Our Pandemic Options

[homersapien 11,362]

As the pandemic surges, there are three scenarios of what happens next

 

Leana S. Wen

Contributing columnist

July 21, 2020

 

At least two Americans will die of covid-19 in the time it takes to read this op-ed. The mortality rate is climbing in 13 states as infections rise in more than 30 states.

As the pandemic surges, policymakers are asking how they can stop this explosive spread. I see three scenarios for what happens next:

1. Status quo. Texas, Florida and Arizona are among the states already on the brink of overwhelming their health-care systems. More and more intensive-care units will reach and exceed capacity. Arizona has already implemented “crisis standards of care” to ration its increasingly scarce resources.

Policymakers have instituted some mitigation measures, but most are too little, too late. Arizona bars are closed, but not restaurants. Some counties in Florida are requiring masks, but the governor refuses to issue a statewide mandate. Politicians are pushing for in-person schooling to begin next month even as test positivity approaches 20 percent there and results take up to two weeks. If schools reopen in this hotbed of infections, outbreaks will quickly mushroom and sicken students, teachers and their families.

There will be a breaking point. Perhaps it will come when patients can’t access non-coronavirus health services: when women in labor or heart attack patients are turned away from ERs. In the meantime, the United States is on track to surpass 200,000 deaths by the fall. By then, out-of-control spread is estimated to leave nearly 1 in 4 Americans unemployed.

2. Full shutdown. A full shutdown would mean that everyone in the entire country stays at home for four to six weeks. Those already infected would spread the virus only to their immediate households. If no one has additional contacts, we collectively starve the virus and stop transmission.

I know what you’re thinking: Didn’t we try that already, back in March? Some states did, and it worked: The New York region is a case in point. But only half the states had full stay-at-home orders at the end of March. Many states began loosening restrictions even as infection rates there climbed. At best, the United States “flattened the curve,” with roughly 17,000 daily infections as our lowest point. Contrast that with Germany, Australia, South Korea and many other countries that crushed their curves and brought their case counts essentially to zero. That’s how these other countries have resumed most parts of pre-pandemic life. Their schools opened with few outbreaks; businesses are back; and large-scale events such as concerts are beginning to safely take place.

There is an argument for a do-over — but this time, we all do it and we do it right. “The idea of a hard shutdown should be on the table,” says Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services. “It would be more difficult and disruptive, but the short-term pain could bring the economy back more quickly.” An added benefit: If we were to reduce cases that much, we would have enough testing and contact tracing when reopening.

3. Whack-a-mole. However effective a full shutdown would be, many would say it’s too impractical. Some believe it may not be necessary. As Harvard global health professor Ashish Jha explains, “We can take a more targeted approach than we did in March; we don’t need to shut down the places that are doing well.” States facing the most dire conditions will need some version of stay-at-home orders until they hit specific goals, such as test positivity rates below 5 percent, results returned in less than 48 hours and sustained downward trends in infections for 14 days. Others trending in the wrong direction must reinstitute some restrictions until they can meet these metrics, too.

Would this approach be sufficient? Perhaps, though the rebound that follows reopening would be much more rapid than with “full shutdown” since cases would not be fully suppressed. Problems of inadequate testing and tracing are almost certain to recur. There is also no evidence from other countries that such a piecemeal approach would work. Some states could get their infections under control but experience surges as a result of interstate travel. And even if political will exists to close businesses (and to offer necessary support for small businesses and employees), there will again be tremendous pressure to reopen before doing so is safe.

So which scenario will it be?

“This is America’s third strike,” says professor and epidemiologist Michael Osterholm of the University of Minnesota. First, the country wasn’t prepared for a pandemic. Next, the U.S. response was far from adequate — and we still lack a national strategy.

Decision time has arrived. Is the specter of “status quo” bad enough to force an urgent course correction, or will complacency continue until death hits home for more families? It would take a lot to switch to “whack-a-mole” — and a “full lockdown” would save even more lives. Either way, we need to muster our collective willpower if we are to stop the death toll and destruction of covid-19.

https://www.washingtonpost.com/opinions/2020/07/21/toll-covid-19-worsens-us-has-three-options/?hpid=hp_save-opinions-float-right-4-0_opinion-card-a-right%3Ahomepage%2Fstory-ans

 

 

[homersapien 11,362]

The pandemic exit lane is jammed. More testing is the way out.

