Category Archives: Personal Protective Equipment (PPE)

The Southern Pandemic

Posted on by • Posted in Asymptomatic Transmission, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Evidence Based Decision Making, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Schools, Public Trust, Scientists, Unvaccinated, Vaccination, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Skepticism, Vaccine Supply • Leave a comment

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Any COVID-19 uptick is a tragedy, but the first major U.S. surge since the start of the vaccination rollout has been uniquely painful to watch because it likely could have been prevented. The Delta variant has driven up cases across the country, with the worst outbreaks in southern states where vaccination rates fall far short of that of the country as a whole, which is nearly half vaccinated. A few examples:

  • In Louisiana, 37.1% of the population is fully vaccinated and the seven-day average of new cases is 4,622, up from 1,426 two weeks ago.
  • In Arkansas, 36.6% of the population is fully vaccinated and the seven-day average of new cases has nearly doubled over the last two weeks to 1,900 new cases a day.
  • In Alabama, 34.4% of the population is fully vaccinated and the seven-day average for daily cases has tripled over the last two weeks to 2,400 new cases a day.
  • In Mississippi—which has the country’s lowest vaccination rate, at 34.5%—the number of new cases has nearly tripled in the last two weeks; it’s now reporting a seven-day average of nearly 1,700 daily cases.

These surges have left many people scrambling to protect themselves, with several hard-hit states reporting an increase in vaccine uptake. In Louisiana, for example, about 52,000 doses were administered during the week ending July 31, compared to about 20,000 the week ending July 10. Unfortunately, people getting vaccinated now won’t be fully protected for another two to four weeks, depending on the shot they receive, meaning the virus will likely continue to spread for some time.

At least some southern governors are taking steps to prevent that, turning to tried and true methods like masking to contain viral spread. Louisiana governor John Bel Edwards (D), for instance, issued an order yesterday mandating face masks in many indoor public settings, including businesses, schools and churches. “I cannot in good conscience sit by while our hospitals lose the capacity to deliver life-saving care to COVID patients and non-COVID patients alike,” Edwards said when announcing the new rules, which begin tomorrow and are currently set to expire Sept. 1.

However, the leaders of other badly hit states are not following suit. Mississippi governor Tate Reeves (R), for instance, has rejected the U.S. Centers for Disease Control and Prevention’s (CDC) updated guidance calling for indoor masking in areas with substantial viral spread, calling it “foolish.” The state may continue to pay the price; Mississippi hospitals are reportedly struggling to find enough nurses to care for patients, even as the state health officer warned last week that new hospitalizations are “skyrocketing” (as of July 27, Mississippi’s seven-day average for new hospitalizations was 126, compared to about 20 on July 1).

The best anyone can do in these states now is get vaccinated, mask up, and socially distance whenever possible. Delta burned hot but fast in India and the United Kingdom, and it’s possible it will do the same in the States as well.

TODAY’S CORONAVIRUS OUTLOOK

Over 400.6 million doses of the COVID-19 vaccine have been shipped to various U.S. states as of this afternoon, of which some 347 million doses had been administered, according to TIME’s vaccine tracker. About 49.7% of Americans had been completely vaccinated.

Nearly 198.9 million people around the world had been diagnosed with COVID-19 as of 1 a.m. E.T. today, and more than 4.2 million people have died. On August 2, there were 556,672 new cases and 7,784 new deaths confirmed globally.

Here’s how the world as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

And here’s every country that has reported over 3 million cases:

The U.S. had recorded more than 35.1 million coronavirus cases as of 1 a.m. E.T. today. Nearly 614,000 people have died. On August 2, there were 127,976 new cases and 451 new deaths confirmed in the U.S.

Here’s how the country as a whole is currently trending:

Here’s where daily cases have risen or fallen over the last 14 days, shown in confirmed cases per 100,000 residents:

7 ways this COVID-19 surge is different

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How to prepare for a winter COVID-19 surge: Advice for cancer patients and caregivers | MD Anderson Cancer Center

Perhaps the worst way a leader can respond to the current surge of COVID-19 is with an exaggerated sense of familiarity.

Although communities have before experienced growing positivity rates, cases, hospitalizations and deaths from COVID-19, the summer 2021 surge involves some new or evolved factors that are worthy of consideration for leaders to best respond to the needs of their teams, patients and communities. 

COVID-19 surges may not be new for hospitals or health systems, but here are seven reasons the one unfolding now differs from those before. 

