[Bgs-list] Fwd: VoxCare: US hospitals prepare for the worst-case scenario as Covid-19 surges again

Tue Oct 27 13:04:35 EDT 2020

Sharing a newsletter with you guys.
Hope it comes through.
Health care professionals all over the country are preparing for a
"Terrible, Horrible, No Good, Very Bad" Winter.

Charles H. Baker
864.990.1297
“Don’t be in a hurry to condemn because he doesn’t do what you do or think
as you think or as fast. There was a time when you didn’t know what you
know today.” — Malcolm X

---------- Forwarded message ---------
From: Dylan Scott, Vox.com <newsletter at vox.com>
Date: Mon, Oct 26, 2020 at 3:12 PM
Subject: VoxCare: US hospitals prepare for the worst-case scenario as
Covid-19 surges again
To: charleshbaker+vox at gmail.com <charleshbaker+vox at gmail.com>

<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-j/>

*Today's coronavirus snapshot, as of 2 pm ET Monday:*

   - *8,661,917 confirmed US cases (43,238,481 worldwide)*
   - *225,379 confirmed US deaths (1,156,212 worldwide)*

*You might think you've seen this story before
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-t/>, but I assure you
it's not a reprint. The same hospital crisis we've seen in previous
Covid-19 surges is happening again.*

*—Dylan*
 .

The latest Covid-19 surge
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-i/> is forcing US
hospitals to take drastic measures — setting up temporary facilities or
preparing to transport patients to other cities and states — to avoid being
overrun.

The number of Americans currently hospitalized with Covid-19 has risen by
12,000 over the last month, reaching 41,753 on October 25, according to the
Covid Tracking Project
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-d/>. Today, some
hospitals are drawing up plans to ration care if they have more patients
than beds, the kind of worst-case scenario they’d been hoping to avoid.
Covid Tracking Project

Case numbers <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-h/> are
still rising too: The US is now averaging nearly 69,000 new Covid-19 cases
every day, higher than the previous peak in July. Hospitalizations lag
behind cases, because it takes time for a person to become ill enough to
require hospitalization‚ and so that number is likely to keep going up as
well. Deaths are already ticking up, with the US now averaging more than
800 every day, and they usually follow the same trends as cases and
hospitalizations with a slightly longer lag. (Fortunately, hospitals have
figured out how to better treat Covid-19
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-k/>, which is leading to
lower mortality rates. But still, more patients in the hospital will
inevitably mean more deaths.)

And the scary feature of this new wave is that cases and hospitalizations
are climbing everywhere. In previous waves, cases were ebbing in one part
of the country while they spiked somewhere else. But now, the entire
country is experiencing a surge at the same time.
Covid Tracking Project

Every state except Hawaii, Delaware and Louisiana (and Washington, DC) saw
their case numbers rise over the last two weeks, according to Covid Exit
Strategy <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-b/>. More than
40 states have a higher number of people hospitalized with Covid-19 now
than they did 14 days ago.

Public health experts have long expected that cases would increase during
the winter months, when social distancing becomes more difficult and the
colder weather makes it easier for the coronavirus to spread. But this new
data shows the difficult days are already here.

And hospitals are feeling the strain, just as they did in previous surges
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-n/>. The weekend brought
numerous reports of hospitals taking emergency measures in order to handle
the influx of Covid-19 patients. According to Covid Exit Strategy, 20
states have more than 70 percent of their ICU currently occupied; that
remaining capacity could quickly shrink if the current trends continue. In
some cities, hospitals have already reached their capacity.

Here are just a few examples of hospitals being pushed to the brink in the
pandemic’s third wave.

*El Paso, Texas, is setting up a field hospital and ordering a mandatory
curfew*

El Paso County has issued a mandatory curfew, from 10 pm to 5 am, after
hospitalizations surged by 300 percent in less than three weeks. A recent
University of Texas study
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-p/> projected a 96
percent likelihood that the area would have more ICU patients than beds by
November 8 and a 85 percent probability that all of the hospital beds would
be filled.

Several other regions in the state — around Amarillo, Lubbock, Wichita
Falls, Abilene, Dallas/Fort Worth, and Odessa — also have better than even
odds of exceeding their ICU capacity in the next two weeks. Statewide, the
number of currently hospitalized Covid-19 patients has risen from 3,190 on
October 1 to 5,206 on October 25.

“We are at a crisis stage,” El Paso County Judge Ricardo Samaniego said
this weekend, according to CBS News
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-x/>.

A field hospital is being set up
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-m/> at the El Paso
Convention and Performing Arts Center, initially with 50 beds but the
capacity to add 50 more. More than 1,000 state and federal health workers
have moved into the county in recent days to try to provide more support.
As Vox has previously reported
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-c/>, one problem
hospitals experience during Covid surges is staffing; sometimes, they may
have open beds, but not enough nurses and doctors to take care of the
patients.

Hospitals are also preparing to airlift patients
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-q/> from the El Paso
area to other parts of Texas with more available beds. Gov. Greg Abbott has
raised the possibility
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-a/> of opening a
military hospital to civilians.

“Hospitals are reaching a point where they have expanded, within their
existing brick and mortar, as much as they can,” the University Medical
Center in El Paso said in a statement.

*Utah hospitals are preparing to ration medical care for Covid-19 patients*

Covid-19 has exploded in Utah over the last two months. On September 1, the
state was averaging less than 400 new cases every day; as of October 25,
the average number of daily new cases had nearly reached 1,500.
Hospitalizations have followed the same trend, with the number of currently
hospitalized Covid-19 patients more than doubling from 145 to 313 over the
same period.

With some hospitals already forced to activate their emergency surge
capacity plans, hospital officials have started drawing up criteria for how
to ration care if they have more patients than beds available.

