October 26, 2020

Mapped: America hits a new peak in coronavirus cases

Daily Briefing

    The United States on Friday reported a record number of new coronavirus cases, as hospitals throughout the country are seeing a surge in Covid-19 patients.

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

    US new coronavirus cases top 8.7M, deaths surpass 225K

    U.S. officials as of Monday morning reported a total of 8,702,600 cases of the novel coronavirus since the country's epidemic began—up from about 8,455,200 cases reported as of Friday morning.

    According to the New York Times, the United States' average daily number of newly reported coronavirus cases over the past week was 69,814—which is up by 32% when compared with the average from two weeks ago. On Friday, 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. On Saturday, U.S. officials reported 79,852 new cases of the virus—and on Sunday, they reported 59,691 new cases, the Times reports.

    The record set Friday comes amid public health experts' warnings about a possible surge in new coronavirus cases during the fall and winter, as temperatures drop and people spend more time indoors, where the risk of transmitting the pathogen is higher.

    Former FDA Commissioner Scott Gottlieb in tweet posted Friday wrote that, "The number of Covid cases, hospitalizations, and deaths is going to continue to grow sharply as we enter the winter; until all of us on our own start taking enough collective action to slow the spread. There is no seasonal backstop, and won't be any new national policy action."

    According to the Times, the geography of the country's coronavirus epidemic has shifted since the virus first reached the United States. Coronavirus outbreaks initially occurred in the Northeast during the spring and in the Sun Belt during the summer, and are now occurring most sharply in the Midwest and the West. When broken down by county, based on a federal report produced internally for HHS, more than 170 counties across 36 states have been categorized as quickly growing hotspots for infection, the Washington Post reports.

    Overall, data from the Times shows that the rates of newly reported coronavirus cases are "staying high" in Guam, Puerto Rico, and 32 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, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Wisconsin, and Wyoming.

    Twelve states that have had comparatively low case rates are now seeing those rates "going up," according to the Times. Those states are Arizona, California, Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Washington, and West Virginia.

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

    U.S. officials as of Monday morning also reported a total of 225,158 deaths linked to the coronavirus since the country's epidemic began—up from about 223,023 deaths reported as of Friday morning.

    Hospitals are seeing an influx in Covid-19 patients

    As the number of newly reported cases of the novel coronavirus has resurged in America, so has the number of Covid-19 patients requiring hospitalization.

    Based on data for the last month, the number of Americans hospitalized with Covid-19 has increased by 40%. And over the last two weeks, alone, there's been a nearly 20% increase in such hospitalizations, Politico reports, with more than 41,000 Americans hospitalized for Covid-19 treatment. Further, over just the past week, Covid-19 hospitalizations increased in 38 states, the Post reports.

    This spike in hospitalized Covid-19 patients is beginning to overwhelm hospitals—particularly in the West and Midwest, according to the Post. In the Midwest in particular, according to Reuters, the number of Covid-19 patients requiring hospitalization hit an "all-time high for the ninth day in a row."

    Angela Dunn—an epidemiologist at Utah's Department of Health, where leaders are trying to establish a field hospital at an exposition center—said, "Our health care system is at capacity, our health care providers are overwhelmed and exhausted, our public health system is stressed. I don't know what to do anymore. I'm really not trying to scare anyone, I'm just trying to inform you of what's going on."

    Separately, Nancy Dickey, director of Texas A&M's Rural and Community Health Institute and former president of the American Medical Association, said, "The majority of rural hospitals are struggling. Most of them on a good day are relatively short staffed and people wear multiple hats."

    For instance, 90% of ICU beds in some parts of Wisconsin are full, according to Gov. Tony Evers' (D) office—and patients are now being admitted to a field hospital established at a state fairgrounds.

    In North Dakota, some small hospitals in rural communities do not have adequately staffed beds or the specialists they need to care for Covid-19 patients. As result, these hospitals are transferring Covid-19 patients to larger hospitals in major metropolitan areas, NPR's "Shots" reports.

    Beverly Vilhauer, CEO of South Central Health in Wishek, North Dakota, said, "Our biggest challenge right now has been finding beds when we need them. What we're finding out is that the bigger hospitals, they don't have enough available staffed ICU beds." As Vilhauer explained, although South Central Health has 24 beds, the hospital cannot staff more than eight beds at a time and it doesn't have a respiratory therapist who can provide care to seriously ill Covid-19 patients.

    North Dakota Hospital Association President Tim Blasl said hospitals in the state may cut back on scheduled surgeries and ask the state government for help to hire more nurses if the situation worsens.

    Separately, in Carroll County, Iowa, which is currently a coronavirus hotspot, St. Anthony Regional Hospital has been accepting patients from smaller hospitals in the region—but it's starting to run into staffing issues.

    "We've actually expanded our Covid unit three times. We've taken care of patients from five different counties," Edward Smith, St. Anthony Regional Hospital's CEO, said. However, according to Smith, staffing is becoming a major challenge as health care workers are being exposed to the novel coronavirus in their communities. "We are seeing greater absenteeism at work due to employee illness or their kids or their husbands," Smith said.

    In fact, according to Kaiser Health News, staffing shortages in Montana led one regional hospital to ask employees who had been exposed to the coronavirus to continue working.

    Karina Brown, a nurse who has been treating Covid-19 patients at the Aurora Sinai Medical Center in Milwaukee since the country's epidemic began, said although she had felt prepared to handle an influx of Covid-19 patients, it still felt shocking when the patients came in for treatment.

    "We had a plan, but once you really saw it and it was go time, that's kind of different," Brown said. According to Brown, she's now assigned to more patients who, on average, are much sicker than the patients she cared for at the beginning of the epidemic.

    These challenges—and particularly staffing shortages—are especially worrisome among this latest surge in new cases because "[o]ne key way we got through the previous waves was by moving health care workers around," Eleanor Murray, an epidemiologist at Boston University, said. "That's just not possible when the virus is surging everywhere."

    Nancy Foster, a VP at the American Hospital Association, said, "It feels more like a slog that we're getting through, rather than something we can rally together and defeat rapidly. There are not as many folks who can leave their community to help out in another one because they're struggling to keep up in their own community."

    According to public health experts, the number of Americans seeking care for Covid-19 will likely continue to rise and overwhelm hospitals.

    Caitlin Rivers, an epidemiologist at Johns Hopkins University, said, "I don't really see any signs that things are slowing down and that concerns me a lot. It has to be our starting premise that it's not going to slow down unless we force it to slow down" (Robertson et al., New York Times, 10/23; Lim, Politico, 10/23; Owens, "Vitals," Axios, 10/26; Shumaker, Reuters, 10/25; Wan/Dupree, Washington Post, 10/23; McDonnell Nieto del Rio/Bogel-Burroughs, New York Times, 10/23; Houghton, Kaiser Health News, 10/26; Stone, "Shots," NPR, 10/22; New York Times, 10/24).

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