ICUs overwhelmed with younger, sicker patients
MIAMI — Inside a COVID-only intensive care unit at Jackson Memorial Hospital in Miami, all eight beds are filled with patients.
Six of the eight patients are younger than 50 years old. None of them has been vaccinated against COVID19.
The youngest patient, a 27-year-old woman on a ventilator, had to be resuscitated with a bag valve mask after her blood oxygen saturation levels crashed. The oldest, a 71year-old man, has been in the ICU for two weeks. He has been in a coma for three days. When he awakens, if he awakens, he will be a widower. The man’s wife, also hospitalized with COVID-19, died two days earlier.
Many health care workers at Jackson Memorial thought the end of the pandemic was in sight, largely due to the effectiveness of the vaccines. Then the delta variant took hold, particularly in areas with low vaccination rates, and cases are surging again, only at a faster clip.
“It just went boom,” said Ademola Ayo Akinkunmi, director of patient care services for Jackson Health.
Nurse managers and staff scrambled to create more space at MiamiDade’s public hospital for the sudden rush of new patients, but they have struggled with what feels like a Sisyphean task.
“No matter how hard we work to discharge patients,” Akinkunmi said, “we know there are others coming.”
During the past month, the COVID-19 pandemic has roared back to life with astonishing speed and frightening virulence, crushing hopes for an end to the epidemic and presenting new challenges for public health officials.
New infections and hospital admissions are rising, driven by the highly contagious delta variant, relatively low vaccination coverage and the resumption of social activities.
At the same time, new evidence strongly suggests that even vaccinated individuals can catch and spread the virus — confounding public health officials struggling to persuade more Americans to get inoculated.
In Florida, the number of new cases and the rate of positive tests for the virus that causes COVID19 — a measure known as the level of community transmission — is high in all 67 counties, according to Centers for Disease Control and Prevention data.
On Saturday, Florida reported 21,683 new COVID19 cases as of July 30, the single-highest daily COVID-19 case count since the pandemic began 18 months ago, according to CDC data. The seven-day moving average soared to 15,817, a more than 750% increase since July 1.
The sudden and unexpected resurgence threatens the return to normalcy that many Americans have longed for after 18 months of the pandemic. Many felt they had done their part by getting vaccinated, but their resolve has turned to anger as they see that preventable disease and death is soaring, primarily among the roughly 50% of the nation that has not yet been vaccinated.
As cases surge, the daily count of total vaccine doses administered in the United States has plummeted from a seven-day rolling average high of 3.4 million in mid-April to fewer than 450,000 on July 29, according to CDC data.
“The vast majority of transmission, the vast majority of severe disease, hospitalization and death is almost exclusively happening among unvaccinated people,” CDC Director Rochelle Walensky said this week during a press call to announce that the agency had reversed its earlier recommendation that vaccinated persons did not have to wear masks indoors or outside because they were protected.
Walensky said new evidence had emerged that some vaccinated people infected with the delta variant may be contagious and spread the virus to others. “This new science is worrisome,” she said. But in announcing the update, Walensky did not provide evidence for the change.
The CDC’s about-face was sharply criticized as inconsistent and confusing by leading Republicans, including Gov. Ron DeSantis. Efforts to enforce the new guidance in the U.S. House of Representatives triggered a standoff, with some members refusing to wear masks as had been ordered by the Capitol Hill physician.
On Friday, the CDC released a new report of the agency’s investigation of an outbreak in Massachusetts during July. Investigators found that among 469 cases of COVID-19 linked to summer events and large public gatherings in Barnstable County on Cape Cod, nearly three quarters or 346 cases occurred in fully vaccinated individuals.
No deaths had been reported as of July 27, the CDC report said. But five people were hospitalized, including four who were fully vaccinated. One hospitalized patient between the ages of 50 and 59 was not vaccinated and had multiple underlying medical conditions. The four vaccinated patients ranged from 20 to 70, and two had underlying medical conditions.
The delta variant was the predominant strain in the outbreak, according to the report, which said that infection with delta led to similarly high viral loads in vaccinated and unvaccinated individuals.
“This finding is concerning and was a pivotal discovery leading to CDC’s updated mask recommendations,” Walensky said in a prepared statement on Friday. “The masking recommendation was updated to ensure the vaccinated public would not unknowingly transmit virus to others.”