Florida’s COVID Response Includes Missing Deadlines and Data

Blog | Florida's COVID-19 Data: What We Know, What's Wrong, and What's  Missing | The COVID Tracking Project

 Since the beginning of the coronavirus pandemic, Florida has blocked, obscured, delayed, and at times hidden the COVID-19 data used in making big decisions such as reopening schools and businesses.

And with scientists warning Thanksgiving gatherings could cause an explosion of infections, the shortcomings in the state’s viral reporting have yet to be fixed.

While the state has put out an enormous amount of information, some of its actions have raised concerns among researchers that state officials are being less than transparent.

It started even before the pandemic became a daily concern for millions of residents. Nearly 175 patients tested positive for the disease in January and February, evidence the Florida Department of Health collected but never acknowledged or explained. The state fired its nationally praised chief data manager, she says in a whistleblower lawsuit, after she refused to manipulate data to support premature reopening. The state said she was fired for not following orders.

The health department used to publish coronavirus statistics twice a day before changing to once a day, consistently meeting an 11 a.m. daily deadline for releasing new information that scientists, the media and the public could use to follow the pandemic’s latest twists.

But in the past month the department has routinely and inexplicably failed to meet its own deadline by as much as six hours. On one day in October, it published no update at all.

News outlets were forced to sue the state before it would publish information identifying the number of infections and deaths at individual nursing homes.

Throughout it all, the state has kept up with the rapidly spreading virus by publishing daily updates of the numbers of cases, deaths and hospitalizations.

“Florida makes a lot of data available that is a lot of use in tracking the pandemic,” University of South Florida epidemiologist Jason Salemi said. “They’re one of the only states, if not the only state, that releases daily case line data (showing age, sex and county for each infected person).”

Dr. Terry Adirim, chairwoman of Florida Atlantic University’s Department of Integrated Biomedical Science, agreed, to a point.

“The good side is they do have daily spreadsheets,” Adirim said. “However, it’s the data that they want to put out.”

The state leaves out crucial information that could help the public better understand who the virus is hurting and where it is spreading, Adirim said.

The department, under state Surgeon General Dr. Scott Rivkees, oversees 53? health agencies covering Florida’s 67 counties, such as the one in Palm Beach County headed by Dr. Alina Alonso.

Rivkees was appointed in April 2019. He reports to Gov. Ron DeSantis, a Republican who has supported President Donald Trump’s approach to fighting the coronavirus and pressured local officials to reopen schools and businesses despite a series of spikes indicating rapid spread of the disease.

At several points, the DeSantis administration muzzled local health directors, such as when it told them not to advise school boards on reopening campuses.

DOH Knew Virus Here Since January

The health department’s own coronavirus reports indicated that the pathogen had been infecting Floridians since January, yet health officials never informed the public about it and they did not publicly acknowledge it even after The Palm Beach Post first reported it in May.

In fact, the night before The Post broke the story, the department inexplicably removed from public view the state’s dataset that provided the evidence. Mixed among listings of thousands of cases was evidence that up to 171 people ages 4 to 91 had tested positive for COVID-19 in the months before officials announced in March the disease’s presence in the state.

Were the media reports on the meaning of those 171 cases in error? The state has never said.

No Testing Stats Initially

When positive tests were finally acknowledged in March, all tests had to be confirmed by federal health officials. But Florida health officials refused to even acknowledge how many people in each county had been tested.

State health officials and DeSantis claimed they had to withhold the information to protect patient privacy, but they provided no evidence that stating the number of people tested would reveal personal information.

At the same time, the director of the Hillsborough County branch of the state health department publicly revealed that information to Hillsborough County commissioners.

And during March the state published on a website that wasn’t promoted to the public the ages and genders of those who had been confirmed to be carrying the disease, along with the counties where they claimed residence.

Firing Coronavirus Data Chief

In May, with the media asking about data that revealed the earlier onset of the disease, internal emails show that a department manager ordered the state’s coronavirus data chief to yank the information off the web, even though it had been online for months.

A health department tech supervisor told data manager Rebekah Jones on May 5 to take down the dataset. Jones replied in an email that was the “wrong call,” but complied, only to be ordered an hour later to put it back.

That day, she emailed reporters and researchers following a listserv she created, saying she had been removed from handling coronavirus data because she refused to manipulate datasets to justify DeSantis’ push to begin reopening businesses and public places.

Two weeks later, the health department fired Jones, who in March had created and maintained Florida’s one-stop coronavirus dashboard, which had been viewed by millions of people, and had been praised nationally, including by White House Coronavirus Task Force Coordinator Deborah Birx.

The dashboard allows viewers to explore the total number of coronavirus cases, deaths, tests and other information statewide and by county and across age groups and genders.

DeSantis claimed on May 21 that Jones wanted to upload bad coronavirus data to the state’s website. To further attempt to discredit her, he brought up stalking charges made against her by an ex-lover, stemming from a blog post she wrote, that led to two misdemeanor charges.

Using her technical know-how, Jones launched a competing COVID-19 dashboard website, FloridaCOVIDAction.com in early June. After national media covered Jones’ firing and website launch, people donated more than $200,000 to her through GoFundMe to help pay her bills and maintain the website.

People view her site more than 1 million times a day, she said. The website features the same type of data the state’s dashboard displays, but also includes information not present on the state’s site such as a listing of testing sites and their contact information.

Jones also helped launch TheCOVIDMonitor.com to collect reports of infections in schools across the country.

Jones filed a whistleblower complaint against the state in July, accusing managers of retaliating against her for refusing to change the data to make the coronavirus situation look better.

“The Florida Department of Health needs a data auditor not affiliated with the governor’s office because they cannot be trusted,” Jones said Friday.

Florida Hides Death Details

When coronavirus kills someone, their county’s medical examiner’s office logs their name, age, ethnicity and other information, and sends it to the Florida Department of Law Enforcement.

During March and April, the department refused requests to release that information to the public, even though medical examiners in Florida always have made it public under state law. Many county medical examiners, acknowledging the role that public information can play in combating a pandemic, released the information without dispute.

But it took legal pressure from news outlets, including The Post, before FDLE agreed to release the records it collected from local medical examiners.

When FDLE finally published the document on May 6, it blacked out or excluded crucial information such as each victim’s name or cause of death.

But FDLE’s attempt to obscure some of that information failed when, upon closer examination, the seemingly redacted details could in fact be read by common computer software.

Outlets such as Gannett, which owns The Post, and The New York Times, extracted the data invisible to the naked eye and reported in detail what the state redacted, such as the details on how each patient died.

Reluctantly Revealing Elder Care Deaths, Hospitalizations

It took a lawsuit against the state filed by the Miami Herald, joined by The Post and other news outlets, before the health department began publishing the names of long-term care facilities with the numbers of coronavirus cases and deaths.

