Texas and Arizona ER doctors say they are losing hope as hospitals reach capacity

https://www.cnn.com/2020/07/08/us/emergency-room-doctors-coronavirus-capacity/index.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-07-08%20Healthcare%20Dive%20%5Bissue:28354%5D&utm_term=Healthcare%20Dive

Texas and Arizona ER doctors say they are losing hope as hospitals ...

As concerns over the capacity of hospitals resurface amid surging Covid-19 cases, two emergency room doctors say they worry about where the pandemic could take them next.

Dr. Mina Tran, an emergency room doctor in Texas, said 70 to 80% of her patients have been admitted with upper respiratory or coronavirus complaints.
In Arizona, which saw its lowest-ever number of available ICU beds Tuesday, Dr. Murtaza Akhter told Lemon so many patients are coming in that he is already having to make tough decisions over resources.
“I’m trying not to be an alarmist. I’m an emergency physician — we’re prepped for this. Dr. Tran and I both trained very hard for this. But we can’t just build beds overnight. We can’t just hire staff overnight. And like I said, our numbers are only increasing,” he said. “It’s only going to get worse and that’s the scary part.”
With a rise in hospitalization rates across the US, doctors like Akhter are reporting waiting lists for ICU beds and having to decide who will be admitted for treatment and who will not.
Surges in hospitalization and infection rates have followed larger crowds gathering in newly reopened public spaces. Every state has started their plan to reopen, and 35 are currently seeing more new cases reported compared to last week.
Tran applauded Texas Gov. Greg Abbott closing down bars once again but said she does think the state was too quick to open back up.
While many states have paused or rolled back reopening in light of a resurgence of cases, Akhter said seeing individuals continue disregard safe practices as his emergency room treats coronavirus patients makes him feel like he is “losing hope.”
“I’m going through shifts making some very tough decisions and then I’m driving home and seeing people who are clearly not distancing, having their Fourth of July celebrations, being in big congregate settings, and it feels like what I’m doing is futile,” Akhter said. “I don’t know what more people need to hear.”
And California and Florida are feeling the strain as well.
In Florida, where cases have surged, ICUs at 56 hospitals have reached capacity. And California’s hospitalizations were at an all-time high on Tuesday with nearly 6,000 coronavirus patients.

 

 

 

IHME Model Projects 208,255 U.S. Deaths By November, But Estimate Falls Sharply If Mask Use Increases

https://www.forbes.com/sites/mattperez/2020/07/07/imhe-model-projects-208255-us-deaths-by-november-but-estimate-falls-sharply-if-mask-use-increases/?utm_source=newsletter&utm_medium=email&utm_campaign=dailydozen&cdlcid=5d2c97df953109375e4d8b68#453db3d56f2e

IHME Model Projects 208,255 U.S. Deaths By November, But Estimate ...

TOPLINE

The University of Washington’s influential Covid-19 model, extended out to November 1 for the first time, estimates that 208,255 Americans will die from the virus by then, though, the death toll could be reduced by nearly 22% if mask use were to become widespread, researchers said.

KEY FACTS

The university’s Institute for Health Metrics and Evaluation (IHME) forecasts 162,808 deaths by November if at least 95% of people were to wear face coverings in public.

A Gallup poll released Monday found that 86% of adults wore masks in the past week.

Masks have become a political issue, with only 66% of Republicans reporting mask use in the poll, while President Trump continues to refuse to wear one in public and his campaign has declared them optional at recent public campaign events and rallies.

“Mask mandates delay the need for re-imposing closures of businesses and have huge economic benefits,” said IHME Director Dr. Christopher Murray.

The model anticipates a surge in deaths in September and October, with the IHME noting Tuesday that, “Current data show a strong statistical relationship between Covid-19 transmission and pneumonia seasonality, which is included as a covariate in the model.”

While many of the people infected during the current surge in cases worldwide have been on the younger side, and therefore at lower risk of death, the university warns its current projection could increase if the virus is spread to at-risk populations.

The U.S. is currently experiencing a surge in cases following the easing of social distancing policies, particularly in Southern and Western states, a situation that Dr. Anthony Fauci, the country’s top infectious disease official, characterized as “really not good” during an interview Monday.

