerned about the Delta variant,”… “Why? Most contagious variant yet. Wreaked havoc in India. Spiking cases in UK. Growing rapidly in the US.”
POST 171. June 19, 2021. “A 34-year-old man (a Covid-19 survivor) has been diagnosed with India’s first known case of “green fungus” infection.”… “Green fungus is the new infection to join the earlier known cases of black, white and yellow fungus.”…”green fungus was earlier seen only as a “junior partner” in other infections… In the current patient, this fungus is acting as the aggressor.”
POST 172. June 23, 2021. CORONAVIRUS. Morgan Stanley chief executive James Gorman said: “If you can go into a restaurant in New York City, you can come into the office.”…”remote work can “dramatically undermine” the character and culture a company is attempting to build; and “virtually eliminates spontaneous learning and creativity.”
POST 173. June 26, 2021. CORONAVIRUS. “The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.”
POST 174. July 1, 2021. CORONAVIRUS. “..while the WHO is encouraging people to keep wearing masks even if they’re vaccinated, Dr. Anthony Fauci says it doesn’t look like the CDC currently plans to change its guidelines.” … health officials in Los Angeles recommended that “everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.”..”
POST 175. July 5, 2021. CORONAVIRUS. “Can a health care worker who is not against vaccines in general still harbor sincere concerns that scientists don’t yet know about all the side effects of these vaccines? Yes, says Ezekiel Emanuel, MD, PhD — but those people should not work in health care.”
POST 176. July 9, 2021. CORONAVIRUS. Mercy Springfield ( Missouri) hospital…” ran out of ventilators for its patients over the Fourth of July weekend…”…“Mercy will require all current and future employees to be fully vaccinated.”…“The US government is deploying a Covid-19 surge team to provide public health support in southwest Missouri
POST 177. July 12, 2021. CORONAVIRUS. the Delta variant is “the 2020 version of Covid-19 on steroids,”… “It is the most hypertransmissible, contagious version of the virus we’ve seen to date…it’s a superspreader strain if there ever was one .” but… now, there’s a Delta Plus variant…
POST 178. July 15, 2021. CORONAVIRUS. “Tennessee’s top vaccine official says she has been fired as punishment for doing her job in the face of political pushback.”..” More than 180 state and local public health leaders…have resigned, retired or been fired since April 1…”“Former President Trump and his GOP allies have stepped up attacks on Anthony Fauci…”
POST 179. July 16, 2021. CORONAVIRUS. “It, therefore, follows that the “harm principle” (“first, do no harm.”) can be used to justify compulsory vaccination programs in specific instances where the community interests or benefits are deemed to be significant.”
POST 180, July 20, 2021. CORONAVIRUS. “Most people will either get vaccinated, or have been previously infected, or they will get this Delta variant,”.. “And for most people who get this Delta variant, it’s going to be the most serious virus that they get in their lifetime in terms of the risk of putting them in the hospital,”
POST 181. July 22, 2021. CORONAVIRUS. “Health experts fear the Tokyo Olympics could become a COVID-19 superspreader event.” “Whatever happens in Japan isn’t likely going to stay in Japan since all of the athletes and accompanying coaches and staff will be returning to their home countries.”
POST 182. July 26, 2021. CORONAVIRUS. Alabama Gov. Kay Ivey (R): “Folks supposed to have common sense.”…“But it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” ““Beginning in mid-September, New York City will require all of its 340,000 municipal workers, including police, firefighters and teachers, to either be vaccinated against COVID-19 or tested weekly.”
POST 183. July 29, 2021. CORONAVIRUS. When I was appointed President and CEO of Jersey City Medical Center in1989 in the peak of the HIV/ AIDS crisis, we had a dedicated, and always full, dedicated 60 bed AIDS unit, staffed by one full time nurse and numerous part-time and per diem nurses. Today, right now, hospitals caught in the Covid-19 surge, are forced to redeploy nursing staff, respiratory therapists and other clinicians, most without prior infectious diseases experience. Why are we tolerating the unvaccinated putting our hospital staffs at risk?
POST 184. August 1, 2021. CORONAVIRUS. “The coronavirus could be “just a few mutations potentially away” from evolving into a variant that can evade existing COVID-19 vaccines, CDC director Rochelle Walensky said..” (A) “The Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox..” (I)
POST 185. August 6, 2021. CORONAVIRUS. ‘If you aren’t going to help, please get out of the way’: Biden turns up the pressure on GOP governors as Delta spreads”
POST 186. August 8, 2021. CORONAVIRUS. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late,” she added, referring to patients who have to be put on a ventilator.” (A) “There is no one definition of what the end of a pandemic means.”.. “The question of when the crisis will be over is a layered one — with different answers from local, national and global perspectives.”
POST 187. August 11, 2021. CORONAVIRUS. “As a result of the increase in COVID-19 cases and hospitalizations, the state of Florida requested 300 ventilators from the federal government.”… “An 11-month-old girl with Covid-19 is stable and no longer intubated one day after she was airlifted to a Texas hospital 150 miles away because of a shortage of pediatric beds in the Houston area.”
POST 188. August 15, 20201. CORONAVIRUS. “According to an internal CDC briefing….an estimated 1.1 million people have already gotten unauthorized booster shots…”….”If it is left up to the honor system, I think many Americans will suddenly wake up and find themselves immunocompromised enough to get a 3rd dose,”
POST 189. August 19,2021. CORONAVIRUS. “There wasn’t a single I.C.U. bed available in Alabama on Wednesday…”…”A triage plan on the Alabama health department’s website suggests that “persons with severe mental retardation” are among those who “may be poor candidates for ventilator support.”
POST 190, August 21, 2021. CORONAVIRUS. “We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,”..“Emergency medical technicians (EMTs) and certified paramedics can now care for patients in Mississippi hospitals and emergency rooms under a new health office order issued by the Mississippi State Department of Health on Wednesday.”
POST 191. August 27, 2021. CORONAVIRUS. “Anthony Fauci, MD, chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases, explained that late September gives the United States time to set up the logistics.” This is not medical science, but perhaps Political Science?
POST 192. August 30, 2021. CORONAVIRUS. Gov. John Bel Edwards on Hurricane Ida – “I hate to say it this way, but we have a lot of people on ventilators today and they don’t work without electricity,” he said.”
POST 193. September 3, 2021. CORONAVIRUS. Nurses are leaving their hospitals and becoming travel nurses at hospitals across town “because they can make $4,000, $5,000, $6,000, $7,000 a week while not having to relocate anywhere..”
POST 194. August 2, 2021. CORONAVIRUS. “Recently-released data is painting a grim picture of the opioid epidemic that has gripped the United States — as the country is still grappling with the coronavirus pandemic that has killed more than half a million Americans. Some people are calling them twin pandemics that have collided”…“Faced with a novel health crisis, researchers are collecting data on the long-term impact of using opioids to treat COVID-19 pain…
POST 195. September 6, 2021. CORONAVIRUS. “…there are “zero ICU beds left for children in Dallas County, Texas,”.,..”That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely if they have Covid and need an ICU bed, we don’t have one. Your child will wait for another child to die… (county judge Clay Jenkins)
POST 196. SEPTEMBER 11, 2001. PART 1. Military helicopters and jets were overhead, as President Bush was getting ready to leave NYC. PART 2. LESSONS LEARNED memorandum by hospital CEO Jonathan Metsch goes “viral”…
POST 197. September 12, 2021. CORONAVIRUS. Idaho officials have instituted “crisis standards of care” to help 10 hospitals and health care systems decide how to allocate personnel and resources to deal with a crush of COVID-19 patients.”… “The Washington Medical Coordination Center oversees facilitating transfers in the state, and it’s warning we could be nearing the point of “Crisis Standards of Care,” just like Idaho.” .. “These crisis models don’t actually save more lives, they just save different lives..”
POST 198. September 15, 2021. CORONAVIRUS. A pundit said “The most elegant policy riposte to the anti-vaxxers… is to refuse to allow Medicare or Medicaid to pay their medical bills in the event they become seriously ill. Private health insurers might also follow suit.” (but is making our hospitals become the bill collectors right?)
