The fall Covid-19 surge keeps growing, with 29 states setting new records this month for the most new daily cases since the pandemic began, according to data from Johns Hopkins University.
And it’s not just due to more testing. The average number of daily new cases this past week is up 21% compared to the previous week, according to JHU. But testing has increased only 6.63% over the same time frame, according to the Covid Tracking Project. “We’re rising quickly. If we just go back about six, seven weeks ago to Labor Day, we were at about 35,000 cases a day,” said Dr. Ashish Jha, dean of Brown University School of Public Health.”
At least 73,240 new US cases and 985 deaths were reported Tuesday, according to JHU. “I would not be surprised if we end up getting to 100,000” new cases a day, Jha said. The surge is hitting all regions of the country. As of Wednesday, 40 states were trending in the wrong direction, with at least 10% more new cases this past week compared to the previous week, according to JHU. Missouri is the only state with at least 10% fewer cases, and the remaining nine states are relatively steady.
Without changes, ‘half a million people will be dead’
This month, 11 states reported their highest single day of new deaths since the pandemic began.
And because a vaccine probably won’t be available to most Americans until the middle of next year, personal responsibility will be key to saving American lives.“If we continue our current behavior, by the time we start to go down the other side of the curve, a half a million people will be dead,”said CNN medical analyst Dr. Jonathan Reiner, a professor of medicine at George Washington University.Under the current conditions, the daily US death toll is projected to reach 2,000 by January 1, according to the University of Washington’s Institute for Health Metrics and Evaluation.In the past nine months, more than 8.7million people in the US have been infected with coronavirus, and more than 226,000 have died.
Imminent threats to hospital capacity
Even after setting up a field hospital at the state fairgrounds, Wisconsin is facing a dire predicament with hospital capacity. “There is no way to sugarcoat it. We are facing an urgent crisis, and there is an imminent risk to you and your family,” Gov. Tony Evers said.
In Ohio, admissions to intensive care units have doubled since the beginning of this month, Gov. Mike DeWine said. Colorado is also worried about hospital capacity as the number of daily new cases skyrocketed this month. “If these trends continue, it would exceed May hospitalization numbers,” Gov. Jared Polis said. “And the modeling suggests that if we don’t change what we’re doing, it’ll exceed all of the existing hospital capacity by the end of the year. This thing moves quick, and we need to change the way we live.”The city and county of Denver has reduced the maximum allowed occupancy of restaurants, retailers and some other businesses from 50% to 25%, according to a statement Tuesday.”Why we’re doing this is to send a clarion call to everyone that we have a responsibility to once again put our hands on this boulder and begin to push it back up the hill,” Denver Mayor Michael Hancock said.
The president’s comments at a recent rally are false and contribute to the spread of misinformation, they say.
Hospital groups are pushing back against President Trump’s claims this week that doctors are over-reporting COVID-19 deaths for financial gain. Trump made the comments at a Wisconsin rally on Saturday.
“You know some countries they report differently,” Trump is quoted as saying in Newsweek. “If somebody’s sick with a heart problem, and they die of COVID they say they die of a heart problem. If somebody’s terminally ill with cancer and they have COVID, we report them. And you know doctors get more money and hospitals get more money. Think of this incentive. … We’re going to start looking at things.”
WHAT’S THE IMPACT
Hospitals and health systems are eligible to receive higher payments for complex coronavirus-related treatment under the Coronavirus Aid, Relief and Economic Security Act, under which they receive a Medicare add-on payment of 20%. However, American Hospital Association President and CEO Rick Pollack refuted Trump’s claims.
Asked to respond, the AHA referred to a viewpoint article written by Pollack in September, in which he sought to dispel what he called certain “myths.”
“Hospitals do not receive extra funds when patients die from COVID-19,” Pollack said. “They are not over-reporting COVID-19 cases. And they are not making money on treating COVID-19.
“The truth is,hospitals and health systems are in their worst financial shape in decades due to the coronavirus. In some cases, the situation is truly dire. An AHA report estimates total losses for our nation’s hospitals and health systems of least $323 billion in 2020. There is no windfall here.”
Pollack also noted that healthcare organizations adhere to strict coding guidelines and use the COVID-19 code for Medicare claims only for confirmed cases. Inappropriate coding can result in criminal penalties and exclusion from the Medicare program altogether.
In a more recent and direct response to the president’s latest comments, American Medical Association President Dr. Susan Bailey bemoaned that physicians are being pulled into a public battle over the legitimacy and motivation behind their work.
“The assault on public health and the undermining of efforts to defeat COVID-19 began with unfounded suspicions about the science and evidence of this novel coronavirus and how it spreads,” Bailey said on Tuesday. “It grew with speculation about harmful and unproven treatments for COVID-19, false claims that masks were a source of infections, and by misleading suggestions that increased testing alone explains why case counts are surging.
