H5N1

COVID-19: The US has passed the hospital breaking point

Early in the life of this blog, I asked my very few readers: What happens to the ordinary patients in a pandemic, when the hospitals are jammed with urgent cases of some new disease? Now we know. 

Via The Atlantic, Robinson Meyer and Alexis C. Madrigal write: The U.S. Has Passed the Hospital Breaking Point. Excerpt (but you'd better read the whole article):

At the springtime peak, even as Northeast hospitals faced a deluge, 60,000 people were hospitalized nationwide. When the Sun Belt frothed with cases this summer, hospitalizations again reached the 60,000 mark before they started to fall.  

A month ago, in early November, hospitalizations passed 60,000—and kept climbing, quickly. On Wednesday, the country tore past a nauseating virus record. For the first time since the pandemic began, more than 100,000 people were hospitalized with COVID-19 in the United States, nearly double the record highs seen during the spring and summer surges. 

The pandemic nightmare scenario—the buckling of hospital and health-care systems nationwide—has arrived. Several lines of evidence are now sending us the same message: Hospitals are becoming overwhelmed, causing them to restrict whom they admit and leading more Americans to needlessly die. 

The current rise in hospitalizations began in late September, and for weeks now hospitals have faced unprecedented demand for medical care. The number of hospitalized patients has increased nearly every day: Since November 1, the number of people hospitalized with COVID-19 has doubled; since October 1, it has tripled. 

Throughout that time, health-care workers have worried that hospitals would soon be overwhelmed. “The health-care system in Iowa is going to collapse, no question,” an infectious-disease doctor told our colleague Ed Yong early last month. The following week, a critical-care doctor in Nebraska warned, “The assumption we will always have a hospital bed for [you] is a false one.” 

These catastrophes seem to be coming to pass—not just in Iowa and Nebraska, but all across the country. A national breakdown in hospital care is now starkly apparent in the coronavirus data.

‘Our hands are tied’: US COVID-19 surge ravages small rural hospitals

Via The Guardian: ‘Our hands are tied’: US coronavirus surge ravages small rural hospitals. Excerpt:

As Dr Shane Wilson makes the rounds at the tiny, 25-bed hospital in rural Missouri, many of his movements are familiar in an age of coronavirus. 

Masks and gloves. Zippered plastic walls between hallways. Hand sanitizer as he enters and exits each room. 

But one thing is starkly different. Born and raised in the town of just 1,800, Wilson knows most of his patients by their first names. 

He visits a woman who used to be a gym teacher at his school, and later laughingly recalls a day she caught him smoking at school and made him and a friend pick up cigarette butts as punishment. 

Another man was in the middle of his soybean harvest when he fell ill and couldn’t finish. 

In November, Wilson treated his own father, who along with his wife used to work at the same hospital. The 74-year-old elder Wilson recovered from the virus. 

The coronavirus pandemic largely hit urban areas first, but the autumn surge is devastating rural America, too. 

The US is now averaging more than 170,000 new cases each day, with hospitalizations breaking records all too frequently, and it’s taking a toll from the biggest hospitals down to the little ones, like Scotland county hospital. 

The tragedy is smaller here, more intimate. Everyone knows everyone. 

Memphis, Missouri, is the biggest town for miles and miles amid the cornfields of the north-eastern corner of this midwestern state.  

Agriculture accounts for most jobs in the region. The area is so remote that the nearest stoplight, McDonald’s and Walmart are all an hour away, the hospital public relations director, Alisa Kigar, said. 

People come to the hospital from six surrounding counties, typically for treatment of things like farm and sports injuries, chest pains and the flu. Usually, there’s plenty of room.  

Not now. The small hospital with roughly six doctors and 75 nurses among 142 full-time staff, is in crisis. The region is seeing a big increase in Covid-19 cases, and all available beds are usually taken. 

Scotland county hospital’s doctors are already making difficult, often heartbreaking decisions about who they can take in.  

Wilson said some moderately ill people have been sent home with oxygen and told, “If things get worse, come back in, but we don’t have a place to put you and we don’t have a place to transfer you.” 

Meanwhile, a staffing shortage is so severe that the hospital put out an appeal for anyone with healthcare experience, including retirees, to come to work.  

Several responded and are already on staff, including a woman working as a licensed practical nurse as she studies to become a registered nurse. 

The hospital’s chief nursing officer, Elizabeth Guffey, said nurses were working up to 24 extra hours each week. Guffey sometimes sleeps in an office rather than go home between shifts. 