Editorial Board

July 21, 2020

THE ROCKEFELLER Foundation makes an essential point in a new report about the coronavirus pandemic. “Testing is the only way out of our present disaster,” the research organization says, recommending a $75 billion crash program to ramp up diagnostic testing across the country so that the sick are identified and the healthy can return to work and school.

Then there is President Trump. Asked about testing in a Fox News interview broadcast Sunday, he said, “We’re finding — in a way, we’re creating trouble. Certainly, we are creating trouble for the fake news to come along and say, ‘Oh, we have more cases.’ ”

Mr. President, we have more cases because we have more sickness. In mid-May, the United States was recording about 23,000 new cases a day, but after ill-considered, premature reopenings and a virus surge, the daily total reached more than 74,000 last Friday. A revealing analysis by the health news organization STAT of all 50 states and D.C. shows that in only seven states was the rise in reported cases from mid-May to mid-July driven primarily by increased testing. In 26 states, the case count rose because there was more disease. For example, the number of cases per 1,000 tests, a measure of the disease prevalence, was 32 in Florida on May 13, rising to 75 on June 13 and 193 on July 13. The jump in hospitalizations reinforces the conclusion that the coronavirus is spreading. Still, Mr. Trump ridiculously brushes it off: “Many of those cases are young people that would heal in a day. They have the sniffles and we put it down as a test.”

Diagnostic testing has risen in frequency to about 800,000 tests a day, or more than 5.4 million a week, but this is still way below what’s really needed. The surge in viral outbreaks has swamped existing testing networks, creating new bottlenecks for supplies such as chemical reagents and equipment, and prolonging the wait for test results for many people to a week or more. That delay can make contact tracing — also vital — practically impossible. The Rockefeller report calls for a massive scale-up of cheap, fast screening tests, say up to 25 million a week, and cutting the processing time for diagnostic testing to 48 hours.

Colorado Gov. Jared Polis (D) said over the weekend, “The national testing scene is a complete disgrace.” If Mr. Trump can’t lift a finger, Congress must. In the next round of stimulus, Congress ought to inject robust new financial support for testing, especially aimed at overcoming the supply-chain troubles that are hampering every state trying to act alone, and to support expanded methods such as pooled testing and antigen testing. In his White House news conference Tuesday, Mr. Trump said that if medical experts want more testing, “I am okay with it.” The urgency is much greater than the president lets on; a leader would make it happen, not be “okay with it.” Congress should try again to spur a national strategy, enabling and encouraging governors to pick up the slack.

All roads out of this pandemic require more testing. It is time to think big.

https://www.washingtonpost.com/opinions/the-pandemic-exit-lane-is-jammed-more-testing-is-the-way-out/2020/07/21/a1e55026-cab4-11ea-91f1-28aca4d833a0_story.html?hpid=hp_save-opinions-float-right-4-0_opinion-card-b-right%3Ahomepage%2Fstory-ans

[McLoofus 35,182]

Hearing that we might be close to an affordable home testing kit that will provide almost-immediate results. It's not terribly reliable- it has to catch the carrier in a fairly specific time frame, after the virus really takes root but before the person is super sick/contagious- but the idea is that it is very inexpensive and meant for very regular testing. Like, every other day testing. Which renders the unreliability moot. 

That's really where we need to be and it was more encouraging than anything I've heard yet. As for actually rolling it out nationwide....

[Grumps 3,704]

These are meant to be serious questions though they may not be perceived as such:

Does it seem odd to spend billions for testing for a condition that has no treatment?

Is the purpose of the testing simply to get us to do what we should already be doing?

[McLoofus 35,182]

12 minutes ago, Grumps said:

These are meant to be serious questions though they may not be perceived as such:

Does it seem odd to spend billions for testing for a condition that has no treatment?

Is the purpose of the testing simply to get us to do what we should already be doing?

They are perceived as serious questions, but it's concerning that they haven't been answered by now.

