U.S. hospitals facing worrisome shortage of nurses, doctors
With so many states seeing a flood of coronavirus patients, U.S. hospitals are again worried about finding enough medical workers to meet demand just as infections from the holiday season threaten to add to the burden on American health care. California, which is enduring by far its worst spike in cases and hospitalizations, is reaching out to places like Australia and Taiwan to fill the need for 3,000 temporary medical workers, particularly nurses trained in critical care. “We’re now in a situation where we have surges all across the country, so nobody has many nurses to spare,” said Dr. Janet Coffman, a professor of public policy at the University of California in San Francisco. Hospitals in some states have enlisted retired nurses and students. In Alabama, more than 120 students and faculty members from the University of Alabama at Birmingham’s nursing school began helping with care last week at UAB Hospital. “I know our biggest concern is staff, even more concerned about that than physical beds and physical ICU units,” North Carolina Gov. Roy Cooper said Tuesday. Elected leaders and health officials across the U.S. are asking people to stay home for the holidays while also trying show the public that the COVID-19 vaccines trickling out to health care workers and nursing home residents are safe. A day after getting vaccinated on live television, President-elect Joe Biden said Tuesday that he has full confidence in the vaccine. He also thanked front-line workers, scientists, researchers, and clinical trial participants while urging Americans to avoid large gatherings over the Christmas holidays. Dr. Anthony Fauci, the nation’s top infectious disease expert, received the initial dose of the newest vaccine, produced by Moderna, alongside other federal health leaders who helped oversee its development. Fauci told “Good Morning America” on Tuesday that he expects to start vaccinating the general population in late March or early April and that most Americans will have access to the injections by mid-summer. Also on Tuesday, Dr. Deborah Birx, coordinator of the White House coronavirus response, said she planned to retire, but she is willing to first help Biden’s team as needed. Birx, in an interview with the news site Newsy, did not give a specific timetable on her plans. The medical worker staffing shortages are happening as some states report a record number of deaths. Both Mississippi and West Virginia surpassed their previous highs for virus deaths reported in a single day on Tuesday while Arizona saw its second-highest daily increase during the pandemic. South Carolina Gov. Henry McMaster tested positive for the virus and was to receive outpatient antibody treatment for “mild symptoms,” his office said Tuesday. In Tennessee, which is seeing the nation’s worst new COVID-19 infection surge per capita, the state health commissioner has warned that combining the Thanksgiving surge with another would “completely break our hospitals.” Deaths in Florida’s nursing homes doubled during the Thanksgiving holiday, according to statistics gathered by AARP. The rise drew concern from advocates also worried about gatherings over Christmas and other year-end celebrations. “There is nothing to celebrate. The national average is a catastrophe,” said Dave Bruns, the spokesperson for AARP Florida. Much of California has exhausted its usual ability to staff intensive care beds. All of Southern California and the 12-county San Joaquin Valley to the north have been out of regular ICU capacity for days. An emergency room physician in Los Angeles who helped set up a surge hospital last spring said there are no plans to reopen it. “There would be no way to staff it,” said Dr. Marc Futernick. California hospitals typically turn to staffing agencies during flu season, when they rely on travel nurses to meet patient care needs. But the pool of available travel nurses is drying up as demand for them jumped 44% over the last month, with California, Texas, Florida, New York, and Minnesota requesting the most extra staff, according to San Diego-based health care staffing firm Aya Healthcare. Dr. Mark Ghaly, California’s Health and Human Services secretary, said the state is “lucky to get two-thirds” of its requests for travel nurses fulfilled right now. It’s a sharp contrast from the spring when health care providers from California flew to New York to help their overworked colleagues. Ghaly said entire areas of California may run out of room even in surge capacity units “by the end of the month and early in January.” It’s trying to avoid that by opening makeshift hospitals in places like gymnasiums, tents, and a vacant NBA arena, and sending patients to parts of the state with empty beds. While larger hospital systems can stretch their staff, some smaller or unaffiliated hospitals do not have that ability and are a priority for state staffing assistance particularly with nurses and respiratory therapists, he said. Sara Houze, a traveling cardiac intensive care nurse from Washington, D.C., began a new assignment this week caring for COVID-19 patients on the brink of death in San Bernardino, about 60 miles (97 kilometers) east of Los Angeles. She said her online community of nurses is offering webinars about moral distress because many of them have had to change the way they care for patients. “The patients that aren’t yet intubated, and even the ones intubated, aren’t getting the kind of nursing care that I want to give them because our resources are so limited and time is taxed,” she said. “It’s really disheartening.” Republished with the permission of the Associated Press.
