The next outbreak? We’re not ready – Bill Gates 2015
Category Archives: Centers for Disease Control & Prevention (CDC)
Another week on the exponential curve
https://mailchi.mp/a3d9db7a57c3/the-weekly-gist-march-20-2020?e=d1e747d2d8
As efforts to increase testing for COVID-19 ramped up this week, the number of cases in the US rose exponentially, and the number of deaths increased sharply as well. Early but incomplete data from the Centers for Disease Control and Prevention (CDC) indicated that the virus was impacting younger people in greater numbers than had been seen in China and Italy, and concerns grew that asymptomatic but infected people could be spreading the virus to those with compromised health status. In response, many cities and states moved aggressively to put in place stricter measures to keep people in their homes to mitigate spread.
Several flashpoints have emerged across the healthcare system. Supplies of personal protective equipment (PPE) are in short supply, raising concerns about putting healthcare workers at risk. Testing supplies—particularly collection swabs—are also running low in many places, forcing some newly-launched testing locations to close after just a few days. Hospitals across the country began to gear up for a wave of patients, with the number of potential cases likely to far exceed existing capacity of hospital beds, intensive care beds, and, in particular, ventilators.
In response, the President invoked the Defense Production Act, which will allow the government to direct private sector production of critically needed equipment. Hospital leaders have been advised by the government to cancel elective surgeries and minimize non-emergency utilization of healthcare resources, to preserve supplies and capacity for the coming wave of cases.
The Centers for Medicare and Medicaid Services (CMS) loosened several key regulations to allow more care to be delivered virtually, in an attempt to relieve pressure on the system (more on that below). By week’s end, hospitals in several areas—including Seattle, San Francisco, New York, and New Orleans—were reporting that they were perilously close to being overwhelmed.
As many have pointed out, we are faced with a decision of which curve we want to be on: one that looks like Italy, which responded late with mitigation and suppression efforts and has found their healthcare system collapsing under the volume of hospitalizations; or one that looks like South Korea, where aggressive measures to suppress spread, including extensive testing, strict social distancing, and isolation of infected people, seem to have “flattened the curve”.
The next two weeks will be critical in determining what the next year looks like in America.
How the coronavirus pandemic differs from the flu
The COVID-19 pandemic is caused by a virus humans haven’t encountered before — meaning our bodies have no built-in immunity to it and researchers are frantically working to learn more about it.
Why it matters: While there are important lessons to be learned from other pandemic flus and even seasonal flu outbreaks, the coronavirus pandemic is new and not exactly comparable, making predictions, policies and treatments all the more difficult.
The latest: The coronavirus is spreading throughout the U.S., with at least 35,224 confirmed cases and 471 deaths early Monday morning, per Johns Hopkins’ Center for Systems Science and Engineering.
- Meanwhile, the Centers for Disease Control and Prevention estimates the 2019-2020 seasonal flu has caused at least 38 million illnesses, 390,000 hospitalizations and 23,000 deaths so far this season.
What they’re saying: Anthony Fauci, who’s served as director of the National Institute of Allergy and Infectious Diseases since 1984, told a JAMA podcast he’s worked on multiple infectious disease crises “but nothing of the magnitude of this.”
- One of the problems, he said, is that without strong containment and mitigation efforts, it hits society and its health care system “all of a sudden — boom! It starts to skyrocket.”
- The World Health Organization on Friday warned against dismissing the coronavirus as just a bad outbreak of the flu, saying overwhelmed health systems are “collapsing” around the world.
- “This is not normal. This isn’t just a bad flu season,” WHO’s Mike Ryan said.
While both seasonal flu and COVID-19 cause similar respiratory illnesses, there are key differences between the viruses.
- Influenza has an incubation period of roughly 2-3 days, whereas the coronavirus incubates longer (5-6 days on average) before symptoms appear, possibly allowing more people to unknowingly spread the virus.
- On average, 1.3 people catch the flu from an infected person versus 2-3 for the coronavirus.
