“This does not mean there are zero ICU beds vacant across California; rather, it means the two regions with 0% capacity — Southern California and the San Joaquin Valley — have reached extremely deep into surge protocols to continue treating severe patients, COVID-19 or otherwise.
Those two regions were placed under the state’s strict stay-at-home order, unveiled by Gov. Gavin Newsom in early December, three weeks ago. The order directs restaurants to cease both indoor and outdoor dining and mandates closures for personal care services like salons and barbershops, on top of the restrictions already in place for purple-tier counties.
State health officials reassess the projected ICU situation in each region after three weeks within the order to determine whether the tight restrictions must continue. Extensions for Southern California and San Joaquin Valley are essentially guaranteed, with an announcement likely coming today from the state as they hit the three-week mark.
For the 13-county Greater Sacramento area, it’s less clear. The region’s three-week window will end this Thursday, on New Year’s Eve. Greater Sacramento has fluctuated around but mostly above the 15% benchmark used as the initial trigger for the stay-at-home order since mid-December. As of Sunday, it had 17.8% ICU availability.
The Bay Area had 11.1% of its ICU beds available through Sunday and must stay under the order through at least Jan. 8. Only the 11-county Northern California region, north of Greater Sacramento, has not entered the shutdown; it still had 28% availability as of Sunday.
The impact on hospitals goes beyond just COVID-19 patients and overwhelmed intensive care units. Kaiser Permanente confirmed over the weekend that it will postpone “elective and non-urgent surgeries” at its Northern California hospitals for one week, from now through Jan. 4, the San Jose Mercury News reported Saturday.
Health experts are supremely concerned about holiday gatherings last week for Christmas, as well as any New Year’s revelry later this week, and their strong potential to deepen the current crisis.
Officials in ravaged Los Angeles County, as well as Newsom, have referred to the prospect of a “surge on top of a surge on top of a surge.” The initial surge started around early November and grew worse after Thanksgiving, with officials fearing Christmas will present an even bigger jolt to infections, hospitalizations and deaths in the weeks to come.
Ahead of Christmas, many in California and across the U.S. pleaded for people to either cancel or scale back their holiday gathering and travel plans. Many Americans appear not to have done so: federal data shows nearly 1.2 million passengers passed through security checkpoints last Wednesday and almost 1.3 million on Sunday, making those the two busiest air travel days since the start of the pandemic in mid-March.
It remains a bit too early to draw many conclusions, but there have been some modest signs of potential slowdown in California’s current surge in data from the past week…
The metrics are all still on upward trajectories — especially deaths, which lag weeks behind the other indicators — but the first step toward plateau or decline is a slower acceleration of increases. But, as health officials warn, it’ll take a couple of weeks to see whether Christmas and/or New Year’s celebrations undo this apparent progress, and if so, to what extent.
Given the holiday impact, Newsom said in a recent video message that the state projects its hospital number will double in the next month, up to more than 36,000 hospitalized patients.” (A)
“With ICUs filled, hospitals will step up measures to ensure the sickest patients still get the highest levels of care possible. That often means moving some patients who would typically be in the intensive care unit to other areas of the hospital, such as a recovery area, or keeping them in the emergency room for longer than normal.
The patients are still getting intensive care, and that strategy can work to a point. But eventually, there may be too many critically ill patients for the limited numbers of ICU doctors and nurses available, leading to greater chances of patients not getting the specialized care they need. And that can lead to increases in mortality.
Once ICU beds are full, hospitals go into surge mode, which can accommodate 20% over usual capacity. Officials have also been training medical personnel who work elsewhere in hospitals to allow them to work in ICUs, and seeking nurses from outside the United States.
But the forecasted size of the surge of severely ill COVID-19 patients needing hospitalization in the coming weeks is now so large, it blew past projections issued just a few weeks ago. Officials were forced to redraw their charts to accommodate the enormous surges in projected ICU bed demand.
There are now more than 1,000 people with COVID-19 in L.A. County’s intensive care units, quadruple the number from Nov. 1. Forecasts say that by early January, there could be 1,600 to 3,600 COVID-19 patients in need of ICU beds if virus transmission trends remain the same.
There are only 2,500 licensed ICU beds in L.A. County.
“There are simply not enough trained staff to care Coronavirus updates: California now for the volume of patients that are projected to come and need care,” Dr. Christina Ghaly, the county’s director of health services, said. “Our hospitals are under siege, and our model shows no end in sight.”
About 600 new patients with COVID-19 are now being admitted to hospitals daily in L.A. County, and officials say that could rise to 750 to 1,350 a day by New Year’s Eve.
“If the numbers continue to increase the way they have, I am afraid that we may run out of capacity within our hospitals,” said Dr. Denise Whitfield, associate medical director with the L.A. County emergency medical services agency and an emergency room physician at Harbor-UCLA Medical Center. “And the level of care that every resident in Los Angeles County deserves may be threatened just by the fact that we are overwhelmed.”
Though officials have noted that the number of available ICU beds changes constantly as new patients are admitted, stabilized or die, the number of unoccupied beds in California’s most populous region has steadily eroded as hospitals have been flooded by unprecedented numbers of COVID-19 patients…
“Many hospitals have already broken nurse staffing ratios, and their staff are not necessarily getting either the breaks or rest that they’re supposed to be getting,” Ghaly said.
Last weekend, Whitfield said, Harbor-UCLA was able to manage its COVID patients, but crowding meant that some patients needed to stay in the emergency department when they should have been transferred elsewhere in the hospital.
“What that means is that when a patient needs to be admitted to the hospital, requiring either an ICU or an inpatient bed, that we just don’t have the staffing or the actual bed space to care for them,” Whitfield said.
A backed-up emergency room then makes it harder for emergency physicians and nurses to take care of patients with other emergencies, including strokes, heart attacks and trauma.
Whitfield said she’s been an emergency room doctor for a decade, but the past weekend was the first time she felt the overcrowding situation “has actually threatened the level of care that we can provide for our patients.”
“And so looking at … how these numbers are increasing throughout the county, it’s really, really quite frightening to me,” Whitfield said.”” (B)
“Hospitals are now postponing elective surgeries in order to help alleviate the growing pressure on our healthcare system.
Emergent surgeries, meaning immediately life or limb threatening, are not being impacted. Any elective surgery that would require admission to a hospital is being looked at as something to potentially postpone.
But what will the delay or avoidance of medical care mean for overall patient health?
A report published by the U.S. Department of health and human services estimated 41% of adults nationwide avoided medical care before June 30th of 2020 because of concerns about the coronavirus, and 12% of adults put off urgent or emergency care.
In a press conference earlier this week, Fresno county’s interim public health officer Dr. Rais Vohra, explained the meaning of an elective procedure.
“You have to understand that, you know, just because something is elective, like for example a tumor operation, you know, that can’t go forever or else the patient is going to have a really bad outcome,” said Dr. Vohra, “So there’s some gray areas there and we’re asking all the hospitals to take really hard looks at exactly how they can conserve their operating room resources and convert those over to help with the acute management issues.”
The department of defense is sending a team of 10 to 12 people, which should help out a bit. Those air force doctors were supposed to get here Monday, but that’s been pushed back to December 31st.
And while Dr. Vohra says coronavirus fatalities are happening in every age group, the group with the highest numbers might surprise you.
“Every age group actually also has very tragic fatalities from the very young to the very old,” said Dr. Vohra, “It turns out one surprising trend is that the 45 to 65 age group is actually having more fatalities than the 65 to 75 age group.”
The county’s system for processing deaths is backed up due to the coronavirus. According to Dr. Vohra, there are still dozens of death certificates that have not been reported out.” (C)
“California’s health care system is in the throes of a coronavirus crisis stemming from ill-advised Thanksgiving gatherings, top executives from the state’s largest hospital systems said Tuesday as they put out a “desperate call” for residents to avoid a Christmas repeat they said would overwhelm the state’s medical system.
Increasingly exhausted staff, many pressed into service outside their normal duties, are now attending to virus patients stacked up in hallways and conference rooms, said officials from Kaiser Permanente, Dignity Health and Sutter Health, which together cover 15 million Californians.