“It expanded again with inaccurate, dangerous statements about children being ‘almost immune’ from the most serious effects of COVID-19, a reckless plan of ‘focused protection’ and naturally acquired ‘herd immunity’ as a pathway out of this pandemic, and most recently with wild and highly offensive claims that physicians are inflating the number of COVID-19 cases and deaths to increase our incomes.”
Bailey said that many public health officials have been threatened and intimidated, prompting some to quit or retire, and decried the “campaign of misinformation” as a betrayal of public trust that threatens the work being done to treat and contain the virus.
“Our AMA will always stand on the side of patients and physicians, of science and evidence, and of free and honest conversations that build the trust that is so crucial to our work,” she said. “We will not hesitate to call out political intimidation and fear-driven rhetoric that undermines this trust or that interferes with our ability to deliver the very best care to patients.”
The American College of Emergency Physicians also issued a statement, calling Trump’s assertions “reckless” and “false.”
“To imply that emergency physicians would inflate the number of deaths from this pandemic to gain financially is offensive, especially as many are actually under unprecedented financial strain as they continue to bear the brunt of COVID-19,” ACEP wrote. “These baseless claims not only do a disservice to our health care heroes but promulgate the dangerous wave of misinformation which continues to hinder our nation’s efforts to get the pandemic under control and allow our nation to return to normalcy.”
THE LARGER TREND
The numbers of COVID-19 cases continue to bring grim news, especially in the U.S., which struggled early in the pandemic to secure testing capacity and necessary personal protective equipment for frontline healthcare workers.
As of Wednesday morning, the Johns Hopkins University coronavirus tracker showed more than 8.7 million confirmed cases of the virus in the U.S., with the death toll climbing to over 226,000. Both lead the world. Second on the list is India (7,990,322 cases, 120,010 deaths), while Brazil comes in third (5,439,641 cases, 157,946 deaths).
Salt Lake City-based Intermountain Healthcare and Sioux Falls, S.D.-based Sanford Health have signed a letter of intent to merge.
The boards of both nonprofit organizations unanimously approved on Oct. 23 a resolution to support moving forward with the due diligence process. Pending regulatory and state approvals, the merger is expected to close in 2021.
“We’re hoping that the actions taken … just 72 hours ago will culminate in a combined organization next summer,” Kelby Krabbenhoft, president and CEO of Sanford Health, said during an Oct. 26 news conference.
Existing boards of trustees from both systems will join to form a combined board, and Gail Miller, chair of the Intermountain board, will serve as board chair of the merged organization.
Marc Harrison, MD, president and CEO of Intermountain, will serve as president and CEO of the combined system, which will operate 70 hospitals and employ more than 89,000 people. Mr. Krabbenhoft will serve as president emeritus.
“These are two great organizations with strong histories that are economically and clinically very strong,” Dr. Harrison said during the news conference. “This is something that should happen for the future of American healthcare.”
Intermountain will be the parent company of the combined organization, and the merged system will be headquartered in Salt Lake City.
The pandemic put nurses on the front lines of the battle against COVID-19 and caused shifts in the way they provide care.
During this year, nurses have adapted to increased adoption of telehealth and virtual patient monitoring, as well as constantly evolving staffing needs.
These factors — and others, such as the physical and emotional conditions nurses have faced due to the public health crisis — are sure to affect nursing in the years to come. Here, 10 healthcare executives and leaders share their predictions for nursing in the next five years.
Editor’s note: Responses were edited lightly for length and clarity.
Beverly Bokovitz, DNP, RN. Vice President and Chief Nurse Executive of UC Health (Cincinnati): In the next five years, as we continue to encounter a national nursing shortage, I expect to see additional innovative strategies to complement the care provided at the bedside.
One of these strategies will be some type of robot-assisted care. From delivery of medications to answering call lights — and completing simple tasks like needing a blanket or requesting that the heat be adjusted — we will see more electronic solutions. These solutions will allow for a better patient experience and help to exceed the expectations of our patients as customers.
Of course, nothing can take the place of skilled and compassionate bedside care, but many tasks could be automated — and will be — to supplement the professional nursing shortage.
Natalia Cineas, DNP, RN. Senior Vice President and Chief Nurse Executive of NYC Health + Hospitals (New York City): Nurses will continue to play a vital role in addressing the health inequities and social determinants of health among vulnerable populations as the nursing workforce itself becomes more diverse and inclusive. As the largest segment of the healthcare workforce — with some 4 million nurses active in the U.S. — nurses represent the faces of the communities in which they serve. As America becomes a more diverse and inclusive society, so too will the nursing profession become more diverse and inclusive. Currently, industry estimates indicate that between one quarter to one-third of all U.S. nurses identify as a member of a minority group, with between 19 percent and 24 percent of U.S. nurses identifying themselves as Black/African-American; 5 percent to 9 percent identifying themselves as Hispanic; and about 3 percent identifying themselves as Asian. The percentage of minority nurses has been rising steadily for the past two decades and is expected to continue to climb in the coming years.
