Houston Chronicle Sunday

Virus deaths inU.S near spring record

COVID fatality rate lower, but outbreak wider

- By Campbell Robertson, Giulia McDonnell Nieto del Rio, Joseph Goldstein and Mitch Smith

On April 15, the United States reached a grimnadir in the pandemic: 2,752 people across the country were reported to have died from COVID-19 that Wednesday, more than on any day before or since.

For months, the record stood as a reminder of the pain the coronaviru­s was inflicting on the nation, and a warning of its deadly potential. But now, after seven desperate months trying to contain the virus, daily deaths are rising sharply and fast approachin­g that dreadful count again.

How the virus kills in America, though, has changed in profoundwa­ys.

Months of suffering have provided a horrific but valuable education: Doctors and nurses know better how to treat patients who contract the virus and how to prevent severe cases from ending in fatality, and a far smaller proportion of people who catch the virus are dying from it than in the spring, experts say.

Yet the sheer breadth of the current outbreak means that the cost in lives lost every day is still climbing. More than 170,000

Americans are now testing positive for the virus on an average day, straining hospitals across much of the country, including in many states that had seemed to avoid the worst of the pandemic. More than 1.1 million people tested positive in the past week alone.

At the peak of the spring wave in April, about 31,000 new cases were announced each day, though that was a vast undercount because testing capacity was extremely limited. Still, the toll of the virus was an abstractio­n for many Americans because deaths were concentrat­ed in a handful of states like New York, New Jersey and Louisiana.

Now the deaths are scattered widely across the entire nation, and there is hardly a community that has not been affected. On Wednesday, when 2,300 deaths were reported nationwide — the highest toll since May — only three counties reported a toll of more than 20.

Forty-four states have set weekly case records, and 25 states have set weekly death records in November, as the nation’s death toll has surpassed 264,000 and officials worry that Thanksgivi­ng gatherings may cause infections to spread still more widely in the coming days.

On April 15, more than half of the people who died were in just three states: New York, New Jersey and Connecticu­t. Michigan, Massachuse­tts, Maryland and California also each reported more than 100 deaths that day.

But in much of the country, the spring looked far different.

In Oklahoma City, Lizanne Jennings, an ICU nurse, was part of a teamin her hospital that was planning for the onslaught of sickness they were hearing about in places like Italy and New York City. The staff was counting beds and calculatin­g how many people they might be able to fit in the units.

“It was just always a sense of ‘it’s coming, it’s coming,’” Jennings said, describing it as “pre-traumatic shock syndrome.”

In March, Jennings remembered sitting after work one day with her husband, Dennis Davis, a machinist and former bodybuilde­r.

“I need you to pay attention,” Jennings, 53, recalled telling him. “Look at me: People we know, people we love — our family, our friends — people are going to get this virus. And people we know are going to die.”

New York City alone recorded hundreds of deaths on April 15, underscori­ng its unique role in that spring surge.

“The city was silent except for the ambulances,” said Dr. Steven A. McDonald, an emergency room doctor at NewYork-Presbyteri­an Hospital.

In a city locked down, emergency rooms were relentless­ly frenzied, filled with patients gasping for breath.

McDonald would head into work every day with the same thought on his mind. “You know someone is going to die in your care that day,” he said. “The question is, How many people?”

The emergency began to subside in the city as summer began, but not before the virus had killed more than 20,000 people and infected, by one estimate, more than a fifth of New York City’s population.

Now daily case counts around NewYork City have begun ticking up again, with an average of 6,600 each day in the metro area, a fivefold increase fromthe start of October. Still, the surge has so far been nothing like the one in the spring.

Patrick J. Kearns, a funeral director in Queens, who in the spring regularly had to transport bodies to a crematory in Schenectad­y, N.Y., nearly three hours away, has noticed a two- or three-day backlog forming again at the city’s crematorie­s. He has called the crematory in Schenectad­y, he said, to let them know he may be returning in the weeks ahead.

“We are at risk of repeating what happened in April,” Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of Presidente­lect Joe Biden’s coronaviru­s task force, said of the death toll.

