'Like ‘a Bus Accident a Day’: Hospitals Strain Under New Flood of Covid-19 Patients' diff viewer (7/8)

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Like ‘a Bus Accident a Day’: Hospitals Strain Under New Flood of Covid-19 Patients	Like ‘a Bus Accident a Day’: Hospitals Strain Under New Flood of Covid-19 Patients
2020-07-15 15:48:21 UTC	2020-07-15 16:20:28 UTC (32 minutes later)
TAMPA — As states across the American South and West grapple with shortages of vital testing equipment and a key antiviral drug, hospitals are being flooded with coronavirus patients, forcing them to cancel elective surgeries and discharge patients early, and doctors worry that the escalating hospital crunch may last much longer than in earlier-hit areas like New York.	TAMPA — As states across the American South and West grapple with shortages of vital testing equipment and a key antiviral drug, hospitals are being flooded with coronavirus patients, forcing them to cancel elective surgeries and discharge patients early, and doctors worry that the escalating hospital crunch may last much longer than in earlier-hit areas like New York.
Even as regular wards are being converted into intensive care units and long-term care facilities open for patients still too sick to go home, doctors say they are barely managing.	Even as regular wards are being converted into intensive care units and long-term care facilities open for patients still too sick to go home, doctors say they are barely managing.
Hospitals are scrambling to call back nurses and recruit new doctors. Florida Gov. Ron DeSantis announced he was sending 100 nurses to help out Jackson Health System in Miami, which said it had already hired 80 extra nurses in the past two weeks. Jackson Memorial, its flagship hospital, has only 28 I.C.U. beds, out of a total of 234, available.	Hospitals are scrambling to call back nurses and recruit new doctors. Florida Gov. Ron DeSantis announced he was sending 100 nurses to help out Jackson Health System in Miami, which said it had already hired 80 extra nurses in the past two weeks. Jackson Memorial, its flagship hospital, has only 28 I.C.U. beds, out of a total of 234, available.
“When hospitals and health care assistants talk about surge capacity, they’re often talking about a single event,” said John Sinnott, chairman of internal medicine at the University of South Florida and chief epidemiologist at Tampa General Hospital. “But what we’re having now is the equivalent of a bus accident a day, every day, and it just keeps adding.”	“When hospitals and health care assistants talk about surge capacity, they’re often talking about a single event,” said John Sinnott, chairman of internal medicine at the University of South Florida and chief epidemiologist at Tampa General Hospital. “But what we’re having now is the equivalent of a bus accident a day, every day, and it just keeps adding.”
Florida is struggling with one of the worst outbreaks in the country, along with Texas, California and Arizona: 43 intensive care units in 21 Florida counties have hit capacity and have no beds available.	Florida is struggling with one of the worst outbreaks in the country, along with Texas, California and Arizona: 43 intensive care units in 21 Florida counties have hit capacity and have no beds available.
In South Carolina, National Guard troops are being called in soon to help insert intravenous lines and check blood pressure. Roper St. Francis Healthcare in Charleston saw a 65 percent increase in coronavirus patients in a single day.	In South Carolina, National Guard troops are being called in soon to help insert intravenous lines and check blood pressure. Roper St. Francis Healthcare in Charleston saw a 65 percent increase in coronavirus patients in a single day.
Dr. Christopher McLain, the hospital’s chief physician officer, said he has begun each day on his knees in prayer and often begins meetings the same way, asking the Lord how to respond to the pandemic. “We’re already at a severe condition,” he said.	Dr. Christopher McLain, the hospital’s chief physician officer, said he has begun each day on his knees in prayer and often begins meetings the same way, asking the Lord how to respond to the pandemic. “We’re already at a severe condition,” he said.
In Mississippi, five of the state’s largest hospitals have already run out of I.C.U. beds for critical patients, Dr. Thomas Dobbs, the state health officer, said on Thursday. “Mississippi hospitals cannot take care of Mississippi patients,” he said.	In Mississippi, five of the state’s largest hospitals have already run out of I.C.U. beds for critical patients, Dr. Thomas Dobbs, the state health officer, said on Thursday. “Mississippi hospitals cannot take care of Mississippi patients,” he said.
