TWITTER @jonathan_metsch FACEBOOK Jonathan M. Metsch LINKEDIN Jonathan Metsch
#CoronavirusTracker #CoronavirusRapidResponse
“Doctor” previously tracked Ebola and Zika. With Coronavirus it’s, as Yogi Berra said, “déjà vu all over again” without any thoughtful differentiation about hospital capacity/ capability matched to patient severity. It seems, for the most part, whichever hospital you are taken to or go to for Coved-19 is where you stay. We don’t default like that for other “critical care” services such as cardiology/ cardiac surgery, trauma, high risk obstetrics, maternal-fetal medicine, and neonatology.
Since we need to be prepared for future pandemics it’s timely to consider levels of care and hospital designations for “emerging viruses.” Back in the day of Certificate of Need this might have already been done. With years of deregulation it’s off the radar.
Here’s one way to look at it in Rapid Response mode.
‘When the first wave of coronavirus patients flooded New Jersey hospitals earlier this year, clinicians were heavily focused on ventilators. At the apex of the pandemic, one in four people hospitalized for COVID-19 needed these machines to breathe, and the state’s supplies were running short.
Six months later, the picture has changed dramatically. Ventilators are still critical for some patients — 10% of those hospitalized earlier this week depended on artificial respiration, according to state data — but clinicians now try to employ less invasive protocols first, like high-flow oxygen or repositioning patients to ease breathing, called “proning.”
“When the pandemic started, we intubated you at the drop of a hat,” said Dr. Lewis Nelson, who leads the emergency department at University Hospital in Newark, which was at the heart of the outbreak. Intubation generally requires the patient to be heavily sedated as a tube is then inserted into the windpipe and connected to the ventilator, which is calibrated to provide a specific oxygen concentration. The patient often requires a catheter to collect urine as well.
“There’s a sweet spot” in balancing who needs to be intubated and who could benefit more from other treatments, said Nelson, who also chairs the emergency medicine department at Rutgers New Jersey Medical School. “You have to use a good amount of clinical judgment.”
The shift in pulmonary treatment is just one example of how inpatient care for COVID-19 has evolved in New Jersey since the virus first emerged publicly in March and began spreading, sickening tens of thousands. Nearly 210,000 residents have tested positive for the virus, including more than 14,400 who have died.
While clinical research remains limited, physicians said some evidence is beginning to emerge about what treatments work best for coronavirus patients. There are a few medications that appear to reduce the related symptoms, they said, and medical providers are better able to identify problems and predict the course of the disease. There is no cure for COVID-19 and the quest for a vaccine continues.
“We’re still not making decisions based on high-quality evidence,” Nelson said. “It’s much better than it was before, but it’s still limited.”
Perhaps the biggest change in New Jersey is in the volume of COVID-19 patients at the state’s 71 acute-care hospitals. State statistics show that as the initial outbreak peaked in mid-April, more than 6,000 people were receiving inpatient treatment; one-third of these patients were in critical-care rooms and more than one in four were on a ventilator. As of Monday, hospitals were treating 445 coronavirus patients, with 29% in critical care and 10% on ventilators…
At times during the surge, multiple hospitals would be forced to temporarily suspend new admissions and divert ambulances to neighboring emergency departments, as coronavirus patients overwhelmed their bed or staff capacity. Several times officials shuttled ventilators from one facility to another to meet demand, and state and hospital leaders worked together to create a strategy to ration these machines and other scarce resources, should there not be enough for all patients. Shortages of nursing staff and personal protective equipment, or PPE — the masks, gowns and gloves designed to help stop the spread — were common in the early months.
While greater knowledge and treatment options have improved patient outcomes, health officials agree more research is needed to confirm the best-practice protocols for treating COVID-19 patients. They are also learning more about the long-term impacts of coronavirus infection, which can involve weeks or months of recovery at home. “It’s not a quick, rapid illness. It takes time,” Breen said.
At the same time, they are bracing for a second wave of the virus. “We do believe we’re going to have a resurgence. COVID has not just disappeared,” Nelson said.” (A)
“How do you choose a hospital?
Doctors at smaller community hospitals, regional medical centers, and the largest academic medical centers described the same general approach to care. This raises the question: Does it matter where you go?
Many doctors said probably not. “A lot of the management around COVID really involves a lot of things that we all have at our disposal in any health-care facility,” Hamilton said.
Some at larger hospitals, though, said that experience with complex intensive-care patients and more extensive resources may make larger health systems the better choice.
“The larger academic medical centers are probably better versed on how to take care of really sick patients,” Powell said.
Others, though, said there are advantages to community hospitals. Ronak Bhimeni, chief medical officer for Prime’s Lower Bucks Hospital, said his patients avoided the crush some larger hospitals experienced. Lower Bucks always had adequate supplies. “There was never a time when we felt that we couldn’t manage this,” he said.
One clear difference is that academic medical centers are far more likely to offer clinical trials. You can search clinicaltrials.gov to see what centers near you offer. If you’re the kind of person who wants to help make scientific progress and have early access to new — unproven — treatments, this may be important to you. Temple has a notably long list of trials, and Criner said more than half of the hospital’s coronavirus patients have joined one. “We try to have multiple options open so we can offer multiple things to people,” he said.
In general, current trials are looking at drugs with tongue-twisting names that might reduce inflammation, improve immune response, or combat cytokine storm…
Wayne Psek, a health-care quality expert at George Washington University’s Milken Institute School of Public Health, says there are not enough data available now to know which types of hospitals are doing a better job. Experience usually is helpful, but, in this case, “we just don’t know how to treat [coronavirus] well enough.” Some hospitals, he said, may be better staffed and better equipped to evaluate new information, but most are sharing now. He said he would make sure hospitals had beds available.
Albert Wu, director of the Johns Hopkins Center for Health Services and Outcomes, said coronavirus patients may benefit from the extra resources and research at larger facilities. Bigger places have more people to monitor and share study results. Practice often improves care. “In general, there is a volume-outcome relationship in almost anything that’s complicated,” he said. Treating HIV patients reinforced the value of clinical trials for him. “Access to clinical trials is an important element of quality care when there’s no agreed consensus treatment,” he said. Still, he said, many smaller hospitals now have easy access to advice from academic medical centers in their networks.
You can expect treatments to continue changing as doctors wade through what Hamilton says is already an “absolutely staggering” amount of research on COVID-19.” (B)
“El Centro Regional Medical Center was overrun with dozens of Covid-19 patients in May, with nowhere to send the critically ill. The only other hospital in Imperial County, Calif., also was swamped.
Chief Executive Adolphe Edward called the state’s emergency medical services director, asking him to intervene. “Please, please help us,” he pleaded.
Doctors and nurses at El Centro swapped text messages and made phone calls, blindly searching for openings at other hospitals.
In the emergency room, coronavirus patient Jose Manuel Abundis Gomez waited. It took 20 hours to find another hospital with a bed for the 71-year-old retired state administrator, said Alidad Zadeh, his primary care physician.
By the time Mr. Abundis was finally transferred, his oxygen levels had dropped. He later died.
During a pandemic, hospitals and local, state and federal agencies rely on a range of real-time metrics to respond to emergencies quickly. They need to know how many beds are available at each facility, whether hospitals need more nurses and the available number of ventilators and other critical supplies. That way, patients can get transferred quickly and medicine distributed to those in most need.
The U.S. has tried—and failed—over the past 15 years to build a system to share such information in a crisis. When the pandemic started, nothing like it existed. The limited and inconsistent access to data has been a major impediment to providing hospital care during the pandemic, according to interviews with industry and government officials and thousands of internal documents and emails.
Weeks after the coronavirus surfaced, administration officials began putting together a solution. It was riddled with mistakes and slowed by competing agency attempts to solve the problem, the interviews and documents show. Today, with some U.S. cities bracing for more cases, there is still no viable way to broadly track what’s happening inside hospitals.
“It’s staggering to most people how little visibility there is outside of a particular health system,” said Gregg Margolis, a former U.S. Department of Health and Human Services emergency health planning official. “Every time these things happen everybody throws their hands up and says, ‘I can’t believe these things don’t work more closely together.’ ”
At hospitals like El Centro, the data gaps meant patients couldn’t be moved to another facility quickly for treatment. Between May and August, hospital, county and California state administrators scrambled to transfer nearly 500 patients to about 90 hospitals outside Imperial County, transfer data and emails show. Some were moved as far as 600 miles…
Lawmakers and federal officials have warned for years that up-to-the-minute hospital data would be essential in emergencies. More than $100 million for the technology was cited in legislation but never formally appropriated. Resistance from hospitals and medical-record software companies to report the data has exacerbated the issue, former federal health officials and other experts say.
A spokeswoman for HHS defended the data-reporting system the Trump administration put in place as comprehensive and unprecedented, and said the government is “poised to go even further by making this system fully automated.”…
El Centro Chief Executive Adolphe Edward called the California Emergency Medical Services Authority director to intervene. ‘Please, please, help us,’ he said.
Transferring patients is a labor-and time-intensive process. Hospitals broker patient exchanges through a transfer center, a unit similar to air traffic control in an airport. Transfer centers rely on repeated phone calls to locate a bed. ‘Sometimes we’re out blind shopping,’ said Tara Mitchell, head of the case managers who coordinate transfers at El Centro.
Between May and August, nearly 500 patients from Imperial County were transferred by ambulance and helicopter to about 90 hospitals outside the county. Some were transferred as far as 600 miles. The helipad was quiet at El Centro Regional on Sept. 1.
Slow U.S. response
When the pandemic hit, government officials raced to put a makeshift system in place to track hospital data, including the number of beds occupied to ventilator inventory and Covid-19 admissions. From the start, there were competing efforts overseen by HHS.