If you can test anyone, any time, anywhere, and get those results back "instantly" (15 minutes or less), then everyone is free to go about their lives as they see fit except those who test positive. Those who test positive will immediately be quarantined and they will not infect others. Therefore, not only is everyone free to move about as they wish, but overall infections (and hospitalizations, and deaths) will drop dramatically. If infections drop dramatically, then the economy operates at or near full capacity. If hospitalizations drop dramatically, then elective surgeries and other forms of non-COVID healthcare can resume at a normal level. 

That's what South Korea did. Their economy reopened almost immediately. They've had about 14,000 total cases and 297 total deaths. Seoul has a population of 17.5 million and is the 6th-most densely populated city on Earth. For comparison, New York City alone has had almost 100 times more deaths than the entire country of South Korea.

 

[Grumps 3,704]

7 hours ago, McLoofus said:

They are perceived as serious questions, but it's concerning that they haven't been answered by now.

If you can test anyone, any time, anywhere, and get those results back "instantly" (15 minutes or less), then everyone is free to go about their lives as they see fit except those who test positive. Those who test positive will immediately be quarantined and they will not infect others. Therefore, not only is everyone free to move about as they wish, but overall infections (and hospitalizations, and deaths) will drop dramatically. If infections drop dramatically, then the economy operates at or near full capacity. If hospitalizations drop dramatically, then elective surgeries and other forms of non-COVID healthcare can resume at a normal level. 

That's what South Korea did. Their economy reopened almost immediately. They've had about 14,000 total cases and 297 total deaths. Seoul has a population of 17.5 million and is the 6th-most densely populated city on Earth. For comparison, New York City alone has had almost 100 times more deaths than the entire country of South Korea.

 

Thanks!

But what about the current tests that take 3-10 days to get back? I really don’t think they are very valuable. And they would be almost worthless if people would wash hands and social distance and stay home.

[wdefromtx 3,159]

11 minutes ago, Grumps said:

Thanks!

But what about the current tests that take 3-10 days to get back? I really don’t think they are very valuable. And they would be almost worthless if people would wash hands and social distance and stay home.

The timeframe for the tests that take 10-14 days to get results is ridiculous. Which I know is partly due to the labs being overburdened, but they can’t expect the majority of the people who say aren’t showing many signs and can’t recall if they’ve been around someone with the virus to stay home for two weeks. Quick turnarounds are needed so people can either stay home or get back to normal life. 

[gr82be 14,423]

12 minutes ago, wdefromtx said:

The timeframe for the tests that take 10-14 days to get results is ridiculous. Which I know is partly due to the labs being overburdened, but they can’t expect the majority of the people who say aren’t showing many signs and can’t recall if they’ve been around someone with the virus to stay home for two weeks. Quick turnarounds are needed so people can either stay home or get back to normal life. 

Would be nice if so but I know someone who was tested, got same day results which showed negative, and was still required to self quarantine for 14 days from work. No back to life as normal for him the past 2 weeks. 

[savorytiger 182]

42 minutes ago, gr82be said:

Would be nice if so but I know someone who was tested, got same day results which showed negative, and was still required to self quarantine for 14 days from work. No back to life as normal for him the past 2 weeks. 

Not sure how widespread it is, but a quick google search shows EU has had 30-60 minute testing for a month now: https://medicalxpress.com/news/2020-06-rapid-covid-granted-eu.html

[McLoofus 35,182]

8 hours ago, Grumps said:

Thanks!

But what about the current tests that take 3-10 days to get back? I really don’t think they are very valuable. And they would be almost worthless if people would wash hands and social distance and stay home.

3 days is still very valuable, in my opinion. At least much more valuable than nothing. Once you get up to a week or longer, it does certainly seem a lot less so. But all of this shows that there was an early need to focus on having robust testing and there remains a need to focus on robust testing, with robust meaning "more, better and faster".

By the way, my test was a simple nose swab with no uncomfortable brain tickle and I got my results in 48 hours. Still not fast enough and we inadvertently leveraged some privilege to even get the test, but the infrastructure exists and if everybody had access to what we did, then that would be a much better situation than the one we are in. In my opinion.