The publication provided the only official source for family members to find out how many people had died of COVID-19 at the long-term care facility housing their loved ones.

While the state agreed to publish the information weekly, it has failed to publish several times and as of Nov. 24 had not updated the information since Nov. 6.

It took more pressure from Florida news outlets to pry from the state government the number of beds in each hospital being occupied by coronavirus patients, a key indicator of the disease’s spread, DeSantis said.

That was one issue where USF’s Salemi publicly criticized Florida.

“They were one of the last three states to release that information,” he said. “That to me is a problem because it is a key indicator.”

Confusion Over Positivity Rate

One metric DeSantis touted to justify his decision in May to begin reopening Florida’s economy was the so-called positivity rate, which is the share of tests reported each day with positive results.

But Florida’s daily figures contrasted sharply with calculations made by Johns Hopkins University, prompting a South Florida Sun-Sentinel examination that showed Florida’s methodology underestimated the positivity rate.

The state counts people who have tested positive only once, but counts every negative test a person receives until they test positive, so that there are many more negative tests for every positive one.

John Hopkins University, on the other hand, calculated Florida’s positivity rate by comparing the number of people testing positive with the total number of people who got tested for the first time.

By John Hopkins’ measure, between 10 and 11 percent of Florida’s tests in October came up positive, compared to the state’s reported rate of between 4 and 5 percent.

Health experts such as those at the World Health Organization have said a state’s positivity rate should stay below 5 percent for 14 days straight before it considers the virus under control and go forward with reopening public places and businesses. It’s also an important measure for travelers, who may be required to quarantine if they enter a state with a high positivity rate.

Withholding Detail on Race, Ethnicity

The Post reported in June that the share of tests taken by Black and Hispanic people and in majority minority ZIP codes were twice as likely to come back positive compared to tests conducted on white people and in majority white ZIP codes.

That was based on a Post analysis of internal state data the health department will not share with the public.

The state publishes bar charts showing general racial breakdowns but not for each infected person.

If it wanted to, Florida’s health department could publish detailed data that would shed light on the infection rates among each race and ethnicity or each age group, as well as which neighborhoods are seeing high rates of contagion.

Researchers have been trying to obtain this data but “the state won’t release the data without (making us) undergo an arduous data use agreement application process with no guarantee of release of the data,” Adirim said. Researchers must read and sign a 26-page, nearly 5,700-word agreement before getting a chance at seeing the raw data.

While Florida publishes the ages, genders and counties of residence for each infected person, “there’s no identification for race or ethnicity, no ZIP code or city of the residence of the patient,” Adirim said. “No line item count of negative test data so it’s hard to do your own calculation of test positivity.”

While Florida doesn’t explain its reasoning, one fear of releasing such information is the risk of identifying patients, particularly in tiny, non-diverse counties.

Confusion Over Lab Results

Florida’s daily report shows how many positive results come from each laboratory statewide. Except when it doesn’t.

The report has shown for months that 100 percent of COVID-19 tests conducted by some labs have come back positive despite those labs saying that shouldn’t be the case.

While the department reported in July that all 410 results from a Lee County lab were positive, a lab spokesman told The Post the lab had conducted roughly 30,000 tests. Other labs expressed the same confusion when informed of the state’s reporting.

The state health department said it would work with labs to fix the error. But even as recently as Tuesday, the state’s daily report showed positive result rates of 100 percent or just under it from some labs, comprising hundreds of tests.

Mistakenly Revealing School Infections

As DeSantis pushed in August for reopening schools and universities for students to attend in-person classes, Florida’s health department published a report showing hundreds of infections could be traced back to schools, before pulling that report from public view.

The health department claimed it published that data by mistake, the Miami Herald reported.

The report showed that COVID-19 had infected nearly 900 students and staffers.

The state resumed school infection reporting in September.

A similar publication of cases at day-care centers appeared online briefly in August only to come down permanently.

Updates Delayed

After shifting in late April to updating the public just once a day at 11 a.m. instead of twice daily, the state met that deadline on most days until it started to falter in October. Pandemic followers could rely on the predictability.

On Oct. 10, the state published no data at all, not informing the public of a problem until 5 p.m.

The state blamed a private lab for the failure but the next day retracted its statement after the private lab disputed the state’s explanation. No further explanation has been offered.

On Oct. 21, the report came out six hours late.

Since Nov. 3, the 11 a.m. deadline has never been met. Now, late afternoon releases have become the norm.

“They have gotten more sloppy and they have really dragged their feet,” Adirim, the FAU scientist, said.

No spokesperson for the health department has answered questions from The Post to explain the lengthy delays. Alberto Moscoso, the spokesman throughout the pandemic, departed without explanation Nov. 6.

The state’s tardiness can trip up researchers trying to track the pandemic in Florida, Adirim said, because if one misses a late-day update, the department could overwrite it with another update the next morning, eliminating critical information and damaging scientists’ analysis.

Hired Sports Blogger to Analyze Data

As if to show disregard for concerns raised by scientists, the DeSantis administration brought in a new data analyst who bragged online that he is no expert and doesn’t need to be.

Kyle Lamb, an Uber driver and sports blogger, sees his lack of experience as a plus.

“Fact is, I’m not an ‘expert’,” Lamb wrote on a website for a subscribers-only podcast he hosts about the coronavirus. “I also don’t need to be. Experts don’t have all the answers, and we’ve learned that the hard way throughout the entire duration of the global pandemic.”

Much of his coronavirus writings can be found on Twitter, where he has said masks and mandatory quarantines don’t stop the virus’ spread, and that hydroxychloroquine, a drug touted by President Donald Trump but rejected by medical researchers, treats it successfully.

While DeSantis says lockdowns aren’t effective in stopping the spread and refuses to enact a statewide mask mandate, scientists point out that quarantines and masks are extremely effective.

The U.S. Food and Drug Administration has said hydroxychloroquine is unlikely to help and poses greater risk to patients than any potential benefits.

Coronavirus researchers have called Lamb’s views “laughable,” and fellow sports bloggers have said he tends to act like he knows much about a subject in which he knows little, the Miami Herald reported.

DeSantis has yet to explain how and why Lamb was hired, nor has his office released Lamb’s application for the $40,000-a-year job. “We generally do not comment on such entry level hirings,” DeSantis spokesman Fred Piccolo said Tuesday by email.

It could be worse.

Texas health department workers have to manually enter data they read from paper faxes into the state’s coronavirus tracking system, The Texas Tribune has reported. And unlike Florida, Texas doesn’t require local health officials to report viral data to the state in a uniform way that would make it easier and faster to process and report.

It could be better.