The CEO of the Martin Luther King, Jr. Community Hospital in Los Angeles, Dr. Elaine Batchlor, separately said patients there have spilled over into the gift shop and five tents outside the emergency department.
The officials offered what they called a “prescription” for Californians to slow the virus spread, a marketing effort dubbed “Don’t share your air.” The underlying message is to stay away from people from other households, which is what many failed to do at Thanksgiving.
“We simply will not be able to keep up if the COVID surge continues to increase,” Kaiser Permanente chairman and CEO Greg Adams said. “We’re at or near capacity everywhere.”
The state reported 32,659 newly confirmed cases Tuesday and another 653 patients were admitted to hospitals, one of the biggest one-day hospitalization jumps. A state data models predict nearly 106,000 hospitalizations in a month if nothing changes. The current level is 17,843.
The officials blamed Thanksgiving transmissions they fear will be repeated if people gather for Christmas and New Year’s and don’t take precautions like wearing masks, socially distancing, staying home as much as possible and not socializing with others….
“We don’t have space for anybody. We’ve been holding patients for days because we can’t get them transferred, can’t get beds for them,” said Dr. Alexis Lenz, an emergency room physician at El Centro Regional Medical Center in Imperial County, in the southeast corner of the state. The facility has erected a 50-bed tent in its parking lot and was converting three operating rooms to virus care.
Imperial County now is seeing 20% of people tested come back positive, compared with the state average of about 13%.
Officials in hard-hit Fresno County in the San Joaquin Valley meanwhile said temperature trackers on their 14,800 Moderna vaccine doses show that some will need replacing, though the vaccine doesn’t need the same ultra-cold care as the Pfizer vaccine.
Vaccine shipments aren’t used if there are “temperature irregularities” as occurred Monday with a shipment to Fresno, said California Department of Public Health spokeswoman Ali Bay. A replacement shipment should arrive Wednesday, she said.
“Temperature irregularities are rare, but they do occur,” she said in an email. “The federal government, manufacturers, distributors, the state, and local government have all planned for this possible scenario and have a system in place to ensure it is immediately addressed.” “ (D)
“As Americans celebrate the rollout of a coronavirus vaccine, many of the doctors and nurses first in line for inoculation say a victory lap is premature. They fear that the optimism stirred by the vaccine will overshadow a crisis that has drawn scant public attention in recent months: the alarming shortage of personal protective equipment, or P.P.E., that has led frontline medical workers to ration their use of the disposable gloves, gowns and N95 respirator masks that reduce the spread of infection.
At St. Mary’s Medical Center in Duluth, Minn., health care workers who treat Covid-19 patients are required to reuse their tightfitting respirator masks up to six times before throwing them away. Although soiled N95s are sterilized each day with ultraviolet light, Chris Rubesch, 32, a cardiac nurse, says the masks invariably sag after two or three shifts, leaving gaps that can allow the virus to seep through. “Our days are filled with fear and doubt,” Mr. Rubesch said. “It’s like driving a car without seatbelts.”
Many of the shortages are the result of skyrocketing global demand, but supply chain experts and health care providers say the Trump administration’s largely hands-off approach to the production and distribution of protective gear over the past nine months has worsened the problem. That has left states and hospitals to compete for limited supplies. Price gouging has become the norm, and scores of desperate institutions have been duped into buying counterfeit products…
With the White House largely disengaged from the crisis, medical workers, supply chain specialists and public health experts are urging President-elect Biden to make good on his campaign promises to use the Defense Production Act to boost domestic manufacturing of personal protective equipment, test kits, vaccines and the medical supplies needed to immunize hundreds of millions of Americans. They are also hoping the incoming administration will take over the distribution of scarce goods and put an end to profiteering and the mad scramble for P.P.E. that has pitted states and deep-pocketed hospital chains against nursing homes and small rural hospitals…
Hospital purchasing agents say they are facing an unparalleled shortage of single-use nitrile gloves — one of the most important items for reducing the spread of infectious pathogens — with prices soaring to $300 a case from $30 before the pandemic. Get Us PPE, a volunteer organization that connects health care facilities to available protective gear, says requests for help have more than tripled in the first half of December compared with the same period last month. Nearly 90 percent of the frontline workers the group surveyed across the country say they are repeatedly reusing masks designed for single use.
The pandemic has exposed flaws in freewheeling distribution system that enables hoarding by wealthy hospital chains and a global supply network overly reliant on overseas manufacturers. This was evident in the early months of the pandemic, when transcontinental flights that ferry Asian-made medical gear to the United States were largely frozen. And the crisis grew worse as China turned off the export spigot and commandeered its mask factories for domestic use.” (E)
“A New York health care provider is being probed over accusations that it illegally acquired COVID-19 vaccines and inoculated people against state guidelines.
The State Department of Health received reports that ParCare Community Health Network in Orange County “may have fraudulently obtained COVID-19 vaccine, transferred it to facilities in other parts of the state in violation of state guidelines and diverted it to members of the public,” according to a statement from state Health Commissioner Dr. Howard Zucker.
The Department of Health and New York State Police are conducting a criminal investigation to determine if ParCare misappropriated the vaccine and violated its distribution plan.” (A)
“Governor Andrew Cuomo announced new penalties in order to rein in possible vaccination fraud as suspected by Parcare Community Health Network which allegedly received the vaccine and distributed to regions and individuals who were not prioritized under state and federal law.
According to the governor, practitioners who break this law will be subject to a $1 million fine as well as all state licenses being revoked.
“You’ll have fraud in the vaccine process it’s almost an inevitable function of human nature, and of the marketplace. Vaccines are valuable and there’ll be people who break the law. And we’re looking at one health care provider who may have done that,” Cuomo said. “That will apply to a provider, a doctor, a nurse, a pharmacist any licensed health care professional. So, if you engage in fraud on this vaccine, we will remove your license to practice in the state of New York.”
New York State Police will be leading investigations into healthcare providers who misrepresent how they will be distributing the vaccine will then be in the hands of Attorney General Letitia James.
“We provide them the vaccine because they fraudulently filled out a form that said that they were a qualified health center, that was incorrect, so that was strike one and number two they moved it from one area to another area, which was inappropriate,” state Health Commissioner Howard Zucker said. “So that strike two, and then they gave it to people who were not on the priority list and so that was strike three.” (B)
“At NewYork-Presbyterian Morgan Stanley Children’s Hospital, one of the most highly regarded hospitals in New York City, a rumor spread last week that the line for the coronavirus vaccine on the ninth floor was unguarded and anyone could stealthily join and receive the shot.
Under the rules, the most exposed health care employees were supposed to go first, but soon those from lower-risk departments, including a few who spent much of the pandemic working from home, were getting vaccinated.
The lapse, which occurred within 48 hours of the first doses arriving in the city, incited anger among staff members — and an apology from the hospital…
The arrival of thousands of vaccine doses in New York City hospitals last week was greeted with an outpouring of hope from doctors and nurses who had worked through the devastating first wave in March and April. But for now, the vaccine is in very short supply, and some hospitals seem to have stumbled through the rollout.
Most of the vaccinations in the New York region to date have involved hospitals giving shots to their own employees, a relatively easy process compared with what is to come as part of the largest vaccination initiative in the nation since the 1940s…
Health care workers and nursing home residents and staff members form what is called Phase 1 of New York State’s vaccine distribution plan. About two million people are in this group, and the state’s initial allocation of the vaccine most likely means that Phase 2, which includes essential workers, won’t begin until late January. (Widespread distribution isn’t likely to begin until the summer, officials have said.)
But the state has left it mostly to each health care institution to devise a vaccination plan during the first phase. In the first week of vaccinations, many hospitals chose a wide variety of health care workers — nurses, doctors, housekeepers — from emergency rooms and intensive care units to be the first at their institutions to receive the vaccine. But in the days after the celebrations accompanying the first shots, the moods at hospitals have shifted.” (C)
“I wouldn’t be surprised that it’s already here,” said Dr. Peter Chin-Hong, an infectious disease professor at UCSF School of Medicine, referring to the new coronavirus variant.
