At a rural health system in Wisconsin, officials and medical experts began drawing up protocols for the once unthinkable practice of deciding which patients should get care. The chief quality officer of a major New York hospital network double- and triple-checked his system’s stockpile of emergency equipment, grimly recalling the last time he had to count how many ventilators he had left. In Arizona, a battle-weary doctor watched in horror as people flooded airports and flocked to stores for Black Friday sales, knowing it was only a matter of time before some of them wound up in his emergency room.
Days after millions of Americans ignored health guidance to avoid travel and large Thanksgiving gatherings, it’s still too soon to tell how many people became infected with the coronavirus over the course of the holiday weekend. But as travelers head home to communities already hit hard by the disease, hospitals and health officials across the country are bracing for what scientist Dave O’Connor called “a surge on top of a surge.”
“It is painful to watch,” said O’Connor, a virologist at the University of Wisconsin at Madison. “Like seeing two trains in the distance and knowing they’re about to crash, but you can’t do anything to stop it.”
“Because of the decisions and rationalizations people made to celebrate,” the scientist added, “we’re in for a very dark December.”
The holiday, which is typically one of the busiest travel periods of the year, fell at a particularly dire time in the pandemic. Some 4 million Americans have been diagnosed with the coronavirus in November — twice the previous record, which was set last month. More than 2,000 people are dying every day. Despite that, over a million people passed through U.S. airports the day before Thanksgiving — the highest number of travelers seen since the start of the outbreak.
Many states did not report new case counts over the holiday, and it typically takes about a week for official records to catch up after reporting delays, said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.
But in two to three weeks, she said, “I fully expect on a national level we will see those trends continue of new highs in case counts and hospitalizations and deaths.”
The nation has already notched several bleak milestones over the holiday weekend. On Thanksgiving Day, hospitalizations in the United States exceeded 90,000 people for the first time. The following day, the country hit 13 million cases. At least nine states have seen 1 in every 1,000 residents die of the coronavirus.
Mark Jarret, the chief quality officer for New York’s Northwell Health system, said he understood that many people are tiring of constant vigilance after nine months of isolation and Zoom gatherings and waving at people from six feet away.
“But we’re so close to getting some control,” he said, noting that federal officials are on the verge of authorizing one or more vaccines against the virus next month. “This is not the time to let up. This is the time to put on the best defense we can to prevent further spread, further death.”
Officials urged people who traveled or spent time with people outside their household to stay at home for 14 days to avoid further spread of the virus. Some jurisdictions are moving toward lockdown measures not seen since the spring. Los Angeles County on Friday issued a three-week “safer at home” order, limiting business capacity and prohibiting gatherings other than religious services and protests.
Meanwhile, the December holidays are looming.
“Hopefully people will try to minimize their risks around Christmas, especially if there’s data that show Thanksgiving was really harmful,” O’Connor said.
To Cleavon Gilman, a Navy veteran and emergency room doctor in Yuma, Ariz., the wave of holiday travel was “a slap in the face.”
“It’s as if there’s not a pandemic happening,” he said. “We’re in a war right now, and half the country isn’t on board.”
On Friday, members of the University of Arizona coronavirus modeling team issued an urgent warning to state health officials, projecting that the state will exceed ICU capacity by the beginning of December.
“If action is not immediately taken, then it risks a catastrophe on a scale of the worst natural disaster the state has ever experienced,” the team wrote in a letter to Steven Bailey, chief of the Bureau of Public Health Statistics. “It would be akin to facing a major forest fire without evacuation orders.”
Arizona has no statewide mask mandate, and businesses in many parts of the state, including indoor dining at restaurants, remain open.
Gilman said the intensive care unit at his hospital is full and there’s nowhere to transfer new patients. When he’s home, his mind echoes with the sound of people gasping for breath. He and his colleagues are exhausted, and with cases spiking across the country, he worries there is no way they can handle the surge that will probably follow Thanksgiving celebrations.
