H5N1

Idaho hospitals nearly buckling in relentless COVID surge

Via The Associated Press: Idaho hospitals nearly buckling in relentless COVID surge. Excerpt:

BOISE, Idaho (AP) — The intensive care rooms at St. Luke’s Boise Medical Center are full, each a blinking jungle of tubes, wires and mechanical breathing machines. The patients nestled inside are a lot alike: All unvaccinated, mostly middle-aged, paralyzed and sedated, reliant on life support and locked in a silent struggle against COVID-19. 

But watch for a moment, and glimpses of who they were before the coronavirus become clear. 

Artfully inked tattoos cover the tanned forearm of a man in his 30s. An expectant mother’s slightly swollen belly is briefly revealed as a nurse adjusts her position. The young woman is five months pregnant and hooked to a breathing machine. 

Down the hall, another pregnant woman, just 24 and hooked to a ventilator, is lying prone — on top of her developing fetus — to get more air into her ravaged lungs. 

Idaho hit a grim COVID-19 trifecta this week, reaching record numbers of emergency room visits, hospitalizations and ICU patients. Medical experts say the deeply conservative state will likely see 30,000 new infections a week by mid-September. 

With a critical shortage of hospital beds and staff and one of the nation’s lowest vaccination rates, Idaho health providers are growing desperate and preparing to follow crisis standards of care, which call for giving scarce resources to patients most likely to survive. 

St. Luke’s Boise Medical Center invited The Associated Press into its restricted ICUs this week in hopes that sharing the dire reality would prompt people to change their behavior. 

“There is so much loss here, and so much of it is preventable. I’m not just talking about loss of life. Ultimately, it’s like loss of hope,” said Dr. Jim Souza, chief medical officer. “When the vaccines came out in December, those of us in health care were like, ’Oh, my God, it’s like the cavalry coming over the hill. ... To see now what’s playing out? It’s all so needless.”

Inside the ICUs, Kristen Connelly and fellow nurses frequently gather to turn over each patient, careful to avoid disconnecting the tangle of tubes and wires keeping them alive. With breathing tubes, feeding tubes and half a dozen hanging bags of medications intended to halt a cascade of organ damage, turning a patient is a dangerous but necessary endeavor that happens twice a day. 

When Idaho’s hospitals were nearly overwhelmed with coronavirus patients last winter, Connelly wasn’t fazed, believing she could make a difference. Now, instead of focusing on one patient at a time, she cares for multiple. Many colleagues have quit, burned out by the relentless demands of the pandemic. 

“At this point, I’m overwhelmed. I don’t have much left,” the 26-year ICU nursing veteran said Tuesday. 

Connelly’s own life is in triage mode as she tries to maintain her last reservoirs of energy. She doesn’t eat at home anymore and has cut out all activities except for walking her dog. Her normally deep sense of compassion — which Connelly considers a critical job skill — has been shadowed by a seething anger she can’t shake. 

“We had a mother-daughter team in the hospital last week, and the mother died and the daughter was still here,” Connelly said. “In that moment, I had a reprieve from the anger, because I got to be just overwhelmed with sadness.” 

“It’s devastating,” she said. “Where we are right now is avoidable — we didn’t have to go here.” 

All of the ICU coronavirus patients were generally healthy people who simply didn’t get vaccinated, Dr. Bill Dittrich said. Idaho could enact crisis care standards in days, leaving him to make gut-wrenching decisions about who gets life-saving treatment. 

“I don’t think anybody will ever be ready to have the kinds of conversations and make the kinds of decisions that we’re concerned we’re going to have to be making in the next several weeks. I’m really terrified,” Dittrich said.

Iran's COVID-19 deaths hit record daily high of 709

Via Reuters: Iran's COVID-19 deaths hit record daily high of 709.

DUBAI, Aug 24 (Reuters) - Iran on Tuesday reported a record daily 709 deaths from COVID-19 as the worst-hit country in the Middle East faced a fifth surge in infections led by the highly contagious Delta variant. 

The health ministry said the total number of cases had reached 4.75 million with 40,623 new infections over the past 24 hours. Total fatalities rose to 103,357, state TV reported. 

Authorities imposed a two-week road travel ban between cities in the Islamic Republic until Aug. 27, except for essential vehicles. Non-essential businesses and public offices were allowed to reopen on Sunday after a week of mandatory shutdown to help limit the spread of coronavirus infections. 

