Twenty-one Kaiser Permanente hospitals in Northern California are suspending elective, non-urgent procedures through Jan. 4 as they continue to face a surge in COVID-19 hospitalizations, according to The Mercury News.
The Oakland, Calif.-based system announced the suspension Dec. 26, days after Chairman and CEO Greg Adams said during a news conference, “We simply will not be able to keep up if the COVID surge continues to increase. We’re at or near capacity everywhere.”
California reported a record-high 20,059 current COVID-19 hospitalizations Dec. 27, a 13 percent increase from one week prior, according to The COVID Tracking Project.
Find a running list of other health systems that have adjusted their elective surgery timelines, organized by state, here.
With bubble-enclosed Santas and Zoom-enhanced family gatherings, much of the United States played it safe over Christmas while the coronavirus rampaged across the country.
But a significant number of Americans traveled, and uncounted gatherings took place, as they will over the New Year holiday.
And that, according to the nation’s top infectious disease expert, Anthony S. Fauci, could mean new spikes in cases, on top of the existing surge.
“We very well might see a post-seasonal — in the sense of Christmas, New Year’s — surge,” Dr. Fauci said on CNN’s “State of the Union.”
“We’re really at a very critical point,” he said. “If you put more pressure on the system by what might be a post-seasonal surge because of the traveling and the likely congregating of people for, you know, the good warm purposes of being together for the holidays, it’s very tough for people to not do that.”
On “Fox News Sunday,” Adm. Brett P. Giroir, the administration’s testing coordinator, noted that Thanksgiving travel did not lead to an increase of cases in all places, which suggested that many people heeded recommendations to wear masks and limit the size of gatherings.
“It really depends on what the travelers do when they get where they’re going,” Admiral Giroir said. “We know the actual physical act of traveling in airplanes, for example, can be quite safe because of the air purification systems. What we really worry about is the mingling of different bubbles once you get to your destination.”
Still, U.S. case numbers are about as high as they have ever been. Total infections surpassed 19 million on Saturday, meaning that at least 1 in 17 people have contracted the virus over the course of the pandemic. And the virus has killed more than 332,000 people — one in every thousand in the country.
Two of the year’s worst days for deaths have been during the past week. A number of states set death records on Dec. 22 or Dec. 23, including Alabama, Wisconsin, Arizona and West Virginia, according to The Times’s data.
And hospitalizations are hovering at a pandemic height of about 120,000, according to the Covid Tracking Project.
Against that backdrop, millions of people in the United States have been traveling, though many fewer than usual.
About 3.8 million people passed through Transportation Safety Administration travel checkpoints between Dec. 23 and Dec. 26, compared with 9.5 million on those days last year. Only a quarter of the number who flew on the day after Christmas last year did so on Friday, and Christmas Eve travel was down by one-third from 2019.
And AAA’s forecast that more than 81 million Americans would travel by car for the holiday period, from Dec. 23 to Jan. 3, which would be about one-third fewer than last year.
For now, the U.S. is no longer seeing overall explosive growth, although California’s worsening outbreak has canceled out progress in other parts of the country. The state has added more than 300,000 cases in the seven-day period ending Dec. 22. And six Southern states have seen sustained case increases in the last week: Tennessee, Alabama, Georgia, South Carolina, Florida and Texas.
Holiday reporting anomalies may obscure any post-Christmas spike until the second week of January. Testing was expected to decrease around Christmas and New Year’s, and many states said they would not report data on certain days.
On Christmas Day, numbers for new infections, 91,922, and deaths, 1,129, were significantly lower than the seven-day averages. But on Saturday, new infections jumped past 225,800 new cases and deaths rose past 1,640, an expected increase over Friday as some states reported numbers for two days post-Christmas.
Two hospital systems in Washington state, CHI Franciscan and Virginia Mason Health System, have signed a definitive agreement to combine through a joint operating company that would be a subsidiary of Chicago-based CommonSpirit Health.
The two organizations inked the agreement Dec. 21 and made it public Dec. 23. The parties signed a letter of intent to explore a combination in July.
The combination would create a nine-hospital system. Two of the hospitals would be from Seattle-based Virginia Mason and seven would come from Tacoma, Wash.-based CHI Franciscan, which is part of CommonSpirit Health.