He says unlike the UK, the United States has not done much genomic testing on positive COVID-19 samples to track emerging variants.
“Mainly because we have so many numbers,” said Chin-Hong.
The CDC says out of 17 million positive cases, only 51,000 have been sequenced since the pandemic began. For comparison, the CDC says the UK has sequenced at least 125,000 samples.” (A)
“Millions of people in the U.K. woke up a day after Christmas to tougher coronavirus restrictions on Saturday as officials in France and other European countries reported their first cases of the mutated, potentially more contagious strain.
Swathes of England were placed under the toughest set of lockdown rules, known as “Tier 4,” which will result in the closure of gyms, cinemas, hairdressers and most shops. People will also be restricted to meeting just one other person from another household in an outdoor public space.
The U.K.’s capital, London, has been living under “Tier 4” regulations since last week, while other parts of the country were under lower, less restrictive tiers numbered from one to three.
From Saturday, the number of people living in “Tier 4” in England will increase by 6 million to 24 million people or just over 40 percent of the population.
Scotland, which has its own tier system, moved much of the mainland into the highest level of restrictions for three weeks from Saturday, while Northern Ireland began six weeks of tight limits including a partial evening curfew. Wales remains under a national lockdown.
The total number of deaths from Covid-19 in the U.K. passed 70,000 on Christmas Day, while more than 2 million cases have been reported, according to Johns Hopkins University data…
A French man arrived in France on Dec. 19 from London and tested positive for the new variant Friday, the French public health agency said in a statement.
He had no symptoms and was isolating in his home in the central city of Tours, the statement said. Adding, that authorities were tracing his contacts and laboratories were analyzing tests from several other people who may have the new variant.
The new strain has also been detected in Sweden, Japan, Ireland and Spain, health officials in those countries said. While it was found in places as far flung as Denmark, Iceland and Australia earlier last week.” (B)
“No matter the underlying reason, policymakers should take this new variant very seriously, says epidemiologist Bill Hanage of the Harvard T.H. Chan School of Public Health. If it’s indeed 50% more transmissible, it will be difficult to stop its spread.
“Given the assumptions in their models, it’s really quite hard to avoid a situation very much like what happened last spring, in terms of hospital bed capacity and surges, without a very high rate of vaccination,” Hanage says.
That said, Hanage says there’s no reason for people to panic or be scared. “It’s not a magic virus,” he says — that’s the message virus expert Ian Mackay at the University of Queensland also wrote on Twitter.
“We have actually come across a large number of ways that we can use to stop it. However, we need to redouble our efforts in that direction.”
The variant will likely come to the U.S. — if isn’t here already. The study strongly suggests that people should be even more diligent about preventive measures: avoiding large gatherings. wearing masks, physical distancing and washing hands. On top of that, Hanage says, “the vaccine needs to be getting out at a very, very high rate.”
Because right now, scientists believe the vaccine will still be effective with this new variant. And Hanage says the quicker we immunize the vulnerable members of a community the safer the whole community will be from the original and future versions of the novel coronavirus.” (C)
“New York Gov. Andrew Cuomo is coordinating with hospitals in the state to test for the fast-spreading COVID-19 variant found in the U.K.
At a Dec. 22 news conference, the governor said the state laboratory, Wadsworth Center, has agreements in place with Montefiore Medical Center, Memorial Sloan Kettering Cancer Center, Northwell, University of Rochester Medical Center, Albany Medical Center and Saratoga Hospital to perform the tests.
A spokesperson for Northwell said the system is selecting samples at random and sending them to Wadsworth to test for the new highly contagious strain. Mr. Cuomo said that the state’s health department is making arrangements with other hospitals in the state to facilitate testing for the new strain, and will provide any hospital that has the lab capacity to test for the variant with the right reagents to test for the mutated strain.
Models have shown the COVID-19 variant found in the U.K. spreads 70 percent faster. It has not been detected in the U.S., and the 4,000 tests that Wadsworth has completed so far have come back negative for the variant. Yet Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said this week it is possible that the new variant is already in the United States.
“We have no evidence at this point that it is in this state,” Mr. Cuomo said. “We do know it has been moving globally. Chances are, if it’s been moving globally, it came here. That was the lesson from the spring.”
Mr. Cuomo said if the new variant is identified in New York, he wants to contact trace immediately from that point back and isolate it immediately.
“This is about time and urgency, and this would be urgent. And that’s why we’re mobilizing every hospital lab in the state that can perform this test, to perform this test,” he said.” (D)
“One thing that the emergence of the new variant has made clear is that scientists must pay greater attention to how the virus is changing in the real world. Though mutations are common, and indeed expected, these changes could ultimately affect how well drugs and vaccines work against the virus.
BioNTech, the German company that has partnered with Pfizer on a Covid-19 vaccine, said in a statement that it is “currently investigating the impact of our vaccine on this mutation.” Several countries, including the U.K. and the U.S., have started administering Pfizer-BioNTech’s vaccine, and the European Union authorized use of the vaccine on Monday.
“So far we have tested approximately 20 different mutations and the vaccine was able to address all of them,” the statement continued. “It is too early to draw any conclusions at this stage, but our vaccine is able to mount a strong and broad immune response so we remain optimistic.”
If the vaccine did need to be modified, it would take about 6 weeks to do so, BioNTech CEO Ugur Sahin said during a press conference Tuesday.
David Engelthaler, a geneticist at the Translational Genomics Research Institute in Arizona, said that we need to increase our surveillance of genetic changes to the coronavirus to study how the virus is changing in real time.
“It’s becoming more and more clear that we really need to watch this virus closely. It is not a static thing. It is continuing to evolve and change in slight ways
arose or what they mean long-term for the virus’s transmission. One possible hypothesis for their origin involves chronically ill patients treated with experimental therapies like convalescent plasma donated by recovered COVID-19 patients. In such lengthy illnesses, the virus has more opportunities to replicate, increasing the odds for mutations. The consistent use of the therapies, meanwhile, may put more pressure on the germ to evolve. that may make a big difference” he said. “Otherwise the virus will always be 10 steps ahead.”
The U.K. has a robust system in place to monitor for genetic changes in the virus; in the U.S., however, just 0.3 percent of infections have been genetically sequenced, according to the CDC. That means that while the variant has not been reported in the U.S., it’s possible that it’s already here, undetected.
Rasmussen and Kindrachuk both described the new variant as a “wake-up call” to expand genetic sequencing of the virus in the U.S., regardless of whether this variant turns out to be more transmissible…
“In the end, it’s possible that seasonal adjustments to the vaccine may need to be done, like for flu. We don’t know yet.””(E)
“Scientists are still uncertain about how the cluster of mutations
“Some of these people who are chronically infected have some quite big shifts in the virus,” says Ravindra Gupta, a virologist at the University of Cambridge. “Some are immune-suppressed. Some of them have had convalescent plasma. Some of them have had [the antiviral] remdesivir.”
“Achieving herd immunity against the coronavirus could require as much as 90 percent of the population to be vaccinated, Anthony Fauci said in an interview published Thursday.
Fauci, the country’s top infectious diseases expert, acknowledged in the New York Times interview that he has been incrementally raising his estimate of herd immunity numbers.
Fauci said he has been increasing the estimates in his public pronouncements because he thinks Americans are now able to handle the message that getting back to normal may take longer than anticipated, and fewer Americans are reporting being skeptical of taking a vaccine.
“When polls said only about half of all Americans would take a vaccine, I was saying herd immunity would take 70 to 75 percent,” Fauci told the Times. “Then, when newer surveys said 60 percent or more would take it, I thought, ‘I can nudge this up a bit,’ so I went to 80, 85.”
The Times noted that about a month ago, Fauci began saying herd immunity would take “70, 75 percent” of Americans being vaccinated.
Last week, in an interview with CNBC News, Fauci estimated “between 75 and 80, 85 percent of the population.”
At that level of vaccination, Fauci said, “we would develop a umbrella of immunity. That would be able to protect, even the vulnerables, who have not been vaccinated, or those in which the vaccine has not been effective.”