But your last point is the most important, assuming that you also meant wearing masks.

[McLoofus 35,182]

7 hours ago, gr82be said:

Would be nice if so but I know someone who was tested, got same day results which showed negative, and was still required to self quarantine for 14 days from work. No back to life as normal for him the past 2 weeks. 

Was that dictated by his employer?

My hospital's policy is occupational health will test you only if you are symptomatic, and You are only allowed back to work once those results come back negative or, if that test is positive, once a second test comes back negative.

I was asymptomatic and got an independent test due to a possible exposure. I was told not to tell anybody at work that I had gotten it done. This is what others in my office have done.

[gr82be 14,423]

Just now, McLoofus said:

Was that dictated by his employer?

My hospital's policy is occupational health will test you only if you are symptomatic, and You are only allowed back to work once those results come back negative or, if that test is positive, once a second test comes back negative.

I was asymptomatic and got an independent test due to a possible exposure. I was told not to tell anybody at work that I had gotten it done. This is what others in my office have done.

His golfing buddy tested positive three days after they playing golf. That buddy had a co-worker who was positive and didn't tell anyone 🙄. Then my friends place of employment told him to self quarantine for two weeks. He went and was tested on his on was negative on the same day, within an hour or so. His job still says he needs to quarantine. Doesn't make sense to me. 

[McLoofus 35,182]

10 minutes ago, gr82be said:

His golfing buddy tested positive three days after they playing golf. That buddy had a co-worker who was positive and didn't tell anyone 🙄. Then my friends place of employment told him to self quarantine for two weeks. He went and was tested on his on was negative on the same day, within an hour or so. His job still says he needs to quarantine. Doesn't make sense to me. 

Doesn't make much sense at all. But I'm relieved that it was his job and not some other authority that dictated that.

Lots of really bizarre behavior from employers, though. I get that they are not trained or equipped to deal with this anymore than anyone else is, but there are some shocking lapses in logic. I might have mentioned that my office had a positive case and so our CIO called the entire department into one conference room to announce this. Had I known it was the entire department, I would not have attended in person but called in, but for reasons that don't matter my team was under the impression that it would just be the five or six of us. I had to call the CIO out on it, but I did use more diplomacy than I typically do on this forum. Mind you, this was literally every single IT employee- minus the positive case- for one of the only two large hospitals serving all of coastal Georgia and several inland counties. In one room in July of 2020.

[Grumps 3,704]

1 hour ago, McLoofus said:

3 days is still very valuable, in my opinion. At least much more valuable than nothing. Once you get up to a week or longer, it does certainly seem a lot less so. But all of this shows that there was an early need to focus on having robust testing and there remains a need to focus on robust testing, with robust meaning "more, better and faster".

By the way, my test was a simple nose swab with no uncomfortable brain tickle and I got my results in 48 hours. Still not fast enough and we inadvertently leveraged some privilege to even get the test, but the infrastructure exists and if everybody had access to what we did, then that would be a much better situation than the one we are in. In my opinion.

But your last point is the most important, assuming that you also meant wearing masks.

Yes, I meant to include masks!

My issue is that there are people who are knowingly dying of treatable cancer because they cannot afford treatment and there are people who are dying due to diabetes and high blood pressure because they don't have transportation to a physician's office or a pharmacy. These problems are really easy to fix with money. We, as a nation, instead choose to spend billions on testing for COVID-19 testing in order to try to convince people to stay home. Many people who test positive still go out in public like it is no big deal. Testing them was not cost effective.

I'm not saying that COVID testing doesn't have a place, but I do believe that 3/4 or more of the tests are a total waste of money. We need more effective education for how not to get infected/infect others more than we need testing.

[McLoofus 35,182]

12 minutes ago, Grumps said:

Yes, I meant to include masks!

My issue is that there are people who are knowingly dying of treatable cancer because they cannot afford treatment and there are people who are dying due to diabetes and high blood pressure because they don't have transportation to a physician's office or a pharmacy. These problems are really easy to fix with money. We, as a nation, instead choose to spend billions on testing for COVID-19 testing in order to try to convince people to stay home. Many people who test positive still go out in public like it is no big deal. Testing them was not cost effective.