In La Crosse, Wis., Gundersen Health System chief executive Scott Rathgaber echoed that fear. “We’ve had to tell our hard-working staff, ‘There’s no one out there to come rescue us,’” he said.
Like many in his college town, Rathgaber is anxious about what will happen when students who spent the holiday with their families return to campus. Though the University of Wisconsin and other schools shifted classes online for the remainder of the semester, he anticipates students who have jobs and apartments in La Crosse will return to town.
“We had trouble the first time the students came back,” Rathgaber said, noting that the start of college classes in September preceded outbreaks in nursing homes and a spike in deaths in La Crosse County. “I will continue to implore, to beg people to take this seriously.”
Gundersen has already more than tripled the size of the covid-19 ward at its main hospital, and even before this week it was almost entirely full. Physicians from the system’s rural clinics have been reassigned to La Crosse to help in the ICU. Staff who may have been exposed to the virus are being called back before completing their 14-day quarantine. And Rathgaber now attends regular meetings with ethicists and end-of-life caregivers to figure out Gundersen’s triage protocol if the hospital becomes overwhelmed.
“We’re not at a breaking point, but we are getting there,” Rathgaber said. “I’m concerned about what the next two weeks will bring.”
Detroit Mayor Mike Duggan (D) on Sunday said mitigation efforts such as mask mandates have been effective in reducing coronavirus rates in the city, calling such efforts an alternative to mass shutdowns.
“Detroit actually has the lowest infection rate in the state of Michigan,” Duggan said on CBS’s “Face the Nation.” “And it’s because behavior changed. In March and April, Michigan was hammered along with New York, and we had within a few weeks, a thousand people hospitalized and 50 of our neighbors dying every day.”
In contrast, he said, the city currently had about 200 patients hospitalized and one or two deaths per day.
“It’s still too high, but the commitment to the testing, the commitment to the masks, has shown that you can dramatically drop the infection rate,” Duggan added.
The mayor noted that the city’s infection rate is about half of those of its surrounding suburbs.
“If you make a commitment to the masks, we don’t have to shut the economy down,” he said.
Asked how the city’s mask mandate and other measures had affected the spread of the virus, Duggan responded that “assembly lines are in our DNA” and pointed to the city’s drive-through testing apparatus.
Duggan went on to say that frontline workers such as firefighters, hospital workers and emergency medical technicians would likely be the first people in the city to receive a coronavirus vaccine, followed by the elderly.
“Occupation is going to go first…then people over the age over 65,” he said. “That’s the way they’re talking about it, I will be really glad when [President-elect] Joe Biden takes control of this and we get clear direction, but we will follow whatever protocols are there.”
Sanford Health’s CEO Kelby Krabbenhoft is leaving the top exec role after almost 25 years, according to a Tuesday announcement from the Sioux Falls, South Dakota-based system, following controversial statements the outgoing CEO made about mask wearing during the coronavirus pandemic.
Krabbenhoft, who has served as CEO since 1996, sent an internal memo to Sanford’s 50,000 employees on Wednesday arguing wearing a mask would defeat its purpose, as he’d already contracted COVID-19 and was therefore immune for at least seven months, as first reported by Forum News Service.
Experts dispute, however, that people previously infected with the novel coronavirus are entirely immune, as the data is not yet definitive. Other Sanford executives sent an email to employees Friday recommending mask wearing and contradicting Krabbenhoft’s claims.
On the heels of the news, Sanford’s board of trustees and Krabbenhoft have now “mutually agreed to part ways,” according to the release. The turnover comes at an acutely crucial time for the major Midwest health system, as it signed a letter of intent last month to merge with Salt Lake City-based Intermountain Healthcare.
If the deal closes, the two would operate 70 hospitals and 435 clinics — many of which will be located in rural communities across the country — and insure 1.1 million people. The merger would form one of the nation’s largest nonprofit health systems with more than $13 billion in combined annual revenue. It’s expected to close in 2021, pending regulatory approvals.