- There’s a flu vaccine and multiple effective treatments, so many exposed to the flu will have lessened symptoms. There’s no vaccine or treatment yet approved for COVID-19.
- Children appear to be more susceptible to severe complications from this seasonal flu than from COVID-19, with the CDC reporting the highest number of influenza-associated deaths (149) at this point in the season, with the exception of the 2009 flu pandemic.
- But, the overall mortality rate for COVID-19 is between 10 and 40 times higher than the average 0.1% mortality rate for the seasonal flu.
The U.S. can learn from both Asia and Europe, which experienced cases of COVID-19 earlier than the U.S., Julie Fischer of Georgetown University’s Center for Global Health Science and Security tells Axios.
- China is providing data showing what measures are working better than others, and is conducting treatment tests on patients, which will be valuable, she said.
- In South Korea, robust diagnostic testing using creative measures like drive-thrus combined with strong health care followup shows the importance of isolating the right people early enough to limit the spread, Fischer says.
- Italy tried to do a widespread but unfocused social distancing. There’s been some success in stemming the outbreak in certain areas that tested a large number of people, tracing and quarantining those who have been in contact with positive cases. But, it wasn’t early enough or sufficiently extensive, and many parts of Italy are now overwhelmed.
Longer term lessons can be drawn from prior pandemics, like the Spanish flu of 1918, Fischer says.
- Comparing Philadelphia’s response with that of St. Louis is quite striking, Fischer says. Philadelphia decided to hold a 200,000-person parade to boost morale — but this led to widespread infections. In contrast, St. Louis rapidly battened down the hatches and reported a smaller epidemic.
- Another lesson from the Spanish flu was that closing schools early on was “one of the most beneficial” non-pharmaceutical interventions.
The bottom line: “This is not an ‘abandon all hope, ye who enter here,’ scenario,” Fischer says. “We can focus our strategy and become much more aggressive” in diagnostics testing and social distancing measures until scientists make advancements on vaccines and treatments.
Cartoon – How will You respond to the Coronavirus?
Experts agree that Trump’s coronavirus response was poor, but the US was ill-prepared in the first place
As the coronavirus pandemic exerts a tighter grip on the nation, critics of the Trump administration have repeatedly highlighted the administration’s changes to the nation’s pandemic response team in 2018 as a major contributor to the current crisis. This combines with a hiring freeze at the Centers for Disease Control and Prevention, leaving hundreds of positions unfilled. The administration also has repeatedly sought to reduce CDC funding by billions of dollars. Experts agree that the slow and uncoordinated response has been inadequate and has likely failed to mitigate the coming widespread outbreak in the U.S.
As a health policy expert, I agree with this assessment. However, it is also important to acknowledge that we have underfunded our public health system for decades, perpetuated a poorly working health care system and failed to bring our social safety nets in line with other developed nations. As a result, I expect significant repercussions for the country, much of which will disproportionately fall on those who can least afford it.
Decades of underfunding
Spending on public health has historically proven to be one of humanity’s best investments. Indeed, some of the largest increases in life expectancy have come as the direct result of public health interventions, such as sanitation improvements and vaccinations.
Even today, return on investments for public health spending is substantial and tends to significantly outweigh many medical interventions. For example, one study found that every US$10 per person spent by local health departments reduces infectious disease morbidity by 7.4%.
However, despite their importance to national well-being, public health expenditures have been neglected at all levels. Since 2008, for example, local health departments have lost more than 55,000 staff. By 2016, only about 133,000 full-time equivalent staff remained. State funding for public health was lower in 2016-2017 than in 2008-2009. And the CDC’s prevention and public health budget has been flat and significantly underfunded for years. Overall, of the more than $3.5 trillion the U.S. spends annually on health care, a meager 2.5% goes to public health.
Not surprisingly, the nation has experienced a number of outbreaks of easily preventable diseases. Currently, we are in the middle of significant outbreaks of hepatitis A (more than 31,000 cases), syphilis (more than 35,000 cases), gonorrhea (more than 580,000 cases) and chlamydia (more than 1,750,000 cases). Our failure to contain known diseases bodes ill for our ability to rein in the emerging coronavirus pandemic.