I'm not saying that COVID testing doesn't have a place, but I do believe that 3/4 or more of the tests are a total waste of money. We need more effective education for how not to get infected/infect others more than we need testing.

Here's the thing, though. We're spending *trillions* to pay people not to work (in reality, we're mostly just giving money to corporations and trump campaign donors) when we could have a fully functioning economy with adequate testing in addition to more effective education. (I'll begrudgingly agree with you on the education, even though the information has been widely available and agreed upon by medical professionals, scientists and public health experts for months. We need King Dumbass and his dumbass GOP governor buddies to push that information more than this idiotic and dangerous personal freedom crap starting yesterday. They've literally worked against this education from the start. So yes, I agree with you on that.)

As for the fact that people can't afford to get healthcare, that was a ridiculous problem long before COVID and Democrats have been working hard to fix it for years. Obamacare is flawed but it was a step in the right direction. Guaranteed health care, like free speech and free press, is much, much more important than any number of personal liberties that a whole lot of people whine about. 

[Grumps 3,704]

1 minute ago, McLoofus said:

Here's the thing, though. We're spending *trillions* to pay people not to work (in reality, we're mostly just giving money to corporations and trump campaign donors) when we could have a fully functioning economy with adequate testing (in addition to* more effective education. (I'll begrudgingly agree with you on the education, even though the information has been widely available and agreed upon by medical professionals, scientists and public health experts for months. We need King Dumbass and his dumbass GOP governor buddies to push that information more than this idiotic and dangerous personal freedom crap starting yesterday. They've literally worked against this education from the start. So yes, I agree with you on that.)

As for the fact that people can't afford to get healthcare, that was a ridiculous problem long before COVID and Democrats have been working hard to fix it for years. Obamacare is flawed but it was a step in the right direction. Guaranteed health care, like free speech and free press, is much, much more important than any number of personal liberties that a whole lot of people whine about. 

No doubt that lack of decent healthcare has been an issue long before COVID. It just bothers me that the government doesn't mind spending billions for testing that, if you really look at it, provides very little value while completely ignoring the lives could be saved by spending money wisely. Anyway, rant over.

[McLoofus 35,182]

6 minutes ago, Grumps said:

No doubt that lack of decent healthcare has been an issue long before COVID. It just bothers me that the government doesn't mind spending billions for testing that, if you really look at it, provides very little value while completely ignoring the lives could be saved by spending money wisely. Anyway, rant over.

That's wildly inaccurate and will continue to become less so as we improve our testing. 

Also, nobody's lives are being "completely ignored". That's just a bizarre thing to say.

Also- and I should have responded with this initially- where are you getting this information that the money for testing is being diverted away from treatment for cancer or other diseases? 

[homersapien 11,362]

9 minutes ago, Grumps said:

No doubt that lack of decent healthcare has been an issue long before COVID. It just bothers me that the government doesn't mind spending billions for testing that, if you really look at it, provides very little value while completely ignoring the lives could be saved by spending money wisely. Anyway, rant over.

The pandemic is a national problem that requires a national response (even though we haven't gotten much of one). I don't think a pandemic should be compared to ordinary medical problems - that aren't contagious - in terms of evaluating spending.

Regardless, the government does spend a lot of research money on the problems you mentioned - cancer, diabetes, etc. as many other medical problems, but our philosophy on delivering healthcare to the victims of those illnesses is mostly individualistic. In other words - unless they are poor and/or qualify for Medicare,  it's pretty much up to the individual to buy insurance or pay out of pocket.

I agree that - considering the amount of money we spend per capita on healthcare as a nation - our healthcare system is very inefficient.  There are many countries who spend less with better results.

But having an adequate covid-19 testing system - which we don't now have - is crucial to controlling the pandemic.  It shouldn't be considered as offsetting or replacing our "routine" healthcare (government) spending. 

In terms of spending on our response, "war" is a good analogy to a pandemic.

