H5N1

COVID-19 outbreak at St. Paul's Hospital spreads to 3 units

Via CBC News: COVID-19 outbreak at St. Paul's Hospital spreads to 3 units.

A COVID-19 outbreak at St. Paul's Hospital in Vancouver has spread to three units.  

Last week, officials declared an outbreak in Unit 5A of the heart centre. Now, outbreaks have also been reported in unit 5B and the cardiac surgery intensive care unit (CSICU), according to an internal memo from Providence Health Care obtained by CBC News.  

The units are all part of the heart centre, where the hospital provides treatment including surgery, transplants and rehabilitation, according to the St. Paul's website. 

All three units are closed to new admissions and transfers, said Providence Health Care.

Canada: Hospitals in COVID-19 hot spots warn situation is about to become even more dire

As 2020 concludes, Canada's healthcare system is feeling the strain. Via The Globe and Mail, a report by The Canadian Press: Hospitals in COVID-19 hot spots warn situation is about to become even more dire. Excerpt:

Hospitalizations from COVID-19 are increasing sharply in several provinces, pushing health care facilities beyond capacity even in places that have had recent success in bringing down infections. 

There were more patients in Canada in intensive care this week than at any other point in the pandemic, according to data compiled by The Globe and Mail, and experts are expecting hospitalizations to continue increasing well into the new year. 

Ontario set a single-day record for both COVID-19 cases and number of people hospitalized on Thursday. Hospitalizations in Quebec have doubled in a little more than a month. In Alberta, which has the highest hospitalization rates in the country, more people were admitted but the province did not provide specifics because of the holidays. Hospitals in Saskatchewan are at or above capacity as the province’s record-setting infections from two weeks ago translate to more emergency room visits. 

“It seems like every day we reach a new kind of threshold that maybe a few months ago we thought was impossible,” said Anthony Dale, president and chief executive officer of the Ontario Hospital Association. “This pandemic is accelerating. We’re not peaking, we’re not at the downward slope, so these numbers are going to get a heck of a lot worse, in all probability.”  

Provinces hardest hit by COVID-19 in the second wave have had to scramble to increase bed capacity and cancel surgeries and other procedures to keep up with the workload. Those same hospitals are also now taking on a significant role in administering vaccines, particularly the one from Pfizer-BioNTech that cannot be easily stored and transported. 

Across the country, there were more than 4,000 people in hospital with COVID-19 as of Wednesday, including 769 in intensive-care units, according to The Globe’s data. That is the highest number of COVID-19 ICU admissions recorded.  

In Ontario, one in five patients in intensive care has COVID-19. In some hospitals, such as Credit Valley Hospital in Mississauga, more than half of the ICU beds hold COVID-19 patients.  

“This comes at a huge cost of cancelled elective surgery. ... Elective includes cancer care, cardiac care, even organ transplants,” Mr. Dale said. 

Staffing has also been a challenge for some hospitals, where Mr. Dale said vacancy rates are likely at a “historic high” at as much as 10 per cent. Hospitals are seeing high levels of early retirement in the second wave, and younger health care workers haven’t always been able to replace retiring colleagues.  

Some patients in overcrowded hospitals are being treated in “unconventional spaces” such as sun rooms, said Gerald Evans, an infectious-diseases physician at Kingston General Hospital. He added there is not always enough staff to properly care for the extra patients. 

“Instead of it being three or four patients for one nurse, now a nurse may be taking care of eight or nine patients,” said Dr. Evans. “It doesn’t take a lot of science to figure out that could be really dangerous, especially if one or two of those patients is very ill and requires a lot of attention.”

'Just unimaginable': Latin America's Covid-19 crisis heads from bad to worse

Via The Guardian: 'Just unimaginable': Latin America's Covid crisis heads from bad to worse. Excerpt:

As the coronavirus epidemic hammered Rio earlier this year, frontline doctor Clarisse Bressan recalls fleeing to her hospital’s toilet to shed surreptitious tears of exhaustion and fear. 