CHIEF CRITIC

President Trump, who pushed back against Fauci’s comments on Tuesday. “Well, I think we are in a good place. I disagree with him,”Trump said, according to CNN. “Dr. Fauci said don’t wear masks and now he says wear them. And he said numerous things. Don’t close off China. Don’t ban China. I did it anyway. I didn’t listen to my experts and I banned China. We would have been in much worse shape.”

BIG NUMBER

57,718. That’s the new daily record for confirmed cases of Covid-19 in the U.S., reached on July 2, according to the CDC. The toll has been broken several times since June, the previous high coming in early April with 43,438. The U.S. leads the world in cases of the coronavirus with 2,981,602, as well as reported deaths with 131,248.

TANGENT

Both Fauci and Murry at the IHME agree that the U.S. is still deep into its first wave, as exemplified by Texas, which broke its records for cases, hospitalizations and deaths on Tuesday. Because of the situation, Houston Mayor Sylvester Turner urged Texas’ GOP on Monday to cancel its in-person convention set for next week.

 

 

 

 

U.S. Tops Three Million Known Infections as Coronavirus Surges

https://www.usnews.com/news/top-news/articles/2020-07-07/us-coronavirus-cases-hit-3-million-stoking-fears-of-overwhelmed-hospitals

U.S. tops three million known infections as coronavirus surges ...

 The U.S. coronavirus outbreak crossed a grim new milestone of over 3 million confirmed cases on Tuesday as more states reported record numbers of new infections, and Florida faced an impending shortage of intensive care unit hospital beds.

Authorities have reported alarming upswings of daily caseloads in roughly two dozen states over the past two weeks, a sign that efforts to control transmission of the novel coronavirus have failed in large swaths of the country.

California, Hawaii, Missouri, Montana, Oklahoma and Texas on Tuesday shattered their previous daily record highs for new cases. About 24 states have also reported disturbingly high infection rates as a percentage of diagnostic tests conducted over the past week.

In Texas alone, the number of hospitalized patients more than doubled in just two weeks.

The trend has driven many more Americans to seek out COVID-19 screenings. The U.S. Department of Health and Human Services said on Tuesday it was adding short-term “surge” testing sites in three metropolitan areas in Florida, Louisiana and Texas.

In Houston, a line of more than 200 cars snaked around the United Memorial Medical Center as people waited for hours in sweltering heat to get tested. Some had arrived the night before to secure a place in line at the drive-through site.

“I got tested because my younger brother got positive,” said Fred Robles, 32, who spent the night in his car. “There’s so many people that need to get tested, there’s nothing you can do about it.”

Dean Davis, 32, who lost his job due to the pandemic, said he arrived at the testing site at 3 a.m. on Tuesday after he waited for hours on Monday but failed to make the cutoff.

“I was like, let me get here at three, maybe nobody will be here,” Davis said. “I got here, there was a line already.”

In Florida, more than four dozen hospitals across 25 of 67 counties reported their intensive care units had reached full capacity, according to the state’s Agency for Health Care Administration. Only 17% of the total 6,010 adult ICU beds statewide were available on Tuesday, down from 20% three days earlier.

Additional hospitalizations could strain healthcare systems in many areas, leading to an uptick in deaths from the respiratory illness that has killed more than 131,000 Americans to date.

A widely cited mortality model from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) projected on Tuesday that U.S. deaths would reach 208,000 by Nov. 1, with the outbreak expected to gain new momentum heading into the fall.

A hoped-for summertime decline in transmission of the virus never materialized as previously predicted, the IHME said.

“The U.S. didn’t experience a true end of the first wave of the pandemic,” IHME Director Dr. Christopher Murray said in a statement. “This will not spare us from a second surge in the fall, which will hit particularly hard in states currently seeing high levels of infections.”

‘PRESSURE ON GOVERNORS’

U.S. President Donald Trump, who has pushed for restarting the U.S. economy and urged Americans to return to their normal routines, said on Tuesday he would lean on state governors to open schools in the fall.

Speaking at the White House, Trump said some people wanted to keep schools closed for political reasons. “No way, so we’re very much going to put pressure on governors and everybody else to open the schools.”

New COVID-19 infections are rising in 42 states, based on a Reuters analysis of the past two weeks. By Tuesday afternoon, the number of confirmed U.S. cases had surpassed 3 million, affecting nearly one of every 100 Americans and a population roughly equal to Nevada’s.