Texas Gov. Greg Abbott on Thursday ordered an increase in hospital bed capacity for dozens of counties, extending a ban on elective procedures to new corners of the state in an effort to assist hospitals dealing with the outbreak.	Texas Gov. Greg Abbott on Thursday ordered an increase in hospital bed capacity for dozens of counties, extending a ban on elective procedures to new corners of the state in an effort to assist hospitals dealing with the outbreak.
Mr. Abbott directed hospitals to “postpone surgeries and procedures that are not immediately, medically necessary.” The governor had already done so in hard-hit urban counties that include San Antonio, Dallas, Houston and Austin.	Mr. Abbott directed hospitals to “postpone surgeries and procedures that are not immediately, medically necessary.” The governor had already done so in hard-hit urban counties that include San Antonio, Dallas, Houston and Austin.
At the 463-bed hospital operated by Eisenhower Health in Rancho Mirage, Calif., east of Los Angeles, the coronavirus case count has gone from less than a dozen in May to 77 this week. Most of the 34 intensive care beds are full, nearly half of them occupied by people who have been infected.	At the 463-bed hospital operated by Eisenhower Health in Rancho Mirage, Calif., east of Los Angeles, the coronavirus case count has gone from less than a dozen in May to 77 this week. Most of the 34 intensive care beds are full, nearly half of them occupied by people who have been infected.
“I’m glad some of you are sheltered from what unbridled Covid-19 looks like. It’s a hell show,” a doctor at the hospital, Dr. Richard Loftus, posted to a Facebook physician group after a computer trainer at the hospital turned out to be infected.	“I’m glad some of you are sheltered from what unbridled Covid-19 looks like. It’s a hell show,” a doctor at the hospital, Dr. Richard Loftus, posted to a Facebook physician group after a computer trainer at the hospital turned out to be infected.
Dr. Diego Maselli Caceres at University Hospital in San Antonio, Texas, said he has watched a sevenfold surge of Covid-19 patients needing intensive care over the past month, filling up three floors of the hospital instead of one. His workload has increased to 15 hours a day, he said.	Dr. Diego Maselli Caceres at University Hospital in San Antonio, Texas, said he has watched a sevenfold surge of Covid-19 patients needing intensive care over the past month, filling up three floors of the hospital instead of one. His workload has increased to 15 hours a day, he said.
“You get bombarded with multiple calls at the same time,” he said, referring to the “code blue” warnings from overhead speakers that send doctors and nurses rushing to save a patient in distress.	“You get bombarded with multiple calls at the same time,” he said, referring to the “code blue” warnings from overhead speakers that send doctors and nurses rushing to save a patient in distress.
“You hear the calls and you’re running from one end to the other, just like putting out fires, and you’re trying to help as much as you can. It gets overwhelming.”	“You hear the calls and you’re running from one end to the other, just like putting out fires, and you’re trying to help as much as you can. It gets overwhelming.”
Hospital bed capacity, including in I.C.U.s, is generally used to gauge a region’s health care infrastructure and the preparedness of its hospitals to respond to the coronavirus. Data showing I.C.U.s at full or near capacity have made headlines recently, but health experts say that attention to capacity does not paint an entirely accurate picture of the severity of the pandemic.	Hospital bed capacity, including in I.C.U.s, is generally used to gauge a region’s health care infrastructure and the preparedness of its hospitals to respond to the coronavirus. Data showing I.C.U.s at full or near capacity have made headlines recently, but health experts say that attention to capacity does not paint an entirely accurate picture of the severity of the pandemic.
Regular beds are easily converted into I.C.U. capability, doctors and hospital experts say. The bigger challenge is having enough nurses who are qualified to care for such patients and equipment such as ventilators.	Regular beds are easily converted into I.C.U. capability, doctors and hospital experts say. The bigger challenge is having enough nurses who are qualified to care for such patients and equipment such as ventilators.
Hospitals can “pivot enough space,” said Jay Wolfson, professor of public health at the University of South Florida. “The trick is going to be staffing. If you get people burned out, they get sick, then you lose critical care personnel.”	Hospitals can “pivot enough space,” said Jay Wolfson, professor of public health at the University of South Florida. “The trick is going to be staffing. If you get people burned out, they get sick, then you lose critical care personnel.”