“We’re in a surge capacity almost 100% of the time,” Guffey said. “So it’s all hands on deck.”

Manitoba signs COVID-19 pay deal with nurses union to shift staff to priority areas

Via The Globe and Mail: Manitoba signs COVID-19 pay deal with nurses union to shift staff to priority areas. Excerpt:

The Manitoba government has signed a pay agreement that will allow nurses to be shifted to priority areas in the fight against COVID-19.  

It says the agreement with the Manitoba Nurses Union will allow nurses to be redeployed in personal care homes, intensive care units and designated COVID-19 units.  

Health Minister Cameron Friesen says it will allow for changes to work assignments, locations, schedules and shifts to support the changing needs of hospital patients and care home residents.  

He says nurses affected by these changes, including those already working in facilities dealing with COVID-19 outbreaks, will get extra pay. 

The agreement also establishes a COVID-19 northern allowance for staff redeployed to the north, as well as an allowance for current northern nurses who work in one community but pick up additional shifts elsewhere in the region.  

Union president Darlene Jackson says the deal will help keep nurses on the job and give them some security and recognition.  

“Nurses have played a critical role on the front line of Manitoba’s pandemic response and they have stepped up to the challenge, working countless long hours to provide quality care for patients and residents,” Jackson said Tuesday in a release.

Why emergency COVID-19 vaccine approvals pose a dilemma for scientists

Via Nature.com: Why emergency COVID-vaccine approvals pose a dilemma for scientists. Excerpt:

After a flurry of positive results from clinical trials of COVID-19 vaccines, developers are now seeking ‘emergency use’ approvals, which could see these immunizations deployed in potentially tens of millions of people. But scientists are concerned that this kind of early deployment could compromise the ongoing clinical trials that seek to show conclusively how well the vaccines work.  

Following the release of early data from phase III trials on 9 November, vaccine makers Pfizer and BioNTech have sought regulatory permission to deploy their vaccine under emergency-use rules. The developer of another leading vaccine, Moderna, is expected to do the same within weeks.  

Once a vaccine is granted emergency approval, there is pressure on developers to offer the immunization to trial participants who received a placebo. But if too many people cross over to the vaccine group, the companies might not have enough data to establish long-term outcomes, such as safety, how long vaccine protection lasts and whether the jab prevents infection or just the disease.  

“It’s a real vaccine development dilemma,” says Klaus Stöhr, who formerly headed vaccine design at the pharmaceutical company Novartis in Cambridge, Massachusetts, and is now retired. Still, Stöhr thinks that the vaccine should be granted emergency use authorization because its effectiveness has been established and there is a dire need.

As COVID-19 soars, hospitals hope to avoid an agonizing choice: Who gets care and who goes home

Via The Washington Post: As coronavirus soars, hospitals hope to avoid an agonizing choice: Who gets care and who goes home. Excerpt:

The coronavirus pandemic is rolling across America like a great crimson wave.  

In Illinois, the rate of new infections is so high that a group of doctors sent an urgent letter to the governor. “We’re having to almost decide who gets treatment and who doesn’t,” said one of its leaders.

In Ohio, the rapid spread of the virus has pushed the state health-care system to the brink. Expressing deep concern, Gov. Mike DeWine (R) vowed to enforce his statewide mask mandate and issued new restrictions on social gatherings. “We can’t surrender to this virus. We can’t let it run wild,” he said. 

And in Iowa, where a record number of new infections in a day coincided with a record number of deaths, the White House coronavirus task force issued a dire warning about “the unyielding covid spread” throughout the state. 

The number of new daily coronavirus cases in the United States jumped from 104,000 a week earlier to more than 145,000 on Wednesday, an all-time high. Nearly every metric is trending in the wrong direction, prompting states to add new restrictions and hospitals to prepare for a potentially dark future.  

“We’re at a fairly critical juncture," said Dave Dillon, a spokesman for the Missouri Hospital Association. The day will soon come when hospital staffing will fall below standards that are normally required, he said. 

“While we have beds, those beds are only as good as the staff that you can place around them. There are hospitals at this point that have, at a given time, been unable to do admits,” Dillon said.

Nursing homes still see dangerously long waits for Covid-19 test results

Via CNN.com, a report by Rachana Pradhan, Jordan Rau, and Lauren Weber of Kaiser Health News: Nursing homes still see dangerously long waits for Covid-19 test results. Excerpt:

(KHN)Nursing homes are still taking days to get back Covid-19 test results as many shun the Trump administration's central strategy to limit the spread of the virus among old and sick Americans. 