1. COVID-19 vaccinations are available. The fact that acute COVID-19 resulting in hospitalization is largely avoidable is a sticky film coating everything about this surge. Under the direction of President Joe Biden, all adults were eligible for the COVID-19 vaccine by May 1. As of Aug. 2, 49.7 percent of the U.S. population is fully vaccinated and 70 percent of adults have received at least one dose of a COVID-19 vaccine, the latter of which is a milestone the president aimed to meet by July 4. Unvaccinated individuals account for 97 percent of the COVID-19 hospitalizations and deaths in the U.S., Jeff Zients, White House COVID-⁠19 response coordinator, said July 22. 

2. Clinicians are experiencing a distinct and deep brand of exhaustion. The term “burnout,” which healthcare recognized long before the pandemic, doesn’t cut it. Many clinicians today are managing competing emotions about patient care, with some feeling resentment slogging through long hours and COVID-19 surges that now feel preventable. “You’re just angry,” Terrence Coulter, MD, critical care medical director at Springfield, Mo.-based CoxHealth, told The Atlantic. “And you feel guilty for getting angry, because they’re sick and dying.”  

3. Hospitals are grappling with labor shortages. Nationwide, organizations are experiencing labor and talent deficits, both of which have been exacerbated by the pandemic. COVID-19 has left many professionals exhausted, with nearly 30 percent of physicians, nurses and other healthcare workers reporting that they have considered leaving healthcare altogether because of pandemic-related burnout, according to a survey by The Washington Post and the Kaiser Family Foundation. At the end of July, PeaceHealth St. John Medical Center in Longview, Wash., said it was facing “unprecedented patient volumes,” with its workforce alleging that a staffing crunch is leading to poor working conditions, according to The Daily News. On the other side of the nation, two North Carolina hospitals have at least 700 unfilled nursing positions — each, reported WNCT-TV. In South Carolina, there are more open positions for registered nurses than any other job in the state, with 4,955 openings, according to a May data analysis by WYFF.

4. The delta variant is more contagious. The delta variant, first detected in India, appears to be as contagious as chickenpox and appears to cause more severe illness than earlier strains, according to an internal CDC presentation obtained by The Washington Post. The report says vaccinated people infected with delta have had similar viral loads as unvaccinated people infected with the strain, which suggests vaccinated people may spread the virus just as easily as those who are unvaccinated — findings based on still unpublished data from studies and outbreak analyses. The variant is thought to contain genetic changes that allow it to spread twice as fast as earlier strains.

5. Public health guidance is more nuanced. In the earliest stage of the pandemic, before the vaccines, public health guidance from the CDC was written for every person as our defense against COVID-19 was collectively minimal. Now, as the number of fully vaccinated populations varies from 68 percent in Vermont to 34 percent in Alabama, the CDC has revised indoor masking guidance to a county level, with nearly 70 percent of U.S. counties experiencing a community transmission rate that meets the CDC threshold for an indoor mask recommendation. The CDC released new guidance for fully vaccinated Americans’ COVID-19 testing the same week. These are two examples of how public health guidance that in past surges was largely “one size fits all” is now tailored to specific circumstances. While precision and right-sized solutions are generally a good thing, nuance can also cause confusion. 

6. COVID-19 patients are younger and fitter. At the start of 2021, people 65 and older made up 53 percent of COVID-19-related hospitalizations and people 18-49 made up 20.5 percent, according to data from COVID-Net, a CDC surveillance system that draws data from numerous states, representing roughly 10 percent of the population. As of Aug. 2, those numbers shifted where people 65-plus now make up 26 percent of COVID-19-related hospitalizations while people 18-49 make up 41 percent. 

7. Non-COVID patients are sicker. Pre-surge, many emergency rooms were already feeling the strain of staffing shortages combined with patients of higher acuity as a result of delayed or deferred care throughout the pandemic. Stanford (Calif.) Healthcare is “outstripping beds everyday,” Dale Beatty, DNP, RN, chief nurse executive and vice president of patient care services, told Becker’s. The hospital is seeing “sicker” patients, reporting higher volumes of critically ill non-COVID-19 patients. COVID-19 long-haulers are also accounting for a significant portion of the patients, Dr. Beatty said. COVID-19 leaves thousands of survivors with health effects that place additional demand on the healthcare system. Nearly one-quarter of people who had COVID-19 still have at least one condition.