“I lost a colleague who was my resident, someone younger than me, a newlywed,” said the 43-year-old tropical medicine specialist. “It’s a disaster – just unimaginable, a nightmare.”  

Ten months and nearly 180,000 Brazilian deaths later, Bressan said she felt anger as she watched cities reopen, bars, restaurants and gyms pack, and her intensive care unit once again fill with wheezing, panicked patients unsure if they would survive. 

“I feel like a schmuck, a total schmuck. For Pete’s sake! It’s like I’m the only one who’s worried,” complained the doctor from Rio’s Fiocruz coronavirus hospital which opened its doors in May.

The Brazilian city is far from the only part of Latin America – where more than 460,000 lives have already been lost – facing what many call a second Covid wave.  

In Mexico, which with over 110,000 fatalities has the world’s fourth highest death toll, the World Health Organization (WHO) last week warned of a “very worrisome” situation after the number of weekly deaths doubled between mid-October and late November. 

“Mexico is in bad shape,” the WHO director-general, Tedros Adhanom Ghebreyesus, declared.  

Issac Chávez Díaz, an anaesthetist from the Universidad Nacional Autónoma de México, said he feared the relaxation of containment measures meant the coming peak could be even higher than the first one in July. 

“We’re probably going to see the worst in December and January,” Chávez Díaz predicted. 

In Paraguay, which won early plaudits for its proactive pandemic response, authorities this week tightened restrictions after a jump in infections. Following an encouraging drop in late October, recent weeks have seen daily figures return to almost their highest point since the pandemic began, topping 1,000 daily infections for the first time since 1 October.  

“There’s been an excessive increase in cases,” said Fabián Ojeda, the municipal chief of staff in the Paraguayan city of Pilar which declared a 15-day health emergency on 1 December. “Our local health system wasn’t reinforced like it was in other places – it’s not far from collapse.”  

Last week Chile’s health minister, Enrique Paris, admitted he was also bracing for a possible new wave of infections in January that could hit “with much greater force than the first”.

Joint statement on BC’s COVID-19 response, latest updates

Via BC Government News: Joint statement on B.C.’s COVID-19 response, latest updates. Excerpt:

Dr. Bonnie Henry, B.C.’s provincial health officer, and Adrian Dix, Minister of Health, have issued the following joint statement regarding updates on the novel coronavirus (COVID-19) response in British Columbia:  

“Today, we are reporting 941 new cases of COVID-19 in the last 24 hours, for a total of 28,348 cases in British Columbia.  

“There are 7,732 active cases of COVID-19 in the province. There are 284 individuals currently hospitalized with COVID-19, 61 of whom are in intensive care. The remaining people are recovering at home in self-isolation. 

“Currently, 10,283 people are under active public health monitoring as a result of identified exposure to known cases and 19,605 people who tested positive have recovered. 

“Since we last reported, we have had 174 new cases of COVID-19 in the Vancouver Coastal Health region, 678 in the Fraser Health region, 11 in the Island Health region, 49 in the Interior Health region, 29 in the Northern Health region and no new cases of people who reside outside of Canada.  

“There have been 10 new COVID-19 related deaths, for a total of 358 deaths in British Columbia. We offer our condolences to everyone who has lost their loved ones during the COVID-19 pandemic.  

“We have two new health-care facility outbreaks at Valley Haven Care Home and Little Mountain Place. The outbreak at Fraserview Intermediate Care Lodge has been declared over. There have been no new community outbreaks. 

“B.C.’s health-care workers are in our labs and hospitals, at our testing sites and in our communities. These people are our health-care system. They are there to support all of us without question and without pause, and we need to show that same support to them by all of us doing our part. 

“We need to slow the spread of COVID-19 in our province and that needs to happen now. That is why we have paused all gatherings, events and indoor group fitness activities. 