At the Medical University of South Carolina in Charleston, emergency room waiting times can last up to four hours before patients are seen by a physician. The hospital has set up large white tents outside to allow for social distancing, but patients are increasingly leaving the site before their treatment, unwilling to endure the wait.	At the Medical University of South Carolina in Charleston, emergency room waiting times can last up to four hours before patients are seen by a physician. The hospital has set up large white tents outside to allow for social distancing, but patients are increasingly leaving the site before their treatment, unwilling to endure the wait.
As physicians and nurses fall ill with the coronavirus, much like their patients, fewer and fewer staff members have been available to accommodate the burgeoning number of sick people at their doorstep. Some emergency room doctors have taken on extra shifts, and the hospital plans to implement a new system where some doctors will be on-call, even on their days off, to respond to the surge.	As physicians and nurses fall ill with the coronavirus, much like their patients, fewer and fewer staff members have been available to accommodate the burgeoning number of sick people at their doorstep. Some emergency room doctors have taken on extra shifts, and the hospital plans to implement a new system where some doctors will be on-call, even on their days off, to respond to the surge.
Mohamed Ibrahim Ali, a critical care doctor at Northside Hospital in St. Petersburg, Fla., one of the hospitals that have no more available I.C.U. beds, said that the system was clogged up by patients, sent from nursing homes, who had recovered but had not yet received the all-clear. Nursing homes at the governor’s direction are not accepting residents back unless they have twice tested negative, a period that could take days.	Mohamed Ibrahim Ali, a critical care doctor at Northside Hospital in St. Petersburg, Fla., one of the hospitals that have no more available I.C.U. beds, said that the system was clogged up by patients, sent from nursing homes, who had recovered but had not yet received the all-clear. Nursing homes at the governor’s direction are not accepting residents back unless they have twice tested negative, a period that could take days.
Roopa Ganga, an infectious disease specialist at two hospitals near Tampa, said that they lacked sufficient supplies of remdesivir, the antiviral drug, forcing her to choose which patients needed it the most. Patients were also being discharged “aggressively” — perhaps too early, she said. They sometimes return a few days later, she said, their symptoms worsened.	Roopa Ganga, an infectious disease specialist at two hospitals near Tampa, said that they lacked sufficient supplies of remdesivir, the antiviral drug, forcing her to choose which patients needed it the most. Patients were also being discharged “aggressively” — perhaps too early, she said. They sometimes return a few days later, she said, their symptoms worsened.
~~Updated July 7, 2020~~	Updated July 15, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.	The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.	Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.	A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.	The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.	The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
“About five people came back in one week last week,” she said. “That is making me feel like, you know, you got to slow down.”	“About five people came back in one week last week,” she said. “That is making me feel like, you know, you got to slow down.”
Dr. Wolfson, from the University of South Florida, said health authorities and public officials needed to collaborate better to bypass regulations that bar out-of-state nurses from working in Florida. New York’s Covid-19 crisis in the spring was aided by a number of health workers from outside the state.	Dr. Wolfson, from the University of South Florida, said health authorities and public officials needed to collaborate better to bypass regulations that bar out-of-state nurses from working in Florida. New York’s Covid-19 crisis in the spring was aided by a number of health workers from outside the state.
“It’s political inertia,” he said. “It takes somebody in a position of significant political stature to say, ‘Let’s do this.’ Florida has always been afraid that people were going to come into the state and take their jobs. Now we need all the help we can get.”	“It’s political inertia,” he said. “It takes somebody in a position of significant political stature to say, ‘Let’s do this.’ Florida has always been afraid that people were going to come into the state and take their jobs. Now we need all the help we can get.”
Traveling nurses were brought in to the Eisenhower Health hospital in California’s Riverside County. It was necessary, said Dr. Alan Williamson, the chief medical officer, because the 3-to-1 nurse-to-patient ratio is much higher even for Covid-19 patients who are not in the intensive care beds. It has been a challenge, said Dr. Williamson, because Eisenhower is competing with two other hospitals in the area that are using the same nurse registries to find help.	Traveling nurses were brought in to the Eisenhower Health hospital in California’s Riverside County. It was necessary, said Dr. Alan Williamson, the chief medical officer, because the 3-to-1 nurse-to-patient ratio is much higher even for Covid-19 patients who are not in the intensive care beds. It has been a challenge, said Dr. Williamson, because Eisenhower is competing with two other hospitals in the area that are using the same nurse registries to find help.