A Mask and a Shot

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May be an image of text that says 'A mask and a shot. @coach.fu No one's asking you to storm the beaches at Normandy.'

Cartoon – Rights vs. Wrongs

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May be a cartoon of standing and text that says '& "I told him as an expert in the field strongly recommend wearing it, but he just kept bringing up his 'rights'"'

Are Camps the Canary in the Coal Mine?

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What your kid needs to learn at summer camp

With August just around the corner, COVID-19 cases surging and the U.S. Centers for Disease Control and Prevention (CDC) again recommending indoor masking for many vaccinated people, parents and health officials are gearing up for tough choices around school reopening.

My colleague Tara Law has a new story on an issue that may foreshadow what’s to come for schools: COVID-19 outbreaks at summer camps.

Tara focused on a camp in Galveston County, Texas, which has been linked to 157 COVID-19 cases. The camp, which was for kids in grades six through 12, reportedly did little to enforce social distancing and few campers wore masks—even though pediatric vaccination rates in the area are low. The outbreak was likely the result of “a partially vaccinated group of people all getting together and everyone acting…like they were all vaccinated,” one expert told Tara.

That statement has big implications for schools trying to reopen this coming fall. With vaccines still not authorized for children younger than 12, and less than half of 12- to 17-year-olds nationwide fully vaccinated, there will be millions of unprotected children returning to school soon.

With the Delta variant spreading, the CDC and the American Academy of Pediatrics say all students and staff should wear masks in school. (The CDC initially said in guidance published July 9 that vaccinated people could go without masks, but the agency reversed that decision yesterday.) But, as camp outbreaks show, it can be difficult to enforce those policies to the letter, particularly in states—like Texas—where elected officials have barred public schools from requiring any students to wear masks.

“Because actually following rules is an important piece of prevention, schools have the advantage of being more controlled environments than camps,” Tara says. We’ll see this fall how well they do.

Read more here.

A new way to visualize the surge in Covid-19 cases in the U.S.

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A new way to visualize the surge in Covid-19 cases in the U.S.

The month of July has seen Covid-19 cases in the United States increase at the fastest pace since last winter, marking the start of the latest wave of infections to afflict the nation. A new STAT analysis of Covid-19 case data reveals this new wave is already outpacing the spring and summer waves of 2020.

There are many metrics that governments, scientists, and media outlets have used to try and reckon with the Covid-19 pandemic. One of the most popular ways of visualizing Covid data has been to track the weekly average of new cases. This is pictured below.

Chart showing new Covid-19 Cases Reported in the U.S.
J. EMORY PARKER/STAT

The number represented by the line could be thought of as the velocity of cases in the U.S. It tells us how fast case counts are increasing or decreasing and does a good job of showing us the magnitude of each wave of cases.

The chart, however, fails to show the rate of acceleration of cases. This is the rate at which the number of new cases is speeding up or slowing down.

As an analogy, a car’s velocity tells you how fast the car is going. Its acceleration tells you how quickly that car is speeding up.

Using Covid-19 case data compiled by the Center for Systems Science and Engineering at Johns Hopkins University and Our World in Data, combined with data from the Centers for Disease Control and Prevention, STAT was able to calculate the rate of weekly case acceleration, pictured below.

J. EMORY PARKER/STAT

In this chart, we see how quickly the weekly average of new cases is changing. When the values are positive, new case counts are increasing, and when the values are negative, new case counts are falling. Highlighted in red, we can see each previous wave’s intensity and duration.

Looking at the data this way is useful because the rate at which cases increase is a reasonable indicator of how intense that wave might be and how long it might last. For example, case acceleration in the U.S. reached a peak in November 2020, closer to the start of the nation’s deadly winter wave than to when cases reached their zenith in January of 2021.

This view of the data reveals that the United States is currently in the midst of a fifth wave of cases and that this new wave is growing faster than the first and second waves from spring and summer of 2020.

STAT also calculated case acceleration rates for each state and major territory in the U.S., revealing where cases are increasing the fastest.

Chart showing case acceleration ranked by state
J. EMORY PARKER/STAT

In the last two weeks, new case counts in Louisiana accelerated the fastest in the nation at an average rate of 444 cases per week per day (2.38 cases per 100,000 people per week per day). Only 36% of the state’s residents are vaccinated, making it among the least vaccinated in the country.