“That is also why everyone, young and old, needs to pause their social interactions and increase their layers of protection and stay within their local communities as much as possible.  

“We need to ease the pressure to allow us to get over this next hurdle, and importantly, give us the ability to once again enjoy those things that are important to all of us. 

“Let’s remember that every case of COVID-19 is a person who requires support and care, who may become severely ill and need to be in hospital, and whose family will experience the stress, emotional burden and for some, the tragedy, that has come with this virus. 

“Let’s step up our efforts to protect our families, friends and neighbours. The time to do that is now.”

COVID-19 deaths among US clinicians

Via JAMA Network: COVID-19 Deaths Among US Clinicians.

More than 100 000 US health care personnel have contracted coronavirus disease 2019 (COVID-19) since February and at least 641 have died, according to a report by health officials from the CDC and several states. 

Based on data reported to the CDC between February 12 and July 16, the report reflects a 10-fold increase in cases among personnel at health care facilities since the last CDC analysis in April. At that time, nearly 10 000 COVID-19 cases and 27 deaths had been reported. The authors note that the current total likely underestimates the true number of cases among health care personnel because occupational status was available for fewer than one-quarter who had COVID-19. 

Among nearly 7000 health care personnel with COVID-19 for whom workplace data were available, two-thirds worked in nursing homes or residential care facilities. About one-third of almost 6000 cases with their occupation reported occurred among health care support workers—nursing assistants, medical assistants, and other providers or aides. Nurses accounted for 29% and physicians for about 3% of cases. Among nonclinical staff, 581 administrative staff and 330 environmental health workers contracted the disease. 

Health worker deaths from COVID-19 were most common among men, those aged 65 years or older, and Asian or Black adults. Ninety-two percent of those who died had an underlying health condition compared with 41% of workers who survived. More than half of those who died had cardiovascular disease or diabetes; one-third had both.  

The authors recommended ensuring universal mask use in health care settings, screening for illness before entering the workplace, granting nonpunitive sick leave policies, and recognizing the social inequities that put some workers at higher risk in the workplace and at home. 

“Ensuring adequate allocation of PPE [personal protective equipment] to all [health care personnel] in the workplace is one important approach to mitigating systemic inequalities in COVID-19 risk,” the authors wrote.

North Dakota Nurses Association against governor’s decision to allow COVID-positive nurses to keep working

Via KFGO: North Dakota Nurses Association against governor’s decision to allow COVID-positive nurses to keep working. 

BISMARCK, N.D. (KFGO) – The North Dakota Nurses Association says it does not support the decision by Governor Burgum to allow nurses who are asymptomatic, COVID-19 positive to continue to work in COVID-19 units at hospitals and nursing homes. Burgum says the decision was made to mitigate staffing shortages as the pandemic outbreak continues to spike and hospitals are reaching their limits.  

The Nurses Association says guidance outlined by the CDC about providing care under these circumstances is the decision of the COVID-19 positive nurse and their willingness to work. If a nurse believes they are not well enough to provide safe patient care and chooses not to work under these circumstances, employers should not retaliate against the nurse for making this decision.  

NDNA says all other measures to reduce the demand on the health care system and address staffing shortages should be used before implementing this particular strategy. This should include effective and scientifically proven preventative measures such as mandating mask-wearing in public places, maintaining physical distancing, and exercising good hand hygiene.  

Burgum said hospital administrators asked for the extraordinary action to be taken and interim State Health Officer Dirk Wilke amended an order to allow the new measure to take effect.

Osterholm: 200,000 cases a day? 'It's going to happen'

Via The Washington Post: With coronavirus cases spiking nationwide, all signs point to a harrowing autumn. Excerpt:

This is the dismal reality America faces as the coronavirus continues its unchecked surge around the country: In North Dakota, health-care workers with asymptomatic cases of the coronavirus will be allowed to keep working as the number of infected patients outstrips the staff members needed to care for them, the governor said this week.