The government has not yet announced whether or not new restrictions will be imposed soon.  

Health authorities have warned that daily deaths might reach 800 in coming weeks if Iranians fail to respect health precautions. 

Social media users have criticised the government for being slow to vaccinate people - only about 6.5 million of the 83 million population are fully inoculated. Officials have blamed U.S. sanctions and delays in importing vaccines. 

Food, medicine and other humanitarian supplies are exempt from U.S. sanctions reimposed on Tehran in 2018 after President Donald Trump walked away from a 2015 deal between world powers and Iran over its nuclear programme. 

But the U.S. measures, which target sectors including oil and financial activities, have deterred some foreign banks from processing financial transactions with Iran. Tehran says this has frequently disrupted efforts to import essential medicines and other humanitarian items.

N.W.T. waiting to see if feds send out-of-territory health-care staff

Via CBC News: N.W.T. waiting to see if feds send out-of-territory health-care staff. Excerpt:

The N.W.T. is still waiting to hear if the federal government will send health-care staff from other parts of the country to help with a surge of COVID-19 in the territory. 

Health Minister Julie Green said Monday she was expecting the total number of cases to increase later in the day, and that it "doesn't seem like we're on top of this yet."  

Green said the territory had asked the federal government if it could act as a "broker of health-care staff" from places that aren't as hard hit by the pandemic, who could provide support in a variety of ways such as nursing, logistics or lab analysis.  

"We haven't heard that we've got a response on that yet," she said.  

The Canadian Armed Forces, however, have activated 15 Canadian Rangers and the Canadian Red Cross has sent five of its nurses to the territory to help respond to the situation. 

Green said eight Rangers had been deployed as of Monday, while the nurses had arrived in the territory the day before and were receiving training before being sent "where they're needed."  

 "They need to understand and have a little orientation onboard session with our medical system," Green explained. 

She also said it's an "awkward time" to be working with the federal government because of the election that was called a little more than week ago, just as case numbers in the N.W.T. were starting to grow.  

"I think even though I'm not directly speaking with them, they understand this is an urgent situation," said Green, adding that she's "satisfied" with the response so far.  

The territory hasn't updated its case count since Friday. At the time, there were nearly 200 cases throughout the N.W.T., most of which were in small communities, including 86 in Fort Good Hope, 73 in Colville Lake, eight in Délı̨nę and 10 in Norman Wells.  

Fewer frontline staff available 

The territory's healthcare system is already under strain. Green said they're asking people who have nursing credentials but who aren't currently working for help. 

Between the resources that have been unlocked so far, and the possibility of health-care staff from other parts of the country, Green said there are a "lot of different possibilities to bring in staff to meet our immediate needs." 

Green also said resources are being shifted to meet demand, noting a high number of cases in Fort Good Hope and Colville Lake, and high risk exposure notices in Délı̨nę. 

"We've made a number of adjustments to acknowledge the fact we do have fewer frontline staff than we did previously, and we're prioritizing where we send them."

Cuba’s health system buckles under strain of overwhelming Covid surge

Via The Guardian: Cuba’s health system buckles under strain of overwhelming Covid surge. Excerpt:

Julia, a community doctor in Havana, was drafted to the intensive care unit soon after Covid-19 first reached Cuba. 

Last week, her cousin died from the virus. This week, she also tested positive amid a surge in cases which has pushed the island’s vaunted health service to its limits and prompted rare public criticism from Cuban doctors. 

“It hurts to see people die from this terrible virus,” she said, recovering at home from nausea after being injected with an immune booster. “The mood among doctors gets worse by the day.” 

After recording one of the world’s lowest Covid rates last year, Cuba now has one of the western hemisphere’s highest. The island, which reported 12,225 confirmed cases in all of 2020, has reported almost 50 times that so far this year. And with the Delta variant having taken root, a lack of medical supplies is crippling the medical response. 

“There are no antibiotics, no painkillers, the basic list of medicines is almost all out of stock,” said Daniela, a family doctor in Havana who has hardly had a day off since the pandemic began. 

In the face of extreme scarcity, doctors are increasingly prescribing herbal remedies. Mortuaries are overwhelmed. The country’s main oxygen factory recently broke down, compounding the intensive care crisis. 