Chart showing covid cases per day in LA
J. EMORY PARKER
Chart showing case acceleration is LA
J. EMORY PARKER/STAT

By looking at the state’s case acceleration rate, we can see that cases in Louisiana are currently increasing faster than they did at the start of last winter’s wave.

Likewise, in the state of Florida, the case acceleration rate has outpaced that state’s 2020 summer wave.

Chart showing new covid cases in Florida
J. EMORY PARKER/STAT
Chart showing case acceleration in Florida
J. EMORY PARKER/STAT

In Florida, about 48% of residents are fully vaccinated against Covid-19.

Cases are increasing in nearly every region of the country, but they are not increasing at the same rate everywhere. Vaccination rates likely help explain these variations.

The five states where cases are accelerating the fastest all have vaccination rates below the national average. But consider the state of Massachusetts, where about 63% of the population is fully vaccinated.

The New York Times’ Covid Dashboard reports the state has an alarming 351% increase in cases over the last 14 days, the highest such percentage change in the nation. Looking at Massachusetts’ case acceleration paints a different picture.

Chart showing new covid cases is Mass
J. EMORY PARKER/STAT
Chart showing case acceleration in Mass.
J. EMORY PARKER/STAT

While cases in Massachusetts are increasing, the rate at which case reports are accelerating is much lower than it has been for any of the state’s previous waves, and is below the national average for case acceleration.

A tidal wave of vaccine mandates

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EP14: What Motivates You? The Carrot or the Stick? | Live and Lead for Impact Podcast with Kirsten E Ross

State governments, private businesses and even part of the federal government are suddenly embracing mandatory coronavirus vaccinations for their employees.

Why it matters: Vaccine mandates have been relatively uncommon in the U.S. But with vaccination rates stagnating and the Delta variant driving yet another wave of cases, there’s been a new groundswell of support for such requirements.

Driving the news: Monday was a turning point.

  • The VA became the first federal agency to require its employees to be vaccinated.
  • More than 50 medical groups called for mandatory vaccinations of all health care workers, WaPo first reported.
  • California announced that state employees and health care workers must show proof of vaccination or get tested regularly.
  • New York City brought all municipal workers — including teachers and police officers — under a vaccine requirement that had previously only applied to health workers.
  • Even the SF Bar Owner Alliance hopped onboard, announcing that the 500 San Francisco bars it represents will require indoor customers to show proof of vaccination or a negative test.

The big picture: Vaccine requirements are also gaining steam internationally.

  • France has required health workers to get vaccinated. Members of the public must also have a vaccine or a negative test to enter most indoor venues.
  • Although the measure has sparked protests, it’s also encouraged millions of people to get vaccinated, per the NYT.

Yes, but: Many Republican-led states have preemptively prohibited vaccine requirements, at least in some settings.

The bottom line: Vaccine mandates have been unpopular in part because they’ll inevitably create a backlash.

  • But the vaccination effort seems to have run out of carrots to incentivize more people to get a shot, and with rates remaining as low as they are in light of a worsening domestic situation, resorting to sticks has clearly become a more attractive option.

Experts warn unvaccinated are greatest threat to pandemic recovery

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Experts warn unvaccinated are greatest threat to pandemic recovery

COVID-19 Vaccine Cheat Days are Adding Up - The Atlantic

Experts are warning that the greatest threat to the pandemic recovery in the United States are the large swaths of Americans who remain unvaccinated. 

Over the past few weeks, the U.S. has seen a surge of coronavirus cases across the country in the wake of the highly infectious delta variant. The new strain has particularly wreaked havoc in states with low vaccination rates.

The state of Missouri has recently become a U.S. hot spot, averaging more than 2,100 cases per day over the last seven-day period, according to data from The New York Times. About 41 percent of the state population is fully vaccinated.

Florida, Arkansas, Louisiana and Nevada have also seen an increase in coronavirus cases.

The nationwide vaccination rate has also dropped following the mad dash for the vaccine earlier in the year. Health experts warn that unvaccinated individuals pose a risk to the country, and could spread the disease until other, vaccine-resistant strains arise.

Some say the U.S. has missed its chance at outrunning the delta strain.

“I think we probably could have done that here in the U.S., if we hadn’t slowed our vaccination rates so much,” Andy Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University, told The Hill.

