Covid-19 cases are rising, but deaths are falling. What’s going on?

Coronavirus cases are rising, but Covid-19 deaths are falling ...

By the time coronavirus deaths start rising again, it’s already too late.

There is something confounding about the US’s new coronavirus spikes: Cases are rising, but the country is seeing its lowest death counts since the pandemic first exploded.

The numbers are genuinely strange to the naked eye: On July 3, the US reported 56,567 new Covid-19 cases, a record high. On the same day, 589 new deaths were reported, continuing a long and gradual decline. We haven’t seen numbers that low since the end of March.

When laypeople observe those contradictory trends, they might naturally have a follow-up question: If deaths are not increasing along with cases, then why can’t we keep reopening? The lockdowns took an extraordinary toll of their own, after all, in money and mental health and some lives. If we could reopen the economy without the loss of life we saw in April and May, then why shouldn’t we?

I posed that very question to more than a dozen public health experts. All of them cautioned against complacency: This many cases mean many more deaths are probably in our future. And even if deaths don’t increase to the same levels seen in April and May, there are still some very serious possible health consequences if you contract Covid-19.

The novel coronavirus, SARS-Cov-2, is a maddeningly slow-moving pathogen — until it’s not. The sinking death rates reflect the state of the pandemic a month or more ago, experts say, when the original hot spots had been contained and other states had only just begun to open up restaurants and other businesses.

That means it could still be another few weeks before we really start to see the consequences, in lives lost, of the recent spikes in cases. And in the meantime, the virus is continuing to spread. By the time the death numbers show the crisis is here, it will already be too late. Difficult weeks will lie ahead.

Even if death rates stay low in the near term, that doesn’t mean the risk of Covid-19 has evaporated. Thousands of Americans being hospitalized in the past few weeks with a disease that makes it hard to breathe is not a time to declare victory. Young people, who account for a bigger share of the recent cases, aren’t at nearly as high a risk of dying from the virus, but some small number of them will still die and a larger number will end up in the hospital. Early research also suggests that people infected with the coronavirus experience lung damage and other long-term complications that could lead to health problems down the road, even if they don’t experience particularly bad symptoms during their illness.

And as long as the virus is spreading in the community, there is an increased risk that it will find its way to the more vulnerable populations.

“More infected people means faster spread throughout society,” Kumi Smith, who studies infectious diseases at the University of Minnesota, told me. “And the more this virus spreads the more likely it is to eventually reach and infect someone who may die or be severely harmed by it.”

This presents a communications challenge. Sadly, as Smith put it, “please abstain from things you like to benefit others in ways that you may not be able to see or feel” is not an easy message for people to accept after three-plus months in relative isolation.

But perhaps the bigger problem is the reluctance of our government to take the steps necessary to control the disease. Experts warned months ago that if states were too quick to relax their social distancing policies, without the necessary capacity for more testing or contact tracing, new outbreaks would flare up and be difficult to contain.

That’s exactly what happened — and now states are scrambling to reimpose some restrictions. Unless the US gets smarter about its coronavirus response, the country seems doomed to repeat this cycle over and over again.


Why Covid-19 deaths aren’t rising along with cases — yet

The contradiction between these two curves — case numbers sloping upward, death counts downward — is the primary reason some people are agitating to accelerate, not slow down, reopening in the face of these new coronavirus spikes.

The most important thing to understand is that this is actually to be expected. There is a long lag — as long as six weeks, experts told me — between when a person gets infected and when their death would be reported in the official tally.

“Why aren’t today’s deaths trending in the same way today’s cases are trending? That’s completely not the way to think about it,” Eleanor Murray, an epidemiologist at Boston University, told me. “Today’s cases represent infections that probably happened a week or two ago. Today’s deaths represent cases that were diagnosed possibly up to a month ago, so infections that were up to six weeks ago or more.”

“Some people do get infected and die quickly, but the majority of people who die, it takes a while,” Murray continued. “It’s not a matter of a one-week lag between cases and deaths. We expect something more on the order of a four-, five-, six-week lag.”

As Whet Moser wrote for the Covid Tracking Project last week, the recent spikes in case counts really took off around June 18 and 19. So we would not expect them to show up in the death data yet.

“Hospitalizations and deaths are both lagging indicators, because it takes time to progress through the course of illness,” Caitlin Rivers at the Johns Hopkins Center for Health Security told me late last week. “The recent surge started around two weeks ago, so it’s too soon to be confident that we won’t see an uptick in hospitalizations and deaths.”

The national numbers can also obscure local trends. According to the Covid Tracking Project, hospitalizations are spiking in the South and West, but, at the same time, they are dropping precipitously in the Northeast, the initial epicenter of the US outbreak.

And a similar regional shift in deaths may be underway, though it will take longer to reveal itself because the death numbers lag behind both cases and hospitalizations. But even now, Alabama, Arizona, Florida, Nevada, South Carolina, Tennessee, Texas, and Virginia have seen an uptick in their average daily deaths, according to Covid Exit Strategy, while Connecticut, Massachusetts, and New York have experienced a notable decline.

There are some reasons to be optimistic we will not see deaths accelerate to the same extent that cases are. For one, clinicians have identified treatments like remdesivir and dexamethasone that, respectively, appear to reduce people’s time in the hospital and their risk of dying if they are put on a ventilator.

The new infections are also, for now, skewing more toward younger people, who are at a much lower risk of dying of Covid-19 compared to older people. But that is not the case for complacency that it might superficially appear to be.


Younger people are less at risk from Covid-19 — but their risk isn’t zero

For starters, younger people can die of Covid-19. About 3,000 people under the age of 45 have died from the coronavirus, according to the CDC’s statistics (which notably have a lower overall death count than other independent sources that rely on state data). That is a small percentage of the 130,000 and counting overall Covid-19 deaths in the US. But it does happen.

Moreover, younger people can also develop serious enough symptoms that they end up having to be hospitalized with the disease. Again, their risk is meaningfully lower than that of older people, but that doesn’t mean it’s zero.