In Wisconsin, health officials report the number of cases and deaths down to the neighborhood level. They also plainly report racial and ethnic disparities, which show the disease hits Hispanic residents hardest.

Still, Salemi worries that Florida’s lack of answers can undermine residents’ faith.

“My whole thing is the communication, the transparency,” Salemi said. “Just let us know what’s going on. That can stop people from assuming the worst. Even if you make a big error people are a lot more forgiving, whereas if the only time you’re communicating is when bad things happen … people start to wonder.”

An Oregon nurse bragged on TikTok about not wearing a mask outside of work. She’s now on administrative leave.

Nurse placed on leave for bragging on TikTok about not wearing a mask -  Mirror Online

Dressed in blue scrubs and carrying a stethoscope around her neck, an oncology nurse in Salem, Ore., looked to the Grinch as inspiration while suggesting that she ignored coronavirus guidelines outside of work.

In a TikTok video posted Friday, she lip-dubbed a scene from “How the Grinch Stole Christmas” to get her point across to her unaware colleagues: She does not wear a mask in public when she’s not working at Salem Hospital.

“When my co-workers find out I still travel, don’t wear a mask when I’m out and let my kids have play dates,” the nurse wrote in a caption accompanying the video, which has since been deleted.

Following swift online backlash from critics, her employer, Salem Health, announced Saturday that the nurse had been placed on administrative leave. In a statement, the hospital said the nurse, who has not been publicly identified by her employer, “displayed cavalier disregard for the seriousness of this pandemic and her indifference towards physical distancing and masking out of work.”

“We also want to assure you that this one careless statement does not reflect the position of Salem Health or the hardworking and dedicated caregivers who work here,” said the hospital, adding that an investigation is underway.

Salem Health did not respond to The Washington Post’s request for comment as of early Monday.

The nurse’s video offers a startling and rare glimpse of a front-line health-care worker blatantly playing down a virus that has killed at least 266,000 Americans. It also has been seen in some coronavirus patients, some on their deathbeds, who still refuse to believe the pandemic is real.

The incident comes at a time when Oregon has continued to see a spike in new coronavirus cases and virus-related hospitalizations. Just last week, the state’s daily reported deaths and hospitalizations rose by 33.3 and 24.2 percent respectively, according to The Post’s coronavirus tracker. At least 74,120 Oregonians have been infected with the virus since late February; 905 of them have died.

The clip posted to TikTok on Friday shows the nurse mocking the health guidelines while using audio from a scene in which the Grinch reveals his true identity to Cindy Lou Who.

Although the original video was removed, TikTok users have shared a “duet” video posted by another user critical of the nurse, which had more than 274,000 reactions as of early Monday.

Soon after she posted the clip, hundreds took to social media and the hospital’s Facebook page to report the nurse’s video and demand an official response from her employer. Some requested that the nurse be removed from her position and that her license be revoked.

Hospital officials told the Salem Statesman Journal that the investigation is aiming to figure out which other staff members and patients have come in contact with the nurse, who works in the oncology department.

But for some, the hospital’s apologies and actions were not enough.

“The video supplied should be evidence enough,” one Facebook user commented. “She needs to be FIRED. Not on PAID leave. As someone fighting cancer, I can only imagine how her patients feel after seeing this news.”

The hospital thanked those who alerted them of the incident, emphasizing that its staff, patients and visitors must adhere to the Centers for Disease Control and Prevention guidelines.

“These policies are strictly enforced among staff from the moment they leave their cars at work to the moment they start driving home,” hospital officials told the Statesman Journal.

Fears of coronavirus jump intensify in Thanksgiving’s aftermath

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: ‘If you make a commitment to the masks, we don’t have to shut the economy down’

https://thehill.com/homenews/sunday-talk-shows/527884-detroit-mayor-if-you-make-a-commitment-to-the-masks-we-dont-have?rnd=1606667483

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.”

66 hospitals postponing elective procedures amid the COVID-19 resurgence

Hospitals still scheduling elective surgery during coronavirus crisis

Hospitals across the U.S. are beginning to suspend elective procedures to respond to an uptick in hospitalized COVID-19 patients. 

Below is a breakdown of 66 hospitals postponing or canceling the procedures to free up space, ensure proper staffing or enough protective gear to care for COVID-19 patients:

1. Mercy Health Youngstown (Ohio) will indefinitely suspend elective procedures that require an inpatient admission starting Nov. 26, according to the Tribune Chronicle. 

2. Prescot, Ariz.-based Yavapai Regional Medical Center, which recently joined Dignity Health, will limit elective procedures effective Nov. 26 to Dec. 4, according to The Daily Courier. 

3. South Bend, Ind.-based Beacon Health System is suspending nonemergency surgeries to free up bed space and staff to care for a surge in COVID-19 cases, according to WSBT. The surgeries affected include those that require an inpatient stay. 

4. Citing a spike in COVID-19 cases, Goshen (Ind.) Health is suspending nonurgent surgeries, according to WSBT.

5. Stormont Vail Health in Topeka, Kan., is rescheduling some elective surgeries that require overnight stays to free up bed space, according to local news station WIBW. 

6. UW Medicine in Seattle will suspend nonemergency surgeries that require an inpatient hospital stay, effective Nov. 23 through Feb. 1.

7. Mercy Hospital South in St. Louis plans to delay some nonurgent procedures that require longer hospital stays amid a spike in COVID-19 hospitalizations, according to the St. Louis Post-Dispatch.  

8. Metro Health-University of Michigan Health in Wyoming, Mich., has delayed some surgeries that require an inpatient stay, according to MiBiz.

9. Albuquerque, N.M.-based Presbyterian Healthcare Services is canceling nonurgent surgeries that require hospitalization, according to local news station KBOB. The health system said it will postpone those surgeries that can be delayed for six weeks or longer safely.  

10. HSHS Sacred Heart Hospital in Eau Claire, Wis., is postponing electives on a case-by-case basis amid a surge in COVID-19 cases, according to The Leader-Telegram.

11. IU Health Methodist Hospital in Indianapolis has started to reduce the amount of elective procedures it will perform, while still trying to catch up on those that were postponed during the initial surge, according to MedPageToday.

12. Carson Tahoe Hospital in Carson City, Nev., has delayed non-time sensitive surgeries for a few weeks to free up space and staff to care for a surge in COVID-19 hospitalizations, according to local station News 4

13. The 267-bed Mercy Health Muskegon (Mich.) has begun to delay elective surgeries as needed amid an influx of COVID-19 cases, according to MiBiz.

14. Buffalo, N.Y.-based Catholic Health will halt all inpatient elective surgeries that require an overnight stay for two weeks amid a COVID-19 hospitalization surge, according to Buffalo News. The healthcare system will start rescheduling procedures Nov. 21, and reevaluate if an extension is needed Dec. 5. 