“But I think it’s important also to emphasize that variants will emerge anywhere the virus is replicating in people to a great degree. And globally, there are so many places where this virus is just freely infecting people and replicating and it’s those situations that are going to be generating variants at a higher frequency.”

The delta variant isn’t even the only variant to worry about.

The lambda strain, first detected in Peru, is now present in the U.S. The World Health Organization (WHO) has designated this strain as a “variant of interest,” the designation beneath that of a “variant of concern,” like that of the delta variant.

Jen Kates, director of global health and HIV policy for the Kaiser Family Foundation, and Pekosz told The Hill that data on the lambda variant is limited at the moment, but what information is available suggests that it is similar to delta in that it is more transmissible than previously dominant strains like the alpha and beta variants. They added that vaccines should still offer protection against it.

At the same time, the lambda variant is not spreading as quickly as the delta variant.

“There’s a lot that we do not yet know about the lambda variants, including compared to the delta,” said Leana Wen, an emergency physician and public health professor at George Washington University.

“Is it more contagious? This is a really important question, because when there is a new variant, and it’s more contagious, it displaces the previous variant. But if there is already a very contagious variant and you have other variants that are appearing as they are all the time, they probably are not going to take over,” Wen said.

Wen, who previously served as Baltimore’s health commissioner, expressed frustration that vaccinations have not been properly incentivized even when she warned earlier in May that the window for intervention was quickly narrowing.

“If we had tied vaccinations to reopening policy, we had a much higher chance of achieving the kinds of immunity that we needed,” Wen said.

Pekosz opined that if the U.S. had reached a 90 percent vaccination rate earlier this year, the nation could have avoided the current situation.

“We stalled at a place where essentially half the population has immunity and half doesn’t and that’s a really awful place to be from a vaccine perspective,” Pekosz said.

According to the most recent data from the Centers for Disease Control and Prevention, around 69 percent of adults in the U.S. have received at least one dose. The country has still yet to reach President Biden‘s 70 percent vaccination goal, weeks after his initial July 4 deadline.

All health experts who spoke with The Hill agreed that the biggest challenge that the U.S. faces to overcome the pandemic is vaccine hesitancy.

The large groups of people holding out from vaccinations pose a significant threat because they are not immune, and are still capable of spreading COVID-19 and new variants. They added another major issue is that unvaccinated people are behaving as though they were vaccinated, going without masks in public and attending large indoor and outdoor gatherings that they should avoid.

However, Pekosz added that the progress that has been made is substantial.

“I always want to emphasize the positive, which is right now the vaccine seems to be working well against the delta variant. And that should be something that people are using to get motivated to get the vaccine,” he said. “I think that’s the critical thing to get across to everybody.”

Cartoon – The Delta Kid

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Pro/Con: Already successful vaccine rollout needs young people's arms, too | Duluth News Tribune

Our personal “canary in the coal mine” for COVID risk

Posted on by • Posted in Asymptomatic Transmission, Canary in the Coal Mine, Coronavirus, Coronavirus Delta Variant, Coronavirus Mutation, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Scientists, Sign of the Times, Social Distancing, Unvaccinated, Vaccination, Vaccine, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Mandate, Vaccine Mandatory, Vaccine Skepticism, Vaccine Supply • Leave a comment

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The Canary in the Coal Mine

Here’s our personal bellwether for how the Delta variant is impacting health systems: we’ve had three different, in-person leadership retreats cancel across the course of the past week, due to COVID concerns. Three very different parts of the country, on both coasts and in the heartland.

Case counts are up, hospitalizations are up, and clinical leaders are (rightly) becoming more skittish about large, in-person meetings. As many have noted, this latest wave of infections is unevenly distributed across the country, primarily affecting the unvaccinated but also putting vaccinated people at risk of transmitting the virus or becoming ill.

As frequent business travelers who thrive on meeting face-to-face with our members, we had just begun to get comfortable being back out “on the road”—but now that’s changing, too. The recent cancellations are a good reminder that we’re still in a fluid situation in this pandemic, and that being flexible and adaptable will continue to be critical for the foreseeable future. (Thank goodness we’re not in the conference business—that’s got to be a nightmare right now.)

Just as we always check the weather forecast for places we’re traveling to, we’ve started checking the number of cases per 100,000 and the test positivity rate as well—over 10 per 100,000, or over 5 percent, and we’ll think twice about visiting.

And our masks have gone back on. We’ll hope to see you out there soon, but in the meantime—stay safe and get vaccinated!