There can also be adverse outcomes that are not hospitalization or death. Illness is not a zero-sum game. A recent study published in Nature found that even asymptomatic Covid-19 patients showed abnormal lung scans. As Lois Parshley has documented for Vox, some people who recover from Covid-19 still report health problems for weeks after their initial sickness. Potential long-term issues include lung scarring, blood clotting and stroke, heart damage, and cognitive challenges.

In short, surviving Covid-19, even with relatively mild symptoms, does not mean a person simply reverts to normal. This is a new disease, and we are still learning the full extent of its effects on the human body.

But even if we recognize that young people face less of a threat directly from the coronavirus, there is still a big reason to worry if the virus is spreading in that population: It could very easily make the leap from less vulnerable people to those who are much more at risk of serious complications or death.


The coronavirus could easily jump from younger people to the more vulnerable

One response to the above set of facts might be: “Well, we should just isolate the old and the sick, while the rest of us go on with our lives.” That might sound good in theory (if you’re not older or immunocompromised yourself), but it is much more difficult in practice.

“The fact is that we live in communities that are all mixed up with each other. That’s the concern,” Natalie Dean, a biostatistics professor at the University of Florida, says. “It’s not like there’s some nice neat demarcation: you’re at high risk, you’re at low risk.”

The numbers in Florida are telling. At first, in late May and into early June, new infections accelerated among the under-45 cohort. But after a lag of a week or so, new cases also started to pick up among the over-45 (i.e., more at-risk) population.

“The rise in older adults is trailing behind, but it is starting to go up,” Dean said.

Anecdotally, nursing homes in Arizona and Texas — the two states with the most worrisome coronavirus trends right now — have seen outbreaks in recent weeks as community spread increases. The people who work in nursing homes, after all, are living out in the community where Covid-19 is spreading. And, because they are younger, they may not show symptoms while they are going to work and potentially exposing those patients.

As one expert pointed out to me, both Massachusetts and Norway have seen about 60 percent of their deaths come in long-term care facilities, even though the former has a much higher total fatality count than the latter. That would suggest we have yet to find a good strategy for keeping the coronavirus away from those specific populations.

“There is so far not much evidence that we know how to shield the most vulnerable when there is widespread community transmission,” Marc Lipsitch, a Harvard epidemiologist, told me.

That means the best recourse is trying to contain community spread, which keeps the overall case and death counts lower (as in Norway) and prevents the health care system from being overwhelmed.


Health systems haven’t been overwhelmed — but some hospitals in new hot spots are getting close

Arizona, Florida, and Texas still have 20 to 30 percent of their ICU and hospital beds available statewide, according to Covid Exit Strategy, even as case counts continue to rise. While some people use those numbers to argue that the health systems can handle an influx of Covid patients, the experts I spoke to warned that capacity can quickly evaporate.

“Let’s keep it that way, shall we?” William Hanage at Harvard said. “Hospitals are getting close to overwhelmed in some places, and that will be more places in future if action isn’t taken now. Also ‘not overwhelmed’ is a pretty low bar.”

Hospital capacity is another example of how the lags created by Covid-19 can lull us into a false sense of security until a crisis presents itself and suddenly it’s too late. Because it can take up to two weeks between infection and hospitalization, we are only now beginning to see the impact of these recent spikes.

And, to be clear, hospitalizations are on the rise across the new hot spots. The number of people currently hospitalized with Covid-19 in Texas is up from less than 1,800 on June 1 to nearly 8,000 on July 4. Hospitalizations in Arizona have nearly tripled since the beginning of June, up to more than 3,100 today.

And the state-level data doesn’t show local trends, which are what really matter when it comes to hospital capacity. Some of the hardest-hit cities in these states are feeling the strain, as Hanage pointed out. Hospitals in Houston have started transferring their Covid-19 patients to other cities, and they are implementing their surge capacity plans, anticipating a growing need because of the trendlines in the state.

Once a hospital’s capacity is reached, it’s already too late. They will have to endure several rough weeks after that breach, because the virus has continued to infect more people in the interim, some of whom will get very sick and require hospitalization when there isn’t any room available for them.

“We’re seeing some drastic measures being implemented right now in Texas and Arizona along those lines: using children’s hospitals for adults, going into crisis mode, etc.,” Tara Smith, who studies infectious diseases at Kent State University, told me. “So it shows how quickly all of that can turn around.”

And, on top of Covid-19, these health systems will continue to have the usual flow of emergencies from heart attacks, strokes, accidents, etc. That’s when experts start to worry people will die who wouldn’t otherwise have. That is what social distancing, by slowing the spread of the coronavirus, is supposed to prevent.


We don’t have to lock down forever — but we have to be smart and vigilant

Lockdowns are extraordinarily burdensome. Tens of millions of Americans have lost their jobs. Drug overdoses have spiked. There has been a worrying increase in heart-related deaths, which indicates people who otherwise would have sought medical treatment did not do so during the worst of the outbreak this spring.

But we cannot will the coronavirus out of existence. Experts warned months ago that if states reopened too early, cases would spike, which would strain health systems and put us at risk of losing more people to this virus. That appears to be what’s starting to happen. And it may get worse; if the summer heat has suppressed the virus to any degree, we could see another rebound in the fall and winter.

So we must strike a balance, between the needs of a human society and the reality that most of us are still susceptible to an entirely novel pathogen that is much deadlier and more contagious than the flu.

That means, for starters, being smarter about how we reopen than we have been so far. There is strong evidence that states were too cavalier about ending stay-at-home orders and reopening businesses, with just a handful meeting the metrics for reopening laid out by experts, as Vox’s German Lopez explained.

“What I’ve seen is that reopening is getting interpreted by many as reverting back to a Covid-free time where we could attend larger group gatherings, socialize regularly with many different people, or congregate without masks,” Kumi Smith in Minnesota said. “The virus hasn’t changed since March, so there’s no reasons why our precautions should either.”

To date, most states have opened up bars again and kept schools closed. Lopez made a persuasive case last week that we’ve got that backward. One of the most thorough studies so far on how lockdowns affected Covid-19’s spread found that closing restaurants and bars had a meaningful effect on the virus but closing schools did not.