In late summer, federal officials began distributing to nursing homes millions of point-of-care antigen tests, which can be given on-site and report the presence or absence of the virus within minutes. By January, the Department of Health and Human Services is slated to send roughly 23 million rapid tests. 

But as of Oct. 25, 38% of the nation's roughly 15,000 nursing homes have yet to use a point-of-care test, a KHN analysis of nursing home records shows. 

The numbers suggest a basic disagreement among the Trump administration, state health officials and nursing home administrators over the best way to test this population and how to strike the right balance between speed and accuracy. Many nursing homes still primarily send samples out to laboratories, using a type of test that's considered more reliable but can take days to deliver results. 

As a result, in 29% of the approximately 13,000 facilities that provided their testing speed to the government, results for residents took an average of three days or more, the analysis found. Just 17% of nursing homes reported their average turnaround time was less than a day, and the remainder tended to get results in one or two days. Wait times for test results of staff members were similar. 

Those lags could have devastating consequences, because even one undetected infection can quietly but rapidly trigger a broad outbreak. It's especially concerning as winter sets in and the pandemic notches daily records of infections. 

In the meantime, the coronavirus continues its march through institutions. Nursing homes have reported more than 262,000 infections and 59,000 deaths since the government began collecting the information in May. Even without estimating how many residents died from Covid-19 before then, reported nursing home deaths amount to more than a quarter of all Covid-19 fatalities in the U.S. so far. 

During the week ending Oct. 25, the most recent period for which data is available, a third of skilled nursing facilities reported a new suspected or confirmed coronavirus infection of a resident or staff member.

Joe Biden's plan to combat COVID-19

Via buildbackbetter.com: Combating COVID-19. It's a sign of our times that these measures, which are self-evident, seem like seismic changes. Excerpt:

The American people deserve an urgent, robust, and professional response to the growing public health and economic crisis caused by the coronavirus (COVID-19) outbreak. President-elect Biden believes that the federal government must act swiftly and aggressively to help protect and support our families, small businesses, first responders, and caregivers essential to help us face this challenge, those who are most vulnerable to health and economic impacts, and our broader communities – not to blame others or bail out corporations. 

The Biden-Harris administration will always: 

• Listen to science 

• Ensure public health decisions are informed by public health professionals 

• Promote trust, transparency, common purpose, and accountability in our government 

President-elect Biden and Vice President-elect Harris have a seven-point plan to beat COVID-19.

Ensure all Americans have access to regular, reliable, and free testing.  

• Double the number of drive-through testing sites. 

• Invest in next-generation testing, including at home tests and instant tests, so we can scale up our testing capacity by orders of magnitude. 

• Stand up a Pandemic Testing Board like Roosevelt’s War Production Board. It’s how we produced tanks, planes, uniforms, and supplies in record time, and it’s how we will produce and distribute tens of millions of tests. 

• Establish a U.S. Public Health Jobs Corps to mobilize at least 100,000 Americans across the country with support from trusted local organizations in communities most at risk to perform culturally competent approaches to contact tracing and protecting at-risk populations. 

Fix personal protective equipment (PPE) problems for good. 

President-elect Joe Biden is taking responsibility and giving states, cities, tribes, and territories the critical supplies they need. 

• Fully use the Defense Production Act to ramp up production of masks, face shields, and other PPE so that the national supply of personal protective equipment exceeds demand and our stores and stockpiles — especially in hard-hit areas that serve disproportionately vulnerable populations — are fully replenished. 

• Build immediately toward a future, flexible American-sourced and manufactured capability to ensure we are not dependent on other countries in a crisis. 

Provide clear, consistent, evidence-based guidance for how communities should navigate the pandemic – and the resources for schools, small businesses, and families to make it through.

Stockholm pauses home COVID-19 testing as system overwhelmed

Via Reuters: Stockholm pauses home COVID-19 testing as system overwhelmed. Excerpt:

STOCKHOLM (Reuters) - Stockholm has paused home COVID-19 testing for four days after surging demand left 16,000 people waiting for tests for active infections in Sweden’s biggest city, overwhelming the system, regional authorities said on Sunday.  

The system whereby residents have been able to apply online for delivery and pickup of tests which they themselves administer, has been popular and in place since the Nordic country ramped up testing during the summer. 

“The number of people ordering home tests has increased so sharply that a queue has formed that now needs to be worked off,” the region of Stockholm said in a statement explaining its decision. 