Failures of health care systems
Yet while we have underinvested in public health, we have been spending massive and growing amounts of money on our medical care system. Indeed, we are spending more than any other country for a system that is significantly underperforming.
To make things worse, it is also highly inequitable. Yet, the system is highly profitable for all players involved. And to maximize income, both for- and nonprofits have consistently pushed for greater privatization and the elimination of competitors.
As a result, thousands of public and private hospitals deemed “inefficient” because of unfilled beds have closed. This eliminated a significant cushion in the system to buffer spikes in demand.
At any given time, this decrease in capacity does not pose much of a problem for the nation. Yet in the middle of a global pandemic, communities will face significant challenges without this surge capacity. If the outbreak mirrors anything close to what we have seen in other countries, “there could be almost six seriously ill patients for every existing hospital bed.” A worst-case scenario from the same study puts the number at 17 to 1. To make things worse, there will likely be a particular shortage of unoccupied intensive care beds.
Of course, the lack of overall hospitals beds is not the most pressing issue. Hospitals also lack the levels of staffing and supplies needed to cope with a mass influx of patients. However, the lack of ventilators might prove the most daunting challenge.
Limits of the overall social safety net
While the U.S. spends trillions of dollars each year on medical care, our social safety net has increasingly come under strain. Even after the Affordable Care Act, almost 30 million Americans do not have health insurance coverage. Many others are struggling with high out-of-pocket payments.
To make things worse, spending on social programs, outside of those protecting the elderly, has been shrinking, and is significantly smaller than in other developed nations. Moreover, public assistance is highly uneven and differs significantly from state to state.
And of course, the U.S. heavily relies on private entities, mostly employers, to offer benefits taken for granted in other developed countries, including paid sick leave and child care. This arrangement leaves 1 in 4 American workers without paid sick leave, resulting in highly inequitable coverage. As a result, many low-income families struggle to make ends meet even when times are good.
Can the US adapt?
I believe that the limitations of the U.S. public health response and a potentially overwhelmed medical care system are likely going to be exacerbated by the blatant limitations of the U.S. welfare state. However, after weathering the current storm, I expect us to go back to business as usual relatively quickly. After all, that’s what happened after every previous pandemic, such as H1N1 in 2009 or even the 1918 flu epidemic.
The problems are in the incentive structure for elected officials. I expect that policymakers will remain hesitant to invest in public health, let alone revamp our safety net. While the costs are high, particularly for the latter, there are no buildings to be named, and no quick victories to be had. The few advocates for greater investments lack resources compared to the trillion-dollar interests from the medical sector.
Yet, if altruism is not enough, we should keep reminding policymakers that outbreaks of communicable diseases pose tremendous challenges for local health care systems and communities. They also create remarkable societal costs. The coronavirus serves as a stark reminder.
The problems with our coronavirus testing are worse than you think
If the coronavirus outbreak in the U.S. gets really bad — if it stretches on longer than we anticipated, if huge numbers of people get sick, if the disruptions to daily life become even more severe — early flaws in the testing process will bear a lot of the blame.
The big picture: You probably know that there were some early problems with testing, and that they’re getting better — which they are. But those early failures will help define the entire scope of this pandemic, and there’s not much we can do now to reverse the damage.
Why it matters: Because we haven’t been doing enough testing, we don’t actually know how many people in the U.S. have coronavirus. We know the official count is too low, and that the number of confirmed cases is likely to explode in the coming weeks as testing improves.
- But that’s not the only problem. The lack of testing hasn’t just left us in the dark about how bad the situation is; it has also made that situation worse.
By the numbers: Independent researchers estimate that the U.S. has completed about 20,000 coronavirus tests as of Friday.
- By contrast, South Korea — a success story in controlling the coronavirus — has performed an estimated 250,000 tests.
- As bad as that discrepancy is, it’s even worse when you consider that the U.S. population is more than six times bigger than South Korea’s (327 million vs. 51 million).
Widespread, accurate testing has been a key component of other countries’ success in bringing their outbreaks under control.