While Intermountain CEO Marc Harrison is slated to lead the combined organization, Krabbenhoft was poised to serve as president emeritus. It’s unclear what the plans are now after Krabbenhoft’s exit.
Sanford, which operates 46 hospitals in 26 states, did not reply to requests for comment by time of publication.
26 million now say they don’t have enough to eat, as the pandemic worsens and holidays near.
It was 5 a.m., not a hint of sun in the Houston sky, as Randy Young and his mom pulled into the line for a free Thanksgiving meal. They were three hours early. Hundreds of cars and trucks already idled in front of them outside NRG Stadium. This was where Young worked before the pandemic. He was a stadium cook. Now, after losing his job and struggling to get by, he and his 80-year-old mother hoped to get enough food for a holiday meal.
“It’s a lot of people out here,” said Young, 58. “I was just telling my mom, ‘You look at people pulling up in Mercedes and stuff, come on.’ If a person driving a Mercedes is in need of food, you know it’s bad.”
More Americans are going hungry now than at any point during the deadly coronavirus pandemic, according to a Post analysis of new federal data — a problem created by an economic downturn that has tightened its grip on millions of Americans and compounded by government relief programs that expired or will terminate at the end of the year. Experts say it is likely that there’s more hunger in the United States today than at any point since 1998, when the Census Bureau began collecting comparable data about households’ ability to get enough food.
One in 8 Americans reported they sometimes or often didn’t have enough food to eat in the past week, hitting nearly 26 million American adults, an increase several times greater than the most comparable pre-pandemic figure, according to Census Bureau survey data collected in late October and early November. That number climbed to more than 1 in 6 adults in households with children.
“It’s been driven by the virus and the unpredictable government response,” said Jeremy K. Everett, executive director of the Baylor Collaborative on Hunger and Poverty in Waco, Tex.
Nowhere has there been a hunger surge worse than in Houston, with a metro-area population of 7 million people.Houston was pulverized in summer when the coronavirus overwhelmed hospitals, and the local economy was been particularly hard hit by weak oil prices, making matters worse.
More than 1 in 5 adults in Houston reported going hungry recently, including 3 in 10 adults in households with children. The growth in hunger rates has hit Hispanic and Black households harder than White ones, a devastating consequence of a weak economy that has left so many people trying to secure food even during dangerous conditions.
On Saturday, these statistics manifested themselves in the thousands of cars waiting in multiple lines outside NRG Stadium. The people in these cars represented much of the country. Old. Young. Black. White. Asian. Hispanic. Families. Neighbors. People all alone.
Inside a maroon Hyundai Santa Fe was Neicie Chatman, 68, who had been waiting since 6:20 a.m., listening to recordings of a minister’s sermon piped into large earphones.
“I’ve been feeding my spirit,” she said.
Her hours at her job as an administrator have been unsteady since the pandemic began. Her sister was laid off. They both live with their mother, who has been sick for the past year. She planned to take the food home to feed her family and share with her older neighbors.
“It’s been hard to survive. Money is low. No jobs. Hard to find work.”
— Randy Young
“I lost my business and I lost my dream.”
— Adriana Contreras
Now, a new wave of coronavirus infections threatens more economic pain.
Yet the hunger crisis seems to have escaped widespread notice in a nation where millions of households have weathered the pandemic relatively untouched. The stock market fell sharply in March before roaring back and has recovered all of its losses. This gave the White House and some lawmakers optimism about the economy’s condition. Congress left for its Thanksgiving break without making any progress on a new pandemic aid deal even as food banks across the country report a crush of demand heading into the holidays.
“The hardship is incredibly widespread. Large parts of America are saying, ‘I couldn’t afford food for my family,’ ” said Stacy Dean, who focuses on food-assistance policy at the Center on Budget and Policy Priorities. “It’s disappointing this hasn’t broken through.”