Fauci said experts don’t really know for sure the level of vaccinations needed for herd immunity, but the initial estimates of 60 to 70 percent were based on early data.” (A)
“Dr. Fauci told The Times in an interview published Thursday that he had slowly but deliberately been moving the goal posts, partly based on new science, and partly on his gut feeling that the American public was ready to receive the information, which is that 70-90% herd immunity should be achieved before the country can go back to normal.
He said he hesitated to state a number as high as 90% weeks ago because many Americans still seemed skeptical about vaccine….
““We need to have some humility here,” he added. “We really don’t know what the real number is. I think the real range is somewhere between 70 to 90 percent. But, I’m not going to say 90 percent.”” (B)
“Asked about Dr. Fauci’s conclusions, prominent epidemiologists said that he might be proven right. The early range of 60 to 70 percent was almost undoubtedly too low, they said, and the virus is becoming more transmissible, so it will take greater herd immunity to stop it…
Measles is thought to be the world’s most contagious disease; it can linger in the air for hours or drift through vents to infect people in other rooms. In some studies of outbreaks in crowded military barracks and student dormitories, it has kept transmitting until more than 95 percent of all residents are infected.
Interviews with epidemiologists regarding the degree of herd immunity needed to defeat the coronavirus produced a range of estimates, some of which were in line with Dr. Fauci’s. They also came with a warning: All answers are merely “guesstimates.”
“You tell me what numbers to put in my equations, and I’ll give you the answer,” said Marc Lipsitch, an epidemiologist at Harvard’s T.H. Chan School of Public Health. “But you can’t tell me the numbers, because nobody knows them.”…
The original assumption that it would take 60 to 70 percent immunity to stop the disease was based on early data from China and Italy, health experts noted.
Epidemiologists watching how fast cases doubled in those outbreaks calculated that the virus’s reproduction number, or R0 — how many new victims each carrier infected — was about 3. So two out of three potential victims would have to become immune before each carrier infected fewer than one. When each carrier infects fewer than one new victim, the outbreak slowly dies out.
Two out of three is 66.7 percent, which established the range of 60 to 70 percent for herd immunity….
Further complicating matters, there is a growing consensus among scientists that the virus itself is becoming more transmissible. A variant “Italian strain” with the mutation known as D614G has spread much faster than the original Wuhan variant. A newly identified mutation, sometimes called N501Y, that may make the virus even more infectious has recently appeared in Britain, South Africa and elsewhere.
The more transmissible a pathogen, the more people must become immune in order to stop it.
Dr. Morens and Dr. Lipsitch agreed with Dr. Fauci that the level of herd immunity needed to stop Covid-19 could be 85 percent or higher. “But that’s a guesstimate,” Dr. Lipsitch emphasized.
“Tony’s reading the tea leaves,” Dr. Morens said.
The Centers for Disease Control and Prevention offers no herd immunity estimate, saying on its website that “experts do not know.”
Although W.H.O. scientists still sometimes cite the older 60 to 70 percent estimate, Dr. Katherine O’Brien, the agency’s director of immunization, said that she now thought that range was too low. She declined to estimate what the correct higher one might be.
“We’d be leaning against very thin reeds if we tried to say what level of vaccine coverage would be needed to achieve it,” she said. “We should say we just don’t know. And it won’t be a world or even national number. It will depend on what community you live in.”
Dr. Dean noted that to stop transmission in a crowded city like New York, more people would have to achieve immunity than would be necessary in a less crowded place like Montana.
Even if Dr. Fauci is right and it will take 85 or even 90 percent herd immunity to completely stop coronavirus transmission, Dr. Lipsitch said, “we can still defang the virus sooner than that.”
He added: “We don’t have to have zero transmission in order to have a decent society. We have lots of diseases, like flu, transmitting all the time, and we don’t shut down society for that. If we can vaccinate almost all the people who are most at risk of severe outcomes, then this would become a milder disease.” (C)
“Dr. Anthony Fauci, the nation’s senior official for infectious diseases, predicts the United States could begin to achieve early stages of herd immunity against the deadly coronavirus by late spring or summer. And if that happens, Fauci anticipates, “we could really turn this thing around” toward the end of 2021…
Fauci said if all goes according to plan, by the end of March or beginning of April more vaccines will be available to the general public.
“Once we get there, if in the subsequent months, April, May, June, July, we get as many people vaccinated as possible, we could really turn this thing around before we get towards the end of the year,” Fauci said…
“We still have a raging outbreak that we need to get under control, so at the same time as we’re administering the vaccine as quickly and as expeditiously as possible, we still have to implement the public health measures to prevent the surges we’re seeing throughout the country.” (D)
“The nation’s top infectious disease expert estimates that most Americans will have access to the new COVID-19 vaccines by mid-summer.
Dr. Anthony Fauci told Good Morning America on Tuesday that he expects to start vaccinating the general population “somewhere in the end of March, the beginning of April.”
He said the process could take up to four months to reach all Americans who want to receive the vaccine.” (E)
“As the nationwide vaccination effort ramps up, the federal government announced it has reached a deal to buy 100 million additional doses of Pfizer’s vaccine. Fauci expressed optimism in the availability of vaccines going into 2021. After the first round of doses goes to frontline health care workers, nursing home residents and others at highest risk, more and more of the American public will be able to get the shots in the months ahead.
“At the end of the summer, if we can get the overwhelming majority of the people in this country to accept vaccinations, I think, we will be in good shape towards approaching what all of us would want, a return to some form of normality,” Fauci said.
There have been more than 18 million confirmed COVID-19 cases in the U.S. since the start of the pandemic, and more than 322,000 Americans have died.
Asked about a mutated strain of the virus recently detected in the U.K. which may be more transmissible than before, Fauci explained that viral mutations are nothing new.
“These RNA viruses mutate all the time. The more infection and the more replication you have, the more likelihood is that you are going to get mutations,” he said, and noted that most viral mutations “have no relevant functional impact.”
He said there was no data thus far that indicated the new variant would withstand the vaccine.
“Having said that, we’ve got to take this seriously. We’ve got to follow it very carefully,” he cautioned.
Viruses like influenza that mutate more rapidly are usually combatted by a modified vaccine. Flu shots, for example, need modification “almost every year.”
However, he said the COVID-19 vaccines may not need such frequent updates. “This vaccine does not drift… it does not drift the way influenza does,” he said, and he expressed confidence that adjustments would be made if needed.” (F)
“On a recent Skype call with my grandmother, I broached the topic of the fast-arriving Covid-19 vaccines.
Advanced age brings wisdom, but it also brings an elevated risk of severe illness from infection with the coronavirus, so I wanted to prime her to get an FDA-approved vaccine as early as possible.
But as I was extolling the benefits of vaccination, I noticed a furrowed brow, a frown, and a look of uncertainty on her face. That took me by surprise. Surely someone who gets a flu shot every year and who raised two doctors shouldn’t feel anxious to get the Covid jab. But she clearly was.
That conversation left me worried not only about her safety but about the safety of our country. If my Grandma was feeling hesitant, millions of other Americans are probably feeling the same way. A nagging question popped into my mind: If vaccine distrust plagues our country, when will we be able to achieve herd immunity and transition to a new normal?
Herd immunity protects those with vulnerable immune systems. Here’s how.
Herd immunity occurs when a critical mass of people become immune to a pathogen like SARS-CoV-2, the virus that causes Covid-19. With enough people immune to the virus, the chain of transmission is halted, which provides indirect protection to individuals who aren’t immune.
Inspired by Dr. Jacob E. Jones, a family medicine physician at my hospital who made some predictions on the time required to achieve herd immunity based on vaccine adoption, I set out to answer my question with a model that uses the following variables and definitions:
The basic reproduction number R0 (pronounced R-naught). This number represents how infectious a pathogen is. An R0 of 2 means one individual infected with SARS-CoV-2 is likely to infect two other people. Currently, most estimates of R0 are between 2.5 and 4. For the sake of this thought experiment, I assumed an R0 of 4.