News of the planned merger prompted Virginia Mason’s 256-bed hospital in Yakima, Wash., to part ways with the health system before it combined with CHI Franciscan. The board of Virginia Mason Memorial said it wants to become an “independent, local healthcare system” instead of joining a larger system.
The two health systems said they expect the transaction to be finalized around Jan. 1, 2021, pending regulatory approval.
If you decided to read the names of every American who is known to have died of covid-19, the disease caused by the novel coronavirus, at a rate of one per second starting at 5 p.m. Tuesday, you would not finish until a bit after 10 a.m. Saturday. Except, of course, that’s only including the deaths known as of writing; by then, we can expect 8,000 more deaths, pushing the recitation past noon.
Preliminary federal figures indicate that more than 3.2 million Americans will die over the course of 2020, the highest figure on record. It’s just a bit shy of 1 percent of the total population as of July 1, and about 1 in 10 of those deaths will be a result of covid-19.
That’s the primary context in which any discussion about how the pandemic has affected the United States should occur. Secondarily, we should consider how the number of new coronavirus infections correlates to that figure. At the moment, nearly two people are dying of covid-19 each minute, a function of a massive surge in the number of new infections that began in mid-September.
The surge and the deaths are inextricable. For months, the number of new deaths on any given day has been about 1.8 percent of new cases several weeks prior. Allowing the virus to spread wildly means allowing more Americans to die.
In an opinion piece for the Wall Street Journal, one of the architects of the decision to let the virus spread, former White House adviser Scott Atlas, blames the scale of the pandemic on the media. It’s the “politicization” of the virus, he argues, that has led to the dire outcomes we see, and that’s largely due to “media distortion.”
It’s hard to overstate both how dishonest Atlas’s argument is and how ironic it is that he should point the blame elsewhere. He makes false assertions about where states have been successful and suggests that mitigation efforts that weren’t 100 percent effective shouldn’t be used. He boasts that the effort to combat the spread of the virus was left to states — which is precisely the criticism aimed at President Trump’s administration. When Trump (and Atlas) undercut efforts to slow the spread of the virus, Trump supporters — including state leaders — picked up on that approach, contributing to the current spread.
Trump and Atlas shared the view that allowing the virus to spread was beneficial, as doing so increased population immunity. That another result would be surging deaths was met with a shrug or silence.
At the end of March, Trump offered one of his only forceful endorsements of slowing the spread of the virus. Having been presented with research indicating that as many as 2.2 million Americans would die of the virus if no effort was taken to limit its spread, he endorsed stay-at-home measures aimed at preventing new infections. His team suggested that implementing such mitigation efforts would keep the death toll under 240,000, with the added benefit of preventing hospitals from being overwhelmed.
This was one of Atlas’s arguments, too: Let the virus spread but backstop hospitals to prevent them from being flooded. The government accomplished the first goal, at least.
So we’ve raced past the 240,000-death mark, passing 300,000 deaths this month.
It’s important to remember, too, how often Trump himself promised this wasn’t going to be the country’s future. As the virus was spreading without detection — in part thanks to the Centers for Disease Control and Prevention’s failure to develop a working test — Trump repeatedly downplayed how bad things would get. There were thousands of deaths around the world, he noted in early March, but less than a dozen in the United States. He compared the coronavirus to the seasonal flu and to the H1N1 pandemic in 2009, an event that had the politically useful characteristic of having occurred while Trump’s eventual opponent in the presidential election was vice president.
Over and over, Trump predicted a high-water mark for coronavirus deaths. Over and over, the country surged past his predictions. As the election approached, he began simply comparing the death toll to that 2.2-million-death figure he’d first introduced in March.
The United States will not reach 2.2 million coronavirus deaths over the course of the pandemic. We probably won’t reach 500,000, assuming that the national vaccination effort — the far-safer way to spread immunity — progresses without significant problems.
Right now, though, thousands of people are dying every day and tens of thousands more are on an inevitable path to the same result. More robust efforts to prevent new infections could have reduced these numbers, as robust efforts did elsewhere (contrary to Atlas’s theories). A consistent, forceful message from a president whose base is devoutly supportive of him would unquestionably have reshaped the virus’s spread. Had Trump embraced the expertise of government virologists, instead of a radiologist he saw on Fox News, it would have perhaps pushed the curve depicting the number of deaths each day back down instead of driving it higher.