In Arizona, another hot spot, the rate of coronavirus tests coming back positive rose to 26% for the week ended July 5, leading two dozen states with positivity rates exceeding 5%. The World Heath Organization considers a rate over 5% to be troubling.

The surge has forced authorities to backpedal on moves to reopen businesses, such as restaurants and bars, after mandatory lockdowns in March and April reduced economic activity to a virtual standstill and put millions of Americans out of work.

The Texas state fair, which had been scheduled to open on Sept. 25, has been canceled for the first time since World War Two, organizers announced on Tuesday.

In Ohio, Governor Mike DeWine said the state was ordering people in seven counties to wear face coverings in public starting on Wednesday evening.

 

 

 

Canada’s “national shame”: Covid-19 in nursing homes

https://www.vox.com/future-perfect/2020/7/7/21300521/canada-covid-19-nursing-homes-long-term-care

Why Canada's coronavirus cases are concentrated in nursing homes - Vox

Nursing homes account for 81 percent of Covid-19 deaths in the country. How did this happen?

Canada’s response to the coronavirus pandemic has generally been viewed as a success, with experts pointing to its political leadership and universal health care system as factors.

But there has been one glaring failure in Canada’s fight against the pandemic: its inability to protect the health of its senior citizens in nursing homes and long-term care facilities.

The situation for these seniors is so dire that the police — and even the military — have been called in to investigate why so many are dying.

In Quebec, some residents have been left for days in soiled diapers, going hungry and thirsty, and 31 residents were found dead at one home in less than a month, leading to accusations of gross negligence. In Ontario, the military found shocking conditions in five homes: cockroaches and rotten food, blatant disregard for infection control measures, and treatment of residents that was deemed “borderline abusive, if not abusive.”

“It’s a national shame,” said Nathan Stall, a geriatrician at Toronto’s Sinai Health System. “I don’t think we’ve done a good job at all in Canada.”

A whopping 81 percent of the country’s coronavirus deaths are linked to nursing homes and long-term care facilities. That means roughly 7,050 out of 8,700 deaths to date have been among residents and workers in these facilities.

In terms of raw numbers, that may not seem like very much. (For comparison, more than 40,000 US coronavirus deaths have been linked to nursing homes.) And, to be clear, Canada is hardly alone in watching tragedy unfold in these facilities. The US and Europe have seen startling numbers of fatalities among nursing home staffers and residents.

But 81 percent is a staggering statistic, especially for Canada, a country that prides itself on its progressive health policies. And it’s higher than the rate in any other country for which we have good data. In European countries, roughly 50 percent of coronavirus deaths are linked to these facilities. In the US, it’s 40 percent.

Experts say a number of factors are probably involved in Canada’s collapse on the nursing home front, like the fact that Canada has done well at controlling community spread outside these facilities (making nursing home deaths account for a greater share of overall deaths) and that residents in Canadian homes tend to be older and frailer than those in US homes (and thus more vulnerable to severe cases of Covid-19). But they say the high death rate in the homes is due, in large part, to egregious problems with the homes themselves.

“I think we have serious issues with long-term care,” said Vivian Stamatopoulos, a professor at Ontario Tech University who specializes in family caregiving. Experts have been warning political leaders about this for years, but, she said, “they’ve all been playing the game of pass the long-term care hot potato.”

Furious over how their elders are being treated, some Canadians have started petitions, protests, lawsuits, and even hunger strikes outside the homes. They say the government’s failure to respond reveals a deeper failure to care about seniors and people with disabilities, and to make that care concrete by sending facilities what they urgently need: more tests, more personal protective equipment (PPE), and more funding to pay staff members so they don’t have to work multiple jobs at different facilities.

Prime Minister Justin Trudeau has acknowledged that the situation in the facilities is “deeply disturbing.” He’s sent hundreds of military troops to help feed and care for the seniors in certain homes, where burnout and fear have prompted some staff members to flee their charges. But to some extent, Trudeau’s hands are tied because the facilities fall under provincial jurisdiction.

That leaves families terrified for their loved ones. They’re asking: Why have things gone so terribly wrong? How could this happen in Canada?

 

Canada’s crisis was a long time in the making

The first thing to understand is that Canada’s universal health care system does not cover nursing homes and long-term care facilities. That means these institutions are not insured by the federal system. Different provinces offer different levels of cost coverage, and even within a given province, you’ll find that some homes are publicly run, others are run by nonprofits, and still others are run by for-profit entities.