[homersapien 11,362]

https://www.vox.com/2020/7/23/21335549/covid-19-coronavirus-us-hospitalizations-record-florida-texas-california

More people in the US are hospitalized with Covid-19 than ever before

With daily cases, hospitalizations, and deaths still on the rise, the coronavirus pandemic is not slowing down in the US.

More Americans are currently hospitalized with Covid-19 than at any prior point in the pandemic, a grim milestone that indicates the coronavirus pandemic is not slowing down in the US.

On July 22, 59,628 people across the United States were in the hospital after testing positive for the novel coronavirus, according to data collected by the Covid Tracking Project; that total surpassed the previous daily high of 59,539 on April 15, when the New York City area was the epicenter of the US outbreak.

Covid-19 has migrated across the country to many more regions in the three months between those peaks. Hospitalizations were overwhelmingly concentrated in the Northeast in the spring, but now more than half of hospitalized Covid-19 patients (35,624) are in the South. The West has also seen the number of hospitalized Covid-19 patients double since April, while the Northeast now accounts for fewer than 5,000 of the nearly 60,000 current hospitalizations.

The current total is likely an undercount. Two states, Kansas and Hawaii, do not report current hospitalization data, and some states may temporarily not be reporting full hospitalization numbers because of a recent change in the reporting system ordered by the Trump administration.

“The hospitalization number is the best indicator of where we are,” Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute, told Vox. “We’re going to go to new heights in the pandemic that we haven’t seen before. Not that what we saw before wasn’t horrifying enough.”

The growth has been driven by accelerating spread in Arizona, California, Florida, Georgia, and Texas in particular. On April 15, when New York City hospitals were nearly being overrun with Covid-19 patients, Texas had about 1,500 patients hospitalized with the disease. Today, more than 10,000 Texans are hospitalized with Covid-19.

Some areas are reaching a woeful tipping point of hospitals stretched to maximum capacity, scrambling to find beds in other facilities for Covid-19 patients. Miami-Dade County reported this week that the number of patients in need of ICU care had exceeded the number of available ICU beds. More than 50 hospitals across the state say they have no ICU beds available.

Texas Medical Center in Houston has already filled up its usual non-pandemic ICU unit and been forced to rely on its surge capacity plans to handle the patient load. Earlier this month, 10 out of the 12 hospitals in the Rio Grande Valley reported that they were completely full and needed to start transferring patients to hospitals elsewhere in the state.

This was, unfortunately, to be expected. Nearly all of the states currently experiencing an increase in new cases and hospitalizations started relaxing their social distancing restrictions in May and June before meeting the government’s reopening guidelines of having sufficiently reduced the virus’s spread and adequately ramped up their testing and tracing capabilities. New cases began rising and hospitalizations followed a few weeks after that. Now deaths are ticking up again, reversing a steady decline that had begun in early May.

Four million Americans have had confirmed cases of Covid-19. More than 143,000 of them have died. With hospitalizations reaching the new peak and several states still reporting thousands of new cases a day, experts say we are in for a difficult August and fall.

“We’ve still got 91 to 92 percent of people who are still vulnerable, who have not been infected,” said Topol. “And so that just shows how many more people can be hurt. Obviously many won’t get so sick, but many will.”

The new hospitalization record, and the untenable pressure it’s putting on the health care system, is also a reminder of how critical it is for states to implement and enforce measures like mandatory face masks, and for the federal government to solve testing and contact tracing problems. “It should be an all-points bulletin to really bear down on this because otherwise there’s no limit on where this might go,” said Topol.

Hospitals are running out of staff, supplies, and beds for Covid-19 patients

Hospitals in hot spots across the country are expanding and even maxing out their staff, equipment, and beds, with doctors warning that the worst-case scenario of hospital resources being overwhelmed is on the horizon if their states don’t get better control of the coronavirus.

“With Covid, a lot of times people who aren’t sick enough yet get pushed to the back, and then they can become really, really sick unfortunately because we were focusing our efforts on the people who are on the brink of death,” an emergency room doctor at the Banner Health system in the Phoenix metro area, who asked to go unnamed fearing retaliation from his employer, told Vox recently.

Other doctors in Arizona, where 85 percent of hospital beds statewide were in use as of Thursday, have said the scarcity of resources means they’ll soon be rationing medical care, as doctors in Italy were forced to do.