POST 199. September 19, 2021. CORONAVIRUS. Crisis Standards of Care. “… to his knowledge, no patient in Idaho has been taken off life-support therapy in order to provide that therapy to another patient who has a better prognosis.” “While that has yet to occur, if we continue on this path, it will,”
Faced with this avoidable catastrophe, President Biden is right to order tighter vaccine rules, which he did for roughly two-thirds of the nation’s work force on Thursday. “We’ve been patient,” Mr. Biden told vaccine holdouts. “But our patience is wearing thin. And your refusal has cost all of us.”…
for links to POSTS 1-198 in chronological order highlight and click on
“President Joe Biden on Thursday imposed stringent new vaccine rules on federal workers, large employers and health care staff in a sweeping attempt to contain the latest surge of Covid-19.
The new requirements could apply to as many as 100 million Americans — close to two-thirds of the American workforce — and amount to Biden’s strongest push yet to require vaccines for much of the country…
At the center of Biden’s new plan is directing the Labor Department to require all businesses with 100 or more employees ensure their workers are either vaccinated or tested once a week, an expansive step the President took after consultation with administration health officials and lawyers. Companies could face thousands of dollars in fines per employee if they don’t comply.
US Postal Service workers would fall under that rule, a senior administration official told CNN, and employees will be required to be vaccinated or face mandatory weekly testing. The Postal Service, a quasi independent agency, employees more than 640,000 people.
Biden also signed an executive order requiring all government employees be vaccinated against Covid-19, with no option of being regularly tested to opt out. The President signed an accompanying order directing the same standard be applied to employees of contractors who do business with the federal government.
He said 300,000 educators in federal Head Start programs must be vaccinated and called on governors to require vaccinations for schoolteachers and staff.
And Biden announced he would require the 17 million health care workers at facilities receiving funds from Medicare and Medicaid to be fully vaccinated, expanding the mandate to hospitals, home care facilities and dialysis centers around the country.
“We have the tools to combat the virus if we come together to use those tools,” Biden said at the outset of what was billed as a major speech to tackle the latest phase of the Covid-19 pandemic.” (A)
“Experts say Mr. Biden has the legal authority to impose vaccine requirements on the private sector, through laws that require businesses to comply with evidence-based federal health safety standards. OSHA, which enforces workplace safety, has already imposed other pandemic precautions, such as a rule in June requiring health care employers to provide protective equipment and adequate ventilation and ensure social distancing, among other measures. Robert I. Field, a law professor at Drexel University, said that OSHA had the authority to protect workers’ safety, keeping them from being exposed to a potentially deadly virus, by requiring vaccinations.
Lawrence O. Gostin, a Georgetown University law professor who specializes in public health, added: “The president’s plan is bold, audacious and unprecedented. But I do think it’s entirely lawful. He’s on extremely strong legal ground.”..
“When you have 75 to 80 million people who are eligible to be vaccinated, who don’t get vaccinated, you’re going to have a dynamic of continual smoldering spread of the infection,” Mr. Biden’s top medical adviser for the coronavirus pandemic, Dr. Anthony S. Fauci, warned in an interview, adding, “It’s very frustrating, because we have the wherewithal within our power to be able to actually suppress it.”…
One thing Mr. Biden cannot do is require all Americans to be vaccinated; in the United States, vaccinations are the province of the states. But Mr. Gostin said the president could also dangle the prospect of federal funding to prod states to require their own workers to be vaccinated, and his administration could offer technical guidance to states that want to develop so-called vaccine passports for people to provide digital proof of vaccination.” (B)
“If a conflict at one New York hospital over vaccine mandates for health care workers is any indication, the Biden administration’s new effort to mandate vaccines for millions of workers could be in for an uphill battle…
In New York, where former Gov. Andrew Cuomo mandated that all health care workers in the state get a vaccine, employees at hospitals and long-term care facilities need to get their first dose by Sep. 27.
At one local hospital in upstate New York, dozens of staff members walked away from their jobs after refusing to get vaccinated. The move has seriously disrupted care in the process.
Lewis County General Hospital in Lowville, N.Y., announced Friday that it is pausing maternity services later this month because dozens of staff members quit rather than get COVID-19 vaccines.
The hospital will be “unable to safely staff” its maternity department and newborn nursery as of Sept. 25, according to Lewis County Health System CEO Gerald Cayer. He added that other departments in the hospital are at risk as well if workers don’t get vaccinated.
As of Friday, 30 employees had resigned from Lewis County General Hospital. At least 464 people in the Lewis County Health System have been vaccinated — a 73% immunization rate among employees.” (C)
“The Equal Employment Opportunity Commission has already clarified that employers can require their staffs to get vaccinated, so long as they provide accommodations for workers who say they can’t get the shot because of their religious beliefs or a disability. Businesses can tell workers to stay home if they can’t be vaccinated for one of those reasons, and workers could be fired if their employer is unable to accommodate remote work, attorneys say.” (D)
“It’s true that courts have upheld vaccine mandates in certain circumstances: In a 1922 case, the Supreme Court famously ruled that a city ordinance could deny admission to students who failed to get the smallpox vaccine. But the assertion that a public official can completely sidestep the legislative process and enact a much farther-reaching vaccine mandate via administrative action should elicit skepticism from even those who vigorously support vaccination.
There are other ways to nudge the populace in the right direction. Rather than punishing the unvaccinated, the government could create an incentive for vaccination by lifting restrictions for the vaccinated. This was the approach initially taken by the C.D.C., which said this year that since the vaccinated were well protected, they could almost always safely discard their masks. Unfortunately, the more transmissible Delta variant spooked federal health officials, and the C.D.C. reversed course. Some municipalities, including Washington, then reimposed mask mandates, even though the science hasn’t actually changed: The vaccinated are still well protected from Covid.
Some people would probably voluntarily get the shot if they knew for certain that a vaccination card was a ticket to living a normal life once again. Regrettably, Mr. Biden’s mandate moves in the exact opposite direction, with the White House saying his plan will ensure that “strong mask requirements remain in place.” If the government is concerned about vaccine hesitancy, it should trust the vaccines and drop other restrictions. People should know that if they get vaccinated, they will be better off. Instead, the White House is sending the message that people must get vaccinated but should hardly expect things to be different afterward.” (E)
“But Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said the policy was necessary, and likened it to military service in a time of war.
“To date, we have relied on a volunteer army,” Dr. Schaffner said. “But particularly with the Delta variant, the enemy has been reinforced, and now a volunteer army is not sufficient. We need to institute a draft.”” (F)
“As Americans contemplate the prospect of a second winter trapped in the grip of Covid-19, remember that it didn’t need to be this way. Vaccines were developed in record time, and have proved to be both incredibly safe and stunningly effective. Nearly two-thirds of eligible Americans have accepted these facts and done their part by getting fully vaccinated.
Yet tens of millions more have not, allowing the more contagious Delta variant to sweep across the country, where it is now killing more than 1,500 people in the United States daily. Right now, the list of the very sick and the dead is made up almost entirely of the unvaccinated. But as long as the virus continues to spread widely, it can and will evolve in ways that put everyone at risk.
Faced with this avoidable catastrophe, President Biden is right to order tighter vaccine rules, which he did for roughly two-thirds of the nation’s work force on Thursday. “We’ve been patient,” Mr. Biden told vaccine holdouts. “But our patience is wearing thin. And your refusal has cost all of us.”…
The Biden administration has already done just about everything in its power to encourage people to get vaccinated, from putting out targeted advertisements, offering financial incentives and reminding people that the shots are free. Carrots haven’t been enough. That’s why Mr. Biden’s actions Thursday were courageous: If the goal is not to pander but to lead, tighter rules ensuring more people are vaccinated were the only meaningful option left.” (G)
“Gail Collins: Well, Bret, if Biden was rounding up the non-vaxxers, having them tied down and inoculated by force — the way many Republicans seem to be drawing the picture — I’d certainly have reservations. But in effect he’s saying that they shouldn’t be allowed in certain places where infection is relatively easy to spread, like workplaces or public buildings.