No place has been spared.In one of the nation’s richest counties, not far from Trump National Golf Club in Virginia, Loudoun Hunger Relief provided food to a record 887 households in a single week recently. That’s three times the Leesburg, Va.-based group’s pre-pandemic normal.
“We are continuing to see people who have never used our services before,” said Jennifer Montgomery, the group’s executive director.
Hunger rates spiked nationwide after shutdowns in late March closed large chunks of the U.S. economy. The situation improved somewhat as businesses reopened and the benefits from a $2.2 trillion federal pandemic aid package flowed into people’s pockets, with beefed-up unemployment benefits, support for food programs and incentives for companies to keep workers on the payroll.
But those effects were short-lived. The bulk of the federal aid had faded by September. And more than 12 million workers stand to lose unemployment benefits before year’s end if Congress doesn’t extend key programs.
“Everything is a disaster,” said Northwestern University economist Diane Whitmore Schanzenbach, a leading expert on the economics of food insecurity. “I’m usually a pleasant person, but this is just crazy.”
Economic conditions are the main driver behind rising rates of hunger, but other factors play a role, Schanzenbach said. In the Great Recession that began in 2008, people received almost two years of unemployment aid — which helped reduce hunger rates. Some long-term unemployed workers qualified for even more help.
But the less-generous benefits from the pandemic unemployment assistance programs passed by Congress in March have already disappeared or soon will for millions of Americans.
Even programs that Congress agreed to extend have stumbled. A program giving families additional cash assistance to replace school meals missed by students learning at home was renewed for a year on Oct. 1. But the payments were delayed because many states still needed to get the U.S. Agriculture Department’s approval for their plans. The benefit works out to only about $6 per student for each missed school day. But experts say the program has been a lifeline for struggling families.
One program that has continued to provide expanded emergency benefits is the Supplemental Nutrition Assistance Program, or SNAP. The Agriculture Department issued an emergency order allowing states to provide more families the maximum benefit and to suspend the time limit on benefits for younger unemployed adults without children.
The sharpest rise in hunger was reported by groups who have long experienced the highest levels of it, particularly Black Americans. Twenty-two percent of Black U.S. households reported going hungry in the past week, nearly twice the rate faced by all American adults and more than two-and-a-half times the rate for White Americans.
The Houston area was posting some of its lowest hunger rates before the pandemic, thanks to a booming economy and a strong energy sector, Everett said. Then, the pandemic hit. Hunger surged, concentrated among the city’s sizable low-income population, in a state that still allows for the federally mandated minimum wage of $7.25 an hour. Houston’s hunger rates — like those nationwide — fell significantly after the $1,200 stimulus checks were mailed out in April and other pandemic aid plans took effect, Everett said.
But most of the effects of that aid are gone.
“Without sustained aid at the federal level, we’ll be hard pressed to keep up,” said Celia Call, chief executive of Feeding Texas, which advocates for 21 food banks in the state. “We’re just bracing for the worst.”
Schools are one of the most important sources of food for low-income families in Houston. The Houston Independent School District has 210,000 students — many of whom qualify for free or reduced-priced meals. But the pandemic closed schools in the spring. They reopened in the fall with less than half of the students choosing a hybrid model of in-school and at-home instruction. That has made feeding these children a difficult task.
“We’ve made an all-out effort to capture these kids and feed them,” said Betti Wiggins, the school district’s nutrition services officer.
The district provided curbside meal pickups outside schools. Anyone could come, not just schoolchildren. School staffers set up neighborhood distribution sites in the areas with the highest need. They started a program to serve meals to children living in apartment buildings. Sometimes the meal program required police escorts.
“I’m doing everything but serving in the gas station when they’re pumping the gas,” Wiggins said.
Wiggins said the normal school meals program she ran before the pandemic has been transformed into providing food for entire families far beyond a school’s walls. She has noticed unfamiliar faces in her meal lines. The “new poor,” she calls them, parents who might have worked in the airline or energy industries crushed by the pandemic.
“I’m seeing folks who don’t know how to handle the poverty thing,” she said, adding that it became her mission to make sure they had food.