“This is the main problem — they don’t fall under the Canada Health Act,” said Stamatopoulos, adding that the same is not true of hospitals. “That’s why you see that the hospitals did so well. They had the resources.”

From the standpoint of someone in the US, where more than 132,000 people have died of Covid-19, Canada may seem to be doing well overall: The death toll there is around 8,700. Per capita, Canada’s coronavirus death rate is roughly half that of America’s. It’s clear that the northern neighbor has been doing better at keeping case numbers down, partly because it’s giving safer advice on easing social distancing.

Which makes the dire situation in nursing homes stand out even more. Longstanding problems with Canada’s nursing homes have clearly fueled the tragic situation unfolding there.

These homes are chronically understaffed. They tend to hire part-time workers, underpay them, and not offer them sick leave benefits. That means the workers have to take multiple jobs at different facilities, potentially spreading the virus between them. Many are immigrants or asylum seekers, and they fear putting their precarious employment at risk by, say, taking a sick day when they need it. (These problems aren’t unique to Canada, but as in other countries, they’ve been thrown into stark relief by the pandemic.)

A lot of Canadian homes also have poor infrastructure, built to the outdated design standards of the 1970s. Residents often live four to a room, share a bathroom, and congregate in crowded common spaces. That makes it very difficult to isolate those who get sick.

These problems are even worse in Canada’s for-profit nursing homes. Research shows that these private facilities provide inferior care for seniors compared to the public facilities, in large part because they hire fewer staff members and put fewer resources into upgrading or redesigning their buildings. The for-profit model incentivizes cost-cutting. (Similarly problematic profit motives and poor living conditions persist in US nursing homes, too.)

Canadian experts have been raising the alarm about these issues for more than a decade. So why haven’t they been addressed?

“Frankly, overall, it really reflects ageism in society. We choose not to invest in frail older adults,” Stall said. He added that early on in the pandemic, the public imagination latched onto stories of relatively young people on ventilators in hospitals. The hospitals and their staff got resources, free food, nightly applause. Homes for older people didn’t get the same attention.

“Nursing homes are not something we’re proud of societally. There’s a lot of shame around even having someone in a nursing home,” Stall said.

Stamatopoulos noted there are other forces at play, too. “I’d say it’s a trifecta of ageism, racism, and sexism,” she said. “When you look at this industry, it’s majority female older residents being cared for by majority racialized women.”

Ronnie Cahana, a 66-year-old rabbi who lives with paralysis at the Maimonides Geriatric Centre in Montreal, recently wrote a letter to Quebec’s premier. “I am not a statistic. I am a fully sentient, confident human being, who needs to have my humanity honored,” he wrote, adding that the premier should help the workers who take care of people like him. “Many of them are immigrants, newly beginning their lives in Quebec. … Please give them all the resources they require. Listen to their voices.”

 

How to make nursing homes safer — in Canada and beyond

If you want to keep nursing homes from becoming coronavirus hot spots, look to the strategies that have proven effective elsewhere. For months now, Canadian public health experts and advocates have been begging leaders to do just that.

All residents and workers in nursing homes should be tested regularly, whether they show symptoms or not. Anyone who gets sick should be isolated in a separate part of the building or taken to the hospital. Workers should be given adequate PPE, and universal masking among them should be mandatory. Working at multiple homes during the pandemic should be disallowed.

“Look at South Korea. They’ve had no deaths in long-term care because they treated it like SARS right from the get-go,” Stamatopoulos said. “They did aggressive testing. They were strict in terms of quarantining any infected residents and were quick to move them to hospitals. We’ve done the opposite.” Earlier in the pandemic, some Canadian hospitals sent recovering Covid-19 patients back to their nursing homes too soon; they inadvertently infected others.

“And look at New York state,” Stamatopoulos continued. “Gov. Cuomo signed an executive order on May 10 requiring all staff and residents to be tested twice a week. That aggressive testing helped halt the outbreaks in the homes.” Quebec and Ontario have yet to do this.

British Columbia, a Canadian standout at preventing deaths in nursing homes, adopted several wise measures early on. Way back on March 27, the western province made it illegal to work in more than one home — and topped up workers’ wages so they wouldn’t have to. It gave them full-time jobs and sick leave benefits.