Blacks and underserved minority populations face numerous genetic, environmental, cultural and socioeconomic factors that account for health disparities, and the impact is particularly visible in the areas of cardiovascular disease, diabetes, pregnancy and childbirth mortality, and cancer outcomes, as well as the enormous toll of the current novel coronavirus global pandemic, where communities of color have been among the hardest hit populations.
In New York City alone, statistics compiled by the city’s health department show Blacks and Hispanics together account for 65 percent of all COVID-19 cases; represented 70 percent of all hospitalizations due to COVID-19; and, sadly, 68 percent of all deaths caused by COVID-19. As demonstrated during this pandemic, in the future, technology such as telehealth and virtual patient monitoring will play a major role in the care of patients. There will be a vast need to address social determinants of health by educating and providing resources to allow utilization of this technology such as using “wearable tech” to monitor ongoing health issues, such as high blood pressure, diabetes, heart conditions and other chronic illnesses.
Ryannon Frederick, MSN, RN. Chief Nursing Officer of Mayo Clinic (Rochester, Minn.):Nursing research will experience extraordinary demand and growth driven by a realization that both complex and unmet patient needs can often be best served by the role of a professional registered nurse. Nurses are uniquely positioned to implement symptom and self-management interventions for patients and their caregivers. Significant disruption in healthcare, including increasing use of technology, will lead to a dramatic shift to understand the role of the RN in improving patient outcomes and implementing interventions using novel approaches. Nursing researchers will provide a scientific body of evidence proving equivalent, if not better, patient care outcomes that can be obtained at a lower cost than traditional models, leading to an even greater demand for the role of the professional nurse in patient care.
Karen Higdon, DNP, RN, Vice President and Chief Nursing Officer of Baptist Health Louisville (Ky.):The value of nursing has never been more apparent. Nurses have led the front line during this pandemic. In the next five years, we must be flexible and creative in establishing new models of care, specifically around roles that support nursing, such as assistant and tech roles. Creating roles with clear role definition, that are attractive and meaningful for nursing support will help build consistent, high-quality models for nursing to lead. This consistency, along with IT capabilities that enhance workflow, will better allow nurses to work at the top of their scope.
Karen Hill, DNP, RN. COO and Chief Nursing Officer of Baptist Health Lexington (Ky.): 2020 was declared the “Year of the Nurse” and this reality has never been more true than realizing the personal and professional sacrifices of nurses in dealing with issues surrounding the pandemic. The next five years will require nursing professionals to be flexible to address new, unknown emerging issues in all settings, to be open to new opportunities for leadership in hospitals, schools and communities and to use technology and telehealth to provide safer care to patients. Nurses need to evaluate our practices and traditions that are value-added and leave behind the task orientation of the past. We need to honor our legacy and create our path.
Therese Hudson-Jinks, MSN, RN. Chief Nursing Officer and Chief Patient Experience Officer at Tufts Medical Center and Tufts Children’s Hospital (Boston):Over the next five years, I expect that the support and retention of clinical nurses will become the top priority of every CNO and executive team, given nurses’ direct impact on supporting the business of healthcare. This will be particularly critical because there will be a concerning shortage of experienced clinical nurses as a result of advancing technologies increasing complexity in care, additional nurse roles created outside traditional areas, fierce competition for talent between large healthcare systems, aging baby boom workforce retiring at higher rates year over year, and a lack of sufficient numbers of PhD-prepared nurses working in academia and supporting higher enrollments.
I also believe that CNOs will be laser-focused on creating the practice environment that enhances retention of top, talented clinical nurses, and we will put a greater emphasis on the influence of effective nursing leadership in reaching that goal. In addition, I fully expect that nurses will be seen more as individuals with talents and experience than ever before — not just a number on a team, but rather a professional with specific, unique, talents that are highly sought after in competitive markets.
Finally, I anticipate that nursing innovation will blossom, given the exposure of the “innovation/solutionist superpower” within nurses during the pandemic. Philanthropy will grow exponentially in support of nursing innovation as a result.
Carol Koeppel-Olsen, MSN, RN. Vice President of Patient Care Services at Abbott Northwestern Hospital (Minneapolis): During the COVID-19 pandemic nurses have been working in difficult physical and emotional conditions, which may lead to significant turnover after the pandemic resolves. Nurses have a commitment to serving others and will persevere until the crisis is past; however, when conditions improve, many nurses may decide to pursue careers outside acute care settings. A possible turnover, coupled with a service economy that has been devastated, may result in large numbers of former service workers seeking stable jobs in nursing. Hospitals will have to be nimble and creative to onboard an influx of new nurses that are not only new to the profession but new to healthcare. Tactics to onboard these new nurses may include the use of retired RNs as mentors, instructor-model clinical groups in the work setting, job shadowing and aptitude testing to determine the best clinical fit.