A rise in new cases in Sweden after a summer lull has gained momentum with fresh daily records in recent weeks though the resurgence of the disease has come later and so far not hit the kind of peaks recorded in countries such as Belgium.

COVID-19: State mask stockpiling orders are hurting nursing homes, small clinics

Via NBC News, a Kaiser Health News report by Lauren Weber: State mask stockpiling orders are hurting nursing homes, small clinics. Excerpt:

Nursing homes, small physician offices and rural clinics are being left behind in the rush for N95 masks and other protective gear, exposing some of the country’s most vulnerable populations and their caregivers to COVID-19 while larger, wealthier health care facilities build equipment stockpiles.  

Take Rhonda Bergeron, who owns three health clinics in rural southern Louisiana. She said she’s been desperate for personal protective equipment since her clinics became COVID testing sites. Her plight didn’t impress national suppliers puzzled by her lack of buying history when she asked for 500 gowns. And one supply company allows her only one box of 200 gloves per 30 days for her three clinics. Right now, she doesn’t have any large gloves on-site. 

"So in the midst of the whole world shutting down, you can’t get PPE to cover your own employees,” she said. “They’re refilling stuff to larger corporations when realistically we are truly the front line here.”  

More than eight months into the pandemic, health care leaders are again calling for a coordinated national strategy to distribute personal protective equipment to protect health care workers and their patients as a new wave of disease wells up across most of the country. The demand for such gear, especially in hot spots, can be more than 10 times the pre-pandemic levels. While supply chains have adjusted, and the availability of PPE has improved dramatically since the mayhem of the spring, limited factories and quantities of raw materials still constrain supply amid the ongoing high demand.  

In this free-market scramble, larger hospitals and other providers are stockpiling what they can even while others struggle. Some facilities are scooping up supplies to prepare for a feared wave of COVID-19 hospitalizations; others are following new stockpiling laws and orders in states such as California, New York and Connecticut.  

“They’re putting additional strain on what’s still a fragile hospital supply chain,” said Soumi Saha, vice president of advocacy for Premier Inc., a group-purchasing organization that procures supplies for over 4,000 U.S. hospitals and health systems of various sizes. “We want available product to go to front-line health care workers and not go into a warehouse right now.”

Over a quarter of nursing homes in the country reported a shortage of items such as N95 masks, gloves or gowns from Aug. 24 through Sept. 20. A recent survey from the American Medical Association found 36 percent of physician offices reported having a difficult time securing PPE. And about 90 percent of nonprofit Get Us PPE’s recent requests for help with protective gear have come from non-hospital facilities, such as nursing homes, group homes and homeless shelters.

Hospital beds, oxygen run short in Russia's regions as COVID-19 cases surge

Via Reuters: Hospital beds, oxygen run short in Russia's regions as COVID-19 cases surge. Excerpt:

MOSCOW (Reuters) - Ekaterina Saraichenko, who lives in Saratov, posted a video on Russian social media this month, describing her mother’s ordeal with COVID-19 as they waited for an ambulance she said was taking too long. It came in the end, but her mother died on the way to hospital. 

The situation was more extreme in Omsk, Siberia, where two patients in serious condition were held for 10 hours in an ambulance outside a hospital, waiting for beds to become free. Alexander Burkov, the regional governor, said the incident was “beyond human comprehension” and demanded an investigation.  

Doctors, patients and officials in several Russian regions have been documenting a healthcare system pushed to its limits as coronavirus cases surge and hospital admission turns into a bleak battleground. 

The Kremlin says it recognises that some places are facing crises, but federal resources are being deployed “at lightning speed”. 

Kremlin spokesman Dmitry Peskov this week cited a case in the Kurgan region, where doctors had appealed to President Vladimir Putin for help. Russia’s defence ministry sent its doctors there in response, he said.  

Other areas say they haven’t got the help they need.  

“Your job is to admit my patient,” an ambulance worker in Kemerovo tells hospital staff in one video sent to Reuters by a member of the ambulance team. 

“What are we supposed to do with our patients then?” staff reply. There are just under 4,000 beds for coronavirus patients in the Kemerovo region, according to local health ministry data, and 86% are currently full.  

“The patient is on oxygen support,” a medical worker can be heard saying in the background of the video. “By the time you reach a decision...” The voice trails off.  

Tatiana Golikova, Russia’s deputy prime minister, said on Wednesday that the situation with hospital admission had become “critical” in 16 Russian regions, with coronavirus hospitals at over 90% capacity.