The Centers for Disease Control and Prevention, an HHS agency, moved quickly to add Covid-19 questions to an existing hospital-disease surveillance system. Known as the National Healthcare Safety Network, the CDC system was used by about 6,000 hospitals to routinely report infection data to the agency…
In late June, White House coronavirus coordinator Deborah Birx admonished health-care industry executives on a call as Covid-19 cases surged across the South and West.
It is easier to get data from HIV clinics in Africa than U.S. hospital data, said Dr. Birx, a former ambassador for global AIDS coordination, according to people familiar with the call. Dr. Birx declined to comment through a spokesman.” (C)
“Older New Jerseyans are still wary of going to the hospital for non-COVID-related treatments despite a steep decline in patients with the virus and numerous health and safety measures in place, the New Jersey Hospital Association found in a survey released Thursday.
Hospitals statewide continue to care for approximately 350,000 non-COVID-19 cases, such as life-saving surgeries, births, trauma services and emergency care. And COVID-19 admissions represented less than 5% of total patients in the state’s medical facilities as of September, down from an April peak that had 20% of the hospital beds filled up with COVID patients.
The NJHA‘s Health Attitudes survey was initiated as part of the “Get Care Now NJ” consumer awareness campaign, which educates residents on the safety and security of hospitals.
The survey found that 84% of New Jersey adults are either “extremely concerned” (23%), “very concerned” (27%), or “somewhat concerned” (34%) about the risk of contracting COVID-19 if they need to visit a hospital.
Elective surgeries for June and July were down 24% year over year…
“These findings confirm our concerns: that our state’s older residents have been delaying surgical procedures and potentially putting their health at risk,” noted NJHA President and CEO Cathy Bennett.
“New Jersey’s hospitals are ranked the eighth safest in the nation and we’re committed to educating our residents through Get Care Now NJ that our hospitals are safe and secure, with compassionate care delivered by our health care teams,” she said.” (D)
“PRESS RELEASE from BRIGHAM AND WOMEN’S HOSPITAL
On Sept. 22, our Infection Control team identified a COVID-19 cluster involving Braunwald Tower 16A and 14CD.
To date, 41 employees and 15 patients related to the cluster have tested positive for a total of 56.
All current inpatients are being tested for COVID-19, and this will be repeated every three days. This is in addition to the current hospital policy which requires testing for all patients upon admission and daily screening for symptoms. The Brigham has reached out to all staff members potentially exposed to the cluster, has facilitated testing for them and will continue to test those in the highest risk groups every three days.
Since Friday, Sept. 25, we have performed 10,213 tests on 7,751 unique employees and received 9,560 results. Of these results, 51 were positive. Of these 51 positive results, 41 are associated with the cluster, seven are not associated with the cluster and three are being investigated further.
We expect that as we continue to test, we will continue to identify a handful of positive employees. To this point, the overall prevalence rate of our non-cluster community is 0.1 percent, a fraction of the community, city and state rates.
As we continue to respond to this cluster, testing for asymptomatic employees will be available through Sunday, Oct. 18 or as long as necessary to support our testing needs. The primary focus of our testing is to ensure that those asymptomatic staff identified as needing ongoing testing can be tested as efficiently as possible.
It is important to stress that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower).
If you are testing all admitted patients and screening all staff and visitors, how did this happen?
Our Infection Control team has investigated the source of the cluster through intensive contact tracing, testing, and staff interviews. Based on the information that we currently have, our Infection Control team is unable to determine whether the source of the cluster was a staff member or patient.
What did you do to stop the spread of this cluster?
There are a number of things we’ve done to address this issue.
We have reached out to all potentially exposed staff members, arranged testing for them, and will continue to test those in the highest risk groups every three days
We offered voluntary testing to all staff members working on the main campus since Sept. 14
Staff who are symptomatic and/or have tested positive have been sent home immediately and are not permitted to return to work until they meet our system’s return-to-work criteria
We are testing patients in the hospital every three days
We have run whole genome sequencing of all isolates in order to confirm the infections are related
We are reaching out to all patients discharged from the affected units to check on their health and to arrange testing for them
Environmental Services has performed a thorough cleaning of the affected areas
How did this spread? Was there a potential breach in infection control measures?
Our Infection Control team is conducting an ongoing investigation and has identified possible factors that may have contributed to the outbreak:
Many involved were very early in their infectious period, a time when they are most contagious
Many patients were not masked during clinical care/interactions with staff
Some patients had multiple risk factors for transmission, such as coughing, shortness of breath or use of nebulizers
Some providers were inconsistent in their use of eye protection during patient encounters
Lack of physical distancing of at least six feet among some staff while unmasked for purposes of eating…
How can you prevent this from happening again?
Our experience over the past few months demonstrates that we can create and maintain a safe environment by adhering to all of the elements of our Safe Care Commitment and our infection control policies. This includes:
Universal masking of both providers and patients
Frequent hand hygiene
Enhanced distribution of eye protection
Daily attestations of health for employees and visitors
Testing all patients on admission, rescreening all patients daily for new symptoms of COVID-19, and retesting if the screen is positive
Requiring patients admitted to the hospital to mask when staff enter the room
Practicing appropriate physical distancing, particularly when eating or drinking
Creating space optimization and seating capacities in all workrooms and breakrooms and enforcing this with increased monitoring measures
Opening up additional, safe eating areas
Is it safe to visit the hospital?
Yes. The Brigham is committed to creating and maintaining a safe care environment by testing all patients admitted to the hospital, requiring staff to attest to their health daily before working, requiring all staff, patients and visitors to wear hospital-issued masks while on campus, insisting on frequent hand hygiene, frequently cleaning the environment, and enforcing appropriate physical distancing.
It is important to note that our Infection Control team believes that the cluster has been contained to two specific inpatient units (16A and 14CD in the Braunwald Tower). This cluster is not impacting any other areas of the hospital or our outpatient clinics.
How is the hospital tracing those who might have been exposed?
Our Infection Control team is conducting intensive contact tracing using the electronic health record and staff interviews. Those individuals who have been exposed have been contacted directly and we have facilitated testing for them.
What is being done to address patients or visitors who had previously left the hospital and the potential for them exposing others to the virus?
Our Infection Control team is reaching out directly to patients and staff who have been exposed (including those patients who have been discharged) to facilitate testing. Each person will be individually advised by a member of our Infection Control team…
Will the hospital provide a free test for those who believe they were exposed?
Yes.” (E)
“Employees at Brigham and Women’s Hospital have sounded the alarm. The facility has a COVID-19 cluster of more than 40 positive cases. Now, a patient in a different part of the hospital has tested positive.
Brigham nurse Kerry Noonan says the virus “is clearly coming back with force in the hospital as well as in the community.”
Noonan also told WBZ-TV, “The hospital stepped up and did a universal testing for everyone. One time. Unfortunately, we know as soon as the test is done, and you walk out the building and go back into the community or you go back home, you could very well come in contact with it again.”..
Noonan says the hospital needs to continue to test routinely, or randomly, people in the building who are providing direct case, and he says those people should have “N95s and face shields.”
“I don’t know why we still have visitors,” Noonan said. “We need to restrict access to essential personnel only.”..
The hospital says with testing, it is likely there will be more positive cases connected to the cluster. So far, researchers have not identified the source of the infection. At this point, doctors do not believe the new case is related to the others.” (F)
“Boston area hospitals say they are preparing for a long winter as COVID-19 cases continue to spike in Massachusetts and across the globe
Over the past week alone, more than 4,000 new coronavirus cases have been reported in the state, including 1,226 over the weekend. The percentage of coronavirus tests coming back positive, on average, is at 1.1%, compared to the 0.8% it had been at in previous weeks.
Boston entered the highest-risk, category on the state’s COVID map last week, even as Gov. Charlie Baker is allowing Massachusetts to move ahead with the latest step in the reopening of its economy.
Those numbers are still not as high as what the state experienced in the spring, but health officials say they are concerned.
Lowell General Hospital told The Boston Globe they are seeing three times the number of coronavirus patients as they were as recently as a month ago. Lowell is one of the 23 communities currently included in the red, or highest-risk, categories on the state’s COVID map.
Southcoast Health said its hospitals have seen COVID-19 cases double in the last two weeks. And UMass Memorial Medical Center in Worcester has also seen a steady increase.
The number of patients hospitalized for COVID-19 in the state is now up to 438. Of that number, 83 were listed as being in intensive care units and 27 are intubated, according to the Department of Public Health.
The three-day average number of coronavirus patients in the hospital is up 41% from the lowest observed value.” (G)
“Wisconsin health officials announced Wednesday that a field hospital will open next week at the state fairgrounds near Milwaukee as a surge in COVID-19 cases threatens to overwhelm hospitals.
Wisconsin has become a hot spot for the disease over the last month, ranking third nationwide this week in daily new cases per capita. Health experts have attributed the spike to the reopening of colleges and K-12 schools as well as general fatigue over wearing masks and socially distancing.
“We hoped this day wouldn’t come, but unfortunately, Wisconsin is in a much different, more dire place today and our healthcare systems are beginning to become overwhelmed by the surge of COVID-19 cases,” Democratic Gov. Tony Evers said in a statement. “This alternative care facility will take some of the pressure off our healthcare facilities while expanding the continuum of care for folks who have COVID-19.” (H)
When Tammy Gimbel called to check on her 86-year-old father two weeks ago, he sounded weak. He was rushed to Sanford Medical Center in North Dakota’s capital, where doctors said he had the coronavirus. But all the hospital beds in Bismarck were full, his relatives were told, and the only options were to send him to a hospital hours away in Fargo, or to release him to be monitored by his daughter, who was herself sick with the virus.
Ms. Gimbel and her father hunkered down in a 40-foot camping trailer in her backyard to try to recover. He only got worse.