Cuba last year hospitalised everybody who tested positive for Covid, including asymptomatic cases. But even for a country with the world’s highest doctor-to-patient ratio, average daily case loads of 9,000 have made that protocol unworkable. Now children, the elderly, pregnant women and severe cases are hospitalised, while others must isolate at home. 

Hundreds of doctors have been brought back from international “missions” abroad – a major hard currency generator for the state – to support exhausted colleagues. But the move has not been enough to stop the system, which last year was a model of test, track and isolate, from fraying.

Orlando urges reduced water usage as liquid oxygen used to purify water goes to COVID patients

Via the Orlando Sentinel: Orlando urges reduced water usage as liquid oxygen used to purify water goes to COVID patients. Excerpt:

The city of Orlando and its water utility made an urgent appeal Friday afternoon for residents to cut back sharply on water usage for weeks because of a pandemic-triggered shortage of liquid oxygen used to purify water. 

If commercial and residential customers are unable to reduce water usage quickly and sufficiently, Orlando Utilities Commission may issue a system-wide alert for boiling water needed for drinking and cooking. Without reductions in water usage, a boil-water alert would come within a week, utility officials said. 

Orlando Mayor Buddy Dyer asked residents to immediately stop watering their lawns, washing their cars and using pressure washers. Landscape irrigation consumes about 40% of the water provided by OUC. 

“It’s a pretty simple thing that we are asking our residential customers,” Dyer said. “Let’s just not water your yard for a week. In all likelihood, there will be thunderstorms during the week anyway.” 

Medical authorities have reported that along with a spike in hospitalizations for COVID cases, hospitals are relying increasingly on treatment involving high flows of supplemental oxygen for patients. 

That has spurred a nationwide shortage for liquid oxygen, which has been exacerbated by a lack of available tanker trucks and drivers. 

As the region’s largest water utility, OUC provides about 90 million gallons of potable water daily to 140,000 customers or an estimated 400,000 people within city limits and in Orange County. 

OUC said the call for reduced water usage will be in place for at least two to three weeks. The city has already stopped irrigation at parks and ballfields.

West Africa COVID-19 deaths surge amid Ebola and other outbreaks

A news release from WHO AFRO: West Africa COVID-19 deaths surge amid Ebola and other outbreaks. Excerpt:

Brazzaville, 20 August 2021 – West Africa has recorded its highest number of COVID-19 deaths since the pandemic began as several countries grapple with outbreaks of cholera, Ebola Virus Disease and Marburg Virus Disease that threaten to further strain the already stretched emergency response capacity in the region. 

COVID-19 fatalities in West Africa over the past four weeks increased by 193% from 348 in the previous four weeks to 1018 in the week ending on 15 August. Although the case fatality ratio, or the proportion of people diagnosed with the disease who have died, stands at 1.4%—below the continental average of 2.5%—it is higher than the previous two waves in the sub-region, a sign that health systems are feeling the strain of a heavy caseload. While new cases in West Africa have dropped this week, they were surging for eight consecutive weeks. 

Overall Africa recorded over 244 000 new cases in the week ending on 15 August, an 11% drop from the week before and a second straight week of declining cases. However, nine out of 23 countries experiencing a resurgence are in West Africa. Cote d’Ivoire, Guinea and Nigeria are experiencing a surge in cases and all three countries are tackling other outbreaks. 

West Africa health systems are even more fragile than those in other sub-regions. A World Health Organization (WHO) assessment of the functionality of health systems in West Africa found that they were 21% lower than in Southern Africa, 

“We are particularly concerned about West Africa and we can expect the pressure of COVID-19 to hit health services harder and faster,” said Dr Matshidiso Moeti, WHO Regional Director for Africa. “In addition to the strain of COVID-19, comes Ebola and other outbreaks. Fighting multiple outbreaks is a complex challenge.” 

COVID-19 vaccines deliveries 

West Africa has to date received around 29 million vaccine doses—almost the same amount as East and Southern Africa. However, the rollout has been slow, with 38% of the doses administered compared with 76% in East and Southern Africa and 95% in North Africa. West Africa has delivered 2.4 doses per 100 people. In East and Southern Africa, the figure stands at 4.8 doses per 100 people. 