This was the deadliest year in American history. Perhaps it would inevitably have been, given the size of the population (particularly the elderly population) and the emergence of covid-19. But it unquestionably didn’t have to be as deadly as it was.
In late November, Cliff Willmeng’s wife handed him a sealed envelope at their Minneapolis home “with some trepidation,” he recalled. He looked at the sender printed on the front: “Minnesota Board of Nursing.” Willmeng, a registered nurse, openedtheletter and read that the board was investigating his conduct as a nurse at United Hospital in St. Paul, from which he’d been fired in May. Clearly his license was at stake.
Willmeng was disappointed, but not surprised. He believes the review is due to his standing up for his own safety and that of other nurses, and for filing a lawsuit and union grievance against United’s parent company, Allina Health, after his termination.
He also thinks the investigation, like his firing, has been orchestrated to scare other healthcare workers away from reporting safety violations and concerns as the pandemic rages, and to make an example out of the former union steward.
The investigation is being led by a former Allina executive: “It feels meant to intimidate me,” he said.
Taking a Stand for Safety
Willmeng is a 13-year nursing veteran, husband, and father, who began working at United in October 2019.
When the pandemic hit late last winter, managers instructed nurses to use and reuse their own scrubs rather than hospital-issued scrubs. They were asked to launder their scrubs themselves at home.
Willmeng and others worried about bringing the virus home and pressed for the hospital scrubs. These scrubs were available, he said, and healthcare workers were permitted to wear hospital gear at Abbott Northwestern, another Allina hospital in Minneapolis.
In addition, while United managers told staff their laundering co-op could not keep up with demand for all the scrubs, the co-op denied that assertion, said Brittany Livaccari, RN, an ER nurse and union steward at United.
Willmeng addressed his concerns with management, filed state OSHA complaints, and enlisted the Minnesota Nurses Association (MNA). “He was taking action 100% to protect himself and to protect his patients,” Livaccari said.
But management did not change its policy, which was devised before the pandemic, and pointed to early-pandemic CDC and Minnesota Department of Health (MDH) guidelines — even when Willmeng shared emerging reports suggesting the policy was jeopardizing safety.
“It did feel like a pissing match,” Livaccari said. “We didn’t feel like we were being protected. … We weren’t being valued.”
Managers repeatedly wrote up Willmeng and colleagues who wore the hospital scrubs despite the policy. “It definitely felt like an intimidation tactic — ‘You’re going to do this, you’re going to follow these policies,'” Livaccari said. “A lot of staff chose to stop wearing those scrubs because they needed their job, they have families to pay for, they were afraid.”
Willmeng continued to wear the hospital scrubs. “I had to decide whether that policy was most important, or the safety of my workplace and public health and my family,” he said.
On May 8, the hospital terminated Willmeng. He said its stated cause was violating hospital policies regarding uniform code and a respectful workplace.
Two weeks later, the local nurses’ union held a rally that drew hundreds of supporters for Willmeng and blasted the hospital’s scrub policy.
‘I’m Not a Bad Nurse’
In June, Willmeng sued Allina for whistleblower retaliation and wrongful termination. The case is scheduled to be heard next August.
His union grievance is set to be arbitrated in January. He maintains his firing was not for “just cause” because United’s uniform code policy violated standard nursing practices.
Willmeng has been running the website WeDoTheWork, which describes itself as “worker-run journalism.” It’s an independent but union-affiliated publication that “unflinchingly tells our side of the story, and takes the fight to management.”
He’s been publicizing his case on that website. In his Twitter account he notes, “I believe in the working class, democratically run economy, socialism, and revolution.”
Willmeng is applying for jobs, but despite his experience, a national nursing shortage, and reports of severe understaffing as hospitalizations surge again, Willmeng has not even been interviewed by any of the roughly 20 medical centers he has applied to.
He thinks he is being blackballed. “I’m not a bad nurse,” he said.
The board letter cited these concerns: “On April 16, 2020, you received a written warning for not following the uniform policy,” reads one item, citing a report shared with the board. “On May 5, 2020, you were issued a final written warning for repeatedly violating policy. … On May 8, 2020, you were terminated from employment based on violating hospital policies, behavioral expectations, code of conduct, and not following the directions of your manager.” The letter asks Willmeng to respond to eight questions.
“This looks like it was taken right out of my HR file,” he said. The board will not reveal who reported him, citing confidentiality policies. But he is certain — given the detail in the letter — that it was Allina/United management.