That study also found that shelter-in-place orders had a sizable impact. While those measures may not be politically feasible anymore, individuals can still be cautious about going out — and when they do, they can stick to outdoor activities with a small number of people.

Masks are not a panacea either, but the evidence is convincingly piling up that they also help reduce the coronavirus’s spread. Whether a given state has a mandate to wear one or not, that is one small inconvenience to accept in order to get this outbreak back under control.

And, really, that is the point. While the current divergence between case and death counts can be confusing, the experts agree that Covid-19 still poses a significant risk to Americans — and it is a risk that goes beyond literal life and death. We know some of the steps that we, as individuals, can take to help slow the spread. And we need our governments, from Washington to the state capitals, to get smarter about reopening.

It will require collective action to stave off the coronavirus for good. Other countries have done it. But we have to act now, before we find out it’s already too late.





America celebrates a grim milestone

Epidemic vs. Pandemic, What Is the Difference Between an Epidemic ...


As the nation headed into the 4th of July weekend, the number of new COVID cases hit a string of daily highs, reaching a record high of more than 55,000 on Thursday. States across the South and Sunbelt, especially those that lifted stay-at-home orders early, saw the worst spikes.

Florida broke a new record with more than 10,000 cases on Thursday, and Georgia also experienced a new daily high. Hospitalizations continued to rise sharply in several states as well. Many hospitals reported a shift in COVID admissions toward younger, otherwise healthy adults, reports borne out by the lower death rate than that experienced in the initial surge of cases in the Northeast. (Advances in the management of severely ill COVID patients have also brought death rates down.)

In a Senate hearing on Tuesday, top White House health advisor Dr. Anthony Fauci said that the US was “not in total control” of the pandemic, and predicted that daily new case counts could top 100,000 if more stringent measures are not taken.

California, Florida, and other states took steps to roll back reopening efforts, and Texas Gov. Greg Abbott abruptly reversed direction and ordered a statewide mask mandate. Welcome news, but likely too late to prevent cities like Houston from exceeding available ICU capacity. Cases in the city have skyrocketed across the past month, with its positive test rate hitting 20 percent yesterday; its cancer and children’s hospitals began admitting COVID-positive adults to provide added capacity.

With celebrations scheduled across the nation this weekend, including another large event today at Mount Rushmore to be attended by President Trump, where masking and social distancing will be optional, it seems certain that we will continue to reap the whirlwind of careless behavior and hasty reopening for the rest of this month and beyond.

And looming in just six weeks—students return to schools and colleges.

US coronavirus update: 2.7M cases; 130K deaths; 33.5M tests conducted.




Hospitals in new COVID-19 hot spots face delicate balancing act with elective surgeries

Hospitals in new COVID-19 hot spots face delicate balancing act ...

Some hospital systems located in states that are seeing huge spikes of COVID-19 are continuing to perform elective procedures and developing strategies to avoid a total shutdown.

The experiences of hospitals in states such as Florida and Arizona could inform how systems will handle new surges of COVID-19 cases, especially if a second surge of the virus arrives in the fall. Hospitals have been reticent to shut down surgical procedures, which are pivotal to their bottom line and also impact patient care.

“We are not turning it all the way off,” said Marjorie Bessel, M.D., chief clinical officer for Banner Health, referring to elective procedures. “Our surgeries are needed and medically necessary and people need to have those surgeries done.”

The 28-hospital system has a large footprint in Arizona, which is experiencing a major spike in cases. Bessel said 45% of Arizona COVID-19 patients are in a Banner Health facility.

Like many states, Arizona’s governor required hospitals to shutter elective procedures to ensure there is enough capacity and personal protective equipment (PPE) for COVID-19 patients. The governor lifted the shutdown May 1, and Banner has slowly ramped up delayed or canceled elective procedures.

“We attempted to reduce the backlog of people who had been waiting or wait-listed,” Bessel told Fierce Healthcare. “We didn’t quite get back to full normal operations, but we got close.”

That progress has been hindered now as COVID-19 cases soar in the state.

But instead of doing a full shutdown, Banner is implementing a tiered and step-wise approach to surgeries.

“One of the things that we are going to try is to do surgeries for patients that don’t need an inpatient stay,” Bessel said. “We are gonna try that and see how that works for us.”

The system is also tightly monitoring the patients that need an intensive care unit stay after their surgery. Banner can transfer patients to other facilities to ensure it has enough capacity.

“We look at our [patient] census almost hourly throughout the day and the night and make these adjustments to best meet the needs of those in the community,” she said.

Tampa General Hospital in Florida resumed elective procedures back in early May and is still performing surgeries as COVID-19 cases rise. The hospital told Fierce Healthcare that it treats COVID-19 patients in a “negative-pressure unit that is separate from other areas of the hospital.”

The hospital has 81 of these rooms and 100 hospitals and has a surge plan to adjust capacity when necessary.

Another important factor for hospitals is to communicate with patients about what is going on. Tampa General, for instance, issued a release on when it is appropriate to go to the emergency room and outlined the procedures for screening patients of COVID-19 to assuage fears.

Hospitals’ own internal processes have also gotten better amid the COVID-19 pandemic.

“In the operating area, COVID-19 has made us more efficient,” said Michael Zinner, M.D., CEO of the Miami Cancer Institute, which is part of 11-hospital system Baptist Health South Florida. “It has taught us how to move things out of the general operating room into ambulatory and more efficient in the turnovers. It has taught us how to adapt.”

Some states could decide to shut down elective procedures again, which is a move Texas has decided to make in four counties in the state.

Getting and keeping enough PPE

One of the key reasons that states ordered hospitals to shut down surgeries was to preserve enough PPE for COVID-19 care.

But hospital systems say they are in a better place now in terms of PPE than they were at the onset of the pandemic, when a buying spree caused hospitals to fight among each other to get supplies.

“We are a heck of a lot better than we were two months ago,” Zinner said.

He added that Baptist Health even bought a stake in a domestic PPE manufacturer, a move Banner Health made as well.

“Besides the current spike, we were preparing for what we think will be a surge in the fall,” Zinner added.