“There I sat in my camper, watching my dad shake profusely, have a 102 temperature with an oxygen level of 86,” Ms. Gimbel recalled. “I am sicker than I had been the whole time, and I wanted to cry. What was I going to do? Was I going to watch my dad die?”..
On Monday, hospitals in Bismarck reported that only six inpatient beds were open and just one intensive care unit bed. Across the entire state, 39 staffed I.C.U. beds were available…
Miles from Bismarck, smaller communities have long turned to city hospitals to handle cases they do not have capacity to manage, but that is shifting.
“In the past two weeks, my ability to send people to Fargo or to Bismarck has been nonexistent,” Dr. Sarah Newton of Linton Hospital, a facility in Emmons County, told her City Council last week.
Emmons County is dealing with the state’s worst level of infections per capita, and Linton Hospital has been completely full. Dr. Newton described spending hours calling around the state for a patient who needed emergency heart surgery. A bed finally opened in Fargo.
“We’ve had to scramble, and I think a lot of the other hospitals have had to scramble as well,” Robert Black, the chief executive of Linton Hospital, said…
In earlier months, some nursing homes with outbreaks had often sent residents with Covid-19 to a hospital for treatment and to help slow the spread of the virus inside the nursing home, according to Sandy Gerving, an administrator at Marian Manor Healthcare Center, a nursing facility an hour west of Bismarck. In the past month, though, she said, nursing homes have been turned away from some hospitals…
“We got to the point where we knew there was no one that would take them,” Ms. Gerving said of patients who were sick but not critically ill. “So then we started keeping them in our building. And then we started having an outbreak internally.”..
Public health officials say they have struggled to press for county-level masking mandates in the state. There is no state-level mask rule.” (I)
“Hospital administrators in Montana say the recent rise in COVID-19 infections statewide could strain the health care system in coming weeks as patients become more ill and cold and flu season picks up. Health experts are making a plea for Montanans to “do their part” after more than 700 people have been hospitalized with the virus since it arrived in the state…
Dr. Shelly Harkins, Chief Medical Officer at St. Peter’s Health in Helena, says while hospitalization rates may seem low now, she’s anticipating an increase soon that could max out St. Peter’s capacity.
“Typically it’s a few weeks following an increase in reported cases that we would see hospitalizations,” Harkins said during a press conference Wednesday, where state health officials, the governor and hospital administrators urged Montanans to take the virus seriously.
State data show 500 more cases were reported last week than the week prior, building on a curve that’s been trending upward since Labor Day.
Harkins says St. Peter’s is also facing staffing shortages as health care workers themselves are quarantined due to exposure or fall ill.
“When resources are strained at the local health system, all the patients, even those with non-covid medical conditions like heart disease, lung disease, kidney disease, many others, they become at risk of being left without adequate services to stay well. It is the morbidity and mortality from all the non-covid related diseases that we are concerned about, too,” Harkins says.
Harkins says four people with COVID-19 are hospitalized at St. Peter’s, more than their typical case load since the virus arrived in state.
Ellner says Billings Clinic’s capacity is a fluid number. He said 13 COVID patients are filling half of the downtown hospital’s intensive care unit beds. A total of 48 COVID patients from as far as Wyoming are hospitalized there.
Michael Skehan, St. Vincent Healthcare chief operating officer, said Wednesday the Billings-based hospital is treating 41 COVID-19 patients, with eight in critical care. Skehan says St. Vincent recently pulled in dozens of nurses, technicials and respiratory therapists from sister hospitals in Colorado.
State health officials said Wednesday that Benefis Hospital in Great Falls is at 115 percent capacity, with 37 COVID-19 patients, seven of whom are in intensive care units.
“There’s concern that those systems are going to be even further stressed,” Jim Murphy, the state’s chief epidemiologist, said.
Hospital administrators say they’re building out additional capacity, bringing in nurses and respiratory therapists, and transferring patients to regional partners as needed. Gov. Steve Bullock says the state has a 90-day supply of personal protective equipment available for hospitals and local agencies as needed, and testing is available for people with symptoms, known exposures and congregate care residents.
But Harkins at St. Peter’s in Helena says Montana is only headed into halftime of the pandemic bowl. She says everyone needs to double down on the basics: wash your hands, keep your distance, wear a mask.” (J)
“Nurses at Alta Bates Summit Medical Center in Oakland, Calif., were on edge as early as March, when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.
The Centers for Disease Control and Prevention had advised hospitals to isolate COVID-19 patients to limit staff’s exposure and help conserve high-level personal protective equipment that’s been in short supply.
Yet COVID-19 patients continued to be scattered throughout the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.
Patients on that floor who had the coronavirus were not staying in their rooms, either because they were confused or disinterested in the rules. Hospital employees were not provided highly protective N95 respirators, says Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator.
“It was just a matter of time before one of the nurses died on one of these floors,” Hill says.
Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from COVID-19 on July 17.
California Nurses Association members had complained to Cal/OSHA about COVID-19 patients being spread throughout the hospital where registered nurse Janine Paiste-Ponder worked. Colleagues say they suspect the practice was a factor in her illness and death.
The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A Kaiser Health News investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID-19 patients from those not infected with the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead…
Our investigation discovered that patients with COVID-19 have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.” (K)
POSTED ON May 15, 2017 (L) – perhaps this needs to be modified for Coronavirus and implemented?
Lesson Learned from recent EBOLA and ZIKA episodes. We need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
1. There should not be an automatic default to just designating Ebola Centers as REVRCs although there is likely to be significant overlap.
2. REVRCs should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and emerging viruses “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
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).
Newspaper headlines paint a terrifying picture of politics crushing public health (and national security).
‘Don’t Be Afraid of Covid,’ Trump Says, Undermining Public Health Messages
““Don’t be afraid of Covid,” he wrote. “Don’t let it dominate your life.” When he arrived at the White House a few hours later, Mr. Trump removed his mask before joining several masked people inside. The president was probably still contagious, as many patients can pass on the virus for up to 10 days after symptoms begin.
Scientists, ethicists and doctors were outraged by the president’s comments about a disease that has killed more than 210,000 people in the United States.” (A)
Instead of Reassurance, Trump’s Doctor Delivers Confusion, Experts Say
“When Dr. Sean P. Conley confessed that he had misled the public on Saturday about President Trump’s treatment for Covid-19 to reflect the “upbeat attitude” of the White House, he lost credibility with many colleagues in the medical world.
“Yesterday’s briefing was a spin doctor, not a medical doctor,” Dr. Carlos del Rio, an infectious disease expert at Emory University in Atlanta, said in an interview Sunday.” (B)
White House Is Not Tracing Contacts for ‘Super-Spreader’ Rose Garden Event,
“Despite almost daily disclosures of new coronavirus infections among President Trump’s close associates, the White House is making little effort to investigate the scope and source of its outbreak.
The White House has decided not to trace the contacts of guests and staff members at the Rose Garden celebration 10 days ago for Judge Amy Coney Barrett, where at least eight people, including the president, may have become infected, according to a White House official familiar with the plans.” (C)
White House Blocks New Coronavirus Vaccine Guidelines
“Top White House officials are blocking strict new federal guidelines for the emergency release of a coronavirus vaccine, objecting to a provision that would almost certainly guarantee that no vaccine could be authorized before the election on Nov. 3, according to people familiar with the approval process.
Facing a White House blockade, the Food and Drug Administration is seeking other avenues to ensure that vaccines meet the guidelines. That includes sharing the standards — perhaps as soon as this week — with an outside advisory committee of experts that is supposed to meet publicly before any vaccine is authorized for emergency use. The hope is that the committee will enforce the guidelines, regardless of the White House’s reaction.” (D)
For the Secret Service, a New Question: Who Will Protect Them From Trump?,
“For more than a century, Secret Service agents have lived by a straightforward ethos: They will take the president where he wants to go, even if it means putting their bodies in front of a bullet…
The problem came into focus on Sunday, when a masked Mr. Trump climbed into a hermetically sealed, armored Chevy Suburban with at least two Secret Service agents — covered head to toe in the same personal protective equipment used by doctors — so the president could wave to a group of supporters outside Walter Reed National Military Medical Center in Bethesda, Md.
Medical experts said the move recklessly put agents at risk. Secret Service personnel have privately questioned whether additional precautions will be put in place to protect the detail from the man they have pledged to protect.” (E)
The Coronavirus May Be Adrift in Indoor Air, C.D.C. Acknowledges
“Two weeks after the Centers for Disease Control and Prevention took down a statement about airborne transmission of the coronavirus, the agency on Monday replaced it with language citing new evidence that the virus can spread beyond six feet indoors.” (F)
Trump makes misleading comparison between coronavirus and the flu
President Donald Trump on Tuesday continued to downplay the coronavirus and suggested the United States should learn to live with the pandemic, posting to Twitter hours after returning to the White House from being hospitalized with Covid-19.
In his morning tweet, the president likened the highly contagious disease to the seasonal flu, reprising a misleading comparison he repeatedly invoked in the early stages of the U.S. outbreak.
“Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu,” Trump wrote. “Are we going to close down our Country? No, we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!” (G)
Senior Pentagon leadership quarantining after exposure to coronavirus
“The top US general, Gen. Mark Milley, and several members of the senior Pentagon leadership are quarantining after a top Coast Guard official tested positive for coronavirus, several US defense officials tell CNN.
The Vice Commandant of the US Coast Guard, Adm. Charles Ray, tested positive on Monday.