Health officials warn Americans not to let their guard down
With a COVID-19 vaccine perhaps just days away in the U.S., most of California headed into another lockdown Sunday because of the surging outbreak, and top health officials warned Americans that this is no time to let their guard down. “The vaccine’s critical,” Dr. Deborah Birx, the White House coronavirus response coordinator, said on NBC’s “Meet the Press.” “But it’s not going to save us from this current surge. Only we can save us from this current surge.” A Food and Drug Administration advisory panel is scheduled to take up a request Thursday to authorize emergency use of Pfizer’s vaccine. Vaccinations could begin just days later, though initial supplies will be rationed, and shots are not expected to become widely available until the spring. With the U.S. facing what could be a catastrophic winter, top government officials warned Americans anew to wear masks, practice social distancing and follow other basic measures — precautions that President Donald Trump and other members of the administration have often disdained. “I hear community members parroting back those situations — parroting back that masks don’t work, parroting back that we should work towards herd immunity, parroting back that gatherings don’t result in super-spreading events,” Birx said. “And I think our job is to constantly say those are myths, they are wrong and you can see the evidence base.” The virus is blamed for over 280,000 deaths and more than 14.6 million confirmed infections in the U.S. New cases per day have rocketed to an all-time high of more than 190,000 on average. Deaths per day have surged to an average of more than 2,160, a level last seen during the dark days in April, when the outbreak was centered around New York. The number of Americans in the hospital with the coronavirus topped 100,000 for the first time over the past few days. Dr. Scott Gottlieb, a former FDA commissioner, warned on CBS’ “Face the Nation” that the U.S. death toll could be approaching 400,000 by the end of January. “As bad as things are right now,” he said, “they’re going to get a lot worse.” In California, the first place to enact a statewide lockdown last spring, new stay-at-home orders were set to take effect Sunday night in Southern California, much of the San Francisco Bay area and other areas. The new rules in the state of 40 million people prohibit residents from gathering with those outside their household. Retailers including supermarkets and shopping centers can operate with just 20% capacity, while restaurant dining, hair salons, movie theaters, museums and playgrounds must shut down. Hospitals in California are seeing space in intensive care units dwindle amid a surge in infections. California health authorities imposed the order after ICU capacity fell below a 15% threshold in some regions. Some law enforcement officials, though, said they don’t plan to enforce the rules, and some business owners are warning that they could go under after a year of on-and-off closings and other restrictions. California Gov. Gavin Newsom said he hopes the new lockdown order is the last one he has to issue, declaring the vaccine offers “light at the end of the tunnel.” The Centers for Disease Control and Prevention is recommending that health care workers and nursing home patients get priority when the first shots become available. Both Pfizer’s vaccine and a Moderna vaccine that will also be reviewed by the FDA later this month require two doses a few weeks apart. Current estimates project that a combined total of no more than 40 million doses will be available by the end of the year. The plan is to use those to fully vaccinate 20 million people. Dr. Moncef Slaoui, head of Operation Warp Speed, the government’s vaccine development program, suggested on CBS that using those 40 million doses more broadly to reach 40 million people right away would be too risky, because of the possibility of manufacturing delays that could hold up the necessary second doses. “It would be inappropriate to partially immunize large numbers of people and not complete their immunization,” he said. But Gottlieb said he would push out as many doses as possible, taking “a little bit of a risk” that the supply would catch up in time for people to get a second dose. Republished with the permission of the Associated Press.