The nursing board cannot comment on Willmeng’s review to protect confidentiality, said executive director Shirley Brekken, MS, RN. The board receives about 1,200 complaints annually and first determines whether a complaint would merit disciplinary action if true. If so, it launches a review.
Allina declined to answer questions via a spokesperson, citing the lawsuit. “We cannot appropriately retain employees who willfully and repeatedly choose to violate hospital policies,” according to an emailed statement. Throughout the pandemic Allina has been following CDC and MDH guidelines, “which do not consider hospital issued scrubs as PPE [personal protective equipment].”
“In the early days of the pandemic, our local and national supply chain was extremely stressed,” the statement continues. “Our practices are aligned with other local and national hospitals … and have enabled us to allocate the appropriate supplies for daily patient care and ongoing care for COVID-19 patients.”
But United healthcare workers still lack hospital scrubs and enough N95 masks, Livaccari said, and the hospital is severely understaffed as the patient load increases. “We hear, ‘It’s a pandemic. You have to do more with less,'” she said. “It’s a really bad situation.”
Retaliation and Intimidation
Some think Willmeng’s review was initiated primarily to retaliate against him, not to protect public health and safety.
“Hospitals, they want a docile workforce, they want a workforce they can control,” said John Kauchick, RN, a retired 37-year nursing veteran who advocates for workplace rights. They do so “by fear and intimidation,” he added. “A nurse’s number one fear is to be turned in to a board of nursing for anything.”
“If you’re a whistleblower and you speak truth to power, that will get you a disciplinary hearing even more so than if there is patient harm.”
The letter was drafted more than six months after Willmeng was fired, and after he filed the lawsuit and union grievance. Just before he received the letter, he was elected to the MNA board. The timing strikes Willmeng and Kauchick as significant.
“If you think there’s been a violation, you are supposed to report that in a much shorter time period,” Kauchick said. Kauchick thinks Allina filed the complaint as leverage, to persuade Willmeng to drop the grievance and lawsuit.
But Livaccari noted the process can take up to six months, and that every firing is supposed to be reported to the board.
Like Kauchick, she takes umbrage with the review’s leader: Stephanie Cook, MSN, RN, a board nursing practice specialist who spent 24 years as a director with Allina. She was a member of multiple Allina committees, including its ethics committee, according to reports. She was with Allina as recently as 2018. Brekken confirmed her employment with Allina, noting that it’s “a very large system.”
Regardless, that’s a conflict of interest, Kauchick and Livaccari said, arguing that Cook should not be part of the review. “It’s just so blatantly obvious. How are you going to look at this with an unbiased lens when you worked for the organization that says Cliff was in the wrong?” Livaccari said. “It’s so inappropriate.”
This is not uncommon, Kauchick said, noting state nursing board reviews are “really just designed to get rid of whistleblowers. It’s like a buddy system. They hire higher-ups from big hospital systems. It’s just incestuous.”
Brekken was aware of Cook’s background before a colleague assigned this review to Cook, she said, noting the board vets staff for personal involvement in cases. Brekken “might consider” removing Cook from the review given her connection to Allina, she said, but added: “Many individuals on our staff may have worked for a particular health system throughout their career.”
The board could throw out the complaint or take action. Such actions typically range from a reprimand to revoking a nurse’s license, Brekken said. A staff member and board member together will review the report and Willmeng’s response, but she said the board itself makes final decisions.
Willmeng is also focused on the grievance, which asks Allina to provide full back pay and reinstate him.
“I would not feel comfortable; I’d feel very anxious” going back, he said. “But I’m an ER nurse. I belong in the ER…. It’s important for a frontline healthcare worker to demonstrate that when they stand up and speak truthfully and assertively about working conditions and patient safety, that they can’t just be triangulated.”
His salary — about twice his current unemployment benefits — is also a draw, he acknowledged.
Meanwhile, he continues applying for other jobs. His life insurance cost doubled and his family switched to his wife’s lesser health insurance plan, he said. A fourth-grade teacher with a local public school system, her salary is the primary support for themselves and their two children.
Willmeng also just hired an attorney at $250 an hour to help him respond to the board letter. “It’s not something I take lightly,” he said. “There’s cause for real concern. That’s my nursing license, that’s everything.“
HENRY KOTULA 