- When we can quickly and accurately diagnose one patient, we can immediately pinpoint who that person is most likely to have infected, then quarantine those people and test the ones who start to show symptoms, and repeat that process on down the line.
- We can spot clusters of new cases, so that the public health system can react quickly and focus its resources.
But the U.S. has not been able to do those things on the scale we’d need. And so, experts say, the virus has probably been spreading undetected for weeks.
- More people than we know about are infected, which means more people than we know about are spreading the virus, which likely means way more people than we know about are infected.
“Our response is much, much worse than almost any other country that’s been affected,” Ashish Jha, a public health expert and the director of Harvard’s Global Health Institute, told NPR last week.
- “Without testing, you have no idea how extensive the infection is. You can’t isolate people. You can’t do anything,” he said.
Between the lines: This makes other interventions, including individual “social distancing” and the cancellation of big events, even more important.
- “We have to shut schools, events and everything down, because that’s the only tool available to us until we get testing back up. It’s been stunning to me how bad the federal response has been,” Jha told NPR.
What’s next: Testing capacity in the U.S. is improving quickly. Nationwide, we now have the ability to test about 26,000 people per day, according to former Food and Drug Administration Commissioner Scott Gottlieb.
- He expects that capacity to “rise substantially” this week.
- As more people can get tested, we’ll be able to get a handle on how many cases there actually are, and to start focusing attention and resources appropriately.
How we got here: The testing shortfall has been a multi-phase failure.
- For reasons that remain unknown, the U.S. did not rely on the World Health Organization’s coronavirus test in the earliest days of the outbreak. Instead, the Centers for Disease Control and Prevention set out to make its own.
- But the CDC’s test didn’t always work. Manufacturing had to be relocated following a possible contamination. And it has taken time to come up with a new one.
- Regulatory red tape slowed down academic labs that wanted to jump in and develop their own tests, and capacity among private-sector labs is still ramping up.
In the early days, testing was focused narrowly on people who had traveled to China. And that was probably the best way to triage limited resources, but it was never going to be sufficient.
- China and the U.S. are so thoroughly connected to the rest of the world that cases were always going to spread from China to multiple countries, and so people travelers from multiple countries could bring it into the U.S. From there, people in the U.S. started spreading it themselves.
The bottom line: Yes, the testing capacity is about to catch up. When it does, we will see a tidal wave of new confirmed cases. The fact that we needed to catch up made that tidal wave bigger — made the outbreak worse. And that won’t be undone by more tests now.
Seattle Coronavirus Care: Short in Staff, Supplies and Space
At ground zero of America’s coronavirus outbreak, Seattle is overwhelmed by patients needing care. Social distancing and persistent hand washing is no longer enough. “The next step is to start thinking about alternate care systems.”
Amid the first signs that the novel coronavirus was spreading in the Seattle area, a senior officer at the University of Washington Medical Center sent an urgent note to staffers.
“We are currently exceptionally full and are experiencing some challenges with staffing,” Tom Staiger, UW Medical Center’s medical director, wrote on Feb. 29. He asked hospital staff to “expedite appropriate discharges asap,” reflecting the need for more beds.
That same day, health officials announced King County’s — and the nation’s — first death from the coronavirus. Now as cases of virus-stricken patients suffering from COVID-19 multiply, government and hospital officials are facing the real-life consequences of shortcomings they’ve documented on paper for years.
Medical supplies have run low. Administrators are searching for ways to expand hospital bed capacity. Health care workers are being asked to work extra shifts as their peers self-isolate.
And researchers this week made stark predictions for COVID-19’s impact on King and Snohomish counties, estimating 400 deaths and some 25,000 infections by April 7 without social-distancing measures.
“If you start doing that math in your head, based on every person who was infected infecting two other people, you can see every week you have a doubling in the number of new cases,” state health oficer Dr. Kathy Lofy said.
Hand-washing, staying home from work and other measures were no longer enough to sufficiently slow the virus, Lofy said.