“On Monday, the Vice Commandant of the Coast Guard, Admiral Charles Ray, tested positive for COVID-19. He was tested the same day, after feeling mild symptoms over the weekend,” the Coast Guard said in a statement Tuesday…
Ray recently attended several meetings at the Pentagon in secure areas with members of the Joint Chiefs of Staff. Multiple defense officials tell CNN that senior Pentagon leadership who had been in proximity to Ray have been tested and are awaiting results.” (H)
The White House Bet on Abbott’s Rapid Tests. It Didn’t Work Out
“The fault for the outbreak lies in no small part with an ill-conceived disease-prevention strategy at the White House, health experts said: From the early days of the pandemic, federal officials have relied too heavily on one company’s rapid tests, with little or no mechanism to identify and contain cases that fell through the diagnostic cracks….
Other health experts noted that the tests deployed by the White House, manufactured by Abbott Laboratories, were given emergency clearance by the Food and Drug Administration only for people “within the first seven days of the onset of symptoms.” But they were used incorrectly, to screen people who were not showing any signs of illness. Such off-label use, experts said, further compromised a strategy that presumably was designed to keep leading officials safe from a pandemic that so far has killed more than 210,000 Americans.” (I)
____________________________________
Donald Trump’s campaign claims the president’s COVID diagnosis will HELP him beat Biden because ‘he has firsthand experience the Democrat doesn’t’
“As President Trump prepared to check out of the hospital, his campaign announced its new Operation MAGA and argued Trump’s coronavirus diagnosis gave him something Democratic rival Joe Biden didn’t have – experience with the virus.
‘He has experience as commander-in-chief, he has experience as a business man, he has experience – now – of fighting the coronavirus as an individual,’ Trump campaign press communications director Erin Perrine told Fox News on Monday afternoon.
‘Those firsthand experiences, Joe Biden, he doesn’t have those,’ she said.” (J)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
“Contact tracing was put into place at the White House immediately after Trump aide Hope Hicks tested positive for coronavirus, White House press secretary Kayleigh McEnany said on Friday…
In separate remarks to reporters, McEnany said it was considered safe for Trump to travel to his resort in Bedminster, New Jersey, for a private fundraiser on Thursday.
“It was deemed safe for the president to go. He socially distanced, it was an outdoor event and it was deemed safe by White House operations for him to attend that event,” she said.” (A)
President Donald Trump’s big-dollar fundraiser at his New Jersey golf club went on as planned Thursday night despite the President and staff knowing he had been exposed to coronavirus.
Trump attended three events at the fundraiser: an indoor roundtable, an indoor VIP reception — donors had a socially distant photo opportunity with him — and an outdoor reception, according to an event invitation obtained by CNN.
Donors that gave $250,000 were able to participate in a roundtable, photo opportunity and reception with the President, according to the event invite. The roundtable included 18 donors, according to a source, and was held indoors at socially-distanced tables.
Another source says that the attendees at the roundtable were tested for coronavirus when they arrived and that no one wore masks.
Three attendees told CNN that most people at the events were not wearing masks; all three say they have not been contacted by any contact tracers….
An hour and a half before the fundraiser, some senior staff and the President were informed Hope Hicks had tested positive for coronavirus, White House chief of staff Mark Meadows told reporters on Friday.
The decision was made to still hold the fundraiser despite Trump’s exposure; attendees say they were not notified the President had been exposed to Covid-19…
On Friday at noon, the Trump campaign emailed attendees officially notifying them the President tested positive for coronavirus.
“We unfortunately write today to notify you that, as you have probably seen, President Trump confirmed late last night that he and the First Lady were tested for COVID-19 and produced positive test results,” the email, obtained by CNN, reads. “Out of an abundance of caution, we want to call this to your attention.”
The email went on to encourage attendees to contact their medical provider if they, or their loved ones, develop Covid-19 symptoms. It did not make any mention of quarantining or self-isolation but did recommend attendees visit the CDC’s website.” (B)
“With President Donald Trump’s positive coronavirus test, the White House is now ground zero for the most closely watched contact tracing exercise of the Covid-19 pandemic in the US….
How big could the cluster of infections around Trump grow? The only way to figure it out is contact tracing: identifying who has been in close contact with the president since he became contagious, and asking them to quarantine to prevent Covid-19 from spreading to others, and to get tested themselves. We also aren’t sure what kinds of tests the Trump administration is using, and that makes a difference in figuring out who else might be exposed.
Testing for Covid-19, tracing people who may have been exposed, and getting them to isolate is the backbone of an effective coronavirus response. It’s also a program that the US has largely failed to execute effectively but which is now of utmost importance to the continued health of our nation’s leaders and those around them.
Ashish K. Jha, dean of the Brown University School of Public Health, laid out in a brief Twitter thread what should happen now, and the challenges that will make contact tracing difficult even at the White House.
This is the first difficulty: People who have contracted the coronavirus and are contagious still might not show symptoms for several days. As Muge Cevik, a virologist at the University of St. Andrews, laid out on Twitter recently, people with Covid-19 generally start to become more infectious in the two days before their symptoms start and then for a week afterward.
So Jha recommended: “Everyone who has been near the President at least from Saturday on needs to be identified.” But that is, as he acknowledged, easier said than done.
Contact tracing, in non-pandemic times, is typically concentrated on sexually transmitted diseases. Generally speaking, people know whom they’ve had sexual contact with; so while these can be sensitive discussions, there is not much confusion about who may have been exposed to HIV or syphilis.
But an airborne virus like Covid-19 is much more difficult to trace. The general rule of thumb, public health workers have told me previously, is you want to identify anybody who has been within 6 feet of an infected person for a period of 15 minutes or more….
So this work of testing, tracing, and isolating is already underway, because the president and senior government leaders being exposed to a deadly pathogen is rightfully seen as a national emergency. This is the right response after learning a person who is in contact with a lot of people has contracted the coronavirus.
But the US has also struggled to implement a test-trace-isolate program more broadly, despite strong expert consensus that it’s the best way to get the pandemic under control.” (C)
….”As you read this, Trump’s immediate contacts are being identified and contacted. Those who got close to Trump after he was infected will need to go into quarantine, defined as a 14-day period of having no contact with anyone, regardless of whether they develop symptoms.
It sounds straightforward in theory—but in practice, it’s a lot harder. When we talk about contact tracing for Trump’s potential Covid-19 exposure, what we really mean is identifying the people who’ve been exposed to Trump in a handful of specific ways, between the time that he encountered the virus and the time that he tested positive. And that’s where things get a little messy.
When did infection happen?
It’s hard to pin down when someone was initially infected with Covid-19 because of the nature of how SARS-CoV-2 enters the body: slowly, one cellular ACE2 receptor at a time, which can trick individuals into thinking they’re healthy even after they’ve been infected.
On average, “you have two days of incubation, in which a PCR test wouldn’t test the virus,” says Brooke Nichols, a health economist at Boston University who uses mathematical models to map infectious spread. During these two days, a person likely wouldn’t have enough of a viral load to infect others.
Then, however, most people enter a pre-symptomatic phase. This is the danger zone: A person is sick, still not showing symptoms, but has enough of a viral load to potentially infect others. This when people are most likely to give the virus to others. Once a person does have symptoms, they’re (usually) wise enough to get tested, tell others, and isolate.
Based on what we know about the appearance of Trump’s symptoms and the test he took on Oct. 1 that came back positive, he could have been exposed, infected, and contagious to others as early as the beginning of the week…
At the moment, no one knows—though hours before Trump announced he had Covid-19 on Twitter, Bloomberg reported that one of his senior aides, Hope Hicks, tested positive. On Sept. 29 Hicks had been aboard Air Force one with Trump and others as he traveled to the debate in Cleveland, and then to Minnesota for a campaign rally. She reportedly felt sick in Minnesota, so isolated herself on the plane ride home.
That means Hicks could have given Trump Covid-19. But given that they tested positive around the same time, it’s possible that one person exposed both of them, says Gurley. And that possibility introduces the need for a totally different approach to contact tracing—not just in the White House, but in general.
Identifying, quarantining, and potentially testing every one of Trump’s contacts in the last week, when it was likely he was exposed—the traditional contact tracing approach—would successfully squash any outbreaks that stem from him, alone. But it wouldn’t stop any outbreaks that started with the person who infected Trump.
A different approach would attempt to identify the missing link between a growing number of positive cases connected to the White House. If we could trace all of their contacts backwards in time, we could potentially identify an infected person who exposed them all… (D)
“The White House has yet to deploy a specialist Centers for Disease Control and Prevention (CDC) team to track and test those whom President Donald Trump came into contact with after being infected with the coronavirus.
Two sources told The Washington Post Saturday that the CDC specialists’ team was on standby but had not yet begun to work tracing all of those the president came into contact with while infected.” (E)
In the days immediately preceding President Donald Trump’s COVID-19 diagnosis, he and his aides travelled to five states, holding several rallies and crowded indoor events with large groups of people. But there’s no clear indication that the White House is playing its stated role as the coordinator of a critical contact tracing effort that could help stem the spread of the virus, according to local and state health officials.
At a press conference on Oct. 3, Trump’s personal physician said the White House was at the center of the contact tracing effort. “The White House medical unit, in collaboration with CDC and local state and health departments, are conducting all contact tracing per CDC guidelines,” said White House physician Dr. Sean Conley.
But in response to questions from TIME, local and state health officials in many of the locations that Trump recently visited indicated the Trump Administration has taken few evident steps on contact tracing to date. Officials in four states—Minnesota, Pennsylvania, New Jersey and Virginia—stated or suggested they had not been contacted by the Trump campaign. Officials with the city of Cleveland, where the presidential debate was held Sept. 29, did not respond to an inquiry, and the Cleveland Clinic declined to comment on that topic.
In response to a TIME inquiry about contact tracing, the Trump campaign pointed to Conley’s comment saying the White House Medical Unit was doing the tracing. The Centers for Disease Control and Prevention (CDC) referred TIME to the White House, which said the White House Medical Unit was doing contact tracing in coordination with CDC personnel.” (F)
“Public health officials in the cities and states that President Trump visited in recent days are working to contact those who were in close proximity to him, first lady Melania Trump and others who traveled with him.