Another important development for hospitals now is there are guidelines for how to reprocess PPE.

“We have found ways to reprocess some PPE safely so you can reuse it without losing efficacy and take it through a decontamination procedure,” said Michael Calderwood, M.D., an epidemiologist at Dartmouth-Hitchcock Medical Center in New Hampshire.

He pointed to using ultraviolet light and hydrogen peroxide as among methods facilities can use to reprocess their supplies.

The type of PPE that is used in surgeries is also sometimes different than the equipment used to treat COVID-19 patients, Bessel said.

“They use a procedural mask for most of the cases, while the masks in shortage has been the N-95 respirators,” she said.




Six months in, coronavirus failures outweigh successes

Covid-19 news: UK deaths fall below five-year average | New Scientist

In the six months since the World Health Organization (WHO) detected a cluster of atypical pneumonia cases at a hospital in Wuhan, China, the coronavirus pandemic has touched every corner of the globe, carving a trail of death and despair as humankind races to catch up.

At least 10.4 million confirmed cases have been diagnosed worldwide, and the true toll is likely multiples of that figure. In the United States, health officials believe more than 20 million people have likely been infected.

A staggering 500,000 people around the globe have died in just six months. More people have succumbed to the virus in the U.S. — 126,000 — than the number of American troops who died in World War I.

But even after months of painful lockdowns worldwide, the virus is no closer to containment in many countries. Public health officials say the pandemic is getting worse, fueled by new victims in both nations that have robust medical systems and poorer developing countries.

“We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over,” WHO Director-General Tedros Adhanom Ghebreyesus said Monday. “Globally, the pandemic is actually speeding up.”

In the U.S., the fierce urgency of March and April has given way to the complacency of summer, as bars and restaurants teem with young people who appear largely convinced the virus poses no threat to them. New outbreaks, especially among younger Americans, have forced 16 states to pause or roll back their reopening plans.

“This is a really challenging point in time. It’s challenging because people are tired of the restrictions on their activity, people are tired of not being able to socialize, not being able to go to work,” said Richard Besser, a former acting director of the Centers for Disease Control and Prevention (CDC) who now heads the Robert Wood Johnson Foundation.

“You have people who have reached that point of pandemic fatigue where they just don’t want to hear it anymore, they just want to go back to their life,” he added.

The number of new U.S. cases has risen sharply in recent weeks, led disproportionately by states in the South, the Midwest and the Sun Belt. More than a quarter-million people tested positive for the coronavirus last week, and more than 40,000 tested positive on three consecutive days over the weekend.

“We are now having 40-plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day if this does not turn around. And so I am very concerned,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told a Senate panel on Tuesday.

Public health experts now worry that a rising tide of death is about to crest across the United States. Officials in Alabama, Arizona, California, Mississippi and Texas are reporting a surging number of COVID-19 hospitalizations, leading to fears that health systems could soon be overrun.

“If you’re over the hospital capacity, people will start dying faster,” said Eric Feigl-Ding, an epidemiologist and health economist at the Harvard T.H. Chan School of Public Health and a senior fellow at the Federation of American Scientists.

Already, Arizona has reported more coronavirus deaths per million residents in the last week, at 4.77, than any nation on Earth except Chile and Peru.

The response to the coronavirus pandemic has varied widely, and in some parts of the world, both wealthy and developing nations have brought it under control. In the U.S., some states hit hard early on have wrangled transmission under control.

But even in states that have achieved some measure of success, the spikes in cases stand in stark contrast to countries that have bent the epidemiological curves to manageable levels.

Mass screenings in South Korea crushed the spread, and quick action to identify and isolate contacts in more recent hot spots have meant new outbreaks are quickly contained. South Korea, with a population of 51 million, has reported just 316 new cases in the past week, fewer than the number of new cases reported in Rhode Island, a state with slightly more than 1 million residents.

Germany raced to protect its elderly population and rapidly expanded its hospital capacity. It deployed the world’s most successful diagnostics test, developed at a Berlin hospital, on a massive scale. With a population of 83 million, the country has reported 78 coronavirus deaths in the past week; Mississippi, population 3 million, reported 96 coronavirus-related deaths during the same period.

Vietnam imposed mandatory quarantines on contacts, including international travelers, in government-run centers to stop the spread. Among its 95 million residents, Vietnam has confirmed 355 total cases since the outbreak began. Alabama, population 4.9 million, reported 358 cases on Sunday alone.

Those countries have begun loosening restrictions on their populations and their economies, with few signs of major flare-ups.

The United States has begun to open up too but without bending the curve downward, and the results have been disastrous. The number of daily confirmed cases has more than doubled in nine states over the past two weeks and has increased by more than half in 17 more.

“I have really grave concerns that viral transmission is going to get out of control,” Besser said.

In interviews, public health experts and epidemiologists confess to feelings of depression and disgust over the state of the nation’s response. Some remain exasperated that there is still no coordinated national response from the White House or federal agencies.

President Trump has rarely mentioned the virus in recent weeks, aside from using racial epithets and suggesting his administration would slow testing to reduce the number of confirmed cases. He later said he was joking.

“There should be some sort of federal leadership,” Feigl-Ding said. “Every state’s on its own, for the most part.”

Left to their own devices, some states are trending in the right direction. Connecticut, Maryland, New Hampshire, New York, North Dakota, Rhode Island, South Dakota and the District of Columbia have seen their case counts decline for two consecutive weeks or more. New York reported 4,591 new cases in the last week — a startlingly high figure but only a fraction of the 65,000 cases infecting the state during its worst week, in early April.

States with their numbers on the decline have benefited from fast action and strict measures. They’re also viewed as role models for states that are now experiencing surges.

“States who are now on the rapid upslope need to act quickly, take the advice and example of states that have already been through this,” said Abraar Karan, an internist at Brigham and Women’s Hospital and Harvard Medical School. “We know what needs to be done to win this in the short run, and we are working on what needs to happen for the longer term.”

If there is a silver lining, it is that the number of tests American states are conducting on a daily basis has grown to about 600,000, on its way toward the millions the nation likely needs to fully control the spread.