15. Chicago-based Northwestern Medicine will reduce the number of nonemergency surgeries it performs to help preserve bed capacity and staff to help care for a surge in COVID-19 cases, according to the Northwest Herald

16. Morris (Ill.) Hospital and Healthcare Centers postponed some inpatient surgeries requiring overnight stays the week of Nov. 16 due to a bed shortage exacerbated by the rise in COVID-19 cases, according to NBC Chicago. 

17. Memorial Community Hospital and Health System in Blair, Neb., is limiting elective surgeries requiring an overnight hospital stay for several weeks to preserve bed capacity and ensure proper staffing levels to care for the influx of COVID-19 cases, according to the Pilot-Tribune & Enterprise

18. Spectrum Health in Grand Rapids, Mich., is deferring elective surgeries requiring an overnight hospital stay, according to Michigan Radio. The deferral rate is about 10 percent, according to the report. 

19. Avera St. Mary’s Hospital in Pierre, S.D., is postponing nonemergency procedures so staff can care for the influx of COVID-19 cases and respond to emergent needs, according to DRGNews.

20. Salt Lake City-based Intermountain Healthcare will postpone some surgeries that require an inpatient admission to free up beds, preserve supplies and free up providers amid a surge in COVID-19 hospitalizations. The hospital system will only delay those that can be safely postponed. 

21. Froedtert Health in Wauwatosa, Wis., will delay non-urgent surgeries that require an inpatient admission post-surgery in an effort to free up staff and beds amid the coronavirus case surge in Wisconsin, according to local news station TMJ4. The hospitals are located in Wauwatosa, Menomonee Falls and West Bend. 

22. Memorial Hospital in Aurora, Neb., has suspended elective surgeries that take place at its Wortman Surgery Center to dedicate staff to inpatient and emergency care.

23. Minneapolis-based Allina Health is delaying some non-urgent procedures at three of its hospitals until at least Nov. 27, according to The Star Tribune. The delays will affect non-urgent procedures that require an overnight hospital stay. 

24. Bloomington, Minn.-based HealthPartners has started postponing some total joint surgeries, including hip or knee replacements, at three Minnesota hospitals, according to The Twin Cities Business Journal. The affected hospitals are Methodist Hospital in St. Louis Park, Regions Hospital in St. Paul and Lakeview Hospital in Stillwater. 

25. Southern Illinois Healthcare, a two-hospital system based in Carbondale, will reduce its elective surgery volume by about 50 percent as more people seek inpatient care for COVID-19, according to The Southern Illinoisan. The surgeries affected by the delay include those that require an overnight hospital stay.

26. University of Cincinnati Health activated surge operations Nov. 16, requiring a 50 percent reduction in elective inpatient surgeries and procedures across the health system, according to local news station WLWT.

27. Rochester, Minn.-based Mayo Clinic has started scaling back elective care to ensure it can care for patients with emergent needs and a high influx of COVID-19 patients, according to The Post Bulletin. 

28. Citing a 1,500 percent increase in COVID-19 hospitalizations between Nov. 1 and Nov. 17, Lake Health in Concord Township, Ohio, is pausing elective surgeries that require an overnight stay, according to The News-Herald. The pause will continue through Nov. 20, but the system will reevaluate if the pause needs to be extended on a weekly basis. 

29. Cook County Health, the public hospital system based in Chicago, is suspending elective surgeries requiring inpatient stays, according to WBEZ. The decision was made to ensure adequate staffing to care for an influx in COVID-19 cases.  

30. Urbana, Ill.-based Carle Foundation Hospital has canceled some elective procedures that require an overnight hospital stay in an effort to free up beds and staff to care for COVID-19 patients, according to The News Gazette.

31. Elkhart (Ind.) General Hospital stopped all elective surgeries Nov. 17 after more than 200 patients were admitted to its 144-bed hospital, according to The New York Times. Of those patients 90 were being treated with COVID-19. The hospital also diverted ambulances during this time.

32. Advocate Aurora Health, with dual headquarters in Milwaukee and Downers Grove, Ill., has started reducing elective procedures by 50 percent at some of its facilities, according to a Nov. 16 media briefing. The health system said that more hospitals will look into the option to postpone elective procedures later the week of Nov. 16. 

33. The University of Kansas Health System in Kansas City started postponing some elective surgeries to free up inpatient beds Nov. 12.

34. St. Luke’s Health System in Boise, Idaho, will stop scheduling certain elective surgeries and procedures through Dec. 25, according to a company news release. The temporary delay starts Nov. 16. St. Luke’s medical centers in Boise, Meridian, Magic Valley and Nampa will also cancel elective cases requiring an overnight stay scheduled for the week of Nov. 16, according to the news release. 

35. Citing an increased demand for inpatient beds, Ascension Genesys Hospital in Grand Blanc, Mich., will not schedule any new inpatient elective surgeries until at least Nov. 30. The hospital said it has asked surgeons to “thoughtfully examine” already scheduled cases requiring extended recovery through Nov. 30.

36. SSM Health St. Mary’s Hospital in Madison began rescheduling nonemergent surgeries to free up intensive care unit bed space, according to local news station NBC 15.

37. Cedar Rapids, Iowa-based Mercy Medical Center will reduce elective surgery cases through Nov. 20. It also temporarily stopped scheduling new elective procedures.

38. Columbia Memorial Hospital in Astoria, Ore., will reduce some elective procedures due to an increase in COVID-19 cases, according to the Cannon Beach Gazette.

39. St. Louis-based BJC HealthCare will postpone some elective surgery cases at all 15 of its hospitals and ambulatory care settings starting Nov. 16. The surgery postponement will last eight weeks. The announcement comes just one week after the health system started rescheduling nonemergency surgeries at four of its hospitals.

40. Citing a significant increase in COVID-19 hospitalizations, Cleveland Clinic said it will postpone some nonemergency surgeries. Cleveland Clinic said it will reschedule nonessential surgical cases that require an inpatient stay at its hospitals in Ohio through Nov. 20.  It will reassess its scheduled surgical cases daily to determine if more cases need to be delayed.

41. Baxter County Regional Medical Center in Mountain Home, Ark., said Nov. 11 it will begin postponing nonemergency surgeries. The hospital will only defer procedures requiring an overnight hospital stay in order to free up beds for COVID-19 patients. 

42. Portland, Ore.-based Legacy Health will reduce the number of elective procedures requiring an overnight hospital stay by 25 percent.

“We will monitor the situation and adjust as needed,” Trent Green, Legacy Health COO, wrote in an email to staff. “If the number of hospitalized patients continues to grow, we may cancel more surgeries. As hospital volumes lower, we will add back elective surgeries.”