Hospital administrators are rapidly changing protocols as the outbreak stresses the system, while frontline health care workers are beginning to feel the effects of disruptions to daily life. UW Medicine on Thursday told employees it would begin postponing elective procedures, beginning March 16.
“We’ve seen what has happened in other countries where they’ve had really rapid spread. The health care system has become overwhelmed,” Lofy said. “We want to do everything we can to prevent that from happening here.”
“We’re Always Full”
King and Snohomish counties offer some 4,900 staffed hospital beds, of which about 940 are used for critical care, according to the researchers — with the Institute for Disease Modeling, the Bill & Melinda Gates Foundation and the Fred Hutchinson Cancer Research Center — who modeled the outbreak’s potential growth. “… This capacity may quickly be filled,” they wrote.
Some of Seattle’s largest hospitals were already near capacity before the outbreak. Harborview Medical Center in downtown Seattle operated at 95 percent of its capacity in 2019, based on its licensed 413 beds and the days of patient care it reported to the Department of Health.
Of 81 hospitals that reported data for all of 2019, excluding psychiatric hospitals, the median hospital operated at 50 percent of its licensed capacity, according to a Seattle Times analysis. Many hospitals staff fewer beds than the maximum their license allows for, so the actual occupancy rate is likely higher.
Katharine Liang, a psychiatry resident physician who works rotations for Seattle-area hospitals, said requests for UW Medicine staffers to discharge patients in a timely fashion are not uncommon as administrators seek extra beds.
“The safety net hospitals, we’re always full,” Liang said, referring to medical centers that care for patients without insurance or means to pay.
Susan Gregg, a spokeswoman for UW Medicine, which operates UW Medical Center, Harborview Medical Center, Valley Medical Center and Northwest Hospital, said that each hospital had a surge-capacity plan being adapted for the outbreak.
“Our daily planning sessions monitor our available beds, supply usage and human resources,” Gregg said in a statement.
While Washington state has a robust system for detecting and monitoring infectious diseases, it has struggled to build the capacity to respond to emergencies like the coronavirus outbreak, according to a review of public data and interviews.
On a per-person basis, the state lags most others in nurses and hospital rooms designed to isolate patients with infectious, airborne diseases, according to a nationwide index of health-security measures.
The U.S. Centers for Disease Control and Prevention launched this initiative — called the National Health Security Preparedness Index — in 2013 to comprehensively evaluate the nation’s readiness for public health emergencies.
The state’s greatest strength, according to the index, is in its ability to detect public-health threats and contain them — scoring 8.5 points out of a possible 10, above the national average.
“It’s a leading state now in terms of how testing capabilities are playing out” for COVID-19, said Glen Mays, a professor at the Colorado School of Public Health who directs the index work.
With the scope of the outbreak becoming clear, the focus is turning to an area that is the state’s weakest on the index: providing access to medical care during emergencies.
When it comes to nurses per 100,000 people, Washington state ranked near the bottom — 46th among states and the District of Columbia — in 2018. It ranked 43rd nationally in the number of hospital isolation rooms — commonly referred to as “negative pressure” rooms, which draw in air to prevent an airborne disease from spreading — per 100,000 people and in neighboring states.
“It’s an area of concern,” Mays said of the state’s health care delivery capacity.
This vulnerability is well known to state policymakers. John Wiesman, Washington state’s health secretary, serves on the national advisory committee of the index and has championed its use as a tool for improvement, Mays said. He recalled Washington seeking lessons from other states that have been more successful and building a “medical reserve corps,” another area where the state has lagged.
The state scored 2.5 points for managing volunteers in an emergency in 2013. In 2018, it had improved to just 2.6.
Health Workers Strained
Less than a week after diagnosed cases of COVID-19 grew rapidly in the Seattle area, administrators at several area hospitals had to hunt for additional medical supplies and called for rationing. They also established fast-shifting isolation policies for sick or potentially exposed staffers.
“Hospitals are being very vigilant. If you have the slightest signs of illness, don’t come to work,” said Alexander Adami, a UW Medicine resident, on Monday.