Vaccine shipments to Africa have picked up with the COVAX Facility delivering almost 10 million doses to Africa so far in August, that is nine times what was delivered in the same period in July. The African Union has so far delivered 1.5 million doses to nine countries. Since June, the number of doses administered per 100 people in sub-Saharan Africa has almost tripled from 1.2 per 100 people to 3.4 per 100 people. 

“While COVID-19 vaccine shipments seem to be taking off, Africa is encountering headwinds. Moves by some countries globally to introduce booster shots threaten the promise of a brighter tomorrow for Africa. As some richer countries hoard vaccines, they make a mockery of vaccine equity,” said Dr Moeti.

US: Hospitals struggle with staff shortages in coronavirus hot spots

Via The Washington Post: Hospitals struggle with staff shortages in coronavirus hot spots. Excerpt:

Just north of Miami, covid-19 patients are flooding into the six Broward County hospitals run by Memorial Healthcare System, as Florida is being slammed with the highest rate of coronavirus admissions in the country. Memorial has enough beds. Not so with nurses. 

The hospital system has scrambled to hire 439 travel nurses from as far away as Alaska, and it is offering some of its own nurses well-paid short-term contracts to compete with the appeal of working for lucrative outside agencies. It is beginning to pause some elective surgeries to shift staff to patients sick with covid-19, the illness caused by the coronavirus. 

Even so, the large public health-care system has about 700 nursing vacancies. 

“I wake up every night and ask myself, ‘What else can I be doing?’ ” said Maggie Hansen, senior vice president and chief nurse executive at Memorial, where the census of patients with covid-19 has soared from about 100 four weeks ago to 670 on Wednesday. 

That predicament is echoed this second pandemic summer in other states, largely across the South, where the virus’s delta variant and relatively low vaccination rates are driving record numbers of coronavirus hospitalizations. 

“Every hospital in Arkansas is having major staffing challenges,” said Chris B. Barber, president and chief executive of Jonesboro-based St. Bernards Healthcare. Barber, who is chairman of the Arkansas Hospital Association’s board, said hospital CEOs in the state hold weekly calls about the pandemic. “I can’t get on a call where that’s not the issue — how to staff their hospital,” he said. 

According to hospital executives and nursing administrators in several states, the struggle to find enough workers to care for people sick with covid-19 has emerged as a critical problem as other daunting shortages, widespread early in the pandemic, have eased. Once-scarce supplies of protective gear, ventilators and coronavirus tests are now plentiful, hospital officials consistently say. 

Finding ways to hire and keep nurses is the main problem, officials say, although some hospitals also are short on respiratory therapists and workers for nutritional services and housekeeping. Some hospitals could enlarge their bed capacity if they had more nurses to tend to the coronavirus patients who would fill them.

Vietnam concerned over vaccine supply as COVID-19 cases near record

Via Reuters: Vietnam concerned over vaccine supply as COVID-19 cases near record.

HANOI, Aug 12 (Reuters) - Vietnam's government on Thursday said it was facing a tense situation over rising coronavirus cases and a shortage of vaccines, as the country saw another day of near-record cases from its longest and most severe outbreak yet. 

Most of the 9,667 new infections were in the epicentre Ho Chi Minh City and its neighbouring industrial provinces of Binh Duong and Dong Nai. The health ministry said there were 326 new COVID-19 deaths on Thursday, taking overall fatalities to 4,813. 

"The disease situation is very tense, and we face a vaccine shortage nationwide," said deputy prime minister Vu Duc Dam, who heads Vietnam's coronavirus taskforce. 

Dam said deals and commitments had been secured for hundreds of millions of vaccines but delivery was slow. Vietnamese leaders have over the past months made around 20 phone calls to foreign counterparts to try to secure more. 

Vietnam until recently has had one of Asia's best coronavirus containment records, but the situation has deteriorated lately, with infection numbers on a typical day exceeding those recorded over the whole of last year. 

Prime Minister Pham Minh Chinh at a cabinet meeting on Thursday urged domestic production of Vietnam's homegrown coronavirus vaccines to be brought forward. 

Fewer than 1.1 million of Vietnam's 98 million people have been fully vaccinated against COVID-19, according to official data, one of Asia's lowest rates of immunisation. It has received around 18 million doses so far. 

The country has recorded more than 246,500 infections, the overwhelming majority of those since late April.

Indonesia: Government orders more oxygen as Covid patients use up supplies

Via JakartaNews.Net: Government orders more oxygen as Covid patients use up supplies.