43. Kaiser Permanente Northwest, which has hospitals in Oregon and southwest Washington state, is implementing a “scheduling pause” at some of its Oregon medical centers through Dec. 31.

44. Portland-based Oregon Health & Sciences University is implementing voluntary elective surgery deferrals. The hospital system will evaluate surgical cases daily to ensure it has the appropriate capacity to care for all patients.

45. Aurora, Colo.-based UCHealth began postponing some nonemergency surgeries due to a surge in COVID-19 hospitalizations. The health system will defer nonemergent surgeries that require inpatient admission. The health system began postponing some of those surgeries the week of Nov. 2.

46. As of Nov. 11, Grand Rapids, Mich.-based Spectrum Health has 14 hospitals nearing capacity amid a surge of COVID-19 cases. As a result it is starting to delay inpatient surgeries that require overnight stays.

47. Community Memorial Hospital in Cloquet, Minn., has halted some elective surgeries to free up beds amid a surge in hospitalizations.

48. Sarah Bush Lincoln, a 145-bed hospital in Mattoon, Ill., is postponing most inpatient elective surgeries due to bed capacity constraints. The hospital said it will make the decision on whether to postpone a surgery on a case-by-case basis. 

49. Memorial Health System in Springfield, Ill., will begin delaying some nonurgent surgeries Nov. 16.

50. Evanston, Ill.-based NorthShore University HealthSystemhas started evaluating elective surgeries on a case-by-case basis and delaying those that can be postponed safely.

51. UnityPoint Health Meriter in Madison, Wis., is rescheduling nonemergent surgeries that require overnight stays to save beds for COVID-19 patients. The hospital has seen a “significant” uptick in COVID-19-related hospitalizations, with about one-third of UnityPoint Meriter’s beds occupied by patients with the virus.

52. St. Luke’s, a two-hospital system in Duluth, Minn., is postponing nonemergency surgeries amid a surge in COVID-19 patients. The health system said it will only delay surgeries that require an overnight stay and can be rescheduled safely.

53. Omaha, Neb.-based Methodist Health System began postponing elective surgeries at its flagship hospital Oct. 29, president and CEO Steve Goeser told Becker’s. It is reviewing the surgery schedule to determine which ones can be postponed safely.

54. Omaha-based Nebraska Medicine is limiting nonurgent procedures due to a rise in COVID-19 hospitalizations. The health system said that it has enough beds, but high-level intensive care unit providers “aren’t an infinite resource.”

55. CHI Health in Omaha, Neb., said that some nonurgent procedures will be postponed amid the COVID-19 resurgence. By postponing some surgeries, CHI Health said it aims to free up beds and capacity for patients.

56. Sanford Health, a 46-hospital system based in Sioux Falls, S.D., will begin rescheduling some nonemergency inpatient surgeries that require an overnight hospital stay due to an influx of COVID-19 patients. 

57. Bryan Health, based in Lincoln, Neb., will begin scaling back elective surgeries requiring an overnight hospitalization due to a rise in COVID-19 cases. The system said it will decrease elective surgeries requiring overnight stay by 10 percent for the week of Nov. 2 to ensure it is able to care for COVID-19 patients and perform essential surgeries.

58. Mayo Clinic Health System began deferring elective procedures at its hospitals in Northwest Wisconsin Oct. 31 amid an escalation of COVID-19 cases. The health system did not say when elective procedures will restart. The Mayo Clinic Health System has clinics, hospitals and other facilities across Iowa, Minnesota and Wisconsin.

59. Madison, Wis.-based UW Health is postponing a small number of elective procedures to free up bed capacity to care for COVID-19 patients, according to WKOW. Jeff Pothof, MD, UW Health’s chief quality officer, said that patients may be asked to push back a non-emergency procedure by about a week. 

60. Saint Vincent Hospital in Erie, Pa., will postpone a small number of elective procedures after some patients and caregivers tested positive for COVID-19. The hospital did not specify the number of patients and staff who tested positive. 

61. Johnson City, Tenn.-based Ballad Health will begin deferring elective procedures at three of its Tennessee hospitals due to a spike in COVID-19 hospitalizations. On Oct. 26, Ballad began rescheduling up to 25 percent of elective services at Holston Valley Medical Center in Kingsport, Tenn. Procedures are also expected to begin being deferred at Bristol Regional Medical Center and Johnson City Medical Center. 

62. Maury Regional Medical Center in Columbia, Tenn., will suspend elective procedures requiring an overnight stay for two weeks. Hospital leadership will re-evaluate the feasibility of elective surgeries by Nov. 9.

63. Cookeville (Tenn.) Regional Medical Center said Oct. 26 it suspended elective procedures requiring an overnight stay after it was caring for a record high of 71 COVID-19 patients, according to WKRN.

64. Salt Lake City-based University of Utah Hospital canceled elective procedures after its intensive care unit hit capacity on Oct. 16. The hospital said it needed to postpone the elective care to allocate staff to care for critically ill patients. 

65. Sanford Health in Sioux Falls, S.D., will stop scheduling new elective surgery cases requiring an overnight stay, according to system CMO Mike Wilde, MD. New elective cases requiring an overnight stay were not scheduled for Oct. 19-23, but previously scheduled elective surgeries were performed.

66. Billings (Mont.) Clinic began evaluating each surgical case for urgency in late September. It is postponing those it says can wait, according to The Wall Street Journal.

COVID-19 hospitalizations top 90,000 in US: Why this number is one to watch even more closely right now

90,000 Americans are hospitalized as COVID-19 cases skyrocket Video - ABC  News

The United States recorded 90,481 people currently hospitalized with COVID-19 Nov. 26, marking the 17th consecutive day of record hospitalizations and the first time the daily count topped 90,000, according to The COVID Tracking Project

The Project has noted that several data points will likely “wobble” over the next several days due to the Thanksgiving holiday, which may cause data points for COVID-19 testing, new cases and deaths to flatten or drop for several days before spiking. It is unlikely that Thanksgiving infections will be clearly visible in official case data until at least the second week of December.

However, the Project’s staff has noted that the new admissions metric in the public hospitalization dataset from HHS shows only moderate volatility and will likely be an additional source of useful data through the expected holiday dip and subsequent spike in test, case and death data.

“If you’re a reporter covering COVID-19, we recommend focusing on current hospitalizations and new admissions as the most reliable indicator of what is actually happening in your area and in the country as a whole,” reads the Nov. 24 blog from The COVID Tracking Project.

Coronavirus: US tops 90,000 COVID-19 cases in 24 hours for the first time |  Al Arabiya English

Supreme Court shows conservative effect in key coronavirus ruling

The Supreme Court’s new conservative majority showed its muscle on Thanksgiving Eve, with Justice Amy Coney Barrett playing a key role in reversing the court’s past deference to local officials when weighing pandemic-related restrictions on religious organizations.