But that silver lining frames a darkening cloud: As the virus spreads, even the higher testing capacity has been strained, and state and local governments are hitting their limits and running low on supplies.

The greater number of tests does not account for the speed of the spread, as Trump has suggested. The share of tests that come back positive has averaged almost 7 percent over the last week, according to The Hill’s analysis of national figures; in the first week of June, just 4.6 percent of tests were coming back positive.

If greater testing were responsible for more cases, the percentage coming back positive should decrease rather than increase. The higher positive rates are an indication the virus is spreading more rapidly.

As with so much else in American life, the coronavirus has become a political battleground. The new front is over face masks, which studies show dramatically reduce transmission. States that have mandated wearing masks in public saw the number of new cases decline by a quarter between the first and third weeks of June; states that do not require masks in any setting saw the number of cases rise by 84 percent over that same span.

“From a public health perspective, it’s demoralizing, it’s tragic … because our public health leaders know what to do to get this under control, but we’re in a situation where the CDC is not out front in a leadership role. We’re not hearing from them every day. They’re not explaining and capturing people’s hearts and minds,” said Besser, the former CDC chief. “If we have a vaccine, that will be terrific if it’s safe and effective. But until that point, these are the only tools we have, these tools of public health, and they’re very crude tools.”






Houston ICUs at 97 Percent Capacity as Texas Coronavirus Cases Break Records

Coronavirus Briefing: What Happened Today - The New York Times

Almost all intensive care unit beds at Houston hospitals were occupied on Wednesday as Texas reported a record number of statewide patient admissions related to the novel coronavirus.

During a City Council meeting Wednesday morning, Houston Mayor Sylvester Turner said 97 percent of the city’s ICU beds were filled. A report from the Texas Medical Center (TMC) said 27 percent of those beds were occupied by COVID-19 patients.

According to data published earlier this week by the TMC, a network of health care and research institutions based in Houston, 90 percent of the city’s ICU beds were filled as of Monday. Virus patients accounted for more than one-quarter of those occupancies.

The TMC’s latest report incorporated ICU admission numbers from seven affiliate hospitals in the Houston area: CHI St. Luke’s Health, Harris Health System, Houston Methodist, MD Anderson Cancer Center, Memorial Hermann, Texas Children’s Hospital and University of Texas Medical Branch. The hospitals can collectively admit 1,330 ICU patients at regular capacity, when 70 to 80 percent of total beds are typically occupied, according to the TMC.

The TMC’s Monday report noted that an additional 373 beds could become available under its “sustainable surge” plan, a procedure that would indefinitely increase ICU capacities as needed during the pandemic. Another 504 beds could be added to Houston ICUs under an emergency “unsustainable surge” plan, which the TMC would implement to address a “significant, temporary” influx of patients, according to its report.

Houston’s heightened ICU admissions were reported as cases and hospitalizations related to the coronavirus are spiking throughout Texas. Ongoing data released by the Texas Department of State Health Services show that of all the state’s regions, the Houston area is one of the hardest hit in terms of virus incidence and hospital admissions. The latest DSHS data estimated that 179 ICU beds were available at medical facilities located in the Greater Houston area as of Tuesday afternoon.

The number of patients hospitalized with the virus peaked in Texas on Tuesday, as the DSHS confirmed more than 4,000 current admissions. The state has set new records for hospitalizations related to COVID-19 every day since June 12, when 2,166 patients were reported.

On Monday, the Houston Health Department said hospitalizations due to the virus had increased 177 percent throughout the surrounding county since May 31. It also noted a 64 percent increase in ICU patients who had tested positive for the virus.

Texas also saw its highest daily increase in virus cases on Wednesday, with 5,489 new diagnoses confirmed. The latest single-day record surpassed its previous high of 4,430 new cases reported last Saturday. Cumulative diagnosis data reflected in graphics published by the DSHS show a sharp upturn in cases reported statewide since the start of June, when about 64,800 total cases were confirmed. As of Tuesday afternoon, the number had risen to more than 120,300. The DSHS estimated that roughly 47,400 of those cases remain active.

Businesses in Texas started to reopen at the beginning of May. Although Texas Governor Greg Abbott has not required residents to wear face masks in the state’s public spaces during the reopening process, he did encourage people to do so earlier this week in response to increasing case counts and hospitalizations.

“Wearing a mask will help us to keep Texas open. Not taking action to slow the spread will cause COVID to spread even worse, risking people’s lives and ultimately leading to the closure of more businesses,” he said during a news conference on Monday.



Coronavirus Doesn’t Recognize Man-Made Borders

Coronavirus Doesn’t Recognize Man-Made Borders

Coronavirus Doesn't Recognize Man-Made Borders - California Health ...

From El Centro Regional Medical Center, the largest hospital in California’s Imperial County, it takes just 30 minutes to drive to Mexicali, the capital of the Mexican state of Baja California. The international boundary that separates Mexicali from Imperial County is a bridge between nations. Every day, thousands of people cross that border for work or school. An estimated 275,000 US citizens and green card holders live in Baja California. El Centro Regional Medical Center has 60 employees who reside in Mexicali and commute across the border, CEO Adolphe Edward told Julie Small of KQED.

Now these inextricably linked places have become two of the most concerning COVID-19 hot spots in the US and Mexico. While Imperial County is one of California’s most sparsely populated counties, it has the state’s highest per capita infection rate — 836 per 100,000according to the California Department of Public Health. This rate is more than four times greater than Los Angeles County’s, which is second-highest on that list. Imperial County has 4,800 confirmed positive cases and 64 deaths, and its southern neighbor Mexicali has 4,245 infections and 717 deaths.

The COVID-19 crisis on the border is straining the local health care system. El Centro Regional Medical Center has 161 beds, including 20 in its intensive care unit (ICU). About half of all its inpatients have COVID-19, Gustavo Solis reported in the Los Angeles Times, and the facility no longer has any available ventilators.