Since he has tested positive for the coronavirus, health officials worry those who attended events with the president could be at risk for the virus, too.
Over the past two weeks, Trump attended events in Florida, Georgia, Pennsylvania and Minnesota as well as a fundraiser in New Jersey and, of course, the presidential debate in Cleveland. He also went to his golf club in Potomac Falls, Va., and hosted an event announcing his Supreme Court nominee Amy Coney Barrett at the White House…
The president’s rally was held on the tarmac of Duluth International Airport, where according to Minnesota Public Radio, thousands of people attended, including many who didn’t distance themselves from each other or wear face masks, with the notable exception of those behind the stage and in camera view.
The Minnesota Department of Health is offering guidance to those who attended the rally, too, warning that community transmission of COVID-19 in the Duluth area was already high before the campaign event, “and people attending the rally may have been infectious without realizing it.”
Before Wednesday’s campaign rally, Trump attended an afternoon GOP fundraiser at a private home in Shorewood, Minn., a suburb of Minneapolis-St. Paul.
Minnesota Republican Party Chair Jennifer Carnahan said in a statement that about 40 people attended that fundraiser but that she did not meet with Trump.
“I have not been in contact with any of the donors who had been at that event,” she said. “My understanding as well, they were all required to take a negative COVID test with results within 24 hours of the president’s visit to donors, and it is also my understanding that people were not allowed to shake hands or come into that close of contact with the president while he was there.”..
In an interview with Minnesota Public Radio, Dr. Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he was alarmed by reports that some who attended the president’s events think they can be tested once and be in the clear.
“I’m a little disturbed by the fact that I heard some of the individuals who are exposed in the last 48 hours saying, ‘Well, I’m going to be tested today and then if I’m negative, I’m going to go ahead and do what I do.’ And in fact, they won’t even show up positive for at least three up to five days after the exposure.”..
White House chief of staff Mark Meadows told reporters that positive test results for senior aide Hicks came to light “right as the Marine One [helicopter] was taking off” Thursday to take the president to Joint Base Andrews for the flight to New Jersey.
“We actually pulled some of the people that had been traveling and in close contact,” Meadows told reporters Friday at the White House, explaining contact tracing had just begun. Other senior staff, including Dan Scavino and Jared Kushner, have since tested negative, he said.
Public health officials in Somerset County, N.J., are asking Trump’s country club, the Trump National Golf Course, for a list of facility staff, event participants and other people who may have come in contact with the president and first lady, according to a statement from the county’s Department of Health.
“As the public health department for Bedminster, and in conjunction with the New Jersey Department of Health, Somerset County has begun the contact tracing investigation to determine the potential risk of exposure to attendees and staff at the facility to COVID-19,” the statement said.
New Jersey Gov. Phil Murphy, a Democrat, said the golf club, White House and Republican National Committee are all cooperating with state and local health officials, according to NPR member station WNYC.
“The process for gathering information for case investigation and contact tracing has begun, and as far as we know folks are cooperating and we need them to,” Murphy said at news conference Friday.
Amid reports that some people who attended the fundraiser are calling doctors’ offices and health departments in a panic, Murphy urged everyone who was there to take precautions.
“Self-quarantine everybody. Take yourself off the field,” Murphy said. “Wait five to seven days probably and get tested. Even if you test negative, you really have to stay off the field for the full 14 days.” (G)
The White House itself may have become a nexus of infection in the Washington, D.C., area and beyond, hosting events like last Saturday’s celebration of Supreme Court nominee Amy Coney Barrett. At many Trump events, masks were a rarity, social distancing minimal. Video of the Barrett event, for instance, shows people shaking hands, hugging and standing close together.
“They’re way behind the curve in trying to catch all the folks that the president has been around,” said Georges Benjamin, executive director of the American Public Health Association. “The fact that he’s been around so many people and that he doesn’t wear a mask, he could be a superspreader, we just don’t know yet.”
Trump on Friday evening was taken to Walter Reed National Military Medical Center, where he will spend the “next few days,” the White House said.
The White House is complying with CDC guidelines and has started contact tracing, with notifications and recommendations for people who may have had exposure to an infected person, spokesperson Judd Deere said.
The Secret Service, while staying mum on how many of its employees have tested positive for Covid-19 or are quarantining, said it’s following CDC protocols on testing and tracing. Anyone who tests positive is immediately isolated, a spokesperson said.” (H)
“To really be out of the out of the woods, we want to continue seeing” negative results for 14 days after exposure to the virus, said Michael Mina, a Harvard University physician and epidemiologist. He said the vast majority of individuals will have a positive test results within five to seven days.
It may be impossible to determine exactly how many people Hicks and Trump exposed before they received their positive test results this week. It’s not even clear right now if Hicks infected Trump – or vice versa. It’s also possible they were infected by a third person.
Welty said it may have been “inevitable” that Trump and others in his inner circle became infected “because they were relying solely on testing to keep them safe” and shunning other tools – such as masks and distancing – that can prevent infection.
“It’s too late once you test positive,” she said. By that time, “you’ve already been around too many people and spread it to too many people.”” (I)
“On Thursday (Oct. 1), the two states each launched their own contact tracing apps called “COVID Alert NY” and “COVID Alert NJ,” respectively. These apps, which keep users’ identities anonymous, are based on a new technology developed by Google and Apple. They use bluetooth to connect to nearby phones and alert users if they’ve been in close contact with someone who has been infected with the coronavirus.
From the very start of the pandemic, contact tracing has been an important part of helping to stop the spread of the virus. Contact tracing involves identifying people with COVID-19, figuring out who they came in close contact with, and notifying all of those people so that they can self-quarantine or get tested before spreading the virus to others. Most of those efforts have been conducted by people conducting phone calls.
“We have about 15,000 people statewide who do contact tracing. They call them disease detectives,” New York Gov. Andrew Cuomo said in a briefing on Thursday. “But we’ve been looking for a technology-based solution.”
The contact tracing app “knows where your cellphone is, the app will know where a person who tested positive was through their cellphone and the app can tell you if you were within 6 feet of that person,” Cuomo said. “It doesn’t give names, it doesn’t give any privacy information [and] it’s voluntary.”
This is how it works: When you’ve spent more than 10 minutes within 6 feet of another person with the app, which is “long enough and close enough for you to catch the virus,” your phone exchanges a “secure” and “random” code with the other person’s phone, according to the COVID Alert NY app. The phones will store these random codes in a list.
If you end up testing positive for COVID-19, a public health representative will call and ask if you’d be willing to share the app’s list of random codes to help protect other people. “Sharing your list is secure and private,” according to the app descriptions. “The app never reveals who you are to anyone.” Also, the app will constantly compare its own list to the list of infected codes, and if there’s a match it will send a notification to the person’s phone, alerting you that you may have been in close contact with an infected person. You also have the option to keep track of your own symptoms on the apps.” (J)
“With the president and first lady’s stunning diagnoses of COVID-19, the couple will receive exemplary care. They will have all the support they need to—we hope—emerge fully recovered from this potentially lethal virus.
That’s as it should be. But the tens of millions of Americans who could receive similar diagnoses will continue to be sent into spirals of uncertainty—and, for a tragically large number, death itself. Too many of those who fall ill will not have the means or wherewithal to follow even the most basic Centers for Disease Control and Prevention guidelines for those who have been exposed.
The news that the coronavirus has infected one of the most powerful people on the planet should serve as a sobering reminder that this pandemic knows no politics and respects no borders. It’s a reminder, too, that the U.S. government, at the federal, state and local level, needs to provide support through the duration of this pandemic so that every American has what’s needed in the event that they, too, are struck by this virus…
During this pandemic, our societal and structural failures have been laid out for the world to see. At least 28 million Americans don’t have health insurance, and millions of others are underinsured. Too many parents, often those in low-wage jobs, don’t have paid sick leave. About 60 percent of the workforce is paid hourly, and the strains on these workers during the waves of closures and economic shutdowns have proved devastating…
The first family’s diagnosis is just the latest indication that we are nowhere near the end of this pandemic. More than nine of every 10 people in this country have yet to be infected by the coronavirus. With more than 200,000 deaths already and a projection of 371,000 deaths by the year’s end, we need to continue to embrace the guidance laid out by public health experts that we know works: again, we must wear masks, practice social distancing, test and trace, and make prudent decisions for individuals and for their communities…
The president and first lady’s diagnoses should serve as a wake-up call to us all. COVID-19 will thrive if we are divided and dismissive of its dangers. And it can only be bowed if we follow the public health road map to a better day.” (K)
“Less than 10 percent of Americans have antibodies to the new coronavirus, suggesting that the nation is even further from herd immunity than had been previously estimated, according to a study published Friday in The Lancet.
The study looked at blood samples from 28,500 patients on dialysis in 46 states, the first such nationwide analysis.
The results roughly matched those of an analysis to be released next week by the Centers for Disease Control and Prevention, which found that about 10 percent of blood samples from sites across the country contained antibodies to the virus.
Dr. Robert R. Redfield, the director of the C.D.C., was referring to that analysis when he told a congressional committee this week that 90 percent of all Americans were still vulnerable to the virus, a C.D.C. spokeswoman said.” (B)
“Covid-19 infections were trending upward again Monday in the United States as thousands of students returned to New York City classrooms and public health experts warned that a “twindemic” could be on the horizon as we head into flu season.
Two days after the U.S. recorded its 200,000 Covid-19 fatality, the number of confirmed cases in the country was closing in on 7 million and accelerating, according to the latest NBC News figures.