All three of President Trump’s nominees to the court were in the 5-to-4 majority that blocked New York Gov. Andrew M. Cuomo’s restrictions on houses of worship in temporary hot spots where the coronavirus is raging.

The court’s most conservative justices distanced themselves from Chief Justice John G. Roberts Jr. Justice Neil M. Gorsuch, Trump’s first nominee, went out of his way to say that lower courts should no longer follow Roberts’s guidance of deference, calling it “mistaken from the start.”

“Even if the Constitution has taken a holiday during this pandemic, it cannot become a sabbatical,” Gorsuch wrote. Rather than applying “nonbinding and expired” guidance from Roberts in an earlier case from California, Gorsuch said, “courts must resume applying the Free Exercise Clause.”

“Today, a majority of the court makes this plain.”

The halt of Cuomo’s orders, which had been allowed to remain in place by lower courts, was the first evidence that Roberts may no longer play the pivotal role he occupied over the past couple of years. He had been at the center of the court, with four consistently more conservative justices and four more liberal ones.

Barrett’s replacement of liberal Justice Ruth Bader Ginsburg means there are now five members of the court — a majority — more willing to move it quickly in a more conservative direction.

And pandemic-related restrictions on worship services have drawn the ire of the conservatives for months.

They were previously outvoted when Ginsburg was alive, as she and the other liberals joined with Roberts to leave in place restrictions in California and Nevada that imposed limits on in-person services at houses of worship.

In the cases involved in the court’s midnight order Wednesday, the Roman Catholic Diocese of Brooklyn and Jewish organizations led by Agudath Israel challenged Cuomo’s system of imposing drastic restrictions on certain neighborhoods when coronavirus cases spike.

Under Cuomo’s plan, in areas designated “red zones,” where the virus risk is highest, worship services are capped at 10 people. At the next level, “orange zones,” there is an attendance cap of 25. The size of the facility does not factor in to the capacity limit.

The diocese said in its petition that the plan subjects “houses of worship alone” to “onerous ­fixed-capacity caps while permitting a host of secular businesses to remain open in ‘red’ and ‘orange’ zones without any restrictions whatsoever.”

And the Jewish organizations noted that Cuomo, a Democrat, had specifically mentioned outbreaks in Orthodox Jewish neighborhoods when imposing the restrictions. “This court should not permit such remarkable scapegoating of a religious minority to stand,” the organizations said in court documents.

Cuomo attributed the court’s order to its more conservative majority. “I think that Supreme Court ruling on the religious gatherings is more illustrative of the Supreme Court than anything else,” Cuomo told reporters. “It’s irrelevant from a practical impact because the zone that they were talking about has already been moved. It expired last week. I think this was really just an opportunity for the court to express its philosophy and politics.”

Technically, the court’s order blocks Cuomo’s restrictions from being reimposed while legal challenges continue. But the court’s unsigned opinion would appear to make the ultimate outcome clear.

Even in a pandemic, the Constitution cannot be put away and forgotten,” the opinion said. “The restrictions at issue here, by effectively barring many from attending religious services, strike at the very heart of the First Amendment’s guarantee of religious liberty.”

The opinion was endorsed by Barrett, Gorsuch and Justices Clarence Thomas, Samuel A. Alito Jr. and Brett M. Kavanaugh, Trump’s second appointment to the court. It was mild compared with recent comments from Alito and the Gorsuch opinion, which no other justices joined.

Alito, who did not write a separate opinion, recently told the conservative legal organization the Federalist Society that the pandemic “has resulted in previously unimaginable restrictions on individual liberty.”

“It pains me to say this, but in certain quarters, religious liberty is fast becoming a disfavored right,” Alito said.

But Justice Stephen G. Breyer, writing for fellow liberals Sonia Sotomayor and Elena Kagan, said it was a strange time for the court to be offering relief.

“The number of new confirmed cases per day is now higher than it has ever been,” Breyer wrote, pointing to the growing national death toll and the outsize number of fatalities New York has suffered, which tracking by The Washington Post puts at more than 34,000.

“The nature of the epidemic, the spikes, the uncertainties, and the need for quick action, taken together, mean that the State has countervailing arguments based upon health, safety, and administrative considerations that must be balanced against the applicants’ First Amendment challenges,” Breyer wrote.

Sotomayor was more pointed in a separate opinion joined by Kagan: “Justices of this court play a deadly game in second guessing the expert judgment of health officials about the environments in which a contagious virus, now infecting a million Americans each week, spreads most easily.”

Roberts noted in his opinion that the rules might be unduly restrictive but said Cuomo has already eased them, essentially giving the churches and synagogues the relief they had requested.

“The Governor might reinstate the restrictions. But he also might not,” the chief justice wrote. “And it is a significant matter to override determinations made by public health officials concerning what is necessary for public safety in the midst of a deadly pandemic.”

Gorsuch disagreed.

“It is time — past time — to make plain that, while the pandemic poses many grave challenges, there is no world in which the Constitution tolerates color-coded executive edicts that reopen liquor stores and bike shops but shutter churches, synagogues, and mosques,” he wrote.

Gorsuch’s solo opinion was at times scathing and sarcastic. He noted that Cuomo had designated, among others, hardware stores, acupuncturists, liquor stores and bicycle repair shops as essential businesses not subject to the most strict limits.

“So, at least according to the governor, it may be unsafe to go to church, but it is always fine to pick up another bottle of wine, shop for a new bike, or spend the afternoon exploring your distal points and meridians,” Gorsuch wrote. “Who knew public health would so perfectly align with secular convenience?”

Gorsuch criticized Roberts for relying on one of the court’s 1905 precedents for his position that the court should defer to local officials during health crises.

The chief justice seemed taken aback. He said his earlier opinion in the California case asserted only that the Constitution chiefly leaves such decisions to local officials.

That, he wrote, “should be uncontroversial, and the [Gorsuch] concurrence must reach beyond the words themselves to find the target it is looking for.”

He also defended the liberal justices from Gorsuch’s tough words, even though Roberts did not join their dissents.

“I do not regard my dissenting colleagues as ‘cutting the Constitution loose during a pandemic,’ yielding to ‘a particular judicial impulse to stay out of the way in times of crisis,’ or ‘shelter[ing] in place when the Constitution is under attack,’ ” Roberts wrote, quoting Gorsuch’s opinion.

“They simply view the matter differently after careful study and analysis reflecting their best efforts to fulfill their responsibility under the Constitution.”

Conservative religious organizations praised the court’s action.