When Mexicali’s hospitals reached capacity in late May, administrators alerted El Centro that they would be diverting American patients to the medical center. “They said, ‘Hey, our hospitals are full, you’re about to get the surge,’” Judy Cruz, director of El Centro’s emergency department, recounted to Rebecca Plevin in the Palm Springs Desert Sun.

By the first week of June, El Centro was so overburdened that “a patient was being transferred from the hospital in El Centro every two to three hours, compared to 17 in an entire month before the COVID-19 pandemic,” Miriam Jordan reported in the New York Times.

Border Hospitals Filled to Capacity

Since April, hospitals in neighboring San Diego and Riverside Counties have been accepting patient transfers to alleviate the caseload at the lone hospital in El Centro, but the health emergency has escalated and now those counties need relief. “We froze all transfers from Imperial County [on June 9] just to make sure that we have enough room if we do have more cases here in San Diego County,” Chris Van Gorder, CEO of Scripps Health, told Paul Sisson in the San Diego Union-Tribune. El Centro patients are now being airlifted as far as San Francisco and Sacramento.

According to the US Census Bureau, nearly 85% of Imperial County residents are Latino, and statewide, Latinos bear a disproportionate burden of COVID-19. The California Department of Public Health reports that Latinos make up 39% of California’s population but 57% of confirmed COVID-19 cases.

Nonessential travel between the US and Mexico has been restricted since March 21, with the measure recently extended until July 21. However, jobs in Southern California, such as in agricultural fields and packing houses, require regular movement between the two countries. “I’m always afraid that people are imagining this rush on the border,” Andrea Bowers, a spokesperson for the Imperial County Public Health Department, told Small. “It’s just folks living their everyday life.”

These jobs, some of which are considered essential because of their role in the food supply chain, may have contributed to the COVID-19 crisis on the border. Agricultural workers often lack access to adequate personal protective equipment and are unable to practice physical distancing. They also are exposed to air pollution, pesticides, heat, and more — long-term exposures that can cause the underlying health conditions that raise the risk of death for COVID-19 patients.

Comite Civico del Valle, a nonprofit focused on environmental health and civic engagement in Imperial Valley, set up 40 air pollution monitors throughout the county and found that levels of tiny, dangerous particulates violated federal limits, Solis reported.

“I can tell you there’s hypertension, there’s poor air pollution, there’s cancers, there’s asthma, there’s diabetes, there’s countless things people here are exposed to,” David Olmedo, an environmental health activist with Comite Civico del Valle, told Solis.

Fear of New Surges

With summer socializing in full swing, health experts worry that COVID-19 spikes will follow. Imperial County saw surges after Mother’s Day and Memorial Day, probably because of lapsed physical distancing and mask use at social events.

Latinos in California are adhering to recommended public health behaviors to slow the spread of the virus. CHCF’s recent COVID-19 tracking poll with Ipsos asked Californians about their compliance with recommended behaviors. Eighty-four percent of Californians, including 87% of Latinos, say they routinely wear a mask in public spaces all or most of the time. Seventy-two percent of Californians, including 73% of Latinos, say they avoid unnecessary trips out of the home most or all of the time, and 90% of Californians, including 91% of Latinos, say they stay at least six feet away from others in public spaces all or most of the time.

A Push to Reopen Anyway

Most counties in California have met the state’s readiness criteria for entering the “Expanded Stage 2” phase of reopening. Imperial County has not. In the past two weeks, more than 20% of all COVID-19 tests in the county came back positive, the Sacramento Bee reported. The state requires counties to have a seven-day testing positivity rate of no more than 8% to enter Expanded Stage 2.

Still, the Imperial County Board of Supervisors is pushing Governor Gavin Newsom for local control over its reopening timetable. The county has a high poverty rate — 24% compared with the statewide average of 13% — and “bills are stacking up,” Luis Pancarte, chairman of the board, said on a recent press call.

He worries that because neighboring areas like Riverside and San Diego have opened some businesses with physical distancing measures in place, Imperial County residents will travel to patronize restaurants and stores. This movement could increase transmission of the new coronavirus, just as reopening Imperial County too soon could as well.

More than 1,350 residents have signed a petition asking Newsom to ignore the Board of Supervisor’s request, Solis reported. The residents called on the supervisors to focus instead on getting the infection rate down and expanding economic relief for workers and businesses.

Cruz, who has been working around the clock to handle the county’s COVID-19 crisis, agrees with the petitioners. The surges after Mother’s Day and Memorial Day made her “really concerned about unlocking and letting people go back to normal,” she told Plevin. “It’s going to be just like those little gatherings that happened [on holidays], but on a bigger scale.”





A 70-year-old man was hospitalized with COVID-19 for 62 days. Then he received a $1.1 million hospital bill, including over $80,000 for using a ventilator.

Man, 70, hospitalized with COVID-19 for 62 days gets $1.1 million ...

  • A man in Washington state who spent more than two months in the hospital and more than a month in the Intensive Care Unit with COVID-19 received a 181-page itemized bill that totals more than $1.1 million, The Seattle Times reported.
  • Michael Flor, 70, will likely foot little of the bill due to his being insured through Medicare, according to the report.
  • “I feel guilty about surviving,” Flor told The Seattle Times. “There’s a sense of ‘why me?’ Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

A 70-year-old man in Seattle, Washington, was hit with a $1.1 million 181-page long hospital bill following his more than two-month stay in a local hospital while he was treated for — and nearly died from — COVID-19. 

“I opened it and said ‘holy (expletive)!’ ” the patient, Michael Flor, who received the $1,122,501.04 bill told The Seattle Times.

He added: “I feel guilty about surviving. There’s a sense of ‘why me?’ Why did I deserve all this? Looking at the incredible cost of it all definitely adds to that survivor’s guilt.”

According to the report, Flor will not have to pay for the majority of the charges because he has Medicare, which will foot the cost of most if not all of his COVID-19 treatment. The 70-year-old spent 62 days in the Swedish Medical Center in Issaquah, Washington, 42 days of which he spent isolated in the Intensive Care Unit (ICU). 