Dr. Anthony Fauci: U.S. may see ‘surge upon surge’ of virus in weeks ahead
The nation’s top infectious disease expert said Sunday that the U.S. may see “surge upon a surge” of the coronavirus in the weeks after Thanksgiving, and he does not expect current recommendations around social distancing to be relaxed before Christmas. Meanwhile, in a major reversal, New York City Mayor Bill DeBlasio said the nation’s largest school system will reopen to in-person learning and increase the number of days a week many children attend class. The announcement came just 11 days after the Democratic mayor said schools would shut down because of rising COVID-19 cases. “We feel confident that we can keep schools safe,” he said. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told ABC’s “This Week” that the level of infection in the U.S. would not “all of a sudden turn around.” “So clearly in the next few weeks, we’re going to have the same sort of thing. And perhaps even two or three weeks down the line … we may see a surge upon a surge,” he said. Fauci addressed the school issue, saying that spread “among children and from children is not really very big at all, not like one would have suspected. So let’s try to get the kids back, but let’s try to mitigate the things that maintain and just push the kind of community spread that we’re trying to avoid,” he said. Fauci also appeared on NBC’s “Meet the Press,” where he made similar remarks, adding that it’s “not too late” for people traveling home after Thanksgiving to help curb the virus by wearing masks, staying distant from others, and avoiding large groups of people. The number of new COVID-19 cases reported in the United States topped 200,000 for the first time Friday, according to data from Johns Hopkins University. Since January, when the first infections were reported in the U.S., the nation’s total number of cases has surpassed 13 million. More than 265,000 people have died. Fauci said the arrival of vaccines offers a “light at the end of the tunnel.” This coming week, the Advisory Committee on Immunization Practices will meet with the Centers for Disease Control and Prevention to discuss a rollout of the vaccine, he said. He added that President-elect Joe Biden should focus on distributing vaccines in an “efficient and equitable way.” Fauci also said he planned to push the new administration for a rigorous testing program. Health care workers will likely be among the first to get the vaccine, with the first vaccinations happening before the end of December, followed by many more in January, February, and March, he said. “So if we can hang together as a country and do these kinds of things to blunt these surges until we get a substantial proportion of the population vaccinated, we can get through this,” Fauci said. Other experts agreed that the coming weeks would be difficult, especially since so many traveled over the holiday and held in-person dinners indoors. Dr. Deborah Birx, the White House coronavirus response coordinator, said Sunday on CBS’ “Face the Nation” that Americans who traveled this past week should try to avoid people over 65. She said that those who were around others for Thanksgiving “have to assume that you were exposed and you became infected and you really need to get tested in the next week.” Meanwhile, a busy travel weekend continued, despite warnings for Americans to stay close to home and limit their holiday gatherings. Aside from the Thanksgiving holiday itself, anywhere from 800,000 to more than 1 million travelers made their way through U.S. airport checkpoints on any day during the past week, according to Transportation Security Administration statistics. That’s a far cry from the 2.3 to 2.6 million seen daily last year. But it far surpasses the number of travelers early in the pandemic, when daily totals fell below 100,000 on some spring days. More COVID-19 restrictions were in store for California starting Monday. Los Angeles County will impose a lockdown calling for its 10 million residents to stay home. Santa Clara County, which includes San Jose, is banning all high school, collegiate, and professional sports and imposing a quarantine for anyone traveling into the region from more than 150 miles away. Back in New York, some elementary schools and pre-kindergarten programs will resume classes Dec. 7, a week from Monday, the mayor said. Others will take longer to reopen. The plan for reopening middle and high schools is still being developed, de Blasio said. About 190,000 students will be eligible to return to classrooms in the first round of reopening, just a fraction of the more than 1 million total pupils in the system. The great majority of parents have opted to have their kids learn remotely by computer. De Blasio said that many of those returning in person will be able to attend five days of class a week, up from one to three days previously. Elementary school students attending in person will be required to undergo frequent testing for the virus. Previously, the city set a target of testing 20% of teachers and students in each school building once a month. Now the testing will be weekly. The mayor said the city was doing away with its previous trigger for closing schools, which was when 3% or more of the virus tests conducted in the city over a seven-day period came back positive. New York exceeded that threshold early in November, and infections have slightly worsened since then. More than 9,300 residents have tested positive for the virus over the past seven days. Republished with the permission of the Associated Press.
Joe Biden chides Donald Trump for lack of cooperation on vaccine