Base prevalence. This is the percentage of people immune to the virus at a given moment in time, either from acquired infection or vaccination.
Monthly infection rate. This is the percentage of people who become infected and acquire immunity to the virus every month.
Using just the basic reproduction number, it’s possible to calculate the percentage of people needed to achieve herd immunity:
If R0 is 4, then 75% of the population needs to acquire immunity to the virus in order to halt transmission.
In late September, a Stanford study estimated that 9.3% of Americans have antibodies against SARS-CoV-2. To be sure, antibody testing may suffer from low positive predictive value when the prevalence of infection is low, but this is the best estimate we have so far. I’ll use that as the base prevalence.
If the base prevalence at the end of September — eight months from the onset of the epidemic in the United States on January 21, 2020 — was 9.3%, the coronavirus has an infection rate of approximately 1.2% of the population per month. This back-of-the-envelope calculation is in line with estimates from the medical literature, with one study estimating 52.9 million infections in the U.S. from February 27 to September 30, or an infection rate of 1.3% per month.
Using the herd immunity threshold, the base prevalence, and the monthly infection rate, it’s possible to calculate the number of months (m) to achieve herd immunity:
If the virus is left to spread at its current rate with no vaccine, it would take 55 months from October 2020 to achieve herd immunity. That means May 2025. Even if I had assumed an R0 of 3, it would still take 48 months to reach herd immunity.” G)
“Vaccination offers two benefits, said Joshua Epstein, a professor of epidemiology at the NYU School of Global Public Health: direct protection of the person vaccinated, as well as the social benefit of vaccinated people not spreading the disease to others.
“If enough get vaccinated, the disease can die out on its own for lack of fuel,” Epstein said. “That’s the herd-immunity idea: Protect enough people that it has insufficient fuel to keep burning.” The goal of a vaccination strategy, he added, “is to tip the epidemic into that declining state.”
How many people need to get vaccinated
The vaccine candidate from Pfizer PFE, -0.45% and its German partner, BioNTech BNTX, -3.10%, showed 95% efficacy in protecting against COVID-19 in a late-stage clinical trial. Moderna’s MRNA, -5.33% vaccine showed about 94% efficacy.
It remains unclear whether the two vaccines, which received emergency-use authorization from the Food and Drug Administration this month, protect against symptomless COVID-19 infection or transmission. Preliminary data from Moderna’s trial suggested there may be a lower risk of asymptomatic infection after one dose, though further analysis is needed.
Estimates vary on what share of the population would need to get vaccinated against COVID-19 in order to achieve herd immunity, and experts warn that it’s hard to pin down a definitive figure just yet.
Both consist of two doses: Pfizer’s requires a second shot three weeks after the first, while the Moderna shots come four weeks apart.
At least 614,117 U.S. vaccine doses had been administered as of Monday morning, according to the Centers for Disease Control and Prevention; that tally only included Pfizer doses. Some 4.6 million doses of both vaccines had been distributed.
The U.S. has never reached herd immunity from natural infection with a novel virus; so far, vaccination has always been required. Estimates vary on what share of the population would need to get vaccinated against COVID-19 in order to achieve herd immunity, and experts warn that it’s hard to pin down a definitive figure just yet.
Moncef Slaoui, the Trump administration’s vaccine czar, told CNN in November that with the roughly 95% efficacy level demonstrated by Pfizer’s and Moderna’s vaccines, “70% or so of the population being immunized would allow for true herd immunity to take place.” “That is likely to happen somewhere in the month of May, or something like that, based on our plans,” he said.
Anthony Fauci, the nation’s top infectious-disease doctor, said during a Nov. 30 livestream with Facebook FB, -0.26% CEO Mark Zuckerberg that while he wasn’t yet sure what percentage of the population would need to get vaccinated against COVID-19 to achieve herd immunity, “I would imagine it’s somewhere between 75 and 85% at least.”
“If you have a highly efficacious vaccine and only 50% of the country gets vaccinated, you’re not going to have that umbrella of protection of herd immunity,” Fauci added. “What you really want is one, what we have, a highly efficacious vaccine — but you want 75, 85% of the people to get vaccinated.”
The percentage of people that will need to be vaccinated will depend on the actual vaccine efficacy in real life and any future vaccine efficacy, Landon added.
“If everyone got one of the mRNA vaccines and they worked about 90% of the time, we would need to vaccinate about 10% more than the ‘herd immunity’ target, whatever that may be,” she said. (mRNA technology, employed in both the Pfizer and Moderna vaccines, teach the body’s cells to create proteins that generate an immune response.) (H)
“County officials who have for years been planning for a mass vaccination said they are seeing that training and preparation — much of it funded by millions of dollars in federal grants — pushed aside as the administration of Gov. Andrew M. Cuomo has retained control of the state’s coronavirus vaccination program, including having hospitals rather than local health departments administer the doses.
Interviews with multiple county officials over the past week confirm that many are unclear why the governor’s administration has not activated the county-by-county system, a plan that included recent practice sessions in which members of the public received regular flu vaccines at drive-thru sites…
Gareth Rhodes, a member of Cuomo’s coronavirus task force, said the county health departments and their pre-designated “points of distribution” for vaccinations are still integral to the governor’s plan, which is being done on a regional rather than county-by-county basis. As part of that process, the state is gathering details from counties about their vaccination plans and capabilities.
“The state then refines and approves and we implement the regional plan, of which every single health department plays a large role,” Rhodes said. “It’s not like we’re sitting on 50 million vaccine doses. … We’re getting a very small number every week, and criteria for who is eligible is obviously very narrow at this point.”
Rhodes, who is helping lead the administration’s vaccination strategy, said the planning is complicated because every person needs to receive two doses of the same vaccine — roughly three weeks apart — and the vaccine being distributed by Pfizer must be kept in deep-freeze storage containers until it’s thawed for use.
Rhodes took issue with the idea that the county plans were being ignored. “We’ve been working very closely with them, have had a number of calls with them,” he said. “I think our goals are all the same; we want to get this thing done as quickly as possible and in the most efficient way as possible.” (I)
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…”
“One of Virginia’s top health officials is warning medical providers about a growing number of COVID-19 outbreaks in state hospitals.
Health Commissioner Dr. Norman Oliver released a new clinician letter on Friday, writing that reported COVID-19 infections in hospitals have “increased substantially” since August.
“The largest monthly number of hospital COVID-19 outbreaks since the pandemic began was reported in October,” he said. Data from the Virginia Department of Labor and Industry, obtained by the Mercury through a Freedom of Information Act request, shows that more than 10 different hospitals reported COVID-19 cases or hospitalizations among employees between August and October.
Some of those facilities, including Bon Secours St. Mary’s Hospital in Richmond and Sovah Health in Martinsville, were also the subject of employee complaints for not following the state’s emergency COVID-19 safety regulations. Dozens of private health care practices — including dental offices, ear, nose and throat specialists and eye doctors — also reported cases or received complaints.
Sarah Lineberger, manager of the Virginia Department of Health’s health care-associated infections program, said COVID fatigue is likely contributing to the spread in hospitals and health care facilities, which have been on the frontline of the pandemic for months.
“With the increase in community transmission, we think we just really have to get to the basics of infection prevention and control,” she said. “We’re seeing issues with personal protective equipment and the need to remind staff to make sure everyone is social distancing and and following public health guidelines before and after work.”
The fact that many hospital employees were furloughed over the spring and summer and are still getting reacquainted with COVID-19 procedures also complicated efforts to control the virus, Lineberger said. Some hospitals have also relaxed visitor restrictions or may still be operating under emergency protocols when it comes to distributing personal protective equipment…
Oliver called the rise of outbreaks in hospitals especially concerning because the state is also seeing an increase in infections related to multidrug-resistant organisms — bacteria and other germs that don’t respond to antibiotics or other treatments.
“Simultaneous transmission of COVID-19 and multidrug-resistant organisms is occurring in several hospitals and other healthcare facilities across Virginia,” he wrote. Lineberger said that both hospitals and long-term care facilities in Virginia have seen co-occurring outbreaks of the virus and other infections such as Candida auris, a multi-drug resistant fungus that hasn’t been historically common in Virginia.
