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Category Archives: Infection Control
Confronting a national emergency over coronavirus
https://mailchi.mp/325cd862d7a7/the-weekly-gist-march-13-2020?e=d1e747d2d8
President Trump declared a national emergency today, in response to the growing spread of coronavirus across the country. The administration had come under sharp criticism for its sluggish response to the coronavirus crisis, in particular the widespread shortage of tests. Dr. Antony Fauci, director of the National Institute of Health’s infectious disease branch, told Congress on Thursday that the government’s response on testing was “not really geared to what we need right now…That’s a failing. Let’s admit it.”
In response, the administration today announced a series of emergency steps to increase testing capacity, turning to private labs to support the effort. The emergency status frees up $50B in federal emergency funding. Trump also announced that the Health and Human Services (HHS) Secretary will be able to waive regulations around telemedicine licensing, critical access hospital bed requirements and length of stay, and other measures to provide hospitals with added flexibility. House Speaker Nancy Pelosi and Treasury Secretary Steven Mnuchin have negotiated a sweeping aid package that would strengthen safety net programs, and offer sick leave for American workers affected by the virus.
Meanwhile, the American economy likely entered a recession, as consumers continued to pull back on spending on airline travel, entertainment, and other discretionary areas, while financial markets experienced the worst one-day drop in more than 30 years. Many school districts and universities shut down and announced plans to convert to online instruction for the foreseeable future. Employers imposed broad travel restrictions on their employees, moved to teleworking where possible, and even began to lay off workers as demand for services cratered. Shoppers stocked up on staples, cleaning supplies, and (inexplicably) toilet paper, as shelves ran bare in many stores.
Epidemiologists and disease experts urged broad adoption of “social distancing”, restricting large gatherings and reducing the ability of the virus to spread person-to-person. The objective: “flattening the curve” of transmission, so that the healthcare delivery system does not become overwhelmed as the virus spreads exponentially.
The Impacts of the Coronavirus Pandemic
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This is the coronavirus math that has experts so worried: Running out of ventilators, hospital beds
Consider the ventilators
For those severely ill with a respiratory disease such as covid-19, ventilators are a matter of life or death because they allow patients to breathe when they cannot on their own.
In a report last month, the Center for Health Security at Johns Hopkins estimated America has a total of 160,000 ventilators available for patient care (with at least an additional 8,900 in the national stockpile).
A planning study run by the federal government in 2005 estimated that if America were struck with a moderate pandemic like the 1957 influenza, the country would need more than 64,000 ventilators. If we were struck with a severe pandemic like the 1918 Spanish flu, we would need more than 740,000 ventilators — many times more than are available.
The math on hospital beds isn’t any better
The United States has roughly 2.8 hospital beds per 1,000 people. South Korea, which has seen success mitigating its large outbreak, has more than 12 hospital beds per 1,000 people. China, where hospitals in Hubei were quickly overrun, has 4.3 beds per 1,000 people. Italy, a developed country with a reasonably decent health system, has seen its hospitals overwhelmed and has 3.2 beds per 1,000 people.
The United States has an estimated 924,100 hospital beds, according to a 2018 American Hospital Association survey, but many are already occupied by patients at any one time. And the United States has 46,800 to 64,000 medical intensive-care unit (ICU) beds, according to the AHA. (There are an additional 51,000 ICU beds specialized for cardiology, pediatrics, neonatal, burn patients and others.)
A moderate pandemic would mean 1 million people needing hospitalization and 200,000 needing intensive care, according to a Johns Hopkins Center for Health Security report last month. A severe pandemic would mean 9.6 million hospitalizations and 2.9 million people needing intensive care.
Now, factor in how stretched-thin U.S. hospitals already are during a normal, coronavirus-free week handling usual illnesses: patients with cancer and chronic diseases, those walking in with blunt-force trauma, suicide attempts and assaults. It’s easy to see why experts are warning that if the pandemic spreads too widely, clinicians could be forced to ration care and choose which patients to save.
No one knows how bad it will be
This is where we need to say that no one knows how bad this is going to get. But, as many experts have pointed out, that is part of the problem.
“The problem with forecasting is you have to know where you are before you know where you’re going and because of the problems with testing, we’re only starting to know where we are,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.
The speed at which the number of U.S. cases is rising hints we are headed in a bad direction.
But because so much is still unknown, exactly how bad could range widely. It will depend largely on two things: The number of Americans who end up getting infected and the virus’s still-unknown lethality (its case-fatality rate).