The Houston Food Bank is the nation’s largest, serving 18 counties in Southeast Texas with help from 1,500 partner agencies. Last month, the food bank distributed 20.6 million pounds of food — down from the 27.8 million pounds handed out in May, but still 45 percent more than what it distributed in October 2019, with no end in sight.
The biggest worry for food banks right now is finding enough food, said Brian Greene, president of the Houston Food Bank. Food banks buy bulk food with donations. They take in donated food items, too. Food banks also benefited from an Agriculture Department program that purchased excess food from U.S. farmers hurt by the ongoing trade war with China, typically apples, milk and pork products. But funding for that program ended in September. Other federal pandemic programs are still buying hundreds of millions of dollars in food and donating it to food banks. But Greene said he worries about facing “a commodity cliff” even as demand grows.
Teresa Croft, who volunteers at a food distribution site at a church in the Houston suburb of Manvel, said the need is still overwhelming. She handles the paperwork for people visiting the food bank for the first time. They’re often embarrassed, she said. They never expected to be there. Sometimes, Croft tries to make them feel better by telling her own story — how she started at the food bank as a client, but got back on her feet financially more than a decade ago and is now a food bank volunteer.
“They feel so bad they’re having to ask for help. I tell them they shouldn’t feel bad. We’re all in this together,” Croft said. “If you need it, you need it.”
The pandemic changed how the Houston Food Bank runs. Everything is drive-through and walk-up. Items are preselected and bagged. The food bank has held several food distribution events in the parking lots outside NRG Stadium — a $325 million, retractable-roof temple to sports and home to the National Football League’s Houston Texans.
Last weekend, instead of holding the 71st annual Thanksgiving Day Parade in Houston, the city and H-E-B supermarkets decided to sponsor the food bank’s distribution event at NRG Stadium. The plan was to feed 5,000 families.
The first cars arrived at the stadium around 1 a.m. Saturday, long before the gates opened for the 8 a.m. event. By the time Young and his mother drove up, the line of vehicles stretched into the distance. Organizers opened the gates early. The cars and trucks began to slowly snake through the stadium’s parking lot toward a series of white tents, where the food was loaded into trunks by volunteers. The boxes contained enough food for multiple meals during the holiday week, with canned vegetables such as corn and sweet potatoes, a package of rolls, cranberry sauce and a box of masks. People picking up food were also given a bag of cereal and some resealable bags, a ham, a gallon of milk, and finally a turkey and pumpkin pie.
The food for 5,000 families ran out. The Houston Food Bank — knowing that would not be enough — was able to assemble more.
It provided food to 7,160 vehicles and 261 people who walked up to the event.
Troy Coakley, 56, came to the event looking for food to feed his family for the week. He still had his job breaking apart molds at a plant that makes parts for oil field and water companies. But his hours were cut when the economy took a hit in March. Coakley went from working overtime to three days a week.
He was struggling. Behind on rent. Unsure what was to come.
But for the moment, his trunk filled with food, he had one less thing to worry about.
“Other than [the pandemic], we were doing just fine,” Coakley said. “But now it’s getting worse and worse.”
BLINKING RED: This is a critical week in the coronavirus pandemic. Economists are nervously watching as much of the nation experiences a worsening fall wave, with U.S. case counts near 200,000 a day and record hospitalizations in many parts of the country, my colleagues Paulina Firozi, Lena H. Sun and Hannah Knowles report.
Whether a crest arrives soon could largely be determined by the Thanksgiving holiday, as the Centers for Disease Control and Prevention and health experts warn against traveling and many of the once commonplace rituals of family gatherings.
Early data doesn’t look great:More than 1 million people went through Transportation Security Administration checkpoints in the nation’s airports on Friday —that’s the second-highest single-day rush since March 16. Meanwhile, nearly 80 percent of epidemiologists surveyed recently by the New York Times said they were having Thanksgiving celebrations with people only in their households or not at all.
