Coronavirus COVID-19 (2019-nCoV) Thread - 2020 Breaking News

Health care is a huge industry, but it’s a for-profit industry, which means hospitals are staffed as lightly as possible, because doctors and nurses cost a lot of money. It’s also concentrated in areas with large populations, which is why the current surge in rural places, while not huge numbers, are enough to overwhelm the few and far between hospitals in those places. Small hospitals with minimal staff and equipment and few resources for expanding, adding field hospitals, bringing in extra staff, etc.

The capacity issue

One thing about capitalism and free markets is that it’s very, very efficient. Hospitals don’t get paid for unused equipment or empty ICU beds. And many state and local governments have had budget woes for decades.

So in many cases (like pandemics) yes, the only significant planning that was ever done was at the federal level. Best case, states and localities might have made agreements with other states and localities to help each other out in a crisis, but that doesn’t help when the crisis is everywhere at once (like in a pandemic).

The downside of having all or most of our pandemic disaster response handled only at the federal level is exactly what we have seen over the last 10 months: there is only one failure point in the event of an inadequate federal response, whether due to incompetence or other.

Related reading here:

Looking at the Johns Hopkins site, there’s a host of states with new highest seven-day-average of daily cases, achieved on Nov. 1 or a couple of days earlier:

North Dakota
South Dakota,
Wisconsin
Alaska
Montana
Wyoming
Minnesota
Illinois
Michigan
Iowa
Indiana
Ohio
Utah
Colorado
Nebraska
Missouri
Kentucky
West Virginia
Pennsylvania
Virginia
North Carolina
Arkansas
New Mexico

What’s striking is how precipitously fast and sharply this is rising. It’s not merely a high rate, but is rapidly going higher, even in states that have not achieved a new 7-day-average peak.

It’s similarly shooting up in several other countries, including Italy, Poland, and Germany.

You buying or not matters naught. Many years influenza alone nearly swamps capacity of both infrastructure and staff. It gets worse when staff or their families get sick.

My PCP is the doctor responsible for pandemic planning for his hospital, and we’ve talked about it some. But the responses a single hospital has are limited. They can clear out beds by canceling non-urgent appointments. (which they did prior to our April surge, and they may do again.) They can accelerate some care when they see the wave on the horizon. (I had my annual physical 2 months early.) They can warn the staff to prepare for overtime. They can talk to the other nearby hospitals and try to coordinate. Maybe they can buy a tent and set it up for temporary isolation or something? But really, what can they do to significantly increase capacity?

The governors can do more, and especially if they ramp up tracking and tracing, mandate masks, shut down bars, and help coordinate distribution of PPE and such, they can help. But they can’t magically create more trained medical staff, either.

What I’m not buying is that hospitals/cities/states don’t prepare for that eventuality. Especially since it happens every year, as you say. I’ve read that it is a standard procedure in at least some places to cancel or reschedule elective procedures when a bad flu season seems afoot, or other things along those lines. I’d be shocked if it weren’t.

Thanks for the insights. That’s very helpful.

Okay, now New Hampshire. We reported 205 new cases Saturday, which is the highest ever.

Not what you don’t get.

Yes, cancelling elective procedures is done. And some years still hospitals resort to parking lot tents. They are prepared for flexing up to regular bad flu season. Over that they are not and more trained ICU staff isn’t something available on a just in time as needed basis. And peak flu surge is usually several weeks. Some elective is only relatively so. Delayed a month, okay. A season, longer? Not.

Exceeding capacity, let alone being ready for the storm to hit, for long durations? Only so much that is possible to do and not an every year thing.

The sister of a friend died this year. She had vague symptoms and hospitals were full (and dangerous) so she didn’t get any tests. Turned out it was cancer. If she’d seen a doctor when the symptoms were still vague, it might have been treatable.

Yeah, if it had just been a month, or a couple weeks, like for flu season, it likely wouldn’t have mattered. Also, most years they DON’T put off elective procedures for flu season. This is WAY more hospitalizations than the flu causes.

Trump country.

With new coronavirus infections surging and area hospitals already at capacity, medical examiners in El Paso, Texas, have received a fourth refrigerated morgue to temporarily store bodies, a county official says.

It is a stark reality for a city where coronavirus patients have been succumbing to COVID-19 at a rate faster than medical personnel can investigate their cases. El Paso sits along the U.S. southern border and is referred to as part of the Borderplex, along with Mexico’s Ciudad Juárez.

“People that die are under investigation, to see if they died of COVID and to discern whether or not they had other diseases. That holds back the process,” El Paso County Judge Ricardo Samaniego told local television station KFOX-TV.

“I think you’re going to see tremendous more deaths coming up in the next two to three days,” he said.

As of Sunday, Samaniego said, the county had a backlog of 85 bodies that still required a medical personnel investigation, according to the station.

This comes as Samaniego faces legal challenges from state officials who say he has no authority to impose a countywide shelter-in-place order that shutters nonessential businesses in El Paso and its surrounding areas.

The order, which went into effect just before midnight Friday, closes salons, gyms, tattoo parlors and in-person dining at restaurants. It is set to expire at the end of the day on Nov. 11.

Businesses considered essential can remain open, including child care facilities, polling sites and grocery stores, the order says.