“The fear is we are going to have to start sharing ventilators, or we’re gonna have to start saying, ‘You get a vent, you don’t.’ I’d be really surprised if in a couple weeks we didn’t have to do that,” says Murtaza Akhter, an emergency medicine physician at Valleywise Health Medical Center in Phoenix.

The rampant transmission of the virus in Arizona and resulting pressure on hospitals are particularly infuriating to some emergency room and ICU staff, who say they’re having to make decisions on the fly that they’re uncomfortable making.

“Sending people with Covid home with oxygen tanks because we don’t have the resources for them? This is something I’ve never done in my life before,” says Akhter. “This is crazy. And this is gonna be even worse in a couple of weeks. So far we’re trying to hold steady, but how long will that last?”

The psychological toll, he says, is serious too.

“To come off a shift and be like, ‘I’m losing hope’ — that’s a dangerous place to be in,” he says. “I don’t want to feel that way. And that’s because despite the horrible numbers, despite the fact I’m still getting the Covid cases [in the ER], despite what we’ve been saying to the media from the front line, I drive home from work and I literally see lots of people congregating together closely and in the grocery store not wearing masks.”

Texas hospitals say they are in better shape now with personal protective equipment than they were in March and April, but that could change as the crisis gets worse. Roberta Schwartz, executive vice president at Houston Methodist, says her facilities have sometimes had trouble getting gowns and disinfectant wipes. John Henderson, who represents a trade association for rural hospitals in the state, says he recently “got a couple of SOS calls.”

Staffing is a universal problem in hot spots. Houston Methodist has already brought in out-of-state nurses and asked its administrative staff with nursing certifications to start doing medical work again. Nurses are also being asked to work longer and overnight shifts.

Rural hospitals in Texas aren’t running out of beds yet, but they are running into a staffing shortage. These facilities might typically have five patients in a given unit, and the hospitals have staffed them accordingly. But now there might be as many as 20 patients.

“You’re working every nurse as much as you can work them and still not meeting the need,” Henderson says.

It’s not clear where more staff could come from. The state has already sent about 2,300 volunteers to the Rio Grande Valley, one of the hardest-hit areas in the state.

“Other areas are requesting that workforce support,” Henderson says. “But there’s not much more in terms of resources to be sent.”

Another concern is ventilators. Rural hospitals in Texas would ordinarily transfer their patients in serious condition, the kind who might be on a ventilator for days, to a larger hospital in the city. But because urban hospitals are already overrun with Covid-19 patients, there is nowhere for the rural hospitals to send their patients. Instead, they are forced to keep those patients, causing their beds to fill up even more quickly.

And while the current coronavirus patients are younger than those seen in the spring, Henderson says his hospitals don’t have enough of the nasal oxygen hookups that are used to help those patients breathe on their own and prevent them from being put on a ventilator.

“They’ve shown to be effective, but everybody’s trying to get them,” he says.

El Centro Regional Medical Center in Imperial County, one of California’s biggest Covid-19 hot spots right now, has already brushed up against its worst-case scenario. The hospital recently saw its available ventilators dwindle to one.

Adolphe Edward, the hospital’s CEO, convened an impromptu committee to evaluate the patients currently on ventilators so they could prioritize if another patient who needed one came through their door. They checked the patients’ lung capacity and considered whether they could risk taking one or two of them off the ventilator if the need arose.

Luckily, Edward figured out a workaround. He called another nearby hospital and asked if they had any ventilators available. They had two, which they shipped over to El Centro. For now, the machines are still there, though Edward says he and the other hospital have stayed in constant contact in case the ventilators need to be transferred again.

Daily deaths are creeping up again but are still far below the earlier peak

While daily Covid-19 hospitalizations reached a record high on July 22, another key metric, daily deaths, 1,126, was still less than half of its May 7 peak of 2,742, according to the Covid Tracking Project. Yet the trend is ominous, since daily deaths were dropping steadily by mid-June and then began rising again in early July.

On Thursday, Florida reported a new record single-day death toll of 173. Texas hit its own respective record on Wednesday, with 193 deaths.