This is a serious, serious health crisis and I don’t think I’d want the president to content himself with giving pep talks.
And don’t I remember a previous conversation in which you suggested the non-vaccinated didn’t deserve to be allowed in hospitals if they got sick?
Bret: Not exactly, but close. The most elegant policy riposte to the anti-vaxxers — and I mean the willful ones, not the people who simply haven’t had access to the shot or have a compelling medical excuse — is to refuse to allow Medicare or Medicaid to pay their medical bills in the event they become seriously ill. Private health insurers might also follow suit. I accept that people don’t want the government or their employer telling them what to do with their bodies. But these same people shouldn’t expect someone else to bail them out of their terrible health decisions.” (H)
“More than a year and a half into the Covid-19 pandemic, America still doesn’t agree on what it’s trying to accomplish.
Is the goal to completely eradicate Covid-19? Is it to prevent hospitals from getting overwhelmed? Is it hitting a certain vaccine threshold that mitigates the worst Covid-19 outcomes but doesn’t prevent all infections? Or is it something else entirely?
At the root of this confusion is a big question the US, including policymakers, experts, and the general public, has never been able to answer: How many Covid-19 deaths are too many?
The lack of a clear end goal has hindered America’s anti-pandemic efforts from the start. At first, the goal of restrictions was to “flatten the curve”: to keep the number of cases low enough that hospitals could treat those that did arise. But that consensus crumbled against the reality of the coronavirus — leaving the country with patchwork restrictions and no clear idea of what it meant to “beat” Covid-19, let alone a strategy to achieve a victory.
The vaccines were supposed to be a way out. But between breakthrough infections, the risks of long Covid, and new variants, it’s becoming clear the vaccines didn’t get rid of the need to answer the underlying question of what the Covid-19 endgame is.
America is now stuck between those two extremes: The country wants to reduce the risk of Covid-19, but it also wants to limit the remnants of social distancing and other Covid-related restrictions on day-to-day life.
“We’re not trying to go for zero Covid,” Ashish Jha, dean of the Brown University School of Public Health, told me. “The question becomes: When do, in most communities, people feel comfortable going about their daily business and not worrying, excessively, about doing things that are important and meaningful to them?”” (I)
“The US shouldn’t ease restrictions in place to prevent Covid-19 before the number of new coronavirus cases falls below 10,000 daily, “and maybe even considerably less than that,” Dr. Anthony Fauci said Thursday.
The US should pull restrictions gradually, after a substantial portion of Americans are vaccinated, Fauci told CNN’s Jake Tapper.
The last time the US saw fewer than 10,000 new daily cases was almost a year ago, on March 22, 2020. The number hasn’t fallen below 50,000 daily cases since mid-October, and the seven-day average on Wednesday was more than 64,000.
“We will be pulling back,” said Fauci, President Joe Biden’s chief medical adviser. “We’re now up to about 2 million vaccinations per day. That means every day that goes by, every week that goes by, you have more and more people protected.”
Fauci’s comments come as some states begin to pull back restrictions, including doing away with mask mandates, allowing businesses to fully open and increasing the number of people allowed at mass gatherings.
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. 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.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 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.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
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.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
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”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
POST 88. December 11, 2020. CORONAVIRUS. “As COVID-19 cases surge, the federal government is releasing data about hospital capacity at facilities around the country….”The new data paints the picture of how a specific hospital is experiencing the pandemic,”…
PART 89. December 12, 2020. CORONAVIRUS. THE VACCINE!!! “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.” Winston Churchill
POST 90. December 14, 2020. CORONAVIRUS. “…the first doses of a Covid-19 vaccine have been given to the American public..”…” Each person who receives a vaccine needs two doses, and it’s up to states to allocate their share of vaccines.”
POST 91. December 15, 2020. CORONAVIRUS. “UPMC will first give (vaccination) priority to those in critical jobs. That includes a range of people working in critical units, from workers cleaning the emergency room and registering patients to doctors and nurses.. “Finally, if needed, UPMC will use a lottery to select who will be scheduled first.”
POST 92. December 17, 2020. CORONAVIRUS. “..each state — and each hospital system — has come up with its own (vaccination) plan and priorities. The result has been a sometimes confusing constellation of rules and groupings that has left health care workers wondering where they stand.” (Trump appointee July 4th email “…we need to establish herd, and it only comes about allowing the non-high risk groups expose themselves to the virus. PERIOD,”)
POST 93. December 19, 2020. CORONAVIRUS. On NPR Congresswoman Shalala (D-Florida) said she wouldn’t jump the vaccination line in Miami; then added she would get vaccinated in Washington this week. This, even though Congress has failed to pass “essential” Coronavirus legislation. So who are our “essential” workers?
POST 94. December 21, 2020. CORONAVIRUS. “A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”.. “I haven’t done ICU medicine since I was a resident — you don’t want me adjusting your ventilator,” he said. “That’s the challenge, actually — it isn’t so much space, it’s staff…”
POST 96. December 26, 2020. CORONAVIRUS. “Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci…”…”..he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….”
POST 97. December 27, 2020. “A new variant of the coronavirus that has been spreading through the UK and other countries has not yet been detected in the United States..”.. . But if new-wave medicines like antivirals and antibody therapy contributed to the development of viral variants, it will be “a reminder for all the medical community that we need to use these treatment options carefully.”
POST 99. December 29, 2020. CORONAVIRUS. “ICUs are being overwhelmed across many parts of California. Statewide aggregate ICU availability has been at 0% since Christmas Eve…. a surge on top of a surge on top of a surge.”… “hospitals are getting close to the point where they would begin putting COVID-positive patients under the care of COVID-positive staff who are asymptomatic.”
POST 100. December 29, 2020. CORONAVIRUS. Front line hospital workers – in the ER, ICUs, EMS, acute medical care, behavioral health – are amongst the most courageous, heroic and dedicated colleagues you will ever meet.
POST 101. December 30, 2020.CORONAVIRUS. Is there a point where the increasing Coronavirus trajectory so far exceeds the slow growth of the vaccination rate that reaching herd immunity through vaccinations becomes less likely?
POST 102. January 2, 2020. CORONAVIRUS. “We’ve taken the people with the least amount of resources and capacity and asked them to do the hardest part of the vaccination — which is actually getting the vaccines administered into people’s arms,” said Dr. Ashish Jha, the dean of Brown University’s School of Public Health. “Ultimately, the buck seems to stop with no one,”…
POST 103. January 4, 2021. CORONAVIRUS. Dr. Fauci said “that the United States would not follow Britain’s lead in front-loading first vaccine injections, potentially delaying the administration of second doses…Dr. Moore – ”British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess.”
POST 104. January 6, 2021. CORONAVIRUS. “Paramedics in Southern California are being told to conserve oxygen and not to bring patients to the hospital who have little chance of survival…”
POST 105. January 8, 2021. CORONAVIRUS. POST 105. January 8, 2021. CORONAVIRUS. “Facing a shortage of vaccinators, the Association of Immunization Managers… recommends relaxing regulation or adjusting licensing requirements. At least two states, Massachusetts and New York, have changed their laws in recent weeks to expand those who are eligible to give shots.”
POST 106. January 9, 2021. CORONAVIRUS. The riots at the Capitol could have been a superspreader event. “From what I saw… you had a large congregation of individuals who were in close contact for an extended period of time and almost universally unmasked…. many coming and going on buses as well, also unmasked, and hanging out in hotel lobbies.”
POST 107. January 8, 2021. CORONAVIRUS. “Our job is to make sure the vaccine isn’t politicized the way masks were politicized,” Rep. Alexandria Ocasio-Cortez, D-N.Y., said after getting her vaccine. South Carolina Rep.-elect Nancy Mace, a Republican, wrote that “Congress shouldn’t be putting themselves first in line for the COVID-19 vaccination when the average American can’t get it.”
POST 108. January 9, 2021. CORONAVIRUS. (vaccination)”Line-cutters will be named and shamed. It’s inevitable, as will be the congressional hearings and front-page investigative stories ferreting out who saved their own skin at the expense of others.”