In multiple states, hospital leaders warned that the current spike is straining resources and sidelining the very staffers needed to face growing numbers of sick people. From Maryland to Iowa, local officials have pleaded for tighter restrictions that might help slow the virus’s accelerating spread.  

As a worrisome summer gives way to a harrowing fall, the nation’s surge of coronavirus cases shows no signs of easing. With little help and scant guidance from a Washington stuck in political limbo, some states and localities rushed to put in place new restrictions aimed at slowing the virus’s spread. Still, almost every metric appeared headed in an ominous direction. 

On Tuesday, the country hit another one-day record, logging more than 135,000 new coronavirus cases, along with 1,403 additional deaths. At least five states, including Missouri and Wisconsin, set single-day highs for fatalities. At least five more, including Illinois and Pennsylvania, set single-day highs for new cases. Almost nowhere in the country are caseloads actually subsiding. 

“We’re now seeing widespread community transmission,” said Maryland Gov. Larry Hogan (R). “More people are getting infected with the virus, more people are being hospitalized and going into intensive care, and more people are dying.”  

He announced plans to return the state to restrictions that haven’t been in place for months, including a 50 percent capacity limit on restaurants and a new health advisory urging a 25-person cap on indoor gatherings. Hogan also issued an updated travel advisory, asking residents to avoid nonessential travel to 35 states with high infection rates. 

Nearly 62,000 infected Americans currently lie in hospital beds — a number the nation has not experienced since April. More than a dozen states have hit new highs for hospitalizations this month, with many setting records again on Tuesday, according to figures compiled by The Washington Post. 

“I’m not sure it disappoints me as much as it scares the hell out of me,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “This is like one huge coronavirus forest fire, and I don’t think it’s going to spare much human wood out there unless we change our behavior.” 

More likely, he said, the grim present will grow only darker as the fall wears on. Despite positive news this week, no vaccine will arrive in time to quickly alter the current trajectory. In many places, bars, gyms and restaurants remain open. Weddings and funerals continue. People fighting pandemic fatigue or who are dismissive of the risks are gathering with friends and family, and doing so more often indoors as cold weather arrives.  

Osterholm believes the United States will soon see new confirmed cases climb above 200,000 a day — a figure that would have seemed unfathomable when daily infections peaked at roughly 30,000 new cases a day last spring. 

“I don’t see anything changing this right now. The behaviors are not changing,” he said. “The deaths will go up precipitously over the course of the next month. It’s going to happen.”

With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work

Via the Grand Forks Herald: With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work. Excerpt:

BISMARCK — North Dakota's hospitals have reached their limit, and the coming weeks could push them past their capabilities, Gov. Doug Burgum said at a news conference on Monday, Nov. 9. 

Due to a major shortage of health care staffing, the state's hospitals have a severe lack of available beds. Rising COVID-19 hospitalizations and high noncoronavirus admissions, some resulting from residents who deferred health care earlier in the pandemic, have caused the crunch on medical centers.  

Burgum said hospitals are implementing their "surge" plans, and some will be voluntarily stopping elective surgeries to free up staff. He added that the state will coordinate with hospitals to move nurses to medical centers in most dire need of staff. 

In an attempt to alleviate some of the staffing concerns, Burgum announced that interim State Health Officer Dirk Wilke has amended an order that will allow health care workers with asymptomatic cases of COVID-19 to continue working in COVID-19 units at hospitals and nursing homes. 

The move aligns with "crisis" guidelines from the Centers for Disease Control and Prevention. Since only patients with COVID-19 could receive care from doctors and nurses with the virus, Burgum said he believes there will be little risk of more spread. He added that health care workers in COVID-19 units already wear protective gear to prevent them from contracting the virus.  

The Republican governor said health care providers asked the state to take the extraordinary step, adding that "apparently some (providers) had the ability to do this in other states." 

Burgum spokesman Mike Nowatzki said he didn't have information on other states that have allowed nurses with COVID-19 to return to work and referred Forum News Service to the state Health Department and hospitals who asked for the measure.  