Of the more than one month he spent in a sealed-off room in the ICU, Flor spent 29 days on a ventilator. According to the Seattle Times, a nurse on one occasion even helped him call his loved ones to say his final goodbyes, as he believed he was close to death from the virus.

While in the ICU, Flor was billed $9,736 each day; more than $80,000 of the bill is made up of charges incurred from his use of a ventilator, which cost $2,835 per day, according to the report. A two-day span of his stay in the hospital when his organs, including his kidneys, lungs, and heart began to fail, cost $100,000, according to the report.  

In total, there are approximately 3,000 itemized charges on Flor’s bill — about 50 charges for each day of his hospital stay, according to The Seattle Times. Flor will have to pay for little of the charges — including his Medicare Advantage policy’s $6,000 out-of-pocket charges — due to $100 billion set aside by Congress to help hospitals and insurance companies offset the costs of COVID-19.

Flor is recovering in his home in West Seattle, according to the report.





Dubai’s Super-Ambulance Is a Mini Hospital-on-Wheels with an Operating Room and X-Ray Unit

Dubai’s Super-Ambulance Is a Mini Hospital-on-Wheels with an Operating Room and X-Ray Unit

Dubai is proud to introduce its impressive fleet of the “world’s largest ambulances,” or “Mercedes-Benz large-capacity ambulances” which were created to give rapid medical assistance in the event of major emergencies with large numbers of causalities. These new emergency vehicles offer a fully-equipped, mobile clinic with an intensive-care unit and an operating room.

Equipped with an X-ray unit and ultrasonic equipment for further evaluation, each super ambulance bus carries 12,000 liters of oxygen, which ensures a dependable supply for up to three days. With the press of a button, oxygen masks fall from special holders, and the oxygen flow to each mask can be individually controlled.

They’re also equipped with an ECG and an InSpectra shock monitor, which monitors the oxygen saturation in tissue-matter and warns doctors of the onset of shock minutes before it occurs. This unit can also detect and monitor internal bleeding. If an emergency caesarian birth is needed, essential obstetrical instruments, including an incubator, are on board.





Banner Health combats growing spike of COVID-19 cases in Arizona after stay-at-home order lifted

Banner Health combats growing spike of COVID-19 cases in Arizona ...

Banner Health warned of a major spike of COVID-19 cases over the past few weeks in Arizona as the state opened back up and eased social distancing guidelines.

Arizona’s COVID-19 hospitalizations are rapidly increasing and raising potential capacity concerns, the system said.

“As of June 4, there were 1,234 hospitalized COVID-19 patients,” the system said in a statement. “About 50% of those patients are hospitalized in Banner Health facilities.”

Banner officials said its ICUs have gotten very busy, and the system has been transferring patients and resources to avoid putting stress on one particular hospital. Banner Health operates 28 hospitals across six states, including several hospitals in Arizona. The health system’s update comes as other hospital systems are eyeing a potential resurgence of COVID-19 cases as states reopen their economies after months of stay-at-home orders.

“If these trends continue, Banner will soon need to exercise surge planning and flex up to 125% bed capacity,” the system warned.

The number of Banner Health patients in Arizona on a ventilator has also increased over the past few weeks, from 41 on May 22 to nearly 120 on June 3.

The system also attributed the increase in COVID-19 cases to a relaxation of the state’s stay-at-home order, which expired May 15.

The cases started to spike two weeks after the end of the order, which is the likely incubation period for the virus.

Banner emphasized that the public needs to continue certain behaviors like wearing a mask in public and social distancing in order to ensure capacity isn’t overwhelmed.

Hospitals not only have to worry about the prospects of a second surge of the virus in the fall but also a wave of pent-up demand for healthcare services put off due to the pandemic.

Banner Health, like all health systems, canceled or postponed elective procedures at the onset of the pandemic back in March. But health systems are taking small steps to resume elective procedures.

Banner Health has also taken steps to preserve its personal protective equipment (PPE), which has been in short supply across the healthcare industry throughout the pandemic. Banner was one of 15 healthcare systems to buy a minority stake in PPE domestic manufacturer Prestige Ameritech in the hopes of shoring up a supply chain that is traditionally reliant on overseas manufacturers.






ICUs become a ‘delirium factory’ for Covid-19 patients

ICUs Become A 'Delirium Factory' For COVID-19 Patients | Health ...

Doctors are fighting not only to save lives from Covid-19, but also to protect patients’ brains.

Although Covid-19 is best known for damaging the lungs, it also increases the risk of life-threatening brain injuries — from mental confusion to hallucinations, seizures, coma, stroke and paralysis. The virus may invade the brain, and it can starve the brain of oxygen by damaging the lungs. To fight the infection, the immune system sometimes overreacts, battering the brain and other organs it normally protects.
Yet the pandemic has severely limited the ability of doctors and nurses to prevent and treat neurological complications. The severity of the disease and the heightened risk of infection have forced medical teams to abandon many of the practices that help them protect patients from delirium, a common side effect of mechanical ventilators and intensive care.
And while Covid-19 increases the risk of strokes, the pandemic has made it harder to diagnose them.
When doctors suspect a stroke, they usually order a brain MRI — a sophisticated type of scan. But many patients hospitalized with Covid-19 are too sick or unstable to be wheeled across the hospital to a scanner, said Dr. Kevin Sheth, a professor of neurology and neurosurgery at the Yale School of Medicine.
Many doctors also hesitate to request MRIs for fear that patients will contaminate the scanner and infect other patients and staff members.
“Our hands are much more tied right now than before the pandemic,” said Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.
In many cases, doctors can’t even examine patients’ reflexes and coordination because patients are so heavily sedated.
“We may not know if they’ve had a stroke,” Sheth said.
study from Wuhan, China — where the first Covid-19 cases were detected — found 36% of patients had neurological symptoms, including headaches, changes in consciousness, strokes and lack of muscle coordination.
“Our hands are much more tied right now than before the pandemic,” said Dr. Sherry Chou, an associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh School of Medicine.
In many cases, doctors can’t even examine patients’ reflexes and coordination because patients are so heavily sedated.
“We may not know if they’ve had a stroke,” Sheth said.
smaller, French study observed such symptoms in 84% of patients, many of which persisted after people left the hospital.
Some hospitals are trying to get around these problems by using new technology to monitor and image the brain.
New York’s Northwell Health is using a mobile MRI machine for Covid patients, said Dr. Richard Temes, the health system’s director of neurocritical care. The scanner uses a low-field magnet, so it can be wheeled into hospital rooms and take pictures of the brain while patients are in bed.
Staffers at Northwell were also concerned about the infection risk from performing EEGs, tests that measure the brain’s electrical activity and help diagnose seizures, Temes said. Typically, technicians spend 30 to 40 minutes in close contact with patients in order to place electrodes around their skulls.
“Right now, we actually don’t know enough to say definitely how Covid-19 affects the brain and nervous system,” said Chou, who is leading an international study of neurological effects of the virus. “Until we can answer some of the most fundamental questions, it would be too early to speculate on treatments.”
To reduce the risk of infection, Northwell is using a headband covered in electrodes, which can be placed on patients in just a couple of minutes, he said.