One forecast, developed by former CDC director Tom Frieden, found that infections and deaths in the United States could range widely. In a worst-case scenario, but one that is not implausible, half the U.S. population would get infected and more than 1 million people would die. But his model’s results varied widely from 327 deaths (best case) to 1,635,000 (worst case) over the next two or three years.
This is why experts have been yelling so much about testing, social distancing and hand washing
“Slowing it down matters because it prevents the health service becoming overburdened,” said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. “We have a limited number of beds; we have a limited number of ventilators; we have a limited number of all the things that are part of supportive care that the most severely affected people will require.”
The sooner you interrupt the virus’s chain of transmission, experts say, the more you limit its climb toward exponential growth. It’s similar to the compounding interest behind all those mottos about invest when you’re young. Early action can have profound effects.
That math is also why so many health officials, epidemiologists and experts have expressed frustration, anger and alarm over how slowly America as a country has moved and is still moving to prepare for the virus and to blunt its spread.
White House to Walk Back 3 Policy Announcements
https://www.axios.com/trump-coronavirus-oval-office-speech-e0f6685f-ffd4-4e28-9794-0e16ee71321b.html
The White House had to walk back three policy announcements from President Trump’s Oval Office announcement Wednesday that are causing more confusion than comfort during the coronavirus outbreak.
Why it matters: COVID-19 is already here in the U.S., and in some communities, it’s spreading rapidly. Trump’s travel restrictions won’t stop the infection in states where person-to-person spread is rampant.
1) Europe travel ban: Trump said Americans will be exempt “who have undergone appropriate screenings.”
- His words caused people in Europe to buy tickets at premium prices back to the U.S. in a panic, per the Washington Post.
- But it will only apply to foreign nationals who have been in the Schengen region of Europe within 14 days of arrival in the U.S. It does not apply to permanent U.S. residents, citizens or immediate family of citizens, per the Department of Homeland Security.
2) Health insurers: “Have agreed to waive all copayments for coronavirus treatments,” Trump said.
- But insurers have agreed to wave copayments for testing, not treatment.
3) Trade: The White House walked back Trump’s statement that the travel restrictions “apply to the tremendous amount of trade and cargo, but various other things as we get approval.”
The big picture: Although Trump spent extra time making sure businesses knew he’d ease economic uncertainty, stocks fell more than 8% on Thursday morning and halted briefly for the second time this week.
- What to watch: More mayors and governors are handling outbreaks by limiting mass gatherings of a certain size. In Seattle, that’s no more than 250 people. In San Francisco and Washington, D.C., it’s no more than 1,000.
Congressional doctor predicts 70 million-150 million U.S. coronavirus cases
Congress’ in-house doctor told Capitol Hill staffers at a close-door meeting this week that he expects 70-150 million people in the U.S. — roughly a third of the country — to contract the coronavirus, two sources briefed on the meeting tell Axios.
Why it matters: That estimate, which is in line with other projections from health experts, underscores the potential seriousness of this outbreak even as the White House has been downplaying its severity in an attempt to keep public panic at bay.
Dr. Brian Monahan, the attending physician of the U.S. Congress, told Senate chiefs of staff, staff directors, administrative managers and chief clerks from both parties on Tuesday that they should prepare for the worst, and offered advice on how to remain healthy.
Between the lines: Forecasting the spread of a virus is difficult, and the range of realistic possibilities is wide.
- But other estimates, including statistical modeling from Harvard epidemiologist Marc Lipsitch, have said that somewhere between 20% and 60% of adults worldwide might catch the virus.
Yes, but: These estimates include people who will get sick and make a full recovery, and many people will catch the virus without ever feeling seriously ill.
- Monahan told staffers that about 80% of people who contract coronavirus will ultimately be fine, one of the sources said.
- Monahan’s office declined to comment.
Meanwhile, Democratic and Republican leaders on Capitol Hill have told lawmakers they have no immediate plans to close Congress, despite it being a potential petri dish for the virus.
- Many lawmakers fit high-risk profiles because they’re over 60, have underlying health conditions and are mixing in close quarters with visitors, staff and reporters.
Coronavirus updates: State Department urges Americans not to travel abroad
The State Department issued a global level 3 health advisory late Wednesday advising Americans to “reconsider travel abroad due to the global impact” of the novel coronavirus pandemic.
The big picture: President Trump announced hours earlier European travel to the U.S. will be restricted for 30 days, with some exemptions, and the NBA suspended its season. There are more than 126,000 cases in over 100 countries and territories and more than 4,600 deaths. There are over 1,300 cases in the U.S.