It’s clear that so long as long-term care falls under provincial jurisdiction, nursing home residents will be better off in some provinces than in others. So some Canadian experts, including Stamatopoulos, are arguing that these facilities should be nationalized under the Canada Health Act. Others are not sure that’s the answer; Stall thinks it may make sense to target only for-profit homes, compelling them to improve their poor infrastructure. In the long term, any homes that do not meet modern standards should be redesigned.

Another lesson for the long term comes from Hong Kong, which has managed to totally avoid deaths in its nursing homes. Even before the coronavirus came along, all homes had a trained infection controller who put precautions in place to prevent the spread of infections. (US homes saw a similar system enacted under President Obama, but President Trump has proposed that it be rolled back.) Four times a year, Hong Kong’s homes underwent pandemic preparedness drills so that if an outbreak occurred, they’d be ready with best practices. It did, and they were.

Preparedness clearly saves lives. Hopefully, Canada and other countries will learn that lesson going forward so that no more lives are needlessly lost.

As Cahana, the resident in the Montreal home, said, “Each of us is crying to be heard. We say: More life! Please! We are not afraid of the future. We are afraid that society is forgetting us.”

 

 

 

 

 

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

https://www.vox.com/2020/7/6/21314472/covid-19-coronavirus-us-cases-deaths-trends-wtf

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.

 

 

 

 

Slow the spread, save the economy—mask up

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3 agency entries for New York governor's mask PSA | Campaign US

If Americans don’t believe public health officials or medical researchers, perhaps they’ll believe Wall Street. A new analysis released by the investment bank Goldman Sachs this week argues that implementing a national mask-wearing mandate is “worth” about 5 percent of US gross domestic product (GDP). Performing a regression analysis of reported masking behavior among residents of states with state-level mandates, as well as infection rates following the mandate implementation, Goldman’s analysts found that mask mandates result in a 25 percent reduction in the growth rate of infections, as well as a decline in COVID fatalities.

The analysis estimates that implementing a national mandate would increase the percentage of people who wear masks by 15 percentage points, with larger impact in states that currently have low levels of mask compliance. Goldman Sachs had previously constructed an “effective lockdown index”, estimating that the coronavirus pandemic subtracted 17 percent from US GDP between January and April.

Given spikes in COVID infections across Sun Belt states, the analysis found that avoiding potential lockdowns by instead implementing a mask mandate could avoid a further 5 percent decrease in GDP. Both the Centers for Disease Control (CDC) and the World Health Organization (WHO) recommend that the general public wear masks, and a growing body of scientific research indicates that masking significantly reduces the spread of COVID.

Now the bankers have weighed in. We don’t know who still needs to hear this, but please wear a mask when you’re out and about this holiday weekend. Please.

 

 

 

Why our “starved” public health system was unprepared for COVID-19

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Exclusive: Health spending in Brazil states as small as USD 20 ...

The American public health system has long been considered one of the best in the world, but decades of underfunding have left states and counties woefully ill-equipped to handle the worst pandemic in a century.

An extensive analysis by Kaiser Health News and the Associated Press found that over the past ten years, per-capita spending by state and local public health departments has dropped by 16 and 18 percent, respectively, leaving our public health system “underfunded and under threat, unable to protect the nation’s health”.

Public health departments are mandated to provide a laundry list of critical functions, from restaurant inspections and water testing to immunizations. But over time, many of these functions have been privatized, and staff and budgets reduced. Both were cut further as state budgets tightened.

The federal government has extended $13B in emergency funding, but many local public health departments have still been forced to furlough workers during the pandemic. Citing comparisons to the funding extended during other crises like Zika and the H1N1 influenza, experts are concerned that baseline budgets will continue to decline.

Moreover, public health workers face unprecedented cultural challenges, and are often disrespected by political and clinical leaders. And as public health workers are putting themselves at risk of COVID exposure just to do their jobs, many face resentment and anger from angry citizens who blame them for the policies they are charged to enforce—with some local public health leaders even resigning due to threats and intimidation.

The current crisis has shown that we need a more expansive, and better coordinated public health infrastructure. Getting there will require not just more investment, but repairs to the foundation of this critical national asset.

 

 

 

America celebrates a grim milestone

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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.