It could literally become a matter of choosing which patients live and
which patients die. From the Salt Lake Tribune
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-f/>:

Greg Bell, president of the Utah Hospital Association, said administrators
of the state’s hospitals confronted Gov. Gary Herbert on Thursday with a
grim list: Criteria they propose doctors should use if they are forced to
decide which patients can stay in overcrowded intensive care units.

Under the criteria, which would require Herbert’s approval, patients who
are getting worse despite receiving intensive care would be moved out
first. In the event that two patients’ conditions are equal, the young get
priority over the old, since older patients are more likely to die.

"We told him, ‘It looks like we’re going to have to request those be
activated if this trend continues,’” Bell recounted, “‘and we see no reason
why it won’t.’”

Utah hospitals are also facing the same staffing problems seen elsewhere:
Though the state created plans to establish a field hospital at an expo
center, medical leaders are warning that they don’t have the doctors or
nurses available to staff those new beds. Health care workers have
described feeling overwhelmed throughout the Covid-19 crisis and now they
are being asked to do even more, months into the pandemic.

“Hundreds and hundreds of nurses are not able to work as they were [before]
because of their own disease or infection in the family, or they’re moms
and dads with school issues,” Bell told the Tribune. “Some are worn out,
some are on leave because they’ve been doing this for seven months.”

*Idaho hospitals are planning to send patients out of state as beds fill up*

Idaho has set a record for Covid-19 hospitalizations over the weekend with
259 people currently hospitalized, up from 135 at the beginning of October.
The state is also averaging almost twice as many new cases as it was a few
weeks ago, meaning more hospitalizations are likely coming.

Hospitals might need to send patients to hospitals in other states as their
beds fill up, an enormous logistical challenge for the facilities and an
emotional one for families that may be separated from their loved ones by
hundreds of miles.

At least one hospital in northern Idaho has already planned for such a
contingency. Kootenai Health in Coeur d’Alene reported
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-z/> at the end of last
week that it had reached 99 percent capacity. The health system will send
patients <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-v/> to
Portland, Oregon, or Seattle, Washington, if its numbers continue to rise,
because nearby hospitals are experiencing the same surge and don’t have
room to take extra patients.

Another hospital, Saint Luke’s Magic Valley in Twin Falls, has announced
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-e/> it will start
transferring children who require hospitalization to hospitals in the state
capital of Boise in order to keep more beds available for Covid-19 patients.

*The surge in Covid hospitalizations is going to be worse before it gets
better*

There are more stories like this across the country:

   - Wisconsin has set up a field hospital
   <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-s/> on the state
   fairgrounds near Milwaukee. (Covid-19 hospitalizations in the state have
   doubled since the start of the month.)
   - Hospitals in Kansas City, Missouri, are reportedly turning away
   ambulances <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-g/>
   because they don’t have any beds available, and urban hospitals warn
   <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-w/> they may not be
   able to accept overflow patients from rural areas. (Hospitalizations in
   Missouri reached a new record last week.)
   - Oklahoma City hospitals are activating their surge capacity plans
   <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-yd/> to add more
   beds, call in extra staff, and possibly reduce non-Covid services.
   (Oklahoma is yet another state to see a record number of Covid-19
   hospitalizations in the last few days.)

With cases rising, hospitalizations will follow and deaths after them. It’s
an established pattern. This will get worse before it gets better.

But we can try to lighten the burden for hospitals and their staff. As Vox
explained at the beginning of the pandemic
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-yh/>, the goal of social
distancing is to suppress Covid-19’s spread so that hospitals don’t become
overwhelmed. It also buys time for hospitals
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-yk/> to put their surge
capacity and staffing plans in place.

It won’t be easy. The federal government isn’t going to provide more
resources to hospitals for the foreseeable future, with hopes for another
Covid-19 relief package before January fading
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-yu/>. Some state and
local governments continue to resist mask mandates (even in these stressed
areas like Idaho <https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-jl/>)
and other social distancing restrictions.

Wearing a mask and keeping our distance is something each of us can do on
our own to reduce Covid-19’s spread and slow down on the rapid growth in
hospitalizations. There is no time to waste.
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-jr/>

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<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-jy/>
CHART OF THE DAY
German Lopez/Vox

*America’s third Covid-19 surge is here. It was predictable — and
preventable**. *The somber assessment from Vox's German Lopez
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-jj/>:

The fall and winter still threaten to make things worse. Schools will
continue to reopen. The cold in northern parts of America will push people
back inside, where the virus has a much easier time spreading than the
outdoors. Families and friends will come together for the holidays. A flu
season could strain the health care system further.

States will likely move to reopen more widely, especially as officials face
pressure from businesses to reopen indoor spaces before colder temperatures
make outdoor activities less feasible. Experts worry that Americans as a
whole will get even more fatigued with social distancing and masking, now
that the US is more than seven months into its battle against Covid-19.

“It’s less excusable this time,” Crystal Watson, senior scholar at the
Johns Hopkins Center for Health Security, previously told me. “We have an
example of what happens when we reopen these types of businesses for indoor
activities.”

It doesn’t have to be this way. Cities, counties, states, and the federal
government — or, short of all that, the public — could take social
distancing seriously again. Governments could mandate masks, and the public
could opt to wear them without a mandate. Bars and restaurants could close,
voluntarily or not. Places that do open, such as schools, could try to
adopt aggressive testing-and-tracing regimes to try to keep the coronavirus
under some control.

Without that, America’s coronavirus epidemic will keep getting worse. That
would lead to not just more Covid-19 cases and deaths, but deal yet another
blow to the prospects of the US returning to normal anytime soon.
<https://voxcom.cmail19.com/t/d-l-citujn-mikuyjkkd-jt/>

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