JAKARTA, Indonesia: Following the deaths of 60 people in hospitals needing oxygen, the Indonesian government has ordered manufacturers of oxygen and tanks to prioritize medical needs amid the growing demand from COVID-19 patients. 

Indonesia is suffering one of the worst outbreaks of the Covid virus, registering 27,913 new cases just on Saturday. 

The Sardjito hospital in Java issued a statement saying 63 patients died after it ran low of oxygen from Saturday until early on Sunday, when new oxygen supplies arrived. 

A hospital spokesman, however, did not know whether all of the fatalities had suffered from COVID-19. 

"We also hope people don't stock up on oxygen," health ministry official Siti Nadia Tarmizi said, fearing additional shortages. 

The hospital said it had sought additional supplies of oxygen, however, large numbers of patients arrived at the hospital on Friday in need of oxygen. 

The crisis only eased before dawn on Sunday when more oxygen was delivered to the hospital. 

The ministry supervising Indonesia's COVID-19 response has ordered the oxygen industry to fill the estimated demand of 800 tonnes of oxygen per day needed for the nation's ill population. 

Hospitals in Java are being left with no empty beds following the spread of the highly infectious Covid Delta variant. 

In the Indonesian capital of Jakarta, the government said there are now 392 burials per day, a ten-fold increase over earlier months. 

Beginning on July 6, Indonesia will not allow foreign visitors onto the island.

Oxygen shortages threaten ‘total collapse’ of dozens of health systems

Via The Guardian: Oxygen shortages threaten ‘total collapse’ of dozens of health systems. Excerpt:

Dozens of countries are facing severe oxygen shortages because of surging Covid-19 cases, threatening the “total collapse” of health systems. 

The Bureau of Investigative Journalism analysed data provided by the Every Breath Counts Coalition, the NGO Path and the Clinton Health Access Initiative (CHAI) to find the countries most at risk of running out of oxygen. It also studied data on global vaccination rates. 

Nineteen countries around the world – including India, Argentina, Iran, Nepal, the Philippines, Malaysia, Pakistan, Argentina, Costa Rica, Ecuador and South Africa – are deemed most at risk after recording huge increases in demand since March – at least a 20% rise – while having vaccinated less than 20% of their populations.

There are concerns that other Asian countries like Laos are at risk, and African countries including Nigeria, Ethiopia, Malawi and Zimbabwe, which have less mature oxygen delivery systems, meaning a small increase in need could create big problems. 

Many of these countries faced oxygen shortages before the pandemic, said Leith Greenslade, coordinator of the Every Breath Counts Coalition. The extra need is pushing health systems to the brink. 

“The situation last year, and again in January this year in Brazil and Peru, should have been the wake up call,” she said. “But the world did not wake up. We should have known India would happen after seeing what happened in Latin America. And now looking at Asia, we should know this will happen in some of the big cities in Africa.” 

 Robert Matiru, who chairs the Covid-19 Oxygen Emergency Taskforce, told the bureau: “We could see the total collapse of health systems, especially in countries with very fragile systems.” 

 Hospitals in India have reported significant shortages of oxygen as the country battles its second wave. By the middle of May, India needed an extra 15.5m cubic metres of oxygen a day just for Covid-19 patients, more than 14 times what it needed in March, according to the bureau’s analysis. 

In response, India has banned all exports of liquid and cylinder oxygen. 

But experts are worried about India’s neighbours – Pakistan, Nepal, Bangladesh, Sri Lanka and Myanmar – some of which rely on Indian-made oxygen and equipment. 

“You’d imagine if they start to see peaks of the same degree, then it could be even worse, because India needs all the supply,” said Zachary Katz, vice-president of essential medicines at CHAI. 

The bureau’s data shows that Nepal now needs more than 100 times as much oxygen as it did in March. 

Demand for oxygen in Sri Lanka has risen sevenfold since mid-March. In Pakistan, which is suffering its third wave of cases, almost 60% more patients are on oxygen in hospital than during the country’s previous peak last summer, according to a government minister, who warned in late April that pressure on the oxygen supply was reaching dangerous levels.

“The mood is extremely grim,” says Dr Fyezah Jehan, a doctor in Karachi. “I think we are very scared of an India-like situation. We’re hoping that some magic happens, and this [current] lockdown can prevent a new onslaught of cases.”