On March 6, UW Medicine directed employees who tested positive for COVID-19, the illness caused by coronavirus, to remain isolated at home for a minimum of seven days after symptoms developed, according to internal UW documents. Hospital workers told workers with symptoms who hadn’t been tested to remain isolated until they were three days without symptoms. Those who tested negative, or had influenza, could return after 24 hours.
Quarantines for sick workers means others must backfill.
“Programs are having to pull residents in other blocks in other hospitals and other clinics to fill gaps,” Adami said. “There simply aren’t enough people.”
School closures further complicate staffing.
Liang, the resident physician who works rotations for several area hospitals, said she had been pulled into an expanded backup pool on short notice to cover shifts.
Liang is the mother of a 1-year-old. On Wednesday, her family’s day care closed, as it typically does when Seattle schools close. Gov. Jay Inslee has ordered all schools in King, Pierce and Snohomish counties to close until late April.
“I’m not really sure what we’re going to do going forward,” Liang said. “My demands at home are increasing, and now, at the same time because of the same problem, my demands at the hospital are increasing as well.”
Adami, a second-year internal medicine resident, said residents were used to taxing hours, and demands had not been much more excessive than usual, but he remained concerned for the future.
“I would be worried about: We eventually get to the point where there are so many health care workers who become sick we have to accept things like saying, All right: Do you have a fever? No? Take a mask and keep working, because there are people to care for,” he said.
One sign of demand: Some hospitals are asking workers at greater risk of COVID-19 to continue in their roles, even after public health officials encouraged people in these at-risk groups among the broader public to stay home.
Staff over the age of 60 “should continue to work per their regular schedules,” a UW Medicine policy statement said. People who are pregnant, immunocompromised or over 60 and with underlying health conditions were “invited to talk to their team leader or manager about any concerns,” noting that hospital workers’ personal protective equipment would minimize exposure risks.
A registered nurse at Swedish First Hill who is over 60 and who has a history of cardiac issues said she told a manager last week of her concern about working with potential or confirmed COVID-19 patients.
She said a manager adjusted her schedule for an initial shift, but couldn’t guarantee that she would be excused from caring for these patients.
Hours later, the nurse said she suffered a cardiac event and was later admitted to another hospital with a stress-induced cardiomyopathy. The nurse did not want to be named for fear of reprisal by Swedish.
“I’m afraid for my life to work in there,” the nurse said. “I don’t think we’re being adequately protected.”
The nurse is now on medical leave.
In a statement, Swedish said it could not comment on an individual caregiver’s specific circumstances, but that employees at a higher risk are able to request reassignment and if it can not be accommodated, they can take a leave of absence.
“Providing a safe environment for our caregivers and patients is always our top priority, but especially during the current COVID-19 outbreak,” according to the statement.
Anne Piazza, senior director of strategic initiatives for the the Washington State Nurses Association said she had heard from a “flood” of nurses with similar concerns.
Additionally, “we are seeing increased demand for nurse staffing and that we do have reports of nurses being required to work mandatory overtime.”
Wuhan was Overwhelmed
China might provide an example of what could happen to the U.S. hospital system if the pace of transmission escalates, according to unpublished work from researchers with Johns Hopkins University, Harvard University and other institutions.
In Wuhan, the people seeking care for COVID-19 symptoms quickly outpaced local hospitals’ ability to keep up, the researchers found. Even after the city went on lockdown in late January, the number of people needing care continued to rise.
Between Jan. 10 and the end of February, physicians served an average of 637 intensive-care unit patients and more than 3,450 patients in serious condition each day.
But by the epidemic’s peak, nearly 20,000 people were hospitalized on any given day. In response, two new hospitals were built to exclusively serve COVID-19 patients; in all, officials dedicated more than 26,000 beds at 48 hospitals for people with the virus. An additional 13,000 beds at quarantine centers were set aside for patients with mild symptoms.
The researchers analyzed what might happen if a Wuhan-like outbreak happened here.
“Our critical-care resources would be overwhelmed,” said Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security who helped lead the study.