The seven-day average of new coronavirus cases in the U.S. dipped below 40,000-per-day for the first time since June on Sept. 11, the day America marked the 19th anniversary of the Al Qaeda terrorist attacks.
By Friday it was back over 40,000 again, according to an NBC News tally.
That’s still far less than the record 70,000-plus infections that were being logged in June. But the upcoming flu season could derail progress made in bringing down the coronavirus infection rate, experts warned.
“As the United States and the rest of the globe tries to gain its footing with a pandemic that has already killed nearly a million people and sickened almost 30 million, it faces another virus this fall that could devastate our progress thus far: the season flu,” Johns Hopkins University warned in a press release in advance of a conference of public health experts Tuesday that will address the issue. “That is, unless we take action now to minimize cases with effective, widespread vaccination.”
Before the pandemic, only about half the U.S. population heeded the advice of most doctors and got a flu vaccine during the 2018-19 season, according to the federal Centers for Disease Control and Prevention.
While President Donald Trump appears determined to unveil a Covid-19 vaccine before Election Day —even if experts and FDA officials might object — “the cold reality is that we should plan for a winter in which vaccination is not part of our lives,” The Atlantic reported.
“We must, over the next few weeks, get that baseline of infections down to 10,000 per day, or even much less if we want to maintain control of this outbreak,” Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, said in an email to the magazine.” (C)
“As COVID-19 cases tick up in Massachusetts, no one is eyeing the numbers more keenly than the hospital leaders who will have to respond to a second surge.
Hospitals officials are watching the case counts daily, with memories still fresh of legions of sick people filling wards in the spring. The number of people hospitalized with COVID-19 around the state remains low, but has been inching up in certain places in the past couple of weeks. So, too, has the rate of positive COVID-19 tests reported statewide. And any increase in cases in the community will eventually reach the hospital doors.
“We are very concerned about the rising [infection] rates that we have seen,” said Dr. Paul Biddinger, director for emergency preparedness at Mass General Brigham, the hospital group formerly known at Partners HealthCare.
Hospitals in Springfield and Boston reported slight upticks in COVID-19 patients, but Mass General Brigham, the largest hospital group, had only 49 cases on Tuesday and has not seen an increase in recent weeks. Statewide, COVID-19 hospitalizations have held relatively steady since July 24, with 396 reported on Wednesday, compared with nearly 4,000 on May 1.
A total of 338 new confirmed cases were reported Wednesday and two deaths.
The percentage of positive COVID-19 tests in Massachusetts rose to 2.2 percent, up from the mid-July low of 1.7 percent, according to Wednesday’s report from the state Department of Public Health.
Usually hospitalizations start to spike about two weeks after positive tests results go up, and intensive care unit admissions increase two weeks after that.
“The key is to recognize changes so that we can act quickly,” Biddinger said.
In the spring, hospitals cobbled together the space and staff to care for hundreds of severely ill patients — in many cases more than ever before seen — and the lessons on how to do that will guide the response to whatever the fall brings. Advances in understanding how to treat the illness might lead to shorter lengths of stay or fewer admissions. And improved testing capacity means hospitals are no longer in the dark about how many patients might show up at their doorstep….
“If you look historically at pandemics, there is almost always a second surge,” Biddinger said. He has no idea when that second surge might occur, but sees two factors that could bring it on: a “loss of vigilance” against the virus as people tire of staying apart and wearing masks, and the tendency to gather inside as temperatures cool…
And two critical problems linger from the spring: inadequate testing and the continuing struggle to obtain enough personal protective equipment or PPE — the gowns, face shields, masks, and gloves that staffers need to avoid infection.
Testing is essential to determine when hospital employees can return to work, and whether patients need to be isolated and cared for only by people in full PPE.
Baystate Health does not “have the capability to do point-of-care, rapid-turnaround testing,” said Artenstein, who called for a coordinated federal response. “We have not yet received the equipment or reagents to do that kind of testing. Without that, we don’t have the ability to make decisions quickly.”” (D)
“As the school year starts up again and sunset gets earlier and earlier, local hospitals are quietly preparing for the possibility of another crisis that could transpire this fall and winter.
It’s referred to is as a “twindemic,” a simultaneous flareup of the coronavirus and the flu, two deadly viruses that have a similar range of symptoms.
Though local hospital executives are hopeful that a twindemic won’t actually befall New Jersey, they’re readying for the possibility that it does and instituting measures in an effort to prevent it.
Those measures include readying tests that would screen for both COVID-19 and influenza with a single swab and rolling out flu vaccinations and encouraging the most vulnerable members of the population to get shots this year…
First-hand experience with coronavirus patients in the spring has made local hospitals more confident about how to respond if a second wave occurs, the doctors said. And now, preparing for a potential onslaught of patients is more of a familiar routine — stocking up on personal protective equipment, readying staff and continuing to check their temperatures daily.” (E)
“Forty percent of healthcare workers with COVID-19 were not showing symptoms when they were diagnosed, according to a new meta-analysis published in the American Journal of Epidemiology.
Researchers examined 97 studies published in 2020, including 230,398 healthcare workers across 24 countries.
The analysis found the estimated prevalence of infection was 11 percent among healthcare workers using polymerase chain reaction testing, and 7 percent of healthcare workers were positive by antibody tests.
Nearly half (48 percent) of healthcare workers testing positive for COVID-19 were nurses, and 25 percent were physicians, according to the analysis. Twenty-three percent were other healthcare workers.
Forty-three percent of COVID-19 positive medical personnel were working in hospitalization/non-emergency wards during the screening, the analysis found. Twenty-four percent of them were working in the operating room, 16 percent were working in the emergency room and 9 percent were working in the intensive care unit. Twenty-nine percent reported “other” locations…
Dr. Muka said: “Healthcare workers suffer a significant burden from COVID-19. A significant proportion of healthcare workers are positive for COVID-19 while asymptomatic, which might lead to the silent transmission of the disease within hospitals and in the community. The symptoms associated with COVID-19 in HCW could be used as an indicator for screening in settings with limited testing capacities.”
Co-author Professor Oscar Franco, MD, PhD, from the Institute of Social and Preventive Medicine, University of Bern, Switzerland, concluded in a news release: “Because we might miss a large proportion of COVID-19 cases if screening targets only symptomatic HCW, universal screening for all exposed HCW regardless of symptoms should be the standard strategy. While more research is needed to understand specific interventions that can help reducing SARS-CoV-2 infection among healthcare personnel, it is clear that providing healthcare workers with adequate personal protective equipment and training is essential.”” (F)
“Roughly nine weeks’ of previously unpublished federal data provided to the Wall Street Journal shows an average of 120 patients a day contracted the new coronavirus inside U.S. hospitals.
The figure comes from data reported by half of U.S. hospitals to the CDC between May 14 and July 14, after which data is unavailable because the government changed its data collection system and dropped the question about new cases of hospital-acquired COVID-19.
In that timeframe, more than 7,400 patients likely caught COVID-19 in hospitals where they sought care for other conditions. The CDC data didn’t track infections among hospital staff.
Ashish Jha, MD, dean of Brown University’s School of Public Health in Providence, R.I., told the WSJ the data shows the need for federal authorities to revive reporting requirements for new cases of hospital-acquired COVID-19. “We need to know this,” he said.” (G)
“Even with relaxed social distancing practices, national and local healthcare experts are still predicting and preparing for a second wave of COVID-19 this fall, according to Health News Hub. Dr. Ajay Kumar, Chief Clinical Officer for Hartford Healthcare said during a media briefing, “Social distancing is the only thing we have to decrease the spread of this disease… (The disease) is still as lethal as it was in February, March and April.”
During the current lull in coronavirus cases in several states across the U.S., healthcare facilities are doing what they can to best prepare themselves for the looming second wave. Below are some tools and preparedness strategies hospitals are doing to best fight the spread of COVID-19, as per Health News Hub:
Stocking up on personal protective equipment (PPE) and making sure there is enough on hand to protect staff and patients.
Optimizing contact tracing efforts to identify those who have has contact with somebody who has tested positive for COVID-19.
Maintaining hospital and healthcare facilities so that they are safe for patients who need treatment for the coronavirus, or for patients who need help for other healthcare concerns.
Streamlining communication plans to make sure staff and patients are kept updated on hospital COVID-19 protocols through a mass notification solution.
Maintaining capacity so that teams can easily scale operations up or down to meet the demand for care anticipated in a second wave.
Healthcare facilities are also leveraging the technology tools they have in place to help with hospital operations throughout the pandemic. SMS opt-in has been extremely helpful for patients and visitors entering a healthcare facility. Those who opt-in will receive targeted notifications on a specific topic, COVID-19 for example, and they can easily opt-out of these notifications after leaving the hospital.
Mass notification solutions with polling capabilities have also been extremely useful for sending wellness checks out to internal staff to ensure they are feeling safe and well. Polling has also been used to fill vacant shifts to make sure hospitals and healthcare facilities are not understaffed. This will be crucial in the case of the second wave.” (H)
“France and the UK on Thursday set all-time records for daily coronavirus infections.
Other European countries are seeing their highest cases since the continent’s peak earlier this year.
The EU’s health commissioner said that in “some member states, the situation is now even worse than during the peak in March.”
Much of Europe was devastated during the first wave of the pandemic, which was followed by a marked lull.
Better testing systems and infrastructure could go someway to explaining the new high figures — but experts agree that a resurgence is underway.
France and the UK recorded their highest daily COVID-19 cases since the global outbreak began, and the EU warned that some of its countries now have worse outbreaks than they had in March.
Stella Kyriakides, the EU’s health commissioner, warned on Thursday that in “some member states, the situation is now even worse than during the peak in March.”