Department of Health spokeswoman Nicole Peske and Sanford Bismarck spokesman Jon Berg both said they were unaware of any other states that have taken the extreme step. 

Scattered news reports from around the country suggest that some nursing homes have allowed workers with asymptomatic cases of COVID-19 to stay on the job, but Forum News Service could find no evidence of a defined policy exception put in place by a state government.   

Burgum also announced that the state would be sending out new-age rapid tests to hospitals, nursing homes, schools and colleges. He said the tests that can produce results in as little as 15 minutes could free up health care workers who might have been relegated to the sidelines while waiting for test results. 

The governor added that the state is looking to hire emergency medical technicians and paramedics to run COVID-19 testing operations, which would allow nurses who are currently administering tests to begin working in hospitals.

COVID-19 in BC: 589 new cases, 2 new deaths

Via BC Government News: Joint statement on B.C.’s COVID-19 response, latest updates. Except:

Dr. Bonnie Henry, B.C.’s provincial health officer, and Adrian Dix, Minister of Health, have issued the following joint statement regarding updates on the novel coronavirus (COVID-19) response in British Columbia:  

“Today, we are reporting 589 new cases, including five epi-linked cases, for a total of 17,149 cases in British Columbia.  

“There are 3,741 active cases of COVID-19 in the province, 7,887 people who are under active public health monitoring as a result of identified exposure to known cases and 13,035 people who tested positive have recovered.  

“Currently, 104 individuals are hospitalized with COVID-19, 28 of whom are in intensive care. The remaining people with COVID-19 are recovering at home in self-isolation.  

“There have been 146 new cases of COVID-19 in the Vancouver Coastal Health region, 402 in the Fraser Health region, five in the Island Health region, 24 in the Interior Health region, 12 in the Northern Health region and no new cases of people who reside outside of Canada.  

“There have been two new COVID-19 related deaths, for a total of 275 deaths in British Columbia. We offer our condolences to everyone who has lost their loved ones during the COVID-19 pandemic.  

“There have been six new health-care facility outbreaks at Suncreek Village, Fort Langley Seniors Community, Northcrest Care Centre, Fellburn Care Center – PATH unit, Ridge Meadows Hospital and Langley Memorial Hospital. The outbreak at Fair Haven Homes Burnaby Lodge has been declared over. In total, 31 long-term care or assisted-living facilities and four acute-care facilities have active outbreaks. 

“There has been one new community outbreak at the Royal Inland Hospital construction site. There continue to be exposure events around the province. Public alerts and notifications are posted on the BC Centre for Disease Control’s (BCCDC) website and on all health authorities’ websites."

Czechs plan first field hospital as COVID-19 infections soar

Via Reuters: Czechs plan first field hospital as COVID-19 infections soar. Excerpt:

PRAGUE (Reuters) - The Czech Republic will start building capacity for COVID-19 patients outside of hospitals, officials said on Thursday, as the country grapples with the fastest rate of infections in Europe, putting healthcare under severe strain.

Coronavirus cases have nearly doubled in October alone to a total so far of 139,290 since the pandemic erupted in March. The Health Ministry reported 9,544 new COVID-19 cases on Wednesday, its highest one-day tally so far.  

The central European country, with a population of 10.7 million, is recording the continent’s fastest per capita rise in infections and deaths from the respiratory disease, forcing hospitals to scramble to free up space.  

The number of patients needing care has more than doubled since Oct. 4 to a current count of 2,678, of which a fifth need intensive care. COVID-related deaths have climbed to 1,172, up 75% this month. 

The head of the Czech Medical Chamber pleaded on Thursday with doctors who have left to work abroad to return home to help as the number of infections among healthcare workers rises. 

The government was also drawing up plans for makeshift hospitals. Interior Minister Jan Hamacek told CTK news agency the army would start building an area for 500 hospital beds at the Letnany fairground in Prague from Saturday.