“Once you go over the case cliff, where you have so many cases that you overwhelm the system, basically at that point when you fall off that case cliff, you’re going to see mortality rates go up substantia­lly,” he said. “I shudder to imagine what things might be like in two weeks.”

With an inconsiste­nt and shifting response from government officials, the virus surged in the Sun Belt in the summer, and then began rising steadily through the Midwest and the Great Plains — and then all over in recent weeks. The country reached a peak seven-day average of 176,000 reported cases on Wednesday, and there is reason to fear the worst is still coming. Outbreaks continue to grow in Southern California, West Texas and South Florida.

After rising cases has come the new surge of deaths.

Texas and Illinois have reported more than 800 deaths over the past week, while Pennsylvan­ia, Michigan, California and Florida added more than 400 each. In the Upper Midwest, where reports of new cases have started to level off, deaths are still mounting. Nearly 40 percent of all coronaviru­s deaths in Wisconsin have been reported since the start of November. In North Dakota, where military nurses have been deployed in hospitals, more than 1 of every 1,000 residents has now died.

The dispersed nature of the catastroph­e means it seems invisible in many places. The emergency is too widespread to draw teams of health care workers from other places to help. The sounds of ambulances are heard across many states. Families say their losses have sometimes been overshadow­ed in communitie­s amid fatigue and impatience after more than eight months of social distancing and economic turmoil.

Around the country, medical examiners and funeral home directors are grappling with a steady rise in the toll. “Our volume is exploding,” said Dale Clock, who alongwith his wife owns and operates two funeral homes inwestern Michigan. On a recent night, they handled four COVID-19 deaths in just 12 hours, he said. In the past two weeks, nearly half of the families they served had lost relatives to the virus. All of that comes as one worker has had to quarantine because of the virus, and the staff is working overtime.

In the spring, Clock said, the homes had seen only a few COVID-19 deaths every few weeks.

For Jennings, the Oklahoma nurse, it has been a long eight months.

The surge her hospital had braced for in the spring never materializ­ed, at least not in big numbers. In July, she traveled to Texas to work with COVID-19 patients at a hospital in the Rio Grande Valley, arriving to find a community that was taking the virus seriously. But “the damagewas done,” she said. Many patients, she said, did not survive.

Back in Oklahoma, she said that many people seemed not to believe the virus was real or to take it seriously. It frustrated her, she said.

Last Friday, her mother, Linda Jennings, who had been infected with the coronaviru­s, died.

“I’m weary, and I’m miserable,” she recalled her mother, who was 78, saying as she lay in a hospital bed. “I can’t do this anymore.”

Then on Monday, Jennings sat beside her husband, 8½ months after warning him of the dangers of this frightenin­g new virus. He was lying on his stomach in a hospital bed, hooked up to a machine that helps with breathing. He had been admitted 11 days earlier, she said, with a COVID-19 diagnosis.

“I love you so much,” Jennings remembered saying as she held his hand in the last hours before he died. “I said, ‘You’re going to go, OK? I’m letting you go. You’re going to be at peace.’”

 ?? Christophe­r Lee / New York Times ?? A patient is admitted to the COVID-19 ICU ward of United Memorial Medical Center in Houston on Thanksgivi­ng. Doctors and nurses know more than ever about how to treat COVID-19 patients.
Christophe­r Lee / New York Times A patient is admitted to the COVID-19 ICU ward of United Memorial Medical Center in Houston on Thanksgivi­ng. Doctors and nurses know more than ever about how to treat COVID-19 patients.
 ?? Justin Hamel / New York Times ?? Dominic Garcia prays for his mother, who had been hospitaliz­ed for three weeks with COVID-19, on Nov. 17 in Las Cruces, N.M.
Justin Hamel / New York Times Dominic Garcia prays for his mother, who had been hospitaliz­ed for three weeks with COVID-19, on Nov. 17 in Las Cruces, N.M.
 ?? Adria Malcolm / New York Times ?? An EMT loads a COVID-19 patient into an ambulance Tuesday in Albuquerqu­e, N.M.
Adria Malcolm / New York Times An EMT loads a COVID-19 patient into an ambulance Tuesday in Albuquerqu­e, N.M.

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