December 22, 2020

'Praying for a Christmas miracle': Experts urge Americans to limit holiday gatherings

Daily Briefing

    Nearly 80% of America's ICU beds were occupied last week, and as hospitalizations for Covid-19 continue to grow in some areas, overwhelmed hospitals are considering implementing plans to ration care.

    America grapples with persistently high rates of new coronavirus cases, deaths

    According to data compiled by the New York Times, U.S. officials as of Tuesday morning had reported a total of about 18 million cases of the novel coronavirus since America's epidemic began—up from about 17.8 million 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 216,163—which is up by 7% when compared with the average from two weeks ago.

    As of Tuesday morning, data from the New York Times showed that the rates of newly reported coronavirus cases were "staying high" in Puerto Rico; the U.S. Virgin Islands; Washington, D.C.; and 29 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, Arizona, Arkansas, California, Delaware, Florida, Georgia, Idaho, Kansas, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Washington, and West Virginia.

    Meanwhile, the New York Times' data showed that, as of Tuesday morning, the daily average number of newly reported cases over the past seven days was "going down" in 20 states that had been seeing comparatively higher rates of coronavirus transmission. Those states are Alaska, Colorado, Connecticut, Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, New Mexico, North Dakota, Rhode Island, South Dakota, Utah, Vermont, Wisconsin, and Wyoming.

    Hawaii has had comparatively low case rates, but it was seeing those rates "going up" as of Tuesday morning, according to the New York Times. In Guam, meanwhile, rates of newly reported coronavirus cases were "staying low" as of Tuesday morning, the New York Times' data showed.

    As of Tuesday morning, U.S. officials also had reported a total of about 319,763 U.S. deaths linked to the virus since the country's epidemic began, up from about 317,800 deaths reported as of Monday morning.

    High numbers of Covid-19 hospitalizations strain ICU capacity

    Meanwhile, U.S. hospitalizations for Covid-19, the disease caused by the novel coronavirus, reached a new high on Monday, according to data from The Atlantic's COVID Tracking Project. The data showed that 115,351 Americans with Covid-19 were hospitalized for treatment on Monday, including 21,899 who were receiving care in an ICU and 7,776 who were on a ventilator.

    According to data from HHS compiled by the New York Times, 78% of America's ICU beds were occupied during the week ending Dec. 17, and nearly one-fifth of U.S. hospitals had reported that their ICUs were at least 95% full. Experts cautioned, however, that the data may not fully reflect capacity issues at some hospitals.

    For instance, Thomas Tsai, an assistant professor of health policy at Harvard University, told the New York Times, "I think the important thing about this current phase of the [epidemic] is it's not so much the hospital capacity shortage that's the issue. It's really a shortage of personnel and health care workers."

    Some hospitals consider implementing plans to ration care

    In California, where many hospitals are particularly strained from influxes in Covid-19 patients, some hospitals are creating emergency plans to dictate rationing care if they reach a point where they can longer provide care to every patient in need, the Associated Press reports.

    According to the AP, a state model predicts that the number of hospitalized Covid-19 patients in California could reach 75,000 within a few weeks. And while hospitals in the state have not yet implemented protocols for rationing care, they need to develop those plans because "the worst is yet to come," Christina Ghaly, health services director for Los Angeles County, said.

    The Los Angeles Times reports that it recently obtained a document being circulated among four Los Angeles-area hospitals that recommended if the hospitals can no longer treat every patient because of  shortages in beds or staff, the hospitals should begin focusing on saving as many patients as possible, "meaning those less likely to survive will not receive the [same] level of care they would have otherwise." According to the Los Angeles Times, the document states, "Some compromise of standard of care is unavoidable; it is not that an entity, system, or locale chooses to limit resources, it is that the resources are clearly not available to provide care in a regular manner."

    The document comes as many hospitals in California and elsewhere already have taken steps to increase their capacity to care patients by implementing surge plans, opening field hospitals, shifting staff to focus on Covid-19 and ICU patients, and more.

    Experts urge Americans to avoid holiday gatherings to help curb coronavirus's spread

    Some health officials say much of the recent surge in Covid-19 hospitalizations likely is tied to Americans gathering with people who don't live in their households for Thanksgiving, Kaiser Health News/NPR's "Shots" reports—and experts worry the upcoming Christmas and New Year's holidays could drive yet another spike.

    "We are seeing a tremendous surge in cases in many locations around the United States that are associated with the Thanksgiving dinners, family get-togethers, and social events," Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said.

    Separately, Timothy Brewer, an epidemiologist at UCLA Health, said, "I have yet to see any clear signals that things are slowing down, and I'm very concerned about the next two months."

    To help stave off new spikes in coronavirus cases, hospitalizations, and deaths, many public health experts and officials are urging Americans to limit their upcoming holiday gatherings to people who live in their households.

    "No one's trying to take Christmas away from anyone," Osterholm said, "but we don't want our future Christmases eliminated because somebody became infected and died. And that is exactly the experience we're seeing off of Thanksgiving. So please take that as a hard lesson."

    Vishnu Chundi, an infectious disease physician who chairs a COVID Task Force for the Chicago Medical Society, said Americans need to realize that Covid-19 can affect anyone. He recalled recently seeing a retired nurse he knew, along with her husband and two children who all got infected with the novel coronavirus after gathering for Thanksgiving dinner. While the nurse's husband and children recovered from their infections, the nurse died.

    "She didn't think this could happen to her and yet it did. And that's the take-home point for all of this," said Chundi, adding, "It just broke my heart when she died." Chundi continued, "This is unnecessary, and it's sad to watch people who still have a lot of quality life left being taken away by this virus."

    Thomas Farley, Philadelphia's health commissioner, said Thanksgiving showed "that get-togethers on a single day can change the entire course of the epidemic."

    And in Alabama, James Boyle, a pulmonologist, said he hopes that's not the case with upcoming holidays. "Our ICU is full and I am praying for a Christmas miracle. … I hope the forecasts models are wrong. I pray the numbers of infection and death go down after Christmas" (Weber, Associated Press, 12/21; New York Times, 12/22; "The COVID Tracking Project," The Atlantic, accessed 12/22; Conlen et al., New York Times, 12/21; Lin et al., Los Angeles Times, 12/19; Stone, "Shots," NPR/Kaiser Health News, 12/21; Wigglesworth/Karlamangla, Los Angeles Times, 12/21).

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