October 27, 2020

As coronavirus surges, hospitals warn: We may have to invoke 'crisis standards of care'

Daily Briefing

    Many hospitals throughout the United States are nearing capacity amid surges in new Covid-19 patients, and some are warning that they soon may need to begin rationing care.

    Q&As: How top health systems are tackling Covid-19

    US new coronavirus cases near 8.8M, deaths approach 226K

    The warnings comes as U.S. officials on Monday reported about 74,323 new cases of the novel coronavirus, bringing the total number of coronavirus cases reported in the country since the epidemic began to 8,776,900 as of Tuesday morning—up from about 8,702,600 cases reported as of Monday morning.

    According to the New York Times, the United States' average daily number of newly reported coronavirus cases over the past week was 71,092—which is up by 40% when compared with the average from two weeks ago. U.S. officials over the past few days have reported record-high daily increases in new coronavirus cases. On Friday, for example, U.S. officials reported more than 85,000 new cases of the virus in a single day, breaking the country's previous single-day record of more than 75,600 new cases, which U.S. officials reported on July 16.

    Former FDA Commissioner Scott Gottlieb during an appearance on CNBC's "Squawk Box" on Monday said the United States has reached "a tipping point" in its coronavirus epidemic. "We're likely to see a very dense epidemic. I think we're right now at the cusp of what is going to be exponential spread in parts of the country," Gottlieb said.

    As of Tuesday morning, data from the Times showed that the rates of newly reported coronavirus cases were "staying high" in Guam, Puerto Rico, and 35 states that have had a daily average of at least 15 newly reported cases per 100,000 people over the past week. Those states are Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, and Wyoming.

    Nine states that have had comparatively low case rates as of Tuesday morning were seeing those rates "going up," according to the Times. Those states are Arizona, California, Maine, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, and Washington.

    In the eight remaining U.S. states and territories, rates of newly reported coronavirus cases were "staying low" as of Tuesday morning, according to the Times' analysis.

    Over the past two weeks, the daily average number of newly reported deaths tied to the novel coronavirus in the United States also has increased, rising by 10% from 721 to nearly 794 as of Sunday, according to data from Johns Hopkins University.

    U.S. officials on Monday reported about 534 new deaths linked to the virus, bringing the total number of reported U.S. deaths linked to the coronavirus since the country's epidemic began to 225,692 as of Tuesday morning—up from about 225,158 cases reported as of Monday morning.

    Hospitals warn they're nearing capacity amid influx of new Covid-19 patients

    As the number of new coronavirus cases in the United States surge by record levels in recent days, hospitals throughout the country are also reporting record levels of new Covid-19 patients, the Washington Post reports. On Monday, more than 42,000 Americans with Covid-19 were hospitalized for treatment, according to the Post.

    In a few states, some hospitals have already reached capacity due to the surge in Covid-19 patients. In El Paso, Texas, for example, Covid-19 hospitalizations have almost quadrupled to nearly 800 in less than three weeks—and ICUs in the city reached full capacity on Saturday, the Post reports.

    In Michigan, hospitalizations have increased by 80% in recent weeks—sparking particular concern in the state's rural regions, where hospitals "are being inundated with patients," said Gary Roth, CMO of the Michigan Health and Hospital Association. "Are we getting concerned regarding the increasing numbers, the surging of patients coming into the hospitals? Absolutely," Roth said.

    In Tennessee, Ballad Health has started to postpone up to 25% of non-emergency services at one of the health system's hospitals to help increase capacity for recent influxes of Covid-19 patients.

    In Utah, where hospitals are close to reaching full capacity, the Utah Hospital Association has warned that if Covid-19 hospitalizations continue to balloon at the current rate, hospitals may have to ask Utah Gov. Gary Herbert (R) to invoke "crisis standards of care"—which would implement a triage system that, for instance, prioritizes care for younger patients. "It's an extreme situation, because this means that all your contingency planning has been exhausted," said Greg Bell, the association's president. According to the Post, Bell "has warned that within two weeks, the hospitals may have to start rationing care among the most seriously ill patients in [ICUs]."

    And in Oklahoma, where hospitals are running low on bed space and reporting staffing shortages, Saint Francis Health System, which operates seven hospitals across the state, similarly has warned that matters could worsen if current trends in Covid-19 hospitalizations continue.

    Sam Ratermann—director of the hospitalist program at INTEGRIS Grove Hospital in Grove, Oklahoma—said patients are being transferred from "hospital to hospital across the state" because of a lack of beds and inadequate staffing. "Even when we have open ICU beds across the state, we don't have staff to fill them," Ratermann said. "There's going to be a point where there's no beds and we can't even care for our local citizens."

    Michael Osterholm, a University of Minnesota expert on infectious diseases, said he expects the worst is yet to come. Osterholm predicts that, in the coming weeks and months, the United States will see shortages of drugs, hospital specialists, and N95 masks and other protective gear that providers need to safely care for patients infected with the novel coronavirus.

    And Megan Ranney, an emergency medicine professor at Brown University, warned that upcoming holidays could especially worsen the epidemic. "We are set up for just a perfect storm—a conflagration. … Right now, you can talk about there being lots of little burning fires across the country. And then Thanksgiving will be the wind that will whip this fire up into an absolute human disaster for our country."

    State, local officials implement new measures intended to contain coronavirus's spread

    To address the issue, some state and local officials are taking new steps aimed at mitigating the coronavirus's spread and, in turn, easing the increased strain on hospitals.

    For example, Joe Dougherty, a spokesperson for Utah's Department of Public Safety, said state officials are hoping the state's recent expansion of mask mandates to more counties will help to curb infection rates, as research has shown that mask mandates that were implemented in the state's largest counties earlier this year helped to slow the coronavirus's spread.

    In El Paso, El Paso County Judge Ricardo Samaniego on Sunday issued an order that directs people to stay home for two weeks and institutes a daily curfew from 10 p.m. to 5 a.m. Under the order, people who violate the directive could face a $500 fine.

    Similarly, Ras Baraka—mayor of Newark, New Jersey—on Monday directed non-essential businesses and restaurants in Newark to close their doors daily at 8 p.m., effective Tuesday.

    And in Idaho, Gov. Brad Little (R) on Monday announced that he was reinstituting certain social distancing measures, noting that "[h]ospitals throughout the state are quickly filling up or are already full with Covid-19 patients and other patients" (Stankiewicz, CNBC, 10/26; Pane/Stobbe, Associated Press, 10/26; Knowles/Dupree, Washington Post, 10/25; Achenbach et al., Washington Post, 10/26; Owens, "Vitals," Axios, 10/26; CNBC, 10/26; Spells, CNN, 10/26; Livingston, Modern Healthcare, 10/26; Sutton, Politico, 10/26; New York Times, 10/27).

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