POST 109.January 9, 2021. CORONAVIRUS. “President-elect Joe Biden will aim to release nearly every available dose of the coronavirus vaccine when he takes office, a break with the Trump administration’s strategy of holding back half of US vaccine production to ensure second doses are available.
POST 110. January 13, 2021. CORONAVIRUS. ““The (federal) government is changing the way it allocates Covid vaccine doses, now basing it on how quickly states can administer shots and the size of their elderly population.”… “New York State sent a letter to hospitals saying if they don’t use their vaccine allocations by the end of this week, they won’t receive any further allocations.”
POST 111. January 14, 2021. CORONAVIRUS. “Visitors from Toronto to New York to Buenos Aires have long flocked to Florida for sun, surf and shopping. Now they are coming for the Covid-19 vaccine….
POST 112. January 14, 2021. CORONAVIRUS. CHINA – “Eleven million people are under lockdown in Hebei province after a new cluster of coronavirus infections.
PART 113. January 17, 2021. CORONAVIRUS. The Next President Actually Has a Covid Plan… New York City and other places in the state expect to exhaust their supply of doses as early as next week… Charles Barkley said during the “NBA on TNT” broadcast that pro athletes should get the first round of the vaccine…..
POST 114. January 18, 2021. CORONAVIRUS. “When government programs that have been unattended, underfunded and bogged down by red tape suddenly have to meet a huge demand in a crisis, they can’t cope and people suffer….”
POST 115. January 21, 2020. CORONAVIRUS. A year ago today an unnumbered POST was headlined “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.” The CORONAVIRUS CONTENT TRACKING PROJECT started with HISTORIOGRAPHY and over time moved to LESSONS LEARNED, RAPID RESPONSE, and THE VACCINATION PROGRAM. Now 115 POSTS later – the BIDEN CORONAVIRUS PLAN.
POST 116. January 22, 2021. President Biden – “We’re entering what may be the toughest and deadliest period of the virus. We must set aside politics and finally face this pandemic as one nation.”
POST 117. January 23, 2021. CORONAVIRUS. 1.Dr. Fauci:“The idea that you can get up here….”and.. let the science speak”… “It is somewhat of a liberating feeling.” 2.updated CDC guidance:”.. providers could give the second dose up to six weeks after the first dose..” 3.Dr. Fauci: people would be “taking a chance” if they follow the CDC’s updated guidance.
POST 118. January 24, 2021. CORONAVIRUS. “Unfortunately, we’ve let this virus spread extensively and are launching the vaccination campaign at the height of the threat,” Dr. Meyers said. “The more the virus spreads before the vaccine reaches people, the fewer deaths we can prevent with the vaccine.”
POST 119. January 27, 2010. CORONAVIRUS. Amazon is offering its help to President Joe Biden with the rollout of COVID-19 vaccines. Washington’s governor, Jay Inslee, included the help of companies like Starbucks, Costco and Microsoft in a plan to vaccinate 45,000 residents a day.
POST 120. January 28, 2021. CORONAVIRUS. “The fact that four vaccines backed by the federal government seem to be less effective against the (South African) B.1.351 variant has unsettled federal officials and vaccine experts alike. Facing this uncertainty, many researchers said it was imperative to get as many people vaccinated as possible — quickly. Lowering the rate of infection could thwart the contagious variants while they are still rare, and prevent other viruses from gaining new mutations that could cause more trouble.”
POST 121. January 30, 2021. CORONVIRUS. Will our communities become stratified by which vaccine is distributed? 95%ters v. 72%ters? Will the easier distribution of the J&J vaccine drive its inequitable distribution to” hard-hit, marginalized, and medically underserved communities.” (thanx! to XJ/LA)
POST 123. February 4, 2021. CORONAVIRUS. “Nursing homes across the country are facing the same struggle, as workers have been more reluctant than residents to be vaccinated…
POST 124. February 5, 2021. CORONAVIRUS. Dr. Osterholm ” …it may be time to..go with a ‘first-dose only’ approach, so more people over the age of 65 can have at least some protection right away. He said that would require delaying second doses until this summer.” Dr.Fauci “warned against this practice, and cautioned people about “the danger” that could come with focusing only on the first dose.”
POST 125. June 9, 2021. CORONAVIRUS. “States are rolling back Covid-19 restrictions as new cases trend down from record highs across the country. But experts warn it might be too much too soon as variants pose an increased risk and the pandemic… is far from over.”
POST 126. February 11, 2021. CORONAVIRUS. “There will be more coronavirus outbreaks in the future. Bats and other mammals are rife with strains and species of this abundant family of viruses. Some of these pathogens will inevitably spill over the species barrier and cause new pandemics. It’s only a matter of time.” (A)
POST 127. February 12, 2021. CORONAVIRUS. “… Trump only agreed to be hospitalized when aides told him that he could walk to Marine One or he could wait until his case progressed and he would be carried out.”
POST 128. February 14, 2021. CORONAVIRUS. “The Centers for Disease Control and Prevention released new research on Wednesday that found wearing a cloth mask over a surgical mask offers more protection against the coronavirus, as does tying knots on the ear loops of surgical masks…
POST 129. February 15, 2021, CORONAVIRUS. “ “The CDC released its much-anticipated, updated guidance to help school leaders decide how to safely bring students back into classrooms, or keep them there.”…” For politicians, parents and school leaders looking for a clear green light to reopen schools, this is not it.”
POST 130. February 16, 2021. CORONAVIRUS. “A second person who had contracted the Ebola virus died this week in the Democratic Republic of Congo, marking another outbreak just three months after the nation outlasted the virus’s second-worst outbreak in history…”
POST 131. February 17, 2021. CORONAVIRUS. “It really is right now – a race between how quickly new variants, particularly the U.K. variant, can spread in the United States and how quickly we can get people vaccinated”
POST 132. February 20, 2021. CORONAVIRUS. “In Texas, where over 2.5 million people are still without power, the state health department said this week’s vaccine shipments wouldn’t arrive until Wednesday at the earliest.”
POST 133. February 23, 2021. CORONAVIRUS. “Going off your meds is a surefire way to aggravate your doctor. What if a whole country did it?” The United Kingdom has veered into uncharted territory by changing tack and introducing a revised COVID-19 vaccination protocol, one that involves distributing the second dose at 12 weeks, rather than the prescribed 21 days.”
POST 134. February 24, 2021. CORONAVIRUS. The first tranche of the J&J (single dose) vaccine must go to K-12 teachers, so schools can open safely in the first 100 days of the Biden Administration. The federal government…”can set up its own vaccination centers in regions with eligible populations it’s trying to target.” We owe our front-line teachers nothing less!
POST 135. February 27, 2021. CORONAVIRUS. “As Chief Executive Officers of New York’s major health care systems, we would like to provide facts to clear up confusion in the public and the media regarding decisions to discharge patients to nursing homes during New York’s spring coronavirus surge.”
POST 136. March 2, 2021. CORONAVIRUS. ““The governors of Texas and Mississippi both announced on Tuesday they would be lifting their states’ mask mandates and rolling back many of their Covid-19 health mandates..”…while “The US could experience a “fourth surge” of coronavirus before the majority of the country is vaccinated.”
POST 137. March 4, 2021. CORONAVIRUS. “The clamor for hard-to-get Covid-19 vaccines has created armies of anxious Americans who have resorted to hunting for leftovers on the fringes of the country’s patchwork vaccination system. They haunt pharmacies at the end of the day in search of an extra, expiring dose. They drive from clinic to clinic hoping that someone was a no-show to their appointment. They cold-call pharmacies like eager telemarketers: Any extras today? Maybe tomorrow? Some pharmacists have even given them a nickname: vaccine lurkers.” (H)
POST 138. March 6, 2021. CORONAVIRUS. “New cases are decreasing in the third wave because we are past the holidays, not because of vaccinations. It is a common misconception that the decrease we are seeing in new cases, hospitalizations, and deaths in the U.S. is due to vaccinations. The two aren’t related; at least yet.”
POST 139. March 8, 2021. CORONAVIRUS. CDC Issues First Set of Guidelines on How Fully Vaccinated People Can Visit Safely with Others…” In practice, that means fully vaccinated grandparents may visit unvaccinated healthy adult children and healthy grandchildren of the same household without masks or physical distancing.” (C)
POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.