Texas Attorney General Ken Paxton joined several El Paso-area businesses in filing a lawsuit on Friday attempting to block Samaniego’s order.

The lawsuit asserts that Samaniego’s order is invalid because it goes beyond emergency orders already put in place by Texas Gov. Greg Abbott.

“Judge Samaniego did not have authority to issue emergency orders more restrictive than Governor Abbott’s,” the court filing states.

“Thus, his order usurps both the Texas Legislature’s ability to control who exercises legislative authority and Governor’s Abbott’s role as the designated individual responsible for meeting disasters on a statewide level,” it adds.

My bold.

I hope the Governor doesn’t feel the County Judge overstepped by ordering additional pop-up morgues. That could be construed as uppity especially from a guy with a Hispanic last name.

I don’t know if this is true in other states, but in Texas a County Judge doesn’t just preside over a court. S/He has a lot of administrative and legal authority over many functions and departments.

Reiterating what other posters have posted in the thread with current information about how the shortage of health care workers is leading to problems across the country. Staffing agencies filled the gap when the demand was just in certain areas, but now that the demand is pretty much all around the country, the demand is too high for all the positions to be filled.

https://www.msn.com/en-us/news/us/hospitals-overwhelmed-exhausted-staffs-surging-covid-19-cases-push-nation-s-limits/ar-BB1ayYXL

Last night, Sixty Minutes did a story on the first nursing home in Washington state that got hit by the virus, the administrator of the nursing home said that the CDC showed up ordering them to fill out tons of forms which interfered with their trying to treat their patients, and then wound up saying the outbreak was the nursing home’s fault.

I know several medical professionals who are now retiring or quitting due to the crushing workload, lack of institutional standards supporting their safety, high stress, and cultural denigration since March.

My college roomie and my stepbrother are both front-line covid docs on the east coast. In addition to the workload, grief and fatigue, working in a Covid ward means you should (and they did) completely quarantine from their family for the duration of the first wave. Both have 3 kids. That’s a lot to ask of a family.

It is to smile :slight_smile:

The hospitals I’ve had contact with either (a) had no eventuality planning at all: it wasn’t their job. or (b) had medical teams that planned for some eventualities, and were quietly aware of other eventualities that they couldn’t handle.

And that’s without even considering the oxymoron “competent management”.

In one of our big nursing-home outbreaks here in Melbourne, management had plans A, B, and C for handling an outbreak.

Then they had an outbreak, the staff all went into home quarantine, the contract agencies were unable to provide any staff, and the state did not provide emergency staff as promised. When the Army went in, there were 3 members of nursing staff present for a high-care facility housing hundreds of elderly people.

FINALLY, Birx steps up:

A top White House coronavirus adviser sounded alarms Monday about a new and deadly phase in the health crisis, pleading with top administration officials for “much more aggressive action,” even as President Trump continues to assure rallygoers the nation is “rounding the turn” on the pandemic.

“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” said the Nov. 2 report from Deborah Birx, coordinator of the White House coronavirus task force. “This is not about lockdowns — It hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”

Birx’s internal report, shared with top White House and agency officials, contradicts Trump on numerous points: While the president holds large campaign events with hundreds of attendees, most without masks, she explicitly warns against them. While the president blames rising cases on more testing, she says testing is “flat or declining” in many areas where cases are rising. And while Trump says the country is “rounding the turn,” Birx notes the country is entering its most dangerous period yet and will see more than 100,000 new cases a day this week.

Through a spokesperson, Birx did not respond to a request for comment.

Other health experts, including Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, have warned of record surges in cases and hospitalizations as the United States records more than 9 million cases and 230,000 deaths. “We’re in for a whole lot of hurt,” Fauci told The Washington Post late Friday, predicting a long and potentially deadly winter unless there’s an “abrupt change” — prompting Trump to suggest he planned to fire the scientist after the election.

But Birx’s daily missives go further, revealing how much the administration’s internal reports are in direct conflict with Trump’s public pronouncements that downplay the seriousness of the threat and erroneously suggest few people are dying. They also speak to the increasing desperation of health officials to spotlight the risks of a pandemic that is forecast to take thousands more lives as the weather worsens unless people change their behaviors.

The increasingly dire tone of her reports has gotten little traction, according to an administration official who works with Birx and spoke on the condition of anonymity to share sensitive information. “She feels like she’s being ignored,” the official said.

Birx’s message “has been urgent for weeks,” said another administration official, “as has the plea for the administration to ask the American people to use masks, avoid gatherings and socially distance, basically since it became apparent that we were heading into a third surge.”

The report hits hard on the worsening situation: “Cases are rapidly rising in nearly 30 percent of all USA counties, the highest number of county hotspots we have seen with this pandemic,” it said. “Half of the United States is in the red or orange zone for cases despite flat or declining testing.”

Sounding a similar theme to past reports, it calls for “much more aggressive action from messaging, to testing, to surging personnel around the country before the crisis point.”

What is “essential at this time point,” the report said, is “consistent messaging about uniform use of masks, physical distancing and hand washing with profound limitation on indoor gatherings especially with family and friends.”

It adds: “This is about empowerment [sic] Americans with the knowledge and data for decision-making to prevent community spread and save lives.”

More at the link and probably other news sources.

But your own quote says:

Yep, you’re right.