The brain under attack

Answering those questions is complicated by the limited data from patient autopsies, said Lena Al-Harthi, a professor and the chair of the microbial pathogens and immunity department at Rush Medical College in Chicago.
But many neuropathologists are unwilling or unable to perform brain autopsies, Al-Harthi said.
That’s because performing autopsies on patients who died of Covid-19 carries special risks, such as the aerosolization of the virus during brain removal. Pathologists need specialized facilities and equipment to conduct an autopsy safely.
Some of the best-known symptoms of Covid-19 might be caused by the virus invading the brain, said Dr. Robert Stevens, an associate professor of anesthesiology and critical care medicine at Johns Hopkins University.
Authors of a recent study from Germany found the novel coronavirus in patients’ brains.
Research shows that the coronavirus may enter a cell through a molecular gateway known as the ACE-2 receptor. These receptors are found not only in the lung, but also other organs, including many parts of the brain.
In a recent study, Japanese researchers reported finding the novel coronavirus in the cerebrospinal fluid that surrounds the brain and spinal cord.
Some of the most surprising symptoms of Covid-19 ― the loss of the senses of smell and taste ― remain incompletely understood, but may be related to the brain, Stevens said.
A study from Europe published in May found that 87% of patients with mild or moderate Covid-19 lost their sense of smell. Patients’ loss of smell couldn’t be explained by inflammation or nasal congestion, the researchers said. Stevens said it’s possible that the coronavirus interacts with nerve pathways from the nose to the brain, potentially affecting systems involved with processing scent.
new study in JAMA provides additional evidence that the coronavirus invades the brain. Italian researchers found abnormalities in an MRI of the brain of a Covid-19 patient who lost her sense of smell.
Many coronavirus patients also develop “silent hypoxia,” in which they are unaware that their oxygen levels have plummeted dangerously low, Stevens added.
When hypoxia occurs, regulatory centers in the brain stem — which control respiration — signal to the diaphragm and the muscles of the chest wall to work harder and faster to get more oxygen into the body and force out more carbon dioxide, Stevens said. The lack of this response in some patients with Covid-19 could indicate the brain stem is impaired.
Scientists suspect the virus is infecting the brain stem, preventing it from sending these signals, Temes said.

Collateral damage

Well-intentioned efforts to save lives can also cause serious complications.
Many doctors put patients who are on mechanical ventilators into a deep sleep to prevent them from pulling out their breathing tubes, which would kill them, said Dr. Pratik Pandharipande, chief of anesthesiology and critical care medicine at Vanderbilt University School of Medicine in Nashville, Tennessee.
Both the disease itself and the use of sedatives can cause hallucinations, delirium and memory problems, said Dr. Jaspal Singh, a pulmonologist and critical care specialist at Atrium Health in Charlotte, North Carolina.
Many sedated patients experience terrifying hallucinations, which may return in recovery as nightmares and post-traumatic stress disorder.
Research shows 70% to 75% of patients on ventilators traditionally develop delirium. Delirious patients often “don’t realize they’re in the hospital,” Singh said. “They don’t recognize their family.”
In the French study in the New England Journal of Medicine, one-third of discharged Covid-19 patients suffered from “dysexecutive syndrome,” characterized by inattention, disorientation or poorly organized movements in response to commands.
Research shows that patients who develop delirium — which can be an early sign of brain injury — are more likely to die than others. Those who survive often endure lengthy hospitalizations and are more likely to develop a long-term disability.
Under normal circumstances, hospitals would invite family members into the ICU to reassure patients and keep them grounded, said Dr. Carla Sevin, director of the ICU Recovery Center, also at Vanderbilt.
Simply allowing a family member to hold a patient’s hand can help, according to Dr. Lee Fleisher, chair of an American Society of Anesthesiologists committee on brain health. Nurses normally spend considerable time each day orienting patients by talking to them, reminding them where they are and why they’re in the hospital.
“You can decrease the need for some of these drugs just by talking to patients and providing light touch and comfort,” Fleisher said.
These and certain innovative practices — such as helping patients to move around and get off a ventilator as soon as possible — can reduce the rate of delirium to 50%.
Hospitals have banned visitors, however, to avoid spreading the virus. That leaves Covid-19 patients to suffer alone, even though it’s well known that isolation increases the risk of delirium, Fleisher said.
Although many hospitals offer patients tablets or smartphones to allow them to videoconference with family, these devices provide limited comfort and companionship.
Doctors are also positioning patients with Covid-19 on their stomachs, rather than their backs, because a prone position seems to help clear the lungs and let patients breathe more comfortably.
But a prone position also can be uncomfortable, so that patients need more medication, Pandharipande said.
All of these factors make coronavirus patients extremely vulnerable to delirium. In a recent article in Critical Care, researchers said the intensive care unit has become a “delirium factory.”
“The way we’re having to care for patients right now is probably contributing to more mortality and bad outcomes than the virus itself,” said Dr. Sharon Inouye, a geriatrician at Harvard Medical School and Hebrew SeniorLife, a long-term care facility in Boston. “A lot of the things we’d like to do are just very difficult.”