President-elect Joe Biden met Thursday with governors from both parties and criticized President Donald Trump’s unprecedented attempt to block the peaceful transition of power, saying it was hindering the flow of information about programs to develop a vitally important coronavirus vaccine. “Unfortunately, my administration hasn’t been able to get everything we need,” Biden said during a video conference with the National Governors Association’s leadership team, which consists of five Republicans and four Democrats. His remarks highlighted the stakes of the Trump administration’s refusal to begin a formal transfer of power to Biden’s team. Besides being a pillar of American democracy, it is especially important this year since Biden will be inheriting responsibility for managing the worst public health crisis in a century. The president-elect also has been denied access to other critical information, including security briefings. Participating from a theater in Wilmington, Delaware, with Vice President-elect Kamala Harris, Biden specifically cited Operation Warp Speed, the federal government’s partnership with private pharmaceutical companies to develop a COVID-19 vaccine. “We haven’t been able to get into Operation Warp Speed, but we will take what we learned today and build it into our plan,” Biden said in remarks after the meeting, which included Republicans Larry Hogan of Maryland, Asa Hutchinson of Arkansas, Kay Ivey of Alabama, Charlie Baker of Massachusetts and Gary Herbert of Utah. Afterward, Biden spoke about distribution of a vaccine once one is ready, saying, “There has to be a prioritization.” “That’s why I’d like to know exactly what this administration has in mind in terms of their Operation Warp Speed and how they plan it,” he said of the Trump White House. “And that’s what we talked about with the governors today. They all mentioned the need to focus on the communities that have been left behind.” Even as he warned of the gravity of the situation, however, Biden reiterated his previous pledges not to institute a nationwide shutdown to curb the virus’s spread and repeated that more states instituting mask-wearing mandates could save tens of thousands of lives. An hourlong briefing by the White House coronavirus task force that also took place Thursday made no mention of the incoming administration or Trump’s refusal to coordinate with Biden on plans to distribute upcoming vaccines. But it did reinforce Biden’s tough-love message to the American people, including warnings that a “dark winter” is coming as virus cases spike across the country. Task force coordinator Dr. Deborah Birx sounded the alarm over the rate of new infections — sharper than the surge this summer or even the initial outbreak last spring. While there have been improvements in treatment protocols and new therapeutics, tens of thousands of people — or more — will die before vaccines are widely available, she said. After the virtual meeting with the governors, Biden took questions from reporters and revealed he’d decided on a treasury secretary nomination for his new administration. He refused to provide more details, except to say it was a choice that would satisfy Democrats from across the political spectrum — presumably including outspoken progressives who worried Biden might go for a safer, more moderate selection. Among the Democrats on the videoconference was Gretchen Whitmer of Michigan, which is among the states Trump has targeted for unfounded claims of voter fraud. Biden nonetheless vowed to rise above politics in a unified front against the virus. “There’s a real desire for real partnership between the states and the federal government,” Biden said. He said he’d forgo a national shutdown “because every region, every area, every community can be different.” Instead, Biden noted that 10 governors have imposed statewide mask mandates to combat the virus, calling wearing face coverings a “patriotic duty.” He’s previously vowed to ask all governors to impose such rules and go around holdouts to local and county officials to cover as much of the U.S. as possible. Ivey told videoconference participants that both parties in Congress need to come together to provide more coronavirus response funding, according to a readout provided by her office. It made no mention of the Alabama governor recognizing Biden as president-elect. Hutchison of Arkansas, by contrast, said over the weekend that Biden would be the next president. He’s also called on the Trump administration to give Biden access to the intelligence briefings he needs to be fully prepared to lead the country on Jan. 20, Inauguration Day. Hogan told The Associated Press recently that Trump’s wild and unsupported claims of widespread voter fraud were “dangerous” and “embarrassing.” “As I said on the day that the president-elect was declared the winner, his election has provided a mandate for cooperation,” the Maryland governor said after the virtual meeting with Biden. “We look forward to working closely with the Biden-Harris administration as we continue to face this unprecedented global pandemic.” Still, some in his party, considering the election settled, didn’t stop Trump on Thursday from coming out with a new round of false claims of voter fraud in key states. With Trump dug in and Republicans on Capitol Hill largely unwilling to challenge him, Biden has been forced to turn to a diverse collection of outside allies to ratchet up the pressure on the president to concede. The CEOs of America’s largest companies have released a statement recognizing Biden and Harris as the clear winners. The heads of the American Hospital Association, the American Medical Association, and the American Nurses Association issued a joint statement on Tuesday urging the Trump administration to share “all critical information related to COVID-19” with Biden. Not doing so, they warned, would jeopardize American lives. Trump, meanwhile, has been getting nowhere in the courts, and his scattershot effort to overturn Biden’s victory is shifting toward obscure election boards that certify the vote. The battle is centered in the states that sealed Biden’s win. Two Republican election officials in Michigan’s largest county initially refused to certify results despite no evidence of fraud. The officials then backtracked and voted to certify before flipping again and saying they “remain opposed to certification.”