LAST 48 HOURS
- Travel restrictions: The Trump administration’s new rules affect European member states of the Schengen Area, which includes most but not all of the EU. The United Kingdom and Ireland are not in the zone and are not affected by the restrictions.
- In Israel, all travelers entering from any country — including Israeli citizens — are required to self-quarantine for 14 days.
- Travel advisory: “Many areas throughout the world are now experiencing COVID-19 outbreaks and taking action that may limit traveler mobility, including quarantines and border restrictions,” the State Department advisory reads. “Even countries, jurisdictions, or areas where cases have not been reported may restrict travel without notice.”
- U.S. cases: Nearly 40 states reported at least 1,220 cases as of Wednesday, and roughly two dozen have declared a state of emergency. The novel coronavirus has now killed at least 30 Americans in five states.
- Washington, D.C., Mayor Muriel Bowser announced a state of emergency Wednesday, as well as six new COVID-19 cases. There are now 10 presumptive cases in D.C. — including person-to-person transmission and at least two individuals who contracted the virus from unknown causes.
- A staffer in the D.C. office of Sen. Maria Cantwell (D-Wash.) has tested positive to the virus — the first known case of a congressional staffer becoming infected with the virus.
- California’s Los Angeles County announced six additional cases on Wednesday — including one that health officials presume is the county’s second case of community spread transmission.
- The state’s health officials now recommend that events larger than 250 people be canceled.
- There are now four deaths in California after Los Angeles County announced Wednesday the death of an “older adult” who “traveled extensively over the past month,” including to South Korea.
- Virginia announced that a teenager in the Chickahominy Health District, who recently traveled internationally, has tested positive for COVID-19 on Wednesday, marking 9 current cases in the state. The affected teen did not attend school.
- The states with the most cases as of Wednesday are: Washington, New York and California — where three TSA officers at Mineta San Jose International Airport were confirmed to have tested positive for the virus Tuesday night.
- Maryland now has 9 confirmed cases after a 70-year-old Montana resident who was visiting Anne Arundel County came in close contact with someone who had contracted the virus, Maryland Gov. Larry Hogan said Wednesday.
- New York Gov. Andrew Cuomo said he planned to deploy the National Guard to the New York City suburb New Rochelle on Tuesday to establish a one-mile “containment zone” and help contain the spread of the novel coronavirus.
- Pandemic classification: The World Health Organization classified the outbreak as a pandemic Wednesday.
- Global impact: Cases continue to surge in Spain, Germany, France and Italy, which is on complete lockdown with more than 12,000 cases — second-highest to China.
- Business: Twitter announced Wednesday night that it instructed all employees globally to work from home.
- Google recommended Tuesday that all its employees in North America work from home until at least April 10 amid the novel coronavirus outbreak, one of the most sweeping cautionary edicts.
- The Securities and Exchange Commission is the first federal agency to direct its staff at its D.C. office to work remotely after an employee with respiratory problems was told they may have the virus.
- IBM is encouraging its employees who live or work in New York City and Westchester County to work from home. Amazon, Facebook, Microsoft and Salesforce have similar practices in place.
- Deloitte has recommended its staff return from areas impacted by COVID-19 to work from home for 14 days from their return date. The consulting firm has asked workers to defer nonessential international and domestic travel.
- Australia: Actor Tom Hanks confirmed Wednesday he and his wife, Rita Wilson, tested positive for the virus while in Australia, which now has 128 cases.
- Federal aid: The Department of Health and Human Services announced Wednesday it is allocating over $560 million to states and local areas to assist with COVID-19 response.
- Cruise ship: Nearly 300 people left the docked Grand Princess ship in Oakland, Calif. on Tuesday, with more than half sent to Travis Air Force base and 98 to Lackland Air Force base in Texas, Gov. Gavin Newsom said Tuesday.
- Community spread warning: Some areas in the U.S. have passed the point of containment and communities should focus on mitigation plans, such as canceling events, CDC director Robert Redfield said Tuesday.
- The Centers for Medicare & Medicaid Services asked nursing homes to limit visitation due to the high amount of deaths and greater risk for people over 60 and/or with underlying health conditions have.
- Seniors should limit unnecessary travel and exposure to large public gatherings, the officials said.
- Conferences and events: Music festival Coachella has been postponed until October. Many international and domestic conferences affecting all businesses, trades and entertainment are being either postponed or canceled.
- Several congressmen are under self-quarantine after they came in contact with a CPAC attendee who tested positive.