But recently, the state has been seeing an increasing number of cases, she added — underscoring the need for health care facilities to review and stringently implement infection control procedures.
“We’ve been working with facilities to focus on the basics and make sure they’re thinking about other organisms, not just COVID-19,” Lineberger said. “These are issues that we really tried to drive home with nursing homes and are now coming up in hospitals.”” (A)
“Brigham and Women’s Hospital in Boston is experiencing an outbreak of COVID-19 among patients and staff, which the facility blames partly on lapses in infection control practices by employees.
The hospital, a Harvard Medical School teaching facility, reported on September 28 that, so far, 30 employees and 12 patients tested positive as a result of exposure within the hospital. The outbreak was first detected on September 22, and cases have risen with increased testing. The hospital said it had tested 488 employees and 581 patients as of September 28…
Brigham and Women’s reported that the outbreak may have started with a presymptomatic employee who had mild symptoms that the worker attributed to seasonal allergies. That worker interacted with a patient. Both the patient — who received an aerosol-generating treatment — and the employee later tested positive.
The hospital said its investigation determined other factors that likely fueled the spread, including that many patients were not masked during clinical care and interactions with staff; that clinicians and health care workers were inconsistent in the use of eye protection during patient encounters; and that staff did not observe physical distancing while eating and unmasked…
Pettis said it is only natural at this point in the epidemic that staff might be less diligent with personal protective equipment and other infection control practices.
“I like to call it PPE fatigue,” she said, noting the difficulty of wearing masks and other PPE throughout a shift.
Infection control specialists at hospitals help gauge the appropriateness and functioning of air handling and filtering and monitor staff on PPE-wearing and other infection control measures because “of that tendency to perhaps let your guard down a little,” Pettis explained.
With the potential for people with SARS-CoV-2 to be asymptomatic or presymptomatic, it is “incredibly difficult to have an absolute risk-free environment,” she said.
“Even if you do everything right, there is the potential for [an outbreak] to happen,” Pettis continued, adding that hospitals are required to report hospital-acquired COVID-19 infections to their local health departments, which then report to state health officials, but there is no national repository of such COVID-19 outbreaks.” (B)
“Several causes contributed to Covid-19 outbreaks at Mayo University Hospital including a lack of understanding of the virus and the importance of wearing face masks, a report has found.”
“Two outbreaks last April and May occurred on two inpatient wards leading to 75 confirmed cases, 33 among patients and 42 staff….
It conducted an unannounced visit last September to assess Covid-19 related aspects of management. And while it found the hospital to be either compliant or substantially compliant in five of six areas, it raised concerns over its emergency department and addressed the causes of the earlier outbreaks.
“Contributory factors [to the outbreaks] included key information deficits relating to the nature of the Sars-CoV-2 virus at that time, inclusive of the potential for asymptomatic and pre-symptomatic spread, and the importance of mask wearing to prevent cross-transmission,” it found.
Other factors included a delay in turnaround time for tests (subsequently addressed with increased on-site capability), the absence of proper contact tracing, a lack of appropriate isolation facilities, staff crossover between wards and asymptomatic transmission to staff and patients.
During the course of this inspection, Hiqa noted the hospital had implemented several measures to reduce the likelihood of further outbreaks.
However, it said while affected areas of outbreak wards were subsequently closed, “it was of concern” that other areas of the wards remained open to admissions for two weeks afterwards.
Was there an overcrowding problem?
The hospital was found to be non-compliant with standards governing infection prevention and control, specifically relating to overcrowding in its non-Covid emergency department A, where the original outbreak occurred.
“If further outbreaks are to be avoided the hospital must urgently address ongoing risks through improvements in the wider hospital infrastructure, addressing emergency department overcrowding, and through the early closure of outbreak wards to new admissions.” (C)
“On Wednesday, we learned Providence Medical Center in Everett experienced a small COVID-19 outbreak within the hospital.
A hospital spokesperson confirmed “a small number of patients in one unit tested positive for COVID-19 within a few days of each other.”
The spokesperson told KOMO News the first positive test result came roughly two weeks ago.
“At this point, we do not know if these patients may have had a common source of exposure. The investigation is ongoing, and the findings aren’t definitive,” said the hospital statement.
The statement went on say that all visitations were halted within the unit, patients on the unit were discharged, and the unit is currently closed for investigation.
This is just the latest reported outbreak within a hospital in the Puget Sound region.
This week, Multicare Auburn Medical Center confirmed one patient died and eight other patients were infected with COVID-19 last week after a patient tested positive for the virus on a 4th floor unit.
Five employees also tested positive after the hospital tested hundreds of employees that were in the unit within 14 days prior to the first patient testing positive.
“MultiCare is following all public health recommendations and has the PPE we need for our employees to continue to safely care for all of our patients at Auburn Medical Center and throughout our health system.”
In Bremerton, at St. Michael Medical Center, six more people (four patients and two staff members) recently tested positive. This comes after three patients died and more than 70 others were infected during an outbreak in August…
Outbreaks within hospitals have occurred since the start of the pandemic.
According to the latest DOH report, there have been 350 outbreaks within non-long term care healthcare settings. These include hospitals, outpatient settings, behavioral health facilities, supported living facilities, home healthcare, dialysis centers, and independent senior living facilities.” (D)
“At least 100 employees from Ocean Medical Center in Brick Township have been infected with the coronavirus, according to a memo posted on the hospital parent company’s website that attributed the recent outbreak to “colleagues socializing outside of work.”
A spokesman for Hackensack Meridian Health, which owns the 318-bed hospital in northern Ocean County, declined to say Monday specifically how many employees have been affected.
Visits with patients have been suspended with the exception of labor and delivery, end-of-life care, pediatrics and adult patients with special needs, Hackensack Meridian spokesman Benjamin Goldstein said in a statement.
“We continue to have adequate staffing for both COVID-19 cases and elective surgeries, and follow all rigorous safety protocols established by the CDC and the New Jersey Department of Health,” according to Goldstein’s statement…
Ocean Medical Center was treating 68 confirmed COVID-19 patients while 12 others were awaiting test results, according to the Hackensack Meridian Health website data on Monday.
Hackensack Meridian’s 12 acute-care hospitals, Carrier Clinic and its long-term care facilities were treating a total of 737 confirmed COVID-19 patients and 37 other awaiting test results, according to the website.
A rising number of cases can be found throughout the state, as New Jersey has entered the second wave of the pandemic. There were 2,961 patients with confirmed (2,761) or suspected (263) cases Sunday night — including 575 in intensive care, with 332 on ventilators, Gov. Phil Murphy announced on Monday.
Ed Lifshitz, medical director for the Communicable Disease Service at the Department of Health, said during the governor’s briefing he was aware of the outbreak at the hospital, and noted cases are rising at hospitals around the state. Given the nature of hospitals, with patients and staff “coming and going all the time” Lifshitz said it was harder to contain the virus.
Seven of New Jersey’s 71 acute-care hospitals were on “divert status” Monday night but Ocean Medical Center was not among them.
Goldstein, the hospital chain spokesman, stressed that all employees undergo a temperature check and a “comprehensive screening” before they report to work.
“As a result of COVID-19 being widespread in the community, we are also continually reinforcing our safety guidelines with team members to ensure they are maintaining infection prevention practices both inside and outside of the medical center – frequent hand washing, wearing a mask, physical distancing, and staying home when you are sick,” Goldstein’s statement said.” (E)
“As a New Jersey hospital faced a surge of Covid-19 cases in the spring, another deadly foe was quietly spreading among its patients: a drug-resistant bacterial infection.
The superbug outbreak, detailed in a report published Tuesday by the Centers for Disease Control and Prevention, shows how the coronavirus can overwhelm a hospital, straining care and leaving patients vulnerable to other unwanted outcomes.