POST 141. March 11, 2021. CORONAVIRUS. Today is the first anniversary of the WHO declaration that the novel coronavirus was a Public Health Emergency of International Concern… “To truly prepare itself against the next pandemic, the U.S. has to reimagine what preparedness looks like.”
POST 142. March 15, 2021. CORONAVIRUS. “Candida auris is a superbug, a pathogen that can evade drugs made to kill it—and early signs suggest the COVID-19 pandemic may be propelling infections of the highly dangerous yeast. That’s because C. auris is particularly prominent in hospital settings, which have been flooded with people this year due to the coronavirus.”
POST 143. March 17, 2021. CORONAVIRUS. “The Trump administration sought to suppress Covid-19 testing in the United States last year by softening guidance from the Centers for Disease Control and Prevention on who needed to be tested, a House panel said Monday.”
POST 144. March 20, 2021. CORONAVIRUS. ““The vaccine hesitancy we are seeing isn’t just about Covid vaccines,”… “It is a general reflection of Americans’ lack of trust in science, the pharmaceutical industry, and large health care institutions. We need a full court press on science and vaccine education right now to prevent more aggressive Covid-19 variants from developing and taking hold.”
POST 145. March 25, 2021. CORONAVIRUS. “Efforts to disseminate Covid-19 vaccines as widely as possible are hitting an unexpected obstacle: health-care workers who decline the shots.
POST 146. March 30, 2021. CORONAVIRUS. Dr. Osterholm told Becker’s: “This is the perfect storm,”…”Here is Europe locking down and having problems containing B.1.1.7, even with vaccinations and previous infection histories. Here we are opening up as wide as we can. We are literally just walking into the mouth of the virus saying, ‘Don’t worry.’” (M)
POST 147. April 5, 2021. CORONAVIRUS. “The pandemic helped cement the shift to “a philosophy of really focusing on the role of the physician in reasoning through ambiguous and unknown problems as the focus of education, rather than teaching students that the role of physician was to memorize a body of knowledge that was already in existence and good enough for what usually happens.”
POST 148. April 7, 2021. CORONAVIRUS. While the Biden administration accelerates vaccinations to ward off numerous variants and as more young people are being hospitalized, states, even with increasing case rates are on paths to fully reopen. Politics v. public health!
POST 149. April 10, 2021. CORONAVIRIUS. “From Michigan to Massachusetts, COVID-19 cases and hospitalizations are on the rise again. Deaths will soon follow. “ ”.. the Biden administration is facing renewed calls to delay second vaccine doses and blanket more of the U.S. population with an initial shot.”
POST 150. April 10, 2021. CORONAVIRUS. “The use of so-called COVID-19 “vaccine passports” is quickly becoming a divisive issue across the US – with several states, including New York, embracing the idea, while others have already moved to ban them.”
POST 151. April 14, 2021. CORONAVIRUS. the J&J vaccination pause. “ Federal officials are concerned that doctors may not be trained to spot or treat the rare disorder if recipients of the vaccine develop symptoms of it…” “…a standard treatment for blood clots — use of an anticoagulant drug — could be dangerous or even fatal in such cases…”
POST 152. April 15, 2021. CORONAVIRUS. “The Chinese Center for Disease Control and Prevention’s director said Saturday authorities are considering mixing COVID-19 vaccines because the country’s domestically made doses “don’t have very high protection rates,”
POST 153. April 18, 2021. CORONAVIRUS. “At least 35 hospitals across Michigan were listed Thursday as nearing capacity and three were at full capacity for COVID-19 patients..”.. We can manufacture beds. We can open up beds. We can create entire wings of the hospital if we have to, but if we don’t have staff for those beds, we’ve got nothing.”..
POST 154. April 19, 2021. CORONAVIRUS. “Breakthrough infections, which occur when fully vaccinated people are infected by the pathogen that their shots were designed to protect against, are an entirely expected part of any vaccination process.” “Pfizer’s chief executive said that a third dose of the company’s Covid-19 vaccine was “likely” to be needed within a year of the initial two-dose inoculation — followed by annual vaccinations.”
POST 155. April 24, 2021. CORONAVIRUS. As the J&J vaccine pause is ended Senator Johnson said “The science tells us that vaccines are 95% effective. So if you have a vaccine, quite honestly, what do you care if your neighbor has one or not? I mean, what is it to you?”
POST 156. April 28, 2021. CORONAVIRUS. As CDC revises guidance on outdoor masking, Texas Governor Abbott says “the state is “very close” to herd immunity… despite acknowledging that he does not know what the herd immunity threshold is for the virus, an uncertainty echoed by the public health community.”
POST 157. April 25, 2021. CORONAVIRUS. Ohio hospitals; “We agreed in multiple conversations, there’s nothing in fighting a pandemic that creates a competitive advantage.”…
POST 158. May 5, 2021. CORONAVIRUS. . As populations get closer to herd immunity “ it may be helpful to introduce some nuance to what we mean by the term. Nationwide herd immunity. Regional herd immunity. Temporary herd immunity. Endemicity.”
POST 159. May 9, 2021. CORONAVIRUS. “Without deeper sharing of expertise in how to make vaccines…waiving patent obligations is unlikely to be a game-changer… Having access to the “recipe” certainly helps, but understanding how to put it together and produce it at scale is something else.”
POST 160. May 13, 2021.CORONAVIRUS. “The CDC acknowledged Friday that airborne spread of COVID-19 among people more than 6 feet apart “has been repeatedly documented.”” Meanwhile states relax or eliminate indoor dining restrictions. HUH?
POST 161. May 15, 2021. CORONAVIRUS. “Even if the spread of Covid-19 decreases enough to allow a return of most activities, there are some aspects of pandemic life that epidemiologists say will persist much longer. In particular, they say that masks are a norm that should continue, even if that view puts them at odds with the new C.D.C. guidance. More than 80 percent of them say people should continue to wear masks when indoors with strangers for at least another year, and outdoors in crowds.”
POST 162. May 21, 2021. CORONAVIRUS. “New Jersey Gov. Phil Murphy is refusing to lift his indoor mask mandate for vaccinated residents…” “…fully vaccinated residents in New York and Connecticut are no longer required to wear masks..”..” “California says it isn’t ready to follow the federal lead and unmask, at least for another month..”.. “..Texas Gov. Greg Abbott issued an executive order Tuesday prohibiting state governmental entities such as counties, public school districts, public health authorities and government officials from requiring mask wearing.”
POST 163. May 23, 2021. CORONAVIRUS. RWJBarnabas Health in New Jersey announced a mandate…saying supervisors and those of higher rank must get the vaccine by June 30. They will eventually require the system’s 35,000 employees to do the same.
POST 164. May 26, 2021. CORONAVIRUS. On Wednesday, health minister Norihisa Tamura warned Olympic organizers they would have to “secure their own” hospital beds for anyone falling ill at the Games, explaining the government would not release beds set aside for Japanese covid-19 patients.”
POST 165. May 31,2001. CORONAVIRUS. “Like all pandemics, this one will end either with millions — maybe billions — being infected or being vaccinated. This time, world leaders have a choice, but little time to make that choice before it is made for them.”
POST 166. June 3, 2020. CORONAVIRUS. “President Biden said Wednesday that he has asked intelligence agencies to double down on their efforts to investigate whether the coronavirus originated from human contact with an animal or in an laboratory in China, saying there is not “sufficient information” to assess whether one is more likely than the other.”
POST 167. June 9, 2021. CORONAVIRUS. Hospitals prevaricate on mandatory staff vaccinations. Florida’s Governor forbids cruise ship vaccine mandates. Pfizer and Moderna apply for FDA full approval.
POST 168. June 10, 2021. CORONAVIRUS. “Our species has a tendency to get distracted. We have a very strong appetite for distraction, and when something is not in the spotlight, when it’s not a crisis anymore, we tend to forget and move on to something else. So the biggest challenge is going to be maintaining focus on this next step of developing vaccines that anticipate pandemics.”