- Financial impact: U.S. stocks have taken a toll with various dips and corrections all week. Worries are growing that the outbreak could shrink global GDP and perhaps sink the U.S. dollar.
- Oil: Already struggling with mounting debt and falling market valuations, energy companies are at serious risk for mass bond defaults.
- Diagnostics: Health insurers and regulators are working to ensure coronavirus diagnostic tests are covered — but that doesn’t necessarily mean COVID-19 treatment will be affordable. Concerns linger as to how the health care system can meet the demands of high-volume testing.
- Universities: As colleges cancel classes and boot students off campus because of the coronavirus, they’re creating logistical and financial nightmares that could leave many students in a bind.
- Tourism: White House advisers are looking at policy changes to help relieve the travel and hospitality industry. Tourism and travel operators have had to reprice globally, as airlines, hotels and travel operators see major declines in bookings and revenue.
- Social media: A large part of the problem is the “infodemic,” as stories get shared that are designed to drive fear rather than build understanding about the illness, according to NewsWhip data provided to Axios.
WHO declares the coronavirus outbreak a pandemic
The World Health Organization on Wednesday declared the rapidly spreading coronavirus outbreak a pandemic, acknowledging what has seemed clear for some time — the virus will likely spread to all countries on the globe.
Director General Tedros Adhanom Ghebreyesus said the situation will worsen.
“We expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher,” said Tedros, as the director general is known.
As of Wednesday, 114 countries have reported that 118,000 have contracted Covid-19, the disease caused by the virus, known as SARS-CoV2. In the United States, where for weeks state and local laboratories could not test for the virus, just over 1,000 cases have been diagnosed and 29 people have died. But authorities here warn continuing limits on testing mean the full scale of spread in this country is not yet known.
The virus causes mild respiratory infections in about 80% of those infected, though about half will have pneumonia. Another 15% develop severe illness and 5% need critical care.
“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this coronavirus,” Tedros said at the WHO’s headquarters in Geneva, in making the announcement. “It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
At the same time, Tedros said: “This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight.”
The virus, which probably originated in bats but passed to people via an as yet unrecognized intermediary animal species, is believed to have started infecting people in Wuhan, China, in late November or early December. Since then the virus has raced around the globe.
While China appears on the verge of stopping its outbreak — it reported only 24 cases on Tuesday — outbreaks are occurring and growing in a number of locations around the world including Italy, Iran and the United States.
South Korea, which has reported nearly 8,000 cases, also appears poised to bring its outbreak under control with aggressive measures and widespread testing. But other countries have struggled to follow the leads of China and South Korea — a reality that has frustrated WHO officials who have exhorted the world to do everything possible to end transmission of the virus.
“The bottom line is: We’re not at the mercy of the virus,” Tedros said on Monday. “The great advantage is that the decisions we all make as governments, businesses, communities, families and individuals can influence the trajectory of this epidemic.”
“The rule of the game is: Never give up,” he insisted.
The WHO has been criticized and second-guessed for not declaring the outbreak a pandemic sooner. Mike Ryan, head of the agency’s health emergencies program, admitted in a press conference on Monday that the agency fears that countries may interpret a pandemic declaration as a sign efforts to contain the virus have failed and they no longer need to try.
“For me, I’m not worried about the word. I’m more concerned about that the world’s reaction will be to that word. Will we use it as a call to action? Will we use it to fight? Or will we use it to give up?” Ryan asked.
The latest on the coronavirus
In less than three months, the novel coronavirus has spread from an unknown pathogen located in a single Chinese city to a global phenomenon that is affecting nearly every part of society.
U.S. stocks closed more than 7% lower on Monday, after a wild day that saw a rare halt in trading, Axios’ Courtenay Brown reports.
- Why it matters: The sell-off reflects serious fears that the coronavirus could help drive the economy into a recession.
Italy’s prime minister announced that the government has extended internal travel restrictions to the entire country until April 3 and that all public gatherings and sporting events would be banned.
- Why it matters: It’s an extreme measure that effectively locks down 60 million people in one of the most populated countries in Europe, where more people have tested positive for the coronavirus than in any country outside of China.
Hospitals are reporting that their supplies of critical respirator masks are quickly dwindling, the New York Times reports.
- Why it matters: Keeping health care workers healthy will be critical as hospitals and other facilities see a surge in patients as the coronavirus spreads.
Coronavirus Update
The spread of the new Coronavirus has continued, with a number of cases showing up in countries like Iran, Italy, and South Korea. Coronavirus information is changing by the minute, so we’re back with another update.
HENRY KOTULA 