Taken together, the developments point to the feared second wave of the pandemic having arrived in Europe.” (I)
“In Munich, normally brimming with boisterous crowds for Oktoberfest this month, the authorities just banned gatherings of more than five people. In Marseille, France, all bars and restaurants will be closed next Monday. And in London, where the government spent weeks urging workers to return to the city’s empty skyscrapers, it is now asking them to work from home.
Summer ended in Europe this week with a heavy thud amid ominous signs that a spike in coronavirus cases may send another wave of patients into hospitals. Officials across the continent fear a repeat of the harrowing scenes from last spring, when the virus swamped intensive care units in countries like Italy and Spain. Already in Spain, some hospitals are struggling with an influx of virus patients.
“I’m sorry to say that, as in Spain and France and many other countries, we’ve reached a perilous turning point,” Prime Minister Boris Johnson said on Tuesday, as he imposed new restrictions — including shutting pubs and restaurants at 10 p.m. — to prevent Britain’s National Health Service from becoming overwhelmed.
But just how imminent is the peril?
As they weigh actions to curb a second wave of the virus, Mr. Johnson and other European leaders are dealing with a confusing, fast-changing situation, with conflicting evidence on how quickly new cases are translating into hospital admissions — and how severe those cases will end up being…
Other experts, however, warn against being lulled into complacency: the gap between case numbers and hospital admissions, they say, is mainly a reflection of the fact that more people are being tested, and more quickly.
“Deaths and hospitalizations are a lagging indicator,” said Devi Sridhar, director of the global health governance program at the University of Edinburgh. “There was no lag back in March because we only tested people who were already in the hospital. At a certain point, your I.C.U.’s are going to fill up.”
The uncertainty about hospitalizations and deaths is another example of how mysterious the virus remains, even after 10 months of intense study. And that uncertainty complicates the task for political leaders who are balancing the need to protect their citizens with a desire to avoid imposing more lockdowns.
In France, where the government has adopted a philosophy of learning to live with the virus, President Emmanuel Macron has bucked pressure to impose new national restrictions and left it to cities to impose tighter curbs on public gatherings.
France currently has more than 5,700 people hospitalized with Covid-19. Roughly 900 of them are in intensive care. That is more than during the summer, when hospitalizations dropped to about 4,500 people, but it is far less than during the peak last April, when more than 32,000 were hospitalized…
There are worrying signs: Hospitals in Paris will postpone 20 percent of surgeries, starting this weekend, because of the increase in virus patients, who now account for 20 percent of all patients in intensive care.” (J)
“UK Prime Minister Boris Johnson on Friday told reporters that the UK is “now seeing a second wave coming in” and that it was “inevitable.”
“Obviously we’re looking very carefully at the spread of the pandemic as it evolves over the last few days,” Johnson said. “There’s no question, as I’ve said for weeks now, that we could (and) are now seeing a second wave coming in. We are seeing it in France, in Spain, across Europe. It has been absolutely inevitable we will see it in this country.
“I don’t want to go into second national lockdown. The only way we can do that is if people follow the guidance.”
British Health Minister Matt Hancock said Sunday that the country was “at a tipping point” following a new rise in cases on Saturday, when Britain registered 4,422 new cases, the highest number since early May.
“People must follow the rules and if they don’t, we will bring in this much more stringent measures,” Matt Hancock said in a BBC interview. When asked about re-imposing a second national lockdown, the minister said: “I don’t rule it out. I don’t want to see it.”…
The UK announced Sunday that anyone who tests positive for coronavirus or has been traced as a close contact will be required by law to self-isolate from September 28 or face fines from £1,000 ($1,300) to £10,000 ($13,000) for repeat offenders. Those with lower incomes will be supported by a £500 ($650) payment, according to a government statement….
New restrictions were also announced on Friday in Madrid, which accounts for approximately a third of all new cases in Spain, according to the Spanish Health Ministry. The country reported a record 12,183 daily cases on September 11, and has the highest number of cases in Europe at more than 600,000, with more than 30,000 deaths….
WHO Europe director Hans Kluge warned this week of “alarming rates of transmission” and a “very serious situation” in the region, adding that weekly cases have exceeded those reported during the March peak.” (K)
“Prime Minister Justin Trudeau is warning Canadians that the second wave has arrived in many parts of the country.
“We’re on the brink of a fall that could be much worse than the spring,” Trudeau said Wednesday during a 12-minute takeover of suppertime television. “It’s all too likely we won’t be gathering for Thanksgiving [Oct. 12], but we still have a shot at Christmas.”
During the height of the pandemic last spring, Trudeau took questions from reporters almost every day for weeks — briefings that networks covered voluntarily. On Wednesday evening, he took the rare step, for a Canadian prime minister, of requesting airtime on major TV networks.
For Canada’s four largest provinces, Trudeau said the second wave of Covid-19 is underway.
With kids at home and classes online, students are extra reliant on technology. But that’s not an easy lift in lower-income districts that lack funding and resources.
The increasingly grim backdrop: Trudeau’s warning comes as Canadian Covid-19 cases climb higher, a setback that follows the country’s success in flattening the curve earlier in the pandemic.
Trudeau noted that back on March 13 when the country went into lockdown there were 47 new cases of the virus. “Yesterday alone, we had well over 1,000,” said Trudeau, who appeared on TV screens in a dark suit and tie, standing in front of four Canadian flags and a desk.
Canada’s top doctor warned this week that the only way to prevent the acceleration of the spread is if everyone works to put on the brakes.
“My message today is the time is now,” Chief Public Health Officer Theresa Tam said. “Our actions right now are what matters for keeping epidemic growth under control.”
On Wednesday, officials said Canada saw an average of 1,123 cases reported daily during the past seven days, compared to just 380 cases reported per day in mid-August.” (L)
“Florida Gov. Ron DeSantis says he is lifting all restrictions on businesses statewide that were imposed to control the spread of the virus that causes COVID-19. Most significantly, that means restaurants and bars in the state can now operate at full capacity.
Up to now, restaurants and bars in Florida could serve customers indoors at 50% of legal occupancy. DeSantis said his new executive order lifts that restriction statewide, though local governments can keep additional limits in place if they’re justified for health or economic reasons.
“Every business has the right to operate,” DeSantis said. “Some of the locals can do reasonable regulations. But you can’t just say no.”
DeSantis also said his order would stop cities and counties from fining people for not wearing mandated face coverings. He said fines and other penalties imposed so far would be suspended.
Currently, Miami-Dade, Broward and other counties in South Florida have locally imposed limits on the hours restaurants and bars can operate and how many customers they can serve indoors.
Broward County Mayor Dale Holness told NPR member station WLRN on Friday, “We’re hoping that the governor will allow us to have deeper restrictions than the rest of the state. We have a greater spread of the virus in South Florida than other parts of the state.”
Miami-Dade officials said they were still assessing what the order means for the county. Mayor Carlos Giménez told The Miami Herald that he believed the county would still be able to enforce its face covering mandate but “will have to speak to our attorneys about [our] ability to enforce individual fines.”
The number of coronavirus cases in Florida has dropped steadily since the peak in mid-July. Since then, DeSantis said, “we’ve actually seen more economic activity, more interaction. Schools have opened, all the theme parks are open, more people have visited.”
Hospitalizations for COVID-19 statewide are down 76% from the peak, the governor said.
DeSantis said he’s seen no signs of a possible “second wave” of infections but said that hospitals have plenty of capacity and the state is ready to respond if one emerges.
There are no restrictions on the number of people who can attend outdoor sporting events in Florida, according to the governor, who added the state hopes to host what he called “a full Super Bowl” in Tampa in February.” (N)
“Florida added 2,795 coronavirus cases Saturday, bringing the total number of infections statewide to 698,682 cases.
The state also announced 107 coronavirus deaths. Since the first coronavirus case was found in Florida, 14,190 people have died from the virus. Among the deaths was a 12-year-old girl in Duval County, the ninth death of a child because of coronavirus in Florida.
The weekly death average increased to about 106 people announced dead per day. The peak death average came in early August, when about 185 deaths were announced per day.
Cases that resulted in a hospitalization increased by 171 admissions.
Hospitalizations: About 2,100 people across Florida are hospitalized with a primary diagnosis of coronavirus, according to the Agency for Health Care Administration. About 420 are in the Tampa Bay area.
Statewide, about 24 percent of hospital beds are open and 22 percent of ICU beds are open. In Tampa Bay, about 20 percent of hospital beds and 14 percent of ICU beds are available.
The largest area hospital, Tampa General Hospital, had no ICU beds available as of Saturday morning.” (O)
“When Dr. Shereef Elnahal walked through his New Jersey hospital in April, he couldn’t believe what he was seeing.
There were 300 patients being treated for Covid-19, filling hospital rooms and spilling out into the halls of the emergency room. The trauma center, once used for gunshot wounds and car crash victims, was now filled with people on ventilators.
“It was really like nothing we’ve ever seen before,” said Elnahal, president and CEO of University Hospital in Newark.
“I have memories of walking around and I would look inside the rooms where that was possible. Almost every person was a person of color,” he told NBC News.
Elnahal’s hospital is one of the more than 100 major medical centers that treat America’s most vulnerable patients: communities of color who have been disproportionately harmed by Covid-19. Data has increasingly shown that Black and Hispanic patients are more likely to be hospitalized with the virus and, in many cases, more likely to die from it.
“We’re learning more and more that it’s these vulnerable communities being hit harder by the pandemic,” said Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, a group representing the more than 300 hospitals that treat uninsured patients. “Our hospitals are absolutely serving those hardest-hit communities.”
A second surge of Covid-19 this fall and winter could be catastrophic for the U.S., and it’s not just more sick people that doctors worry about. The very hospitals that treat lower-income patients could be forced to shut down or cut crucial services.