Carbapenem-resistant Acinetobacter baumanii, or CRAB, is a drug-resistant bacterium known to spread in hospitals, particularly in intensive care units. It can cause pneumonia as well as wound, blood and urinary tract infections, according to the CDC. Carbapenem, a powerful antibiotic, is ineffective at treating the infection.
Not all patients get sick — in some cases, the bacteria can “colonize” the body, but not cause an infection. These patients can still spread the bacteria to others.
The outbreak was first detected in the unnamed New Jersey hospital on May 28, according to the CDC report. Further investigation by the hospital and the state health department identified a total of 34 patients who had caught the superbug from February to July. Typically, the hospital sees up to two cases a month.
The majority of the cases — 82 percent — occurred in March through June, when the hospital was facing a surge of Covid-19 patients, and with it, severe shortages in necessary staff, supplies and equipment.
The bacteria pose a threat to hospitalized patients because they can survive on surfaces for a long time, according to the CDC. Contaminated surfaces must be rigorously cleaned and disinfected to prevent outbreaks.
Such infection control measures, however, took a hit during the hospital’s Covid-19 surge. Personal protection equipment was reused, for example. Fewer screening tests for the bacteria were given to patients, because of staff shortages and higher-need patients.
The report also noted that before the pandemic, key parts of a ventilator were changed every 14 days. To conserve equipment during the surge, however, the hospital switched to replacing these parts only when they were visibly soiled or malfunctioning.
Twenty-five of the 34 patients either infected or colonized with the bacteria were on ventilators at the time.
Twenty of the 34 patients did become infected, including 11 patients with Covid-19. Fourteen developed a form of pneumonia linked to the bacterial infection, four of whom also had bacteremia, a blood infection. A total of 10 patients died, and one remains hospitalized, according to the report.
It wasn’t until late May that the hospital was able to resume normal operations — and with that, CRAB cases fell.” (F)
“The Murphy administration may step in to force hospitals to report COVID-19 outbreaks among staff as legislation requiring the public disclosure remains stalled in the state capital.
Hospitals have so far evaded the same detailed reporting requirements of nursing homes and schools during the pandemic. But with the second wave of the coronavirus threatening to deplete the state’s health care workforce, Gov. Phil Murphy said Monday that he is “100%” in favor of transparency and it is something his staff is working on.
“I can’t promise you executive action,” Murphy said. “That’s something we’re very seriously looking at. Folks have a right to know what’s going on.”
Later Monday, the state hospital association said it would support the now-stalled measure, pending in the Assembly, that “calls for a transparent reporting process for hospital workers infected with the COVID-19 virus.”
Public posting of information about hospital outbreaks will help “residents of this state feel confident seeking medically necessary care at our facilities,” said Cathleen Bennett, president of the association, which represents 71 acute-care hospitals. The association had added its support to A4129, she said.
But to this point neither the state nor hospitals have offered details on recent outbreaks among staff, which generally mean three positive COVID-19 cases that have a “clear link.”
In the past several weeks, outbreaks have sickened more than 100 health care workers at Ocean Medical Center in Brick, sidelined between 30 and 40 employees of Palisades Medical Center in North Bergen and infected hospital workers at Jersey Shore University Medical Center in Neptune.
The Harborage with is part of the Hackensack Meridian Health Palisades Medical Center in North Bergen, N.J. on Wednesday April 22, 2020.
Murphy’s comments came a day after a story by The Record and NorthJersey.com outlining the lack of data on hospital outbreaks, and just hours after unionized health care workers pressed for the passage of a bill to require that hospitals report to the state positive cases, hospitalizations and COVID deaths among staff members.
That bill was introduced shortly after the first wave subsided and passed unanimously in the Senate, but it has made no progress in the Assembly even after the arrival of the second wave of COVID cases this fall…
Hospitals must report some details to the state, such as the number of admitted COVID patients, ventilator use and how many critical care beds are treating COVID patients. That data has helped to show the evolution of the virus and inform decisions by the governor.
As of Monday, there were 3,346 hospitalizations. At the peak of the first wave in the spring there were about 8,300 people hospitalized with COVID, and New Jersey was “at the edge” on hospital capacity, Murphy said.” (G)
“Hospital systems (and other indoor facilities) should focus on a number of provisions in addition to distributing a sufficient supply of masks to all staff and patients. Adequate, well-ventilated, and ideally dedicated space must be provided for breaks from daily work activities and mealtimes for health care workers, with processes in place to ensure that these are staggered to minimize contact and conversation during these higher-risk periods. Shared patient rooms should be avoided when possible, especially when local prevalence of infection is high, because of the possibility that patients might be admitted during the SARS-CoV-2 incubation period and because they must remove their masks to eat. The marginal benefit of universal eye protection should be evaluated, particularly during clinical encounters. Regular, flexible, and convenient testing with short turnaround times and adequate and statutory sick leave should be made available to all health care workers, with systems in place to ensure progression of training for medical trainees. Through these measures, transmission could be further minimized (and perhaps even eliminated), and emerging evidence could continue to direct policies designed to maintain safety in the hospital setting.” (H)
“A doctor at an L.A. County public hospital said the number of COVID-19 patients is “increasing exponentially, without an end in sight.”
Many parts of that hospital are being converted to COVID-19 wards, and ICU teams are being staffed up with workers from other departments that are temporarily halting services. The doctor, who was not authorized to speak to the media and requested anonymity, said it appears that by early January, the hospital will have to begin rationing care….
Already, UCLA Health is scheduling multiple infectious-disease doctors to be on call at any time, due to the unprecedented numbers of COVID-19 patients needing hospitalization, he said. The biggest issue is that hospitals may quickly run out of providers who can administer ICU-level care and will be forced to draft doctors from other specialties.
“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. It’s the physicians, the nurses, the respiratory therapists, all of the trained people to do that highly specific work that you can’t just pull out of a hat.”…
Many hospitals are preparing for the possibility of rationing care in the coming weeks as the number of patients exceeds their staffs’ abilities to care for them. A document obtained by The Times, outlining how to allocate resources in a crisis situation, was recently circulated among doctors at the four hospitals run by Los Angeles County.
The guidelines call for a shift in mindset that is unfamiliar to many medical providers. Instead of trying everything to save a patient, the goal during a crisis is to save as many patients as possible, meaning those less likely to survive will not receive the level of care they would have otherwise. In other words, doctors will no longer be pulling out all the stops to save a life but, instead, will be strategizing about how to keep as many people as possible from perishing.” (A)
““I’m not going to sugarcoat this. We are getting crushed,” said Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center, which has more than 600 beds and is one of the largest in the county.
It’s a scene playing out across California. According to state data Friday, all of Southern California and the 12-county San Joaquin Valley to the north had exhausted their regular intensive care unit capacity and some hospitals have begun using “surge” space….,
Spellberg said that every day for the last week at his hospital has begun with no available intensive care beds and a scramble to find room in spaces that don’t usually handle critical patients, like post-surgery recovery areas.
Los Angeles County Health Services Director Dr. Christina Ghaly said hospitals “are adding three beds to a room that maybe was a double room, or turning a single room into a double room,” dangerously stretching staff.
John Chapman, president and chief executive at San Antonio Regional Hospital in Upland, said telemetry nurses who monitor vital signs of patients should be overseeing no more than four people but could wind up taking on five or six because of the crush of cases.
“It definitely increases the risk of something going wrong,” he said…” (B)
“California’s remaining intensive care capacity is alarmingly low, just 2.1% as of Friday. What happens if that number drops even further and hits 0%? Gov. Gavin Newsom explained in a video update Friday afternoon.
“When you see 0%, that doesn’t mean there’s no capacity, no one’s allowed into an ICU. It means we’re now in our surge phase, which is about 20% additional capacity that we can make available,” Newsom said.
Four alternative care sites have already been set up to help handle overflow patients. The sites are located at Imperial Valley College, Sleep Train Arena in Sacramento, Porterville Developmental Center in Tulare County and Fairview Developmental Center in Orange County.
Some sites are accepting COVID-positive patients while others are just helping decompress local hospitals, Newsom said.” (C)
“Brad Spellberg, the chief medical officer of LA County USC Medical Center — one of the largest hospitals in the state — told NPR member station KPCC that means some patients are waiting hours for care as hospitals struggle to free up beds as quickly as possible.