“Governor Cuomo should have known that openly targeting Jews for a special covid crackdown was never going to be constitutional,” said Eric Rassbach, vice president and senior counsel at the Becket Fund, which represented Agudath Israel. Covid-19 is the disease caused by the coronavirus. “The Supreme Court was right to step in and allow Jews and Catholics to worship as they have for centuries.”

But Donna Lieberman, executive director of the New York Civil Liberties Union, said the court’s action was dangerous.

“New York’s temporary restrictions on indoor gatherings do not discriminate against houses of worship, and, in fact, treat them better than comparable non-religious gatherings,” Lieberman said in a statement. “The Supreme Court’s decision will unfortunately undermine New York’s efforts to curb the pandemic.”

Sanford Health CEO out after two decades following mask controversy

Sanford Health, CEO Kelby Krabbenhoft part ways
  • 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 definitiveOther 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.

We’re celebrating Thanksgiving amid a pandemic. Here’s how we did it in 1918 – and what happened next

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On Thanksgiving more than a century ago, many Americans were living under quarantines, and officials warned people to stay home for the holiday.

More than 200,000 dead since March. Cities in lockdown. Vaccine trials underway.

And a holiday message, of sorts: “See that Thanksgiving celebrations are restricted as much as possible so as to prevent another flare-up.”

It isn’t the message of Thanksgiving 2020. It’s the Thanksgiving Day notice that ran in the Omaha World Herald on Nov. 28, 1918, when Americans found themselves in a similar predicament to the millions now grappling with how to celebrate the holiday season amid the coronavirus pandemic.

“Every time I hear someone say these are unprecedented times, I say no, no, they’re not,” said Brittany Hutchinson, assistant curator at the Chicago History Museum. “They did this in 1918.”

On Thanksgiving more than a century ago, many Americans, like today, lived under various phases of quarantines and face mask orders. Millions mourned loved ones. And health officials in many cities issued the same holiday warning: Stay home and stay safe.

Giving thanks for WWI victory, beating pandemic

By late November 1918, the USA – in the midst of the suffrage movement, Jim Crow and the tail end of WWI – battled the ebbing second wave of the H1N1 influenza epidemic, also known as the Spanish flu.

The first cases were detected in the USA in March of that year, growing exponentially by the fall. In October, the virus burned through the nation. Dozens of cities implemented face mask orders and curfews and locked down for two to three weeks, temporarily closing schools, libraries, theaters, movie houses, dance halls, churches, ice cream parlors and soda shops. The virus killed about 195,000 Americans during October alone.

As Thanksgiving rolled around, some cities celebrated the relaxation of flu-related restrictions– partly due to opposition campaigns by retailers, theater owners, unions, mass transportation companies and other economically stressed stakeholders. Washington, Indianapolis and Oakland, California, had lifted restrictions days before, and San Francisco was on the brink of lifting its mask mandate.

San Francisco had one of the nation’s largest anti-masking campaigns, spearheaded by the Anti-Mask League of San Francisco, according to Howard Markel, a professor of the history of medicine at the University of Michigan and co-editor-in chief of The American Influenza Epidemic of 1918-1919. Many people refused to wear masks and were arrested, and when the “line into the courtroom was so long, they laid off arresting people because the system couldn’t enforce it,” Markel said.

On Nov. 13, the San Francisco Examiner reported that “Thanksgiving Day will be celebrated in San Francisco by the discarding of gauze masks, if the present rate of decrease in influenza continues.”

A week later, San Franciscans ceremoniously removed their masks as a whistle sounded across the city at noon. “San Francisco Joyously Discards Masks In Twinkling; Faces Beam As Gauze Covers Come Off At Time Fixed,” the San Francisco Chronicle wrote on its front page Nov. 22.

Resistance to public health measures was not as “vociferous or widespread as today,” but it was there, Markel said. “A lot of these rules and regulations were wrapped up in the patriotism of World War I, and most people followed them. But we don’t have that unifying situation right now. You would think the pandemic would be unifying.”

In some cities, Thanksgiving rituals brought a welcome sense of normalcy. Many Americans returned to religious services, performed charity work and went through with planned football games, parties and performances.

In Portland, a “grand reunion service” was planned for the Sunday after Thanksgiving, “in honor of the reassembling after being debarred from worship on account of the epidemic for the last five weeks.” Members of various congregations were “ready to greet each other after the long absence,” according to the Oregon Daily Journal on Nov. 16.

“The chimes of church bells will once more be heard on Sunday morning throughout the city, beckoning one and all to attend their chosen place of worship, where a double celebration will be held, first over the suppression of autocracy and, second, over the eradication of a frightful plague,” the paper wrote.

Rabbis, priests, pastors and more conveyed a unified message, Hutchinson said – one of “forgiveness and compassion.”

“People are urging to be considerate of one another, to care for one another,” Hutchinson said. “There are messages of putting the smallness of the individual into perspective with the vastness of humanity.”

Other cities were still trending in the opposite direction.

Lockdowns, quarantines on Thanksgiving

By the end of November, cases were rising in cities such as Atlanta, Denver, Louisville, Kentucky, Milwaukee, Omaha, Nebraska, Portland, Oregon, and Richmond, Virginia. Many health experts attributed the “renewal of the grip epidemic” to festivities Nov. 11 – later designated as Armistice Day – when thousands flooded the streets to celebrate the end of WWI.

“It is not the lifting of the closure ban that is the cause of spreading of the epidemic but the putting aside of all precautions and restrictions by the people of Denver when they celebrated on Victory Day,” City Manager of Health and Charity William H. Sharpley told the Denver Post in a story Nov. 21.

On Nov. 27, the day before Thanksgiving, St. Louis reported its highest new daily case count since the epidemic began, and Buffalo, New York, reported its largest jump in daily cases since the lifting of its pandemic ban weeks earlier. Both cities subsequently cracked down on public gatherings, limited the number of passengers on streetcars and ordered those cars to be ventilated and cleaned.

In Salt Lake City, residents were under “quarantine” on Thanksgiving, shops were prohibited from holding sales and celebrations were postponed until Christmas Day. Placards indicating households infected with influenza were placed on the front and rear entrances of 2,000 homes.

“Owing to the influenza quarantine, the day’s festivities … had to be postponed till Christmas day. But Thanksgiving services of some sort are being held in nearly every home,” an article on the front page of the Desert Evening News said. “Because the influenza quarantine prevents public gatherings, the day in Utah is being observed quietly and without any spectacular features.”

Officials in Los Angeles promoted a “Stay at Home Week” over Thanksgiving. The Los Angeles Times issued a call on its front page to “REMEMBER AFFLICTED THANKSGIVING DAY; Influenza Ban Is Felt,” saying, “Thanksgiving Day held many attractions, although in a modified sense.”

“The salvation Army served fifty pounds of turkeys to fifty old men, but dispensed with its usual big dinner to the outcasts at the headquarters, because of the influenza ban,” the Times wrote.