POST 169. June 14, 2021. CORONAVIRUS. “Hospitals in Washington, D.C…announced a consensus agreement to mandate COVID-19 vaccinations for more than 30,000 workers, 70% of which are already vaccinated. Each of 14 hospitals will set their own deadline…”
POST 170. June 17, 2021. CORONAVIRUS. “Dr. Ashish Jha…is worried about the potential impact the delta variant could have in the United States… “I’m concerned about the Delta variant,”… “Why? Most contagious variant yet. Wreaked havoc in India. Spiking cases in UK. Growing rapidly in the US.”
POST 171. June 19, 2021. “A 34-year-old man (a Covid-19 survivor) has been diagnosed with India’s first known case of “green fungus” infection.”… “Green fungus is the new infection to join the earlier known cases of black, white and yellow fungus.”…”green fungus was earlier seen only as a “junior partner” in other infections… In the current patient, this fungus is acting as the aggressor.”
POST 172. June 23, 2021. CORONAVIRUS. Morgan Stanley chief executive James Gorman said: “If you can go into a restaurant in New York City, you can come into the office.”…”remote work can “dramatically undermine” the character and culture a company is attempting to build; and “virtually eliminates spontaneous learning and creativity.”
POST 173. June 26, 2021. CORONAVIRUS. “The daily toll of COVID-19, as measured by new cases and the growing number of deaths, overlooks a shadowy set of casualties: the rising risk of mental health problems among health care professionals working on the frontlines of the pandemic.”
POST 174. July 1, 2021. CORONAVIRUS. “..while the WHO is encouraging people to keep wearing masks even if they’re vaccinated, Dr. Anthony Fauci says it doesn’t look like the CDC currently plans to change its guidelines.” … health officials in Los Angeles recommended that “everyone, regardless of vaccination status, wear masks indoors in public places as a precautionary measure.”..”
POST 175. July 5, 2021. CORONAVIRUS. “Can a health care worker who is not against vaccines in general still harbor sincere concerns that scientists don’t yet know about all the side effects of these vaccines? Yes, says Ezekiel Emanuel, MD, PhD — but those people should not work in health care.”
POST 176. July 9, 2021. CORONAVIRUS. Mercy Springfield ( Missouri) hospital…” ran out of ventilators for its patients over the Fourth of July weekend…”…“Mercy will require all current and future employees to be fully vaccinated.”…“The US government is deploying a Covid-19 surge team to provide public health support in southwest Missouri
POST 177. July 12, 2021. CORONAVIRUS. the Delta variant is “the 2020 version of Covid-19 on steroids,”… “It is the most hypertransmissible, contagious version of the virus we’ve seen to date…it’s a superspreader strain if there ever was one .” but… now, there’s a Delta Plus variant…
POST 178. July 15, 2021. CORONAVIRUS. “Tennessee’s top vaccine official says she has been fired as punishment for doing her job in the face of political pushback.”..” More than 180 state and local public health leaders…have resigned, retired or been fired since April 1…”“Former President Trump and his GOP allies have stepped up attacks on Anthony Fauci…”
POST 179. July 16, 2021. CORONAVIRUS. “It, therefore, follows that the “harm principle” (“first, do no harm.”) can be used to justify compulsory vaccination programs in specific instances where the community interests or benefits are deemed to be significant.”
POST 180, July 20, 2021. CORONAVIRUS. “Most people will either get vaccinated, or have been previously infected, or they will get this Delta variant,”.. “And for most people who get this Delta variant, it’s going to be the most serious virus that they get in their lifetime in terms of the risk of putting them in the hospital,”
POST 181. July 22, 2021. CORONAVIRUS. “Health experts fear the Tokyo Olympics could become a COVID-19 superspreader event.” “Whatever happens in Japan isn’t likely going to stay in Japan since all of the athletes and accompanying coaches and staff will be returning to their home countries.”
POST 182. July 26, 2021. CORONAVIRUS. Alabama Gov. Kay Ivey (R): “Folks supposed to have common sense.”…“But it’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down.” ““Beginning in mid-September, New York City will require all of its 340,000 municipal workers, including police, firefighters and teachers, to either be vaccinated against COVID-19 or tested weekly.”
POST 183. July 29, 2021. CORONAVIRUS. When I was appointed President and CEO of Jersey City Medical Center in1989 in the peak of the HIV/ AIDS crisis, we had a dedicated, and always full, dedicated 60 bed AIDS unit, staffed by one full time nurse and numerous part-time and per diem nurses. Today, right now, hospitals caught in the Covid-19 surge, are forced to redeploy nursing staff, respiratory therapists and other clinicians, most without prior infectious diseases experience. Why are we tolerating the unvaccinated putting our hospital staffs at risk?
POST 184. August 1, 2021. CORONAVIRUS. “The coronavirus could be “just a few mutations potentially away” from evolving into a variant that can evade existing COVID-19 vaccines, CDC director Rochelle Walensky said..” (A) “The Delta variant is more transmissible than the viruses that cause MERS, SARS, Ebola, the common cold, the seasonal flu and smallpox, and it is as contagious as chickenpox..” (I)
POST 185. August 6, 2021. CORONAVIRUS. ‘If you aren’t going to help, please get out of the way’: Biden turns up the pressure on GOP governors as Delta spreads”
POST 186. August 8, 2021. CORONAVIRUS. “One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late,” she added, referring to patients who have to be put on a ventilator.” (A) “There is no one definition of what the end of a pandemic means.”.. “The question of when the crisis will be over is a layered one — with different answers from local, national and global perspectives.”
POST 187. August 11, 2021. CORONAVIRUS. “As a result of the increase in COVID-19 cases and hospitalizations, the state of Florida requested 300 ventilators from the federal government.”… “An 11-month-old girl with Covid-19 is stable and no longer intubated one day after she was airlifted to a Texas hospital 150 miles away because of a shortage of pediatric beds in the Houston area.”
POST 188. August 15, 20201. CORONAVIRUS. “According to an internal CDC briefing….an estimated 1.1 million people have already gotten unauthorized booster shots…”….”If it is left up to the honor system, I think many Americans will suddenly wake up and find themselves immunocompromised enough to get a 3rd dose,”
POST 189. August 19,2021. CORONAVIRUS. “There wasn’t a single I.C.U. bed available in Alabama on Wednesday…”…”A triage plan on the Alabama health department’s website suggests that “persons with severe mental retardation” are among those who “may be poor candidates for ventilator support.”
POST 190, August 21, 2021. CORONAVIRUS. “We’re looking, in essence, at running two systems — a COVID system and a non-COVID system of care,”..“Emergency medical technicians (EMTs) and certified paramedics can now care for patients in Mississippi hospitals and emergency rooms under a new health office order issued by the Mississippi State Department of Health on Wednesday.”
POST 191. August 27, 2021. CORONAVIRUS. “Anthony Fauci, MD, chief medical advisor to the president and director of the National Institute of Allergy and Infectious Diseases, explained that late September gives the United States time to set up the logistics.” This is not medical science, but perhaps Political Science?
POST 192. August 30, 2021. CORONAVIRUS. Gov. John Bel Edwards on Hurricane Ida – “I hate to say it this way, but we have a lot of people on ventilators today and they don’t work without electricity,” he said.”
POST 193. September 3, 2021. CORONAVIRUS. Nurses are leaving their hospitals and becoming travel nurses at hospitals across town “because they can make $4,000, $5,000, $6,000, $7,000 a week while not having to relocate anywhere..”