“We are the safety net — that is the point,” Spellberg said. “The safety net itself is being stretched to the limit.”
Some hospitals are now preparing for the possibility of rationing care in the coming weeks, according a document obtained by the Los Angeles Times. The document, which was circulated among doctors at four hospitals run by Los Angeles County, outlined guidelines on how to allocate resources in a crisis situation, shifting from a goal of trying to save every patient to instead saving as many as possible. This would mean that those less likely to survive would not receive the same care that they would in a non-crisis situation.
“Some compromise of standard of care is unavoidable; it is not that an entity, system, or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner,” the document reads, according to the Times.
In an email, L.A. County Health Services Director Dr. Christina Ghaly told the Times that the guidelines were not in place as of Friday night.
“We have enough beds, supplies, and equipment for now, but we don’t have enough trained staff for the number of patients who need care. We have brought in new staff, retrained and redeployed staff from other areas of the system, and have requested additional resources from the state,” Ghaly wrote. “But these measures are not anticipated to be enough to meet the continuously escalating number of patients that are presenting across the county for care.”
Last week, California was forced to activate its “mass fatality” program, which coordinates mutual aid across several government agencies. According to the California Office of Emergency Services, a mass fatality is an incident in which more deaths take place in a period of time than can be handled by local coroner or medical emergency personnel.” (D)
“Late Wednesday, the Orange County Health Care Agency issued an order suspending the ability of hospitals that take part in the 911 system to request a diversion of ambulances to other medical centers.
Dr. Carl Schultz, the agency’s EMS medical director, said in a statement that hospital emergency rooms have become so overwhelmed due to the COVID surge that “almost all hospitals were going on diversion.”
“If nothing was done, ambulances would soon run out of hospitals that could take their patients,” Schultz said. Therefore, we temporarily suspended ambulance diversion. While this will place some additional stress on hospitals, it will spread this over the entire county and help to mitigate the escalating concern of finding hospital destinations for ambulances.”
Schultz added: “To the best of our knowledge, this has never happened before.”
On Monday, Schultz issued a memo to authorize ambulance providers to take patients up to 29 years old to Children’s Hospital of Orange, but another memo released Tuesday from Schultz scrapped that.
“Multiple logistic complications have occurred as a result of this directive and it would be in everyone’s best interest to cease this activity, effective immediately,” Schultz said.” (E)
“Tennessee Department of Health officials announced Sunday that the state could “break” its hospital system if a Christmas surge of COVID-19 cases matches that of Thanksgiving.
Commissioner Lisa Piercey said there have been multiple household gatherings where people have been affected statewide, as Thanksgiving surges proved.
Piercey said Tennessee requested National Guard staff in the northeastern system and to the Memphis and Shelby County region to go into the hospitals, not just serve testing services. Five large health care systems across the state have also been given flexibility to allow paramedics to practice inside hospitals.
Workers who have tested positive for COVID-19 and “feel up to the challenge” are now allowed to work in long-term care facilities. The same doesn’t apply to hospitals.
Piercey said the state is running out of options for staffing.
“I tell you this because we are looking under every rock. We are turning over every stone to help hospitals. We are running out of options,” she said.
Piercey said the state did identify more than 700 health care professionals, including some from the education system, who could volunteer or seek employment.
“All of the money in the world can’t buy more staff,” Piercey said. “That money will only go so far. We have spent all the money we can spend on staff. There are no more staff to spend money on.” (F)
“A swamped ICU and escalating COVID-19 crisis forced a turning point at VCU Health last week: The Richmond area’s anchor hospital formally deployed the next level of its surge capacity plan, signaling the end of normal operations to prepare for significant strain on its resources.
In Virginia’s hard-hit Southwest, a front-line physician at Ballad Health said weeks and weeks of escalating numbers are threatening a “second pandemic”: the physical and mental exhaustion of its workforce.
At hospitals across the state, a workforce firm is helping backfill 926 health care jobs, three-fourths of which are for the care of the state’s sickest patients.
A relentless surge in COVID-19 cases is threatening to overwhelm Virginia’s hospitals and health care resources — the front lines of the fight against the coronavirus — before new vaccines can change the course of the pandemic…
The state and hospital association declined to publish the levels for each of the state’s hospitals, but said all of the state’s regions remained at a level one. Carey said Ballad Health and VCU Health were the only hospital systems reporting a level two.
“Normal operations is a level one. Two is contingency. And that is the middle ground where you know that you’re starting to either feel the stress, so you have to alter operations, or you’re anticipating that you could in the very near future. And VCU is a good example of that, whereas Ballad Health would be an example of where they definitely have altered their normal operations,” Carey said.
“Then you have the third level, which is crisis standards of care, and that means there is a true crisis where all of the need cannot be met,” he added. “We pray and we’re working very hard to not get there, where you can’t care for everyone the way you want to.”
Carey was briefed by VCU Health officials on the decision Wednesday. Asked about his reaction, he said: “I would recommend that this is clear evidence that Virginia’s health care system is strained, and it’s not just in far Southwest Virginia.”
One way hospitals are managing staffing challenges is by turning to temporary, contracted staff, like traveling nurses.
Qualivis, a South Carolina-based workforce firm that contracts with the Virginia Hospital and Healthcare Association, is working to fill 926 vacancies across Virginia hospitals, said Sherry Kolb, the firm’s president.
Three-quarters of those jobs are for “high-acuity” positions, meaning they work with the sickest patients. That includes ICU nurses, surgical nurses and telemetry nurses.
Kolb said Virginia’s numbers match nationwide trends. The need for temporary hospital staff to help with shortages has spiked. Before the pandemic, Qualivis was working to fill 10,000 health care jobs nationwide; that number is now 29,000. Most of those are “high-acuity” jobs.” (G)
“California’s most recent stay-at-home order zeroes in on a region’s ability to care for their sickest COVID-19 patients.
But for rural hospitals that don’t have an intensive care unit, administrators say the worsening surge is presenting new challenges.
“The critical access hospital program was designed such that these hospitals would primarily be available to accept and stabilize patients and then transfer those patients to a higher level of care,” said Peggy Broussard Wheeler, vice president of rural health for the California Hospital Association. “Now that is whittling away because the larger facilities are all tremendously impacted by COVID and other patients.”…
Wheeler, with the California Hospital Association, says she’s heard stories from many of the rural member facilities that have had to “MacGyver” solutions to treat COVID-19 patients that a few months ago they might have transferred.
“You now have to ask a nurse or maybe even a physical therapist or a respiratory therapist assigned to the COVID beds to be the deliverer of food so that you’re not exposing other people in your hospital,” she said. “You’re having to do this on the fly to keep those patients safe.”
The hospital association says the larger facilities are hitting a bottleneck with staffing. ICU capacity is measured not just by the number of physical beds, but by who is available to treat critically ill patients.
“A hospital might have beds available for patients but they don’t have the staff to support those patients,” said Read of Plumas District Hospital. “Usually they’ll say ‘we don’t have any beds’, but that’s really not true. They have the beds, they don’t have the staff. So opening up whatever bottleneck exists to have more staff available in our hospitals will be really helpful”
Gov. Gavin Newsom took a step in that direction this week when he loosened the required nurse-to-patient staffing ratio in ICUs. Under the change, a nurse can be assigned to three patients at a time instead of just two. The temporary order also loosens rations in other areas of the hospital.
Nurses unions have criticized the measure, arguing it could lower the quality of care, but the California Hospital Association says it will strengthen facilities’ ability to respond to the pandemic.
“California’s ability to care for COVID-19 patients depends on staff, not beds,” the association wrote in a statement. “Without this temporary staffing flexibility, very sick patients will wait on gurneys in the emergency department until a specially trained ICU nurse is available.”
The state has also deployed medical workers from the California National Guard, asked the federal government for medical personnel, and renewed calls for medical or nursing school students to join the volunteer California Health Corps, which launched earlier this year but initially yielded few qualified workers.” (H)