Since many Covid-19 fatalities to date have occurred among people who were hospitalized for weeks before succumbing, experts say they expect deaths will continue to rise in the coming days and weeks. Yet it’s possible, they say, that fewer people who are hospitalized will end up dying in this summer stage of the pandemic as compared to the spring.

“Hospitalizations undoubtedly are going to be associated with more deaths or chronic illnesses, but I’m hoping that the deaths are not as steep as they were back in March and April,” said Topol. “And maybe that’s because they are more young people that are sick and they will pull through. Maybe it’s also because the treatments are getting better, not just the drugs but just the whole approach.”

Overall, he says, “The hope is that the relationship between hospitalizations and fatalities won’t be as tight as it was, but we have to watch this closely because that’s the optimistic view.”

 

[McLoofus 35,182]

9 minutes ago, homersapien said:

In terms of spending on our response, "war" is a good analogy to a pandemic.

I've said it before, but if this thing had a brown person's face then every redneck from Jacksonville to Anchorage would be wearing an American flag mask everywhere they went. 

And speaking of war, it's interesting how the inflated spending and "how we gonna pay for it" talk never involves dipping into that $700 billion discretionary budget for the DoD. 

 

[McLoofus 35,182]

1 minute ago, homersapien said:

More people in the US are hospitalized with Covid-19 than ever before

Maybe, but what is the hospitalization rate, Homer??? #whatcurve

[homersapien 11,362]

16 minutes ago, McLoofus said:

Maybe, but what is the hospitalization rate, Homer??? #whatcurve

Well, thanks to our inadequate testing capability, we have no way of really knowing what the total number of infections are - and it's probably a lot higher than we think.  That means the hospitalization rate is probably lower than we think.  

So yaaaay for us!  We're making progress!

. 

 

[McLoofus 35,182]

4 minutes ago, homersapien said:

Well, thanks to our inadequate testing capability, we have no way of really knowing what the infection rate is - and it's probably a lot higher than we think.  That means the hospitalization rate is probably lower than we think.  

So yaaaay for us!  We're making progress!

 

[Grumps 3,704]

7 hours ago, McLoofus said:

That's wildly inaccurate and will continue to become less so as we improve our testing. 

Also, nobody's lives are being "completely ignored". That's just a bizarre thing to say.

Also- and I should have responded with this initially- where are you getting this information that the money for testing is being diverted away from treatment for cancer or other diseases? 

You may be right about the value of testing, but here is how I see it:

Person with symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person with symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

If the test is not going to change anything at all about the treatment then is there really a point in getting the test? We are spending billions on testing that is not changing the treatment at all.

The "completely ignored" people I was referring to are those with medical issues without family and transportation and also the poor without insurance coverage for cancer treatment. If you don't think that many of them are ignored then we will just disagree.

I did not intend to say that it was diverted from one group for the other. I was just working from the assumption that the supply of money from the government is limited and therefore spending the money in one area of healthcare might lessen the chances of the money going to another area of healthcare. I may be wrong on that as well.

[homersapien 11,362]

2 hours ago, Grumps said:

You may be right about the value of testing, but here is how I see it:

Person with symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person with symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with positive test: Stay home. Wear mask if out. Wash hands. Social Distance.

Person without symptoms with negative test: Stay home. Wear mask if out. Wash hands. Social Distance.

If the test is not going to change anything at all about the treatment then is there really a point in getting the test? We are spending billions on testing that is not changing the treatment at all.

The "completely ignored" people I was referring to are those with medical issues without family and transportation and also the poor without insurance coverage for cancer treatment. If you don't think that many of them are ignored then we will just disagree.

I did not intend to say that it was diverted from one group for the other. I was just working from the assumption that the supply of money from the government is limited and therefore spending the money in one area of healthcare might lessen the chances of the money going to another area of healthcare. I may be wrong on that as well.

Our problem with tests are currently, 1) not enough of them,  2) too slow.

(Accuracy is another issue that can be factored in, but as long as we have enough, fast tests, you can work around that.)

We need to spend "billions" (whatever it takes) on 1 and 2.  And we should have started doing that months ago.