POST 194. August 2, 2021. CORONAVIRUS. “Recently-released data is painting a grim picture of the opioid epidemic that has gripped the United States — as the country is still grappling with the coronavirus pandemic that has killed more than half a million Americans. Some people are calling them twin pandemics that have collided”…“Faced with a novel health crisis, researchers are collecting data on the long-term impact of using opioids to treat COVID-19 pain…
POST 195. September 6, 2021. CORONAVIRUS. “…there are “zero ICU beds left for children in Dallas County, Texas,”.,..”That means if your child’s in a car wreck, if your child has a congenital heart defect or something and needs an ICU bed, or more likely if they have Covid and need an ICU bed, we don’t have one. Your child will wait for another child to die… (county judge Clay Jenkins)
POST 196. SEPTEMBER 11, 2001. PART 1. Military helicopters and jets were overhead, as President Bush was getting ready to leave NYC. PART 2. LESSONS LEARNED memorandum by hospital CEO Jonathan Metsch goes “viral”…
POST 197. September 12, 2021. CORONAVIRUS. Idaho officials have instituted “crisis standards of care” to help 10 hospitals and health care systems decide how to allocate personnel and resources to deal with a crush of COVID-19 patients.”… “The Washington Medical Coordination Center oversees facilitating transfers in the state, and it’s warning we could be nearing the point of “Crisis Standards of Care,” just like Idaho.” .. “These crisis models don’t actually save more lives, they just save different lives..”
POST 198. September 15, 2021. CORONAVIRUS. A pundit said “The most elegant policy riposte to the anti-vaxxers… is to refuse to allow Medicare or Medicaid to pay their medical bills in the event they become seriously ill. Private health insurers might also follow suit.” (but is making our hospitals become the bill collectors right?)
“Idaho officials have instituted “crisis standards of care” to help 10 hospitals and health care systems decide how to allocate personnel and resources to deal with a crush of COVID-19 patients.
The crisis standards are for the hospitals in two health districts in the state’s panhandle and north central areas.
“When crisis standards of care are in effect, people who need medical care may experience care that is different from what they expect,” the news release said. “For example, patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (such as a conference room) or that needed equipment is not available.”
Idaho has a low vaccination rate and health experts fear that the state could be dealing with up to 30,000 new COVID cases per week by mid-September if current trends continue, The Associated Press reported…
Hospitals report severe staff shortages in nursing, housekeeping, and other positions because workers are burned out or affected by the pandemic, The Associated Press said.
The governor recently tried to fill the staffing gap by calling in 220 medical workers through federal programs and mobilizing 150 Idaho National Guard soldiers.” (A)
“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” said DHW Director Dave Jeppesen. “This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places. Please choose to get vaccinated as soon as possible – it is your very best protection against being hospitalized from COVID-19.”
The process to initiate crisis standards of care began when resources were limited to the point of affecting medical care. The director of DHW convened the Crisis Standards of Care Activation Advisory Committee on Sept. 6, 2021, to review all the measures that were taken to address the staffing and bed shortages. The committee determined that the ability of northern Idaho hospitals and healthcare systems to deliver the usual standard of care has been severely affected by the staffing shortages, and all contingency measures to address these shortages had been exhausted. The committee recommended to the director that crisis standards of care be activated. Director Jeppesen issued his decision on Sept. 6, 2021, under the authority vested in him through the temporary rule.
Efforts will continue with earnest to alleviate the staffing and any other resource constraints in North Idaho. The crisis standards of care will remain in effect until there are sufficient resources to provide the usual standard of care to all patients.” (B)
“The move came as the state’s confirmed coronavirus cases skyrocketed in recent weeks. Idaho has one of the lowest vaccination rates in the U.S.
The state health agency cited “a severe shortage of staffing and available beds in the northern area of the state caused by a massive increase in patients with COVID-19 who require hospitalization.”
The designation includes 10 hospitals and healthcare systems in the Idaho panhandle and in north-central Idaho. The agency said its goal is to extend care to as many patients as possible and to save as many lives as possible.
The move allows hospitals to allot scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients. Other patients will still receive care, but they may be placed in hospital classrooms or conference rooms rather than traditional hospital rooms or go without some life-saving medical equipment.
At Kootenai Health — the largest hospital in northern Idaho — some patients are waiting for long periods for beds to open up in the full intensive care unit, said Dr. Robert Scoggins, the chief of staff. Inside the ICU, one critical care nurse might be supervising up to six patients with the help of two other non-critical care nurses. That’s a big departure from the usual one ICU nurse for one ICU patient ratio, he said.
On Monday, the Coeur d’Alene hospital started moving some coronavirus patients into its nearby conference center. A large classroom in the center was converted into a COVID-19 ward, with temporary dividers separating the beds. Some emergency room patients are being treated in a converted portion of the emergency room lobby, and the hospital’s entire third floor has also been designated for coronavirus patients.
Urgent and elective surgeries are on hold, Scoggins said, and Kootenai Health is struggling to accept any of the high-level trauma patients that would normally be transferred from the smaller hospitals in the region.
Other states are preparing to take similar measures if needed. Hawaii Gov. David Ige quietly signed an order last week releasing hospitals and health care workers from liability if they have to ration health care…
The designation will remain in effect until there are enough resources — including staffing, hospital beds and equipment or a drop in the number of patients — to provide normal levels of treatment to all…
The state’s crisis guidelines are complex, and give hospitals a legal and ethical template to use while rationing care.
Under the guidelines, patients are given priority scores based on a number of factors that impact their likelihood of surviving a health crisis.
Those deemed in most in need of care and most likely to benefit from it are put on priority lists for scarce resources like ICU beds.
Others in dire need but with lower chances of surviving will be given “comfort care” to help keep them pain-free whether they succumb to their illnesses or recover.
Other patients with serious but not life-threatening medical problems will face delays in receiving care until resources are available.” (C)
IDAHOCRISIS STANDARDS OF CARE – highlight and click on
“Idaho adopted the standards by applying elements from the Institute of Medicine (IOM) Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, published in 2012. “The plan is based on the five key elements of CSC planning identified by the IOM. They include Emergency Management and Public Safety, EMS, Hospital, Public Health, and Out of Hospital Care,” the Idaho CSC document states.
So what does that mean for healthcare professionals working at the ten centers in Idaho’s Panhandle and the city of Coeur d’Alene? MedPage Today examined the CSC document, as well as other recently updated guidelines.
The standards were designed to maximize care at the population health level, and it is recommended that medical centers use them as guideposts to help devise their own game plans, though they stop short of making many detailed stipulations. “The goal of [the] crisis standards of care is to extend care to as many patients as possible and save as many lives as possible,” the DHW news release stated. “Hospitals will implement as needed and according to their own [crisis] policies.”
But the CSC document does offer several specific suggestions, including:
“Continue efforts to increase surge capacity through changes in care practices, e.g., further changes in documentation, nurse-patient ratios, [and] active recruitment for alternative care providers”
“Defer non-life-sustaining outpatient services, including physical and occupational therapy”
“Adapt services and venue for cardiac/stroke rehab and cancer therapy (in pandemic setting) to minimize risk of exposure to severe transmissible illness and free staff for other duties”
“Cancel all job duties considered non-essential and reassign personnel as appropriate”
“Move patients who cannot be discharged but who are stable to alternate facilities experiencing less surge”
“Defer surgeries not essential to preserve life and limb or not needed to facilitate discharge from hospital”
“In mass trauma settings, pull staff with surgical experience from other areas of hospital to support trauma response capacity”
In addition, the document notes that “the EMS Physician Commission will need to create specific guidance for EMS providers that corresponds with the care continuum … In the case of COVID-19 … EMS staff must stringently adhere to infection control and decontamination procedures.”
EMS dispatchers should “utilize non-certified dispatch personnel to handle incoming emergent calls … [and] decline response to calls without evident potential threat to life.” The document also suggests “allowing an experienced critical care Paramedic or RN be the sole provider versus a three-person team if they are comfortable providing that care based on patient needs.”…
Idaho does not appear to be triaging care based on specific COVID-19 criteria — including vaccination status — and MedPage Today could not find any mention of the impact of the dire situation on malpractice, among other issues that concern clinicians during hospital surges. It is also unclear if other states have yet adopted crisis or similar guidelines in any of their hot spots.
In Idaho, the standards “will remain in effect until there are sufficient resources to provide the usual standard of care to all patients.”…
The standards are not likely to be very effective, said Joel Zivot, MD, of Emory University School of Medicine in Atlanta. “These crisis models don’t actually save more lives, they just save different lives,” he noted. “The only way to really do this is first-come, first-serve.”