Jacalyn Liebowitz, DNP, RN. Senior Vice President and System Chief Nurse Officer of Adventist Health (Roseville, Calif.): Over the next five years, I see nurses providing more hospital-based care in the home using remote technology. Based on that shift, we will see lower-acuity patients move into home-based care, and higher-acuity care in hospitals will increase. With that, hospital beds will be used at a different level. My bold prediction is that we will not need as many beds, but we will need higher acute care in the hospitals.
Nurses will learn differently. As we are seeing now, nurses have not been able to train in the traditional way. They are already using more remote technology to educate, onboard and orient to their roles. It looks and feels vastly different, and nurses need to be comfortable with that.
As for patient care, I think data that can be gleaned from wearable biometrics, and the use of artificial intelligence will help predict patient care on a patient-by-patient basis. Nurses will work with AI as part of their thought process, instead of completely focusing on their own judgment and assessment.
I also believe we are going to face a nursing shortage post-COVID for a few reasons. Due to the emotional and physical toll of responding to a pandemic, some nurses will decide to retire, and another group will leave based on the risks that go hand-in-hand with the profession.
As for patient care, we are going to collaborate differently. There will be more video conferencing regarding collaboration around the patient. And I think in the future we will see that the full continuum of care will include a wellness plan.
Debi Pasley, MSN, RN. Senior Vice President Chief Nursing Officer of Christus Health (Irving, Texas):I believe the demand for nurses will become increasingly visible and newsworthy throughout the pandemic. This could drive increases in salaries and numbers of qualified candidates seeking nursing as a profession in the medium and long term. The shortage will, however, continue to be a factor, leading to more remote work options to both supplement nursing at the bedside and substitute for in-person care.
Denise Ray, RN.Chief Nursing Executive of Piedmont Healthcare (Atlanta): Nursing schools will need to focus on emergency management and critical care training utilizing a team nursing model. While nursing has become very specialty-driven, the pandemic has demonstrated gaps in our ability to adapt as quickly utilizing a team model where nurses lead and direct care teams. By implementing a team model and enhancing education in the areas of emergency management and critical care, nursing can adapt quickly to the ever-changing environment.
Also, communication with patients and families will take on different dimensions with wider use of tele-therapeutic communication. Nurses will be leaders and liaisons in the process, connecting physicians, patients and patient families virtually.Nurses will play a key role in integrating patient family members as true patient care partners— making sure they have the information they need to serve an active caregiving role for their family members during and after hospitalization. We’ll also see more nurses becoming advanced nurse practitioners, playing an expanded role in all healthcare settings.
The U.S. is well into its third peak of the coronavirus, marking a new record for daily cases at more than 83,000 over the weekend.
The total case count has surpassed 8.6 million and the death toll rose above 225,000. Globally, more than 43 million have been affected with more than 1.1 million dead.
In recent days, some experts and reports have referred to this as a third wave, while others refer to it as either an elongated first wave or a second wave.
Dr. Anthony Fauci, the nation’s top infectious disease expert, settled the debate with Yahoo Finance this Monday at its annual All Markets Summit.
“I look at it more as an elongated — and an exacerbation of — the original first wave,” Fauci said.
He explained that while the Northeast has been able to reduce its outbreak, the national baseline never fell to a more manageable number like 10,000 cases per day. Instead it’s stayed high at about 20,000 cases per day.
In addition, for areas which chose to open up after the initial brief national lockdown, some states did not follow strict guidelines.
“We started to see a peak that brought us up to around 70,000 per day,” Fauci said, adding that, “Now as we’re getting into the cold weather, we came back up again to the worst that we’ve ever had, which was over 80,000 per day.”
We’ve never really had waves in the sense of up and then down to a good baseline. It’s been wavering up and down. So now, we’re at the highest baseline. … [It’s] kind of semantics. You want to call it the third wave or extended first wave. No matter how you look at it, it’s not good news,” he added.
A similar debate ensued in the summer, with many pointing to the surge hitting parts of the country that had yet been unaffected, thereby making it the first wave. Some experts say they are used interchangeably, and others say the differentiation is actually only between the local and national levels.
Dr. Shira Doron, an infectious disease physician at Tufts Medical Center echoed Fauci’s declaration of an elongated first wave.
“Only when looking back at the shape of a curve can you truly call something a peak or wave. It’s also important to mention that the overall U.S. graph looks very different than individual state graphs,” Doron said.
“The U.S. as a whole, however, never declined to low levels after its first peak, which is why some peoplesay we are still in the ‘first wave,’” she said.
“Overall, I think it’s more a matter of semantics than something scientific.”
HENRY KOTULA 