November 30, 2020

The worst coronavirus surge yet is overwhelming hospitals

Daily Briefing

    New coronavirus cases, hospitalizations, and deaths are surging to new heights throughout much of the United States, overwhelming hospitals and forcing many to once again scale back non-emergent care.

    US coronavirus cases top 13.4M, deaths surpass 266K

    In recent weeks, America's coronavirus epidemic has accelerated throughout the country, with numbers of new cases, hospitalizations, and deaths spiking for the first time in many smaller, rural areas and resurging in major cities, including Baltimore, Los Angeles, Miami, and Phoenix, the New York Times reports. Over the past two months, coronavirus outbreaks in rural counties and midsize cities in the Great Plains and Upper Midwest had been primarily driving the country's growth in new coronavirus cases, hospitalizations, and deaths, but the virus is now once again spreading rapidly in states with larger populations, as well, including California and Texas.

    In November alone, the United States reported more than four million new cases of the novel coronavirus, breaking its previous one-month record of 1.9 million new cases, which the country had reported in October, according the Times. And that record growth likely will continue accelerating, Tom Inglesby, director of the Center for Health Security at Johns Hopkins University, said. "We are on track to continue this accelerated pace of the epidemic and see even more speed of rise of cases because of the movement indoors, of activities around the country, and because large numbers of people have moved around the country for the holidays."

    On Sunday, U.S. officials reported about 136,313 new cases of the novel coronavirus, according to data compiled by the Times.  As of Monday morning, U.S. officials had reported a total of about 13.4 million cases of the novel coronavirus since America's epidemic began.

    According to the Times, the United States' average daily number of newly reported coronavirus cases over the past week was 162,007—which is up by 8% when compared with the average from two weeks ago.

    As of Monday morning, data from the Times showed that the rates of newly reported coronavirus cases were "staying high" in Puerto Rico; Washington, D.C.; and 38 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, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, and West Virginia.

    The Times' data also shows that, as of Monday morning, the daily average of newly reported cases over the past seven days was "going down" in Guam and nine states—Illinois, Iowa, Missouri, Montana, North Dakota, South Dakota, Utah, Wisconsin, and Wyoming—which had been seeing comparatively higher rates of coronavirus transmission.

    The U.S. Virgin Islands has had comparatively low case rates, but it was seeing those rates "going up" as of Monday morning, according to the Times. In Hawaii, Maine, and Vermont, meanwhile, rates of newly reported coronavirus cases were "staying low" as of Monday morning, according to the Times' analysis.

    As of Monday morning, U.S. officials had reported a total of about 266,758 U.S. deaths linked to the virus since the country's epidemic began.

    Covid-19 hospitalizations surpass 93K—straining hospitals

    Hospitalizations for Covid-19, the disease caused by the novel coronavirus, also have surged to new highs, Reuters reports. As of Sunday, 93,219 Americans with Covid-19 were hospitalized for treatment, according to data from The Atlantic's COVID Tracking Project.

    And as a result of the recent spikes in Covid-19 hospitalizations, hospitals throughout the United States are facing bed, staffing, and equipment shortages, the Times reports. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President-Elect Joe Biden's Covid-19 Advisory Task Force in a recent podcast said U.S. health systems "are verging on the edge of breaking."

    In response, hospitals throughout the United States have begun canceling or postponing planned, non-emergent medical procedures to preserve resources for Covid-19 patients. For instance, Advocate Aurora Health has cut back on some scheduled procedures by up to 50%, Robert Citronberg, executive medical director of infectious disease and prevention at the health system, said. And in Texas, HCA Healthcare and Tenet Healthcare Corp last week said they were postponing some scheduled procedures in El Paso.

    In Phoenix, data projects that patient demand will surpass health systems' capacity in coming days. For example, Banner Health is projecting that 125% of its licensed hospital beds will be full by the first week of December.

    Marjorie Bessel, Banner Health's chief clinical officer, during a news conference on Tuesday said hospital administrators believe they have enough equipment, ventilators, and beds to get through the latest surge in coronavirus patients, but they're concerned about staffing—even though they've recently hired nearly 1,000 health care workers and plan on recruiting an additional 900.

    Meanwhile, in St. Louis, Alexander Garza, the chief community health officer for SSM Health, said the health system has turned away about 50 patients over the past month because it could not immediately provide them with care. Garza also said SSM Health's nurses have had to take on more shifts, be reassigned from pediatric ICUs to adult ICUs, and double up patients in single-patient rooms, among other things, the Times reports.

    In Wisconsin, the situation has gotten so dire that employees from UW Health's University Hospital published an ad in the Wisconsin State Journal urging state residents to help mitigate the coronavirus's spread.

    "Without immediate change, our hospitals will be too full to treat all of those with the virus and those with other illnesses or injuries," they wrote. "Soon you or someone you love may need us, but we won’t be able to provide the lifesaving care you need, whether for Covid-19, cancer, heart disease, or other urgent conditions. As health care providers, we are terrified of that becoming reality."

    Jeff Pothof, UW Health's chief quality officer, said the health system's occupancy is now "super high." As a result, UW Health is "starting to do things it hasn't done before," including enlisting the help of primary care and family physicians to treat severely ill patients, Pothof said.

    "It works, but it's not great," he added.

    Health systems in other areas are struggling with shortages of equipment needed to protect health care workers against contracting the novel coronavirus, Consuelo Vargas, an ED nurse in Chicago, said during a recent news conference held by National Nurses United.

    And in Illinois, Kamaljit Sandhu Singh, an infectious-disease specialist at NorthShore University HealthSystem, said he and other health care workers are "exhausted physically and mentally," as they grapple with treating the increasing numbers of Covid-19 patients.

    CMS expands 'at home' acute care flexibilities to help increase hospital capacity

    To help address some of the capacity issues, CMS on Wednesday announced that it is expanding a program that allows hospitals to provide home care for Medicare beneficiaries that should be hospitalized but do not require intensive care, which can include some Covid-19 patients. Hospitals must meet certain standards to qualify for the program, CMS said.

    CMS also updated a policy the agency issued earlier this month that allow ambulatory surgery centers to offer inpatient hospital care for more than the 24-hour period typically allowed, HealthLeaders Media reports (Fernandez et al., New York Times, 11/25; Mzezewa/Cahalan, New York Times, 11/28; Shammas et al., Washington Post, 11/26; Robertson et al., New York Times, 11/28; Abelson, New York Times, 11/27; Owens, "Vitals," Axios, 11/29; Tozzi, Bloomberg, 11/25; Johnson, Associated Press, 11/25; Commins, HealthLeaders Media, 11/25; New York Times, 11/30; "The COVID Tracking Project," The Atlantic, accessed 11/30).

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