One bright spot: A third vaccine, made by AstraZeneca, is 90 percent effective if administered in two doses (a half-dose followed by a full-dose booster) and is easier to store than vaccines by Pfizer and Moderna, my colleagues reported this morning.
“The Oxford-AstraZeneca vaccine is likely to be cheaper than those made by Pfizer and Moderna, and it does not need to be stored at subzero temperatures but can be kept in ordinary refrigerators in pharmacies and doctor’s offices,” they wrote.
More than 1 million people flew through U.S. airports on Friday, according to TSA data, the second highest number since the coronavirus pandemic began hit the U.S. in mid-March.
Why it matters: As coronavirus cases and hospitalizations continued to soar this week, the CDC issued new guidance on Thursday advising Americans not to travel for Thanksgiving, warning doing so may increase the chance of getting and spreading COVID-19.
By the numbers: The 1,019,836 people TSA screened at U.S. airports on Friday is still less than half the number (2,550,459) that passed through screenings on the same weekday a year ago.
TSA screened 1,031,505 passengers on Oct. 18, the highest number since March 17.
America’s coronavirus outbreak has surpassed Europe’s.
Why it matters: It wasn’t long ago that public health experts were pointing to Europe as a warning sign for the U.S. But the U.S. now has a higher per capita caseload than the EU ever has during its recent surge.
By the numbers: As of Saturday, 15 states had higher per capita caseloads, averaged over seven days, than the European country with the highest caseload — Luxembourg.
The U.S. overall saw 52.4 cases per 100,000 people. The EU saw 37.6 per 100,000 on Saturday, and peaked at 46.7 cases per 100,000 on Nov. 8.
The big picture: Europe’s steady rise in coronavirus cases over the last couple of months prompted many countries to bring back lockdowns or other strict behavioral restrictions.
Meanwhile, in the U.S., some of the hardest-hit states — like Iowa — are just now adopting mask mandates, and airports over the weekend were packed with people traveling for Thanksgiving.
Yes, but: Cases in the hardest-hit states are starting to trend down, a sign that people are modifying their behavior on their own.
What we’re watching: There’s no sign that the number of U.S. cases nationally is going to stop rising anytime soon, especially in the absence of strong federal or state restrictions.
Hospitalizations and deaths lag behind cases by a few weeks. That means that Europe likely has easier days ahead, while America’s dark days are just getting started.
In the U.S., today’s overwhelmed hospitals will continue to keep getting hit with ever-growing caseloads for awhile.
Cleveland Clinic has about 1,000 employees away from work due to COVID-19, the health system told Becker’s Nov. 23.
The count includes 925 workers in Ohio and other workers across the health system, which also has locations in Florida and Las Vegas. It is an increase from about 800 Cleveland Clinic employees in Ohio reported sidelined as of Nov. 16.
Cleveland Clinic spokesperson Andrea Pacetti said the increase in the number of employees affected by COVID-19 reflects more spreading of the virus in the community and in Ohio, and most affected employees are contracting the virus in the community.
Due to a surge in cases, Cleveland Clinic has taken steps to ensure enough staffing to meet patients’ needs, said Ms. Pacetti. This includes shifting some employees to different areas of the health system to enable Cleveland Clinic to expand bed capacity for COVID-19 patients.
“We are also evaluating our surgical schedule weekly based on hospital occupancy and admissions of patients with COVID-19,” Ms. Pacetti said. “Our leadership meets every day and reviews our staffing to ensure we can provide the highest quality care to all our patients.”
Cleveland Clinic also urges the public to help reduce the spread of the virus so the health system can continue to care for COVID-19 patients and patients who need care but who don’t have the coronavirus.
“This isn’t just a Cleveland Clinic issue, but true for the whole state. We are asking the community to follow guidelines — wear masks, social distance and wash your hands — so we can keep our medical teams healthy,” Ms. Pacetti said.
Cleveland Clinic has about 50,000 employees in Ohio.
HENRY KOTULA 