“The lesson here, though, is we have an opportunity to learn from their experience and to intervene before it gets to that point.”
Preparing For The Worst
Hospital administrators are stretching to make the most of their staff, avoid burnout and find space for patients flooding into hospitals.
As of Thursday afternoon, there hadn’t been an unusual uptick in hospitals asking emergency responders to divert patients elsewhere, according to Beth Zborowski, a spokeswoman for the Washington State Hospital Association.
Zborowski said administrators are getting creative to deal with shortages of supplies, staff and space, such as potentially hiring temporary workers.
The state is trying to reduce regulations to help scale up staffing.
The state health department’s Nursing Commission said last Friday it would give “top priority” to reviewing applications for temporary practice permits for nurses to help during the COVID-19 crisis.
After the governor’s emergency proclamation, the Department of Health also said it was allowing volunteer out-of-state health practitioners who are licensed elsewhere to practice without a Washington license.
All the doctors with UW Medicine have been trained, or are being trained on how to care for patients via telemedicine. The number of people using the service has increased tenfold since public health officials urged patients to not visit emergency rooms or visit clinics for minor issues, said Dr. John Scott, director of digital health at UW Medicine.
Some hospitals are creating wards for COVID-19 patients. EvergreenHealth, in Kirkland, converted its 8th floor for the use of these patients.
King County officials last week purchased a motel, which could allow patients to recover outside a clinical setting and free up beds.
“These are places for people to recover and convalesce who are not at grave medical risk, and therefore do not need to be in a hospital,” said Alex Fryer, spokesperson for King County Executive Dow Constantine.
Supply problems are ongoing, even after the federal government fulfilled a first shipment that included tens of thousands of N95 respirator masks, surgical masks and disposable gowns from a federal stockpile.
Piazza said the nursing association continues to receive reports that members at area hospitals are being asked to reuse or share personal protective equipment, wear only one mask a shift or conserve masks for use exclusively with COVID-19 confirmed patients.
“We need to address the safety of frontline caregivers,” Piazza said.
State officials placed a second order for supplies last weekend.
Casey Katims, director of federal affairs for Inslee, said three trucks of medical supplies from the federal stockpile arrived Thursday morning, including 129,380 N-95 respirators; 308,206 surgical masks; 58,688 face shields; 47,850 surgical gowns; and 170,376 glove pairs.
If the measures taken now aren’t enough, state officials have contingency plans they’ve been working on “for a while now,” said Lofy, the state health officer.
“The next step is to start thinking about alternate care systems or alternate care facilities. These are facilities that could potentially be used outside the clinic or the health care system walls.”
Too much for the health care system to handle
A severe coronavirus could easily overwhelm the U.S. health care system, Axios health care editor Sam Baker writes.
Most pandemics put health care workers at particular risk, both to become infected and then to spread the infection.
- Experts were sounding the alarm even before the first U.S. cases about limited supplies of masks and protective equipment.
- If health care workers do get sick in large numbers, staffing shortages would make it all the harder to care for new patients.
Experts fear a shortage of ventilators and intensive-care beds, if the outbreak becomes severe.
- The U.S. has roughly 46,500 beds designated for ICU use, but even in a moderate scenario, it’s projected that 200,000 people could need ICU treatment, according to a report from Johns Hopkins.
- Yes, but: Many younger, healthier patients will likely be able to recover at home, leaving hospital capacity dedicated mainly to seniors and people with other health complications.
What we’re watching: The coronavirus also seems likely to expose structural gaps in the health care system.
- Insurers have promised to make coronavirus testing available for free, and a handful of hospital systems have imposed temporary freezes in billing patients for coronavirus treatments.
- But relying on individual acts of corporate benevolence won’t provide any blanket assurance that care will be affordable, especially to the poor or uninsured — and if people don’t get care because they’re afraid of the cost, rightly or not, that risks further spreading the infection.
Go deeper: Listen to Sam and Dan examine the health care issue.
What you need to know about the Coronavirus
There’s a lot of confusion and misinformation swirling around the virus, so here are quick just-the-facts answers to your most urgent concerns, based on current knowledge:
Q: What are the symptoms I should watch for?