Zivot is “troubled” by the idea that a healthcare workforce can consistently decide which patients to treat and when in an ethical manner. “We are talking about letting people die; let’s not be so quick to decide,” he said. “All patients — COVID, non-COVID — are equally valuable and they’re due equal access to care.” (D)
“Idaho’s crisis standards of care plan is 48 pages long, with an additional 41-page guide and a 42-page set of checklists. You can download them by visiting the Idaho Department of Health and Welfare’s Emergency Preparedness page.
The state also created guidelines for nursing homes, should they need crisis standards of care.
Crisis standards won’t just apply to people with COVID-19. They will apply to patients who need medical care for any reason, such as car crashes, heart attacks, strokes and influenza.
Hospitals likely won’t get to that point. Hospital officials have maintained that they would provide as much care as they can and provide treatments to keep patients comfortable, even if they’re denied a resource. Health care providers would also maintain contact with the patients, who could be brought back even if they can’t be treated immediately.
Activating the Crisis Standards of Care Plan may not mean shutting down a certain kind of treatment or service. Depending on the situation, the standards may apply to just one health care resource — such as oxygen or ventilators once hospitals begin to run short — or one region. But if the situation doesn’t improve, these standards likely would be activated statewide after hospitals ran out of resources they could share, Jeppesen has said.
Patients, regardless of diagnosis, would likely face significantly longer wait times for care. Smaller health care centers will have even more challenges. They may not be able to accept transfers from outside hospitals, according to the Department of Health and Welfare. Rural hospitals especially would suffer, the department said.
“Rural hospitals would likely need to care for higher complexity patients than they are used to during crisis standards of care and would likely struggle to even transfer traumas, strokes, or heart attacks,” DHW said.
WILL PEOPLE WHO DIDN’T FOLLOW COVID-19 GUIDELINES BE DENIED?
No, they will be prioritized the same way as people who faithfully followed the guidelines.
It is against the law and against medical ethics for Idaho’s health care system to triage patients based on things like politics, where they live or whether they obeyed mask mandates.” (E)
“After a request from overfilled and understaffed hospitals in the panhandle, Idaho has activated “Crisis Standards of Care.”
Under crisis standards, hospital beds, medicine, and equipment like ventilators may be given to those considered most likely to survive, not the most critical.
The goal is to save as many lives as possible while space is limited. Care is not guaranteed for everyone.
“They have over 200 national support personnel coming in to help them. Their hospital is 50% full of COVID-positive patients,” said Cassie Sauer, president of the Washington State Hospital Association (WSHA). “It is an absolute gut-wrenching decision for anyone who works in health care to have to make. It is terrible. We do not want that to happen here.”
Hospitals are filling up in Washington state as well.
“I think it’d be really hard for the hospitals in Spokane, even as full as they are, who have very strong relationships with the hospitals in Idaho, to say no,” said Sauer. “This feels like an incredible ethical conundrum.”
As Washington hospitals approach capacity, some patients from Idaho could be transferred to Washington state. But Washington is under no obligation to take them, according to the WSHA.
“It is each individual hospital’s decision whether or not they take an out-of-state patient,” explained Sauer. “But we have some special processes of the Washington Medical Coordination Center, and those only apply to patients… that are in a Washington state hospital. So that we are not… guaranteeing the help to anyone that’s outside of Washington state.”
“A major epidemic or pandemic can overwhelm the capacity of outpatient facilities, emergency departments (EDs), hospitals, and intensive care units, leading to critical shortages of staff, space, and supplies with serious implications for patient outcomes.
In the late summer of 2009, with an H1N1 pandemic looming, the Institute of Medicine (IOM, and as of 2015, the National Academy of Medicine), at the request of the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services (HHS), convened an ad hoc committee to generate a letter report addressing how resource allocation and triage decisions could be fairly made under crisis conditions [1]. The 2009 IOM letter report Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations: A Letter Report was followed by a more thorough exploration of these concepts in 2012 and the creation of a toolkit for planners focused on specific disaster event indicators and triggers in 2013 [2,3].
Ten years later, in the early months of 2020, another potential pandemic looms. This time it is due to the emergence of a novel coronavirus (SARS-CoV-2, causing COronaVIrus Disease 2019 or COVID-19), a beta coronavirus similar to the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses. The principles of Crisis Standards of Care (CSC) are as relevant now as they were a decade ago. It is simply too early to say, at the time of this writing, what the course of the COVID-19 epidemic will be, although its rapid geographic spread within China, the concomitant meteoric rise in the number of persons affected, along with the detection of the virus in more than two dozen countries, raises the specter of a global pandemic. More people were reported dead in the first month after the SARS-CoV-2 virus was recognized than died during the 8 months that SARS circumnavigated the globe [4].
Proactive planning, in which leaders anticipate and take steps to address worst-case scenarios, is the first link in the chain to reducing morbidity, mortality, and other undesirable effects of an emerging disaster. It is vital that the principles and practices of crisis care planning guide public health and health care system preparations. This discussion paper summarizes some key areas in which CSC principles should be applied to COVID- 19 planning, with an emphasis on health care for a large number of patients. Hospitals routinely utilize selected principles of CSC to deal with seasonal outbreaks, lack of bed availability, and drug shortages, but a potential pandemic requires a deeper understanding and application of CSC.
Reduced to its fundamental elements, CSC describe a planning framework based on strong ethical principles, the rule of law, the importance of provider and community engagement, and steps that permit the equitable and fair delivery of medical services to those who need them under resource-constrained conditions. CSC are based on the following key principles [1]:
Fairness
Duty to Care
Duty to Steward Resources
Transparency
Consistency
Proportionality
Accountability
Since the release of the 2009 IOM letter report, a “duty to plan” has been espoused by leaders in the disaster preparedness and response community and recognized in legal decisions in the setting of hurricane evacuation and sheltering [5,6,7]. This duty is worth highlighting, as a failure to plan for scarce resource situations may lead to the inappropriate application of CSC, wasted resources, inadvertent loss of life, loss of trust, and triage/rationing decisions being made unnecessarily. This will force poor choices on health care providers who will already be markedly limited in their ability to deliver care.” (G)
“I’m going to come right out and say it: In situations where hospitals are overwhelmed and resources such as intensive care beds or ventilators are scarce, vaccinated patients should be given priority over those who have refused vaccination without a legitimate medical or religious reason.
This conflicts radically with accepted medical ethics, I recognize. And under ordinary circumstances, I agree with those rules. The lung cancer patient who’s been smoking two packs a day for decades is entitled to the same treatment as the one who never took a puff. The drunk driver who kills a family gets a team doing its utmost to save him — although, not perhaps, a liver transplant if he needs one. Doctors are healers, not judges.
But the coronavirus pandemic, the development of a highly effective vaccine, and the emergence of a core of vaccine resisters along with an infectious new variant have combined to change the ethical calculus. Those who insist on refusing the vaccine for no reason are not in the same moral position of the smoker with lung cancer or the drunk driver. In situations where resources are scarce and hard choices must be made, they are not entitled to the same no-questions-asked, no-holds-barred medical care as others who behaved more responsibly.
There are a number of reasons. It’s hard to quit smoking, stop drinking, lose weight or even take up exercise. So even those whose health problems can reasonably be blamed on their own lapses deserve the best care possible. After all, for the most part, they are their own victims.
Vaccine resisters are different. Their refusal to take the shot doesn’t just affect their own health — it poses a known risk to the health of others, especially now, with the spread of the delta variant. To decline to be vaccinated is to fail to live up to your duty to your community. And it should mean that you forfeit — if necessary — your claim to equal medical treatment….
Emergency physician Dan Hanfling has written extensively about how to triage care, and he agrees. “If you believe there’s a certain degree of accountability that we as citizens have to take for each other to protect our community, then that group of individuals who have willingly chosen not to vaccinate, for illegitimate reasons, it would be fair to place them at the back of the line. Not kick them out of line, just move them back,” he told me. “At the end of the day, if you have willingly chosen not to do something that benefits the public good in the setting of a national crisis, then there are certain consequences.”
This is an uncomfortable conversation. The irresponsibly unvaccinated have made it a necessary one.” (H)