Denver, which was under a face mask order, had just opened three emergency hospitals and issued an urgent call for nurses. Churches were expected to hold Thanksgiving services, but “extra precautions will be taken to guard against spread of epidemic,” the Rocky Mountain News reported the day before. 

“Special pains have been taken to provide all the ventilation necessary and to make attendance at the services safe in spite of the influenza epidemic. In a number of churches electric fans have been placed in the auditoriums so as to change the air every few minutes,” the article said.

In many cities, traditional Thanksgiving Day pageants were held outside. In Cincinnati, which saw a surge in cases among children and firemen, Thanksgiving “exercises” at school were held in auditoriums instead of classrooms to “avoid crowding,” the Cincinnati Enquirer wrote Nov. 28.

A handful of cities began to see a surge in cases on Thanksgiving.

Cities see cases rise on Thanksgiving

Cincinnati health officials “requested parents to forego children’s parties and gatherings during the Thanksgiving vacation,” but the number of hospitalized patients rose on the holiday. Schools added an extra day of vacation to the Thanksgiving holiday break to promote “a beneficial result in the influenza situation.”

“We are not in a happy frame of mind tonight,” Dr. Walter List, superintendent of the city’s General Hospital, told the Cincinnati Enquirer on Thanksgiving. “An institution such as this can stand the strain of an epidemic for five or six weeks, but when it continues for such a long period the situation is complicated.”

Kansas City saw a similar trend. The week of Thanksgiving, the number of flu cases at the city’s General Hospital doubled, and on Thanksgiving Day, city health officials reinstituted home quarantine for influenza victims and their families. Schools on break for Thanksgiving were closed until further notice.

Public dance halls and restaurants were closed on Thanksgiving in Spokane, Washington, and private parties were prohibited. The next day, the city’s emergency hospital received more applications for admission than on any other day during the entire epidemic. On Thanksgiving, “the hospital was filled and death a frequent visitor,” the Spokesman-Review wrote.

Jefferson, Iowa, physician C.W. Blake spent much of his Thanksgiving evening making house calls on people ill from influenza, author Thomas Morain wrote in his 1998 book, “Prairie Grass Roots.” Blake was attending a Thanksgiving dinner at a farm outside town and let the local phone operator know he would be available later in the day. When he received the call about patients in the early evening, the operator had a list of 54 patients who had come down with the flu that day.

“At one farm north of Jefferson a family of four was too sick even to make themselves the most simple meal,” Morain wrote. “While Blake checked each one, (his assistant) made a soup from ingredients on hand and left it for the family.”

Hopes of a vaccine on Thanksgiving

By the fall of 1918, scientists were working on an influenza vaccine, and many were developed and used over the course of the pandemic. Researchers in New York, Boston, Pittsburgh, New Orleans and Seattle developed vaccines, and thousands of people in those cities and many others were inoculated.

Days before Thanksgiving, health officers in Rochester, New York, encouraged people to obtain the vaccine available at a health bureau. In Salt Lake City, the emergency hospital gave more than 100 vaccinations Nov. 30. By early December, free inoculation clinics were established across the city, and thousands of residents lined up for their vaccinations.

The problem? Researchers didn’t know influenza was a virus.

“The vaccine that was made was a vaccine against (a bacteria), which they thought was the cause of influenza,” Markel said. “So not only were vaccines of this era crude and not all that effective, the vaccine that they did produce was for the wrong organism.”

Vaccine science was nowhere near the scientifically advanced level of 2020, said Markel, whose mother died from COVID-19 this year. The study of virology was in its infancy, and researchers didn’t have the tools to see viruses. Though bacteria are much larger and can be viewed under a light microscope, viruses require an electron microscope, which had not been invented in 1918, Markel said.

The vaccines that researchers developed did not stop an impending third wave of the flu.

Third wave of influenza surges after the holidays

Just as cases rose after Armistice Day celebrations, they rose again after Thanksgiving. Dallas, Minneapolis, San Antonio, San Francisco and Seattle saw surges. Omaha relaunched a public health campaign. Parts of Cleveland and its suburbs closed schools and enacted influenza bans in early December.

On Dec. 6, the St. Paul Daily News announced that more than 40 Minneapolis schools were closed because of the flu, below the headline “SANTA CLAUS IS DOWN WITH THE FLU.” Health officials asked “moving picture show” managers to exclude children, closed Sunday schools and ordered department stores to dispense with “Santa Claus programs.”

On Christmas Eve, health officials in Nebraska made influenza a mandatory quarantine disease, and fines ranged from $15 to $100 for violations. Approximately 1,000 homes in Omaha were placarded, meaning their occupants were unable to leave for at least four days after the fever had subsided.

In Denver, the Salvation Army canceled its annual Christmas parties for children, and the Women’s Press Club canceled its New Year’s Eve ball. School Christmas assemblies were canceled in Fall River, Massachusetts, and families with an influenza patient in their homes were warned not to entertain guests and barred from borrowing books from the library.

By January, the USA was fully engulfed in its third wave of influenza. The virus spread throughout the winter and spring, killing thousands more. It infected one-third of the world’s population and killed approximately 675,000 Americans before subsiding in the summer of 1919.

“What did they do wrong? That’s hard to say, but all of these measures are like Swiss cheese. They have holes, so you try to use as many layers as possible,” Markel said. “To me, those surges just represented whether there was social distancing or not. Flu didn’t stop circulating, the question was when did people go out and get exposed to it? And that’s what’s going on now.”

A warning for 2020: ‘Stay home and stay safe’

A century later, the nation has recorded more than 12 million cases of COVID-19, and more than 255,000 people in the USA have died. Dozens of states reimplemented coronavirus-related restrictions, and health officials echo the stay-at-home guidance issued decades ago.

“The risk of not traveling is less than the risk of traveling,” Anthony Fauci, the nation’s leading infectious disease expert, told USA TODAY Wednesday. “During this interesting period of a lot of infection going on, colder weather, indoors: Do you want to travel and go to a Thanksgiving meal where there may be 12, 15, 20 people?”

Fauci said his three adult daughters won’t come home for Thanksgiving this year. Hutchinson, the Chicago-based curator who had COVID-19 in April, said she plans to celebrate Thanksgiving at home with her dog and Facetime family members. Markel, in Ann Arbor, said he plans to eat Thanksgiving dinner alone, downsize from a full turkey to a sliced turkey breast and Zoom with family.

If history tells us anything, Markel said, it’s that “the risk of contracting the virus or spreading the virus by congregating in groups or even traditional holiday parties is right now too great.”

“It is disappointing, but let’s get through this, so we can celebrate many, many more Thanksgivings,” he said. “The better part of valor is to stay home and stay safe.”