- Fever (88%) and dry cough (68%) are two of the most common symptoms, followed by fatigue, thick mucus coughed from lungs, shortness of breath, muscle and joint pain, sore throat, headache and chills.
Q. If I have those symptoms, should I go to my doctor or the hospital?
- Right now, the CDC recommends you distance yourselves from others, including your family and your pets. If you can, designate a separate bedroom and bathroom for yourself.
- Call your provider and tell them you suspect COVID-19. Remind them of any travel and if you are over 60 or have underlying conditions like diabetes or a heart condition.
- Don’t share dishes/glasses with anyone; wash hands often; clean surfaces frequently. Stay hydrated.
- The CDC does not recommended you go to the hospital unless you have shortness of breath, persistent chest pain, new confusion or strong lethargy, or a bluish tint to lips or face.
- CDC’s hotline number for questions: 800-CDC-INFO (800-232-4636).
Q: Why is there a shortage of tests in the U.S.? When will we get them?
- The CDC’s initial test for the virus was faulty. And, for reasons that remain unknown, the U.S. opted not to rely on the World Health Organization’s test while the CDC developed a new one. Red tape slowed down academic labs that wanted to quickly develop their own.
- With both academic and commercial labs now pitching in, testing is becoming more widely available. But we’re still playing catch-up, and the virus has likely been spreading undetected in the meantime.
Q: What’s known about children and COVID-19?
- Children, fortunately, rarely seem to experience severe complications from the coronavirus, but it’s not known whether children with underlying conditions may be at higher risk for severe illness.
- It’s unclear what about children’s immune systems is protecting them.
Q: What stage is the outbreak in the U.S.?
- The virus has now been confirmed in 49 states plus Washington, D.C., and Puerto Rico. However, due to the lack of testing, the level of infection in the U.S. beyond the currently confirmed 2,508 cases is unknown.
- Scientists believe the number of infections doubles roughly every five to six days.
- Some think the U.S. and the rest of Europe could follow Italy’s exponential trajectory arc, but this will depend on how effective school closings and event stoppages are at flattening the trajectory curve of the outbreak.
The pandemic shaping the future
The world that emerges from the coronavirus pandemic will be fundamentally different, Axios Future correspondent Bryan Walsh writes.
- Why it matters: This crisis may prove to be as significant as the 2008 financial meltdown or even 9/11.
- So the choices that businesses and governments are making now will have enormous social and economic ramifications.
The intrigue: U.S. health and government officials are facing the epidemiological equivalent of the “fog of war,” worsened by a massive American failure to act on weeks of warnings as the virus spread in China.
- The Trump administration declared a national emergency yesterday, seven weeks after the first U.S. case was announced by the Centers for Disease Control and Prevention.
- By failing to rapidly scale up testing, U.S. officials have added an additional — and partly unnecessary — layer of uncertainty about how to respond.
- Harvard epidemiologist Michael Mina calls it “the most daunting virus that we’ve contended with in half a century or more.”
Flashback: As recently as the 1918 influenza pandemic, scientists lacked the ability to rapidly respond to an infectious disease outbreak.
- Today, scientists can sequence a virus in days, develop rapid tests that can determine infection before obvious symptoms, and use complex mathematical models to predict future spread.
What we’ll find out in coming days:
- The actual fatality rate of the virus.
- How contagious it is, and the precise role that children — who seem outwardly unaffected by the disease — may play in transmission.
- If the outbreak will naturally slow down when the weather warms, as tends to happen with influenza.
What’s next: For now, distance becomes the first line of defense. Schools and companies are shifting online — with potential consequences.
- If companies are able to function relatively well with a largely remote workforce, expect lower levels of business travel.
- After decades of emphasizing the efficiency of supply chains — which often meant complex international linkages and just-in-time inventories — businesses will look to build resilient supply chains.
The bottom line: The mobility — of people, capital and products — that we’ve taken for granted may not outlast the virus.
HENRY KOTULA 