“We would absolutely be at risk of closing,” Elnahal said. “It would be a public health disaster for this community.”
The pandemic hit all U.S. hospitals with a financial “triple whammy,” said Aaron Wesolowski, the American Hospital Association’s vice president for policy research, analytics and strategy. Costs increased dramatically, while revenues plummeted.
The hospitals were forced to cover the exorbitant costs of buying extra personal protective equipment like N95 masks, as well as convert wards to treat Covid-19 patients and more uninsured patients. At the same time, they had to stop performing revenue-generating procedures like elective surgeries.
By the end of 2020, hospitals across the U.S. will lose about $300 billion, according to the American Hospital Association. But for major medical centers like University Hospital in Newark, the financial hit of a second wave of Covid-19 would be especially devastating.
“Where there are already cracks in the system, those cracks become earthquakes,” said Dr. Chris Pernell, University Hospital’s chief of strategic integration and health equity officer.
That’s because these safety net hospitals are nonprofit and promise care for all patients, regardless of insurance coverage. Even before the pandemic, they operated on shaky budgets. Jackson Health System in Miami, for example, only has enough cash on hand to operate for 50 days. Private hospitals typically have more than triple that amount of cash in reserve…
In the meantime, hospitals are preparing for the second wave, stocking up on PPE despite lingering shortages and implementing lessons learned from the first surges, especially when it comes to treatment.” (P)
“The pandemic has shown us the importance of vigilant EM planning. When viruses of the past have run their course, EM plans often go back on the shelf and aren’t revisited until the next crisis. This is not to say that organizations always need to have incident command readiness. However, aspects of an emergency command structure and communication should be a constant part of daily workflow and the risk of an outbreak should be a consideration in everyday meetings and reports. For example, assuring that incident command roles are assigned daily and distributing a daily briefing, such as an email, will go a long way in promoting readiness. Ultimately, all organizations should move ahead conservatively – watch the data and evaluate what new trends mean, plan out next steps as new information unfolds, and be flexible to scale up or down accordingly…
“The next surge – whether COVID-19 or something new – will come. Flexibility may be the key to future surge response. While options and plans need to be tailored to each institution or site, here are some ideas to consider based on lessons learned:
• Assure a flexible, but robust, communication structure for use during surge events. This structure should be easily embedded in the incident command response once a decision is made to activate a command center, but flexible enough to assure daily use when the command center is closed.
• Develop options to enable a quicker expansion or conversion to support defined patient care spaces and the required staffing. These alternative care areas may include converting or repurposing existing space into temporary critical care areas or using temporary external structures as we have seen during COVID-19. Alternative staffing models also need to be agreed upon to support these possible new care areas.
• Develop plans for rapidly updating staff, including education on new care guidelines and new care area assignments as well as new communication models to ensure staff is aware of PPE guidelines, technology updates and other changes.
• Create room flexibility using carts or rail systems. This can allow for rapid repurposing of rooms to accommodate specific needs.
• Create plans for “clean” and “infectious” corridors to minimize comingling of likely infectious and likely non-infectious patients.” (Q)
“With a growing tally of more than 7 million COVID-19 cases and over 200,000 deaths from the virus in the United States, the country’s top infectious disease expert is warning that the nation needs to prepare as fall and winter loom.
“Given the fact that we have never got down to a good baseline, we are still in the first wave,” Dr. Anthony Fauci told CNN.
During the 1918 pandemic, the number of cases plummeted before exploding during the colder months later in the year.
“Rather than say, ‘A second wave,’ why don’t we say, ‘Are we prepared for the challenge of the fall and the winter?’” Fauci said.
Among other preventative measures, Fauci says Americans need to wear face coverings, wash their hands and avoid crowds to avoid “surges” in cities and states across the country.
Another precaution that could help first line medical workers dealing with COVID-19 patients is the flu shot. The more people vaccinate this year, the less patients sick with the flu will divert hospital resources away from coronavirus patients…
Fauci warns life may not be ‘normal’ until end of 2021
“We feel cautiously optimistic that we will be able to have a safe and effective vaccine, although there is never a guarantee of that,” Dr. Fauci told a Senate committee this week…
How we got here.
More than 200,000 Americans have died from COVID-19 so far this year, and in many states, infections still are climbing. The U.S. is confirming an average of 41,968 new daily cases, up 13% compared with the average two weeks ago.
Fauci was blunt: More lives could have been saved if everyone in the country better followed recommendations to wear masks, avoid crowds and keep 6 feet apart.
“We know some states did a good job. Some states did not so good a job. Some states tried to do a good job but people didn’t listen,” he said, singling out mask-less crowds in bars. Going forward, “we need uniformity throughout the country.”” (M)
“As Germany cleared away spent fireworks and slept off its hangovers on New Year’s Day, Christian Drosten got a sobering wake-up call: A member of his team—he heads the virology department at Berlin’s Charité hospital—reported that a strange pneumonia was spreading in the Chinese city of Wuhan.
For Drosten, a leading developer of tests for emerging viruses, there was an element of déjà vu. As a doctoral student in Hamburg in 2003, he’d discovered that the outbreak of severe acute respiratory syndrome, or SARS, then terrifying Asia was caused by a coronavirus. Although it was unclear whether a coronavirus was responsible for the Wuhan outbreak, Drosten fully understood the danger. While the viruses are common pathogens known to cause colds, some discovered in recent decades are highly lethal.
He alerted his staff to get ready for the possibility of a deadly pandemic. When Chinese researchers confirmed that the culprit was indeed a coronavirus and on Jan. 10—a Friday—published its genome sequence, the Charité scientists sprang into action. Working through the weekend, they pulled together samples of the SARS virus and other coronaviruses, aiming to make a test that could detect the new threat. Late on Saturday a team member tweeted, “Lab days are happy days! #Wuhan #Coronavirus.”
By Monday they had a test that could confirm whether someone had been infected by the novel coronavirus. Drosten shared the details with the World Health Organization, which published them on its website, and the test was soon deployed around the world. One place that declined to use Drosten’s test was the U.S.; it came up with its own diagnostic tool, which turned out to be flawed and left the country blind for two months as the virus raged. Germany’s test confirmed the country’s first case on Jan. 27. There were 13 more in the coming days, at the time constituting the largest known cluster outside of China. Authorities sequestered Covid-19 patients, tracked down their recent contacts, and slowed infections.”
…..Since developing the test, the 48-year-old scientist…has led a research team at Charité that’s explored how the virus spreads and affects people differently. He’s shared thoughts with colleagues around the world, offered insights at press conferences alongside Germany’s health minister, and advised Chancellor Angela Merkel—a role some have compared to that played by Dr. Anthony Fauci in the U.S.” (R)
“Robert Redfield was overheard by an employee of NBC News on a flight from Atlanta to Washington. According to NBC, Redfield criticized Scott Atlas, a radiologist and Fox News talking head added to the taskforce last month.
“Everything he says is false,” Redfield said about Atlas, NBC reported. Redfield later confirmed he had been talking about Atlas.
Atlas, who has no background in infectious diseases but who appears to have the best current access to Trump of any medical adviser, has been frequently criticized by the scientific and medical communities for offering what public health professionals say is bad advice about coronavirus.
On Monday afternoon, the top US public health expert and infectious diseases lead on the taskforce, Anthony Fauci, chimed in to tell CNN he was concerned that Atlas was at times providing misleading or incorrect information on the pandemic to Trump.
“Well, yeah, I’m concerned that sometimes things are said that are really taken either out of context or are actually incorrect,” Fauci, the head of the National Institute of Allergy and Infectious Diseases, said when asked in an interview if he was worried Atlas was sharing misleading information.” (S)
The United States Postal Service had planned to distribute 650 million face coverings for the Trump administration in April to help curb the spread of the coronavirus, according to newly obtained internal documents reviewed by CNN.
But those plans were scrapped by the White House because it didn’t want to spark “concern or panic” among Americans, senior administration officials told The Washington Post.
“There was concern from some in the White House Domestic Policy Council and the office of the vice president that households receiving masks might create concern or panic,” one administration official told the Post.
The documents obtained by the transparency group American Oversight show the Postal Service was doing this in partnership with the White House Coronavirus Task Force, the Department of Health and Human Services and “a consortium of textile manufacturers.”
USPS was planning to ship the masks in April and was going to prioritize areas “which HHS has identified as experiencing high transmission rates of Covid-19,” according to a draft USPS release. Louisiana’s Orleans and Jefferson parishes were going to be sent masks first, followed by King County, Washington; Wayne County, Michigan; and New York…” (T)
“Top White House officials pressured the Centers for Disease Control and Prevention this summer to play down the risk of sending children back to school, a strikingly political intervention in one of the most sensitive public health debates of the pandemic, according to documents and interviews with current and former government officials.
As part of their behind-the-scenes effort, White House officials also tried to circumvent the C.D.C. in a search for alternate data showing that the pandemic was weakening and posed little danger to children.
The documents and interviews show how the White House spent weeks trying to press public health professionals to fall in line with President Trump’s election-year agenda of pushing to reopen schools and the economy as quickly as possible. The president and his team have remained defiant in their demand for schools to get back to normal, even as coronavirus cases have once again ticked up, in some cases linked to school and college reopenings.
The effort included Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, and officials working for Vice President Mike Pence, who led the task force. It left officials at the C.D.C., long considered the world’s premier public health agency, alarmed at the degree of pressure from the White House.” (U)
“Fauci also discussed Dr. Scott Altas, a White House coronavirus task force member with whom CDC director Robert Redfield has questioned for sharing misleading information with President Trump, according to CNN.
Fauci called Atlas an “outlier,” saying that most members of the task force are working together.
“My difference is with Dr. Atlas, I’m always willing to sit down and talk with him and see if we could resolve those differences,” he said.” (V)