Coronavirus deaths are rising again in the US, as feared
Deaths per day from the coronavirus in the U.S. are on the rise again, just as health experts had feared, and cases are climbing in practically every state, despite assurances from President Donald Trump over the weekend that “we’re rounding the turn, we’re doing great.” With Election Day just over a week away, average deaths per day across the country are up 10% over the past two weeks, from 721 to nearly 794 as of Sunday, according to data from Johns Hopkins University. Newly confirmed infections per day are rising in 47 states, and deaths are up in 34. Health experts had warned that it was only a matter of time before deaths turned upward, given the record-breaking surge in cases engulfing the country. Deaths are a lagging indicator — that is, it generally takes a few weeks for people to sicken and die from the coronavirus. Michael Osterholm, a University of Minnesota expert on infectious diseases who warned over the summer of a fall surge, said what’s happening now is a confluence of three factors: “pandemic fatigue” among people who are weary of hunkering down and are venturing out more; “pandemic anger” among those are don’t believe the scourge is a real threat; and cold weather, which is forcing more Americans indoors, where the virus can spread more easily. “When you put those three together, we shouldn’t be surprised what we’re seeing,” Osterholm said. The virus is blamed for more than 8.6 million confirmed infections and over 225,000 deaths in the U.S., the highest such totals in the world. Deaths are still well below the U.S. peak of over 2,200 per day in late April. But experts are warning of a grim fall and winter, with a widely cited model from the University of Washington projecting about 386,000 dead by Feb. 1. A vaccine is unlikely to become widely available until mid-2021. The seven-day rolling average for daily new cases hit a record high on Sunday of 68,767, according to Johns Hopkins, eclipsing the previous mark of 67,293, set in mid-July. The U.S. recorded more than 80,000 new cases on both Friday and Saturday — the highest marks ever — though testing has expanded dramatically over the course of the outbreak, making direct comparisons problematic. The true number of infections is thought to be far higher because many Americans have not been tested, and studies suggest people can be infected without feeling sick. On Wall Street, stocks had their worst day in more than a month, amid the surging caseload and mounting doubts that Washington will come through with more relief for the economy before Election Day. The S&P 500 slid 1.9% Monday, while the Dow Jones Industrial Average shed 650 points, or 2.3%. On Monday, the White House coronavirus response coordinator spent the day looking around North Dakota’s capital city and proclaimed the COVID-19 protocols to be the worst she’s seen in her travels around the country. Dr. Deborah Birx, whose tour has taken her to nearly 40 states, said she found the absence of face coverings and the lack of social distancing in Bismarck “deeply unfortunate” and a danger. “Over the last 24 hours as we were here and we were in your grocery stores and in your restaurants and frankly even in your hotels, this is the least use of masks that we have we seen in retail establishments of any place we have been,” Birx said. “And we find that deeply unfortunate because you don’t know who’s infected and you don’t know if you’re infected yourself.” In the Texas border city of El Paso, authorities instructed people to stay home for two weeks and imposed a 10-p.m.-to-5-a.m. curfew because of a surge that has overwhelmed hospitals. The state is converting part of the city’s civic center into a hospital. “We are in a crisis stage,” El Paso County Judge Ricardo Samaniego, the county’s top elected official, as he issued the stay-at-home order over the weekend. On Monday, the county reported a record high in daily cases, with 1,443, and 853 patients hospitalized because of the virus, up from 786 a day earlier. The state has provided over 900 medical personnel to El Paso, some of whom will staff the convention center site. Just last week, Trump during the last presidential debate downplayed the virus’ effect in the Lone Star State, saying: “There was a very big spike in Texas, it’s now gone.” Trump said repeatedly over the weekend that the country is “rounding the turn.” His remarks came amid another outbreak in the White House inner circle. Several close aides to Vice President Mike Pence tested positive, including his chief of staff. In Idaho, where large numbers of residents resist wearing a mask, Republican Gov. Brad Little on Monday ordered a return to some restrictions to slow the spread of the virus as rising cases put a strain on the hospital system. Little’s directive limits indoor gatherings to 50 people, urges businesses to encourage employees to work from home, among other steps. Idaho’s positivity test rate is fourth-worst in the nation. St. Luke’s, with hospitals in southwestern and central Idaho, is reporting that 20% of hospitalized patients are suffering from COVID-19. Its hospital in Twin Falls has postponed elective surgeries and are sending children in need of medical care to Boise, about 125 miles away. Primary Health Medical Group, the largest independent medical group in Idaho, has had to close two of its 19 urgent care clinics in southwestern Idaho because of sick or quarantined staff. The clinics are a buffer keeping hospital emergency rooms in the region from getting clogged with patients not needing emergency-level care. Oklahoma is one of the states consistently breaking records for new cases, and the strain is being felt in hospitals. Bed space is running out, and an equally daunting problem is a shortage of nursing staff. Dr. Sam Ratermann, director of the hospitalist program at INTEGRIS Grove Hospital in Grove, Oklahoma, said patients are being transferred from
Martha Roby: Tips for a healthy fall
Congresswoman Roby reminds each of us to stay healthy as flu season starts amid the coronavirus pandemic.
White House official praises Alabama virus response, tells men to wear masks
Dr. Deborah Birx noted a gender gap as she traveled the state in mask wearing, one of the tools to curb the spread of the virus.
Donald Trump says ‘toughest’ weeks ahead as coronavirus spreads
The number of people infected in the U.S. has exceeded 300,000.
