Northwest Arkansas Democrat-Gazette
States take new steps as fears of hospital-care shortage rise
Coronavirus infections across the U.S. continue to rise as the country moves deeper into a holiday season that threatens to push the numbers even higher.
The governor of New Mexico is contemplating “crisis standards,” a move that would allow hospitals to ration care depending on a patient’s likelihood of surviving.
Vast swaths of California imposed new restrictions on businesses and activities Saturday as hospitals in the nation’s most populous state face a shortage of beds.
In Missouri, children’s hospitals have started treating adult patients.
And in Idaho, patients have been sent home to care for themselves.
A new daily high of nearly 228,000 confirmed cases was reported nationwide Friday, eclipsing the high of 217,000 cases set the day before, according to Johns Hopkins University data.
The seven-day rolling average of deaths in the U.S. passed 2,000 for the first time since spring, rising to 2,011.
Two weeks ago, it was 1,448. There were 2,607 deaths reported in the U.S. on Friday.
Much of the nation saw surging numbers in the week after Thanksgiving, when millions of Americans disregarded warnings to stay home and celebrate only with members of their household.
Arizona’s top public health official adopted a blunt tone as she reported the state’s latest case numbers, a near-record, telling people to wear masks around anyone outside their household, “even those you know and trust.”
“We must act as though anyone we are around may be infected,” Dr. Cara Christ, director of the Arizona Department of Health Services, wrote on Twitter. Arizona’s intensive-care units are experiencing caseloads not seen since the summer, when the state had one of the worst outbreaks in the world. Just 8% of ICU beds and 10% of all inpatient beds were unoccupied Friday, according to state data.
Hospital officials around the country issued bleak warnings about the potential for severe overcrowding, fearing that Thanksgiving gatherings seeded new outbreaks that are not yet showing in daily case counts.
“In less than a week, we went from exceeding 5,000 new cases reported in one day to exceeding 6,000,” said Dr. Mandy Cohen, North Carolina’s health secretary. “This is very worrisome.”
Hospitals are struggling not only with the increase in patients but also with their own staffs as health workers contract covid-19 or quit under the pressure of caring for so many infectious patients.
“We continue to be concerned about the potential implications of the travel we have seen in the past week with Thanksgiving, as well as social gathering related to the holidays,” said Dr. Adnan Munkarah, executive vice president and chief clinical officer for Henry Ford Health System in Detroit.
The health system currently has 576 employees out because they have tested positive, have pending tests or are quarantined because of close contact, up from 378 a week ago, Munkarah said.
As of Saturday evening, Johns Hopkins University reported more than 14.5 million confirmed covid-19 cases in the United States and 281,000 deaths.
IDAHO’S STRUGGLES
In Idaho’s capital, Boise, soldiers triaging patients in parking lots is the new reality, with troops directing people outside an urgent-care clinic revamped into a facility for coronavirus patients as infections and deaths surge.
Inside Primary Health Medical Group’s clinic, physician assistant Nicole Thomas works extra 12-hour shifts to help out. She dons goggles, an N95 mask, a surgical mask over that, gloves and a body covering to examine 36 patients a day with symptoms. Some days, she said, half of them test positive.
“I’ve had patients crying in the car because they think they’re going to die,” Thomas said, resting against a desk between patients. “There are some people that it’s just a mild cold, and there are some people in the ICU on life support. We don’t know, medicine-wise, how it’s going to affect them.”
What was once a facility with family practice doctors and an urgent care that treated things such as cuts and colds has become a covid-19 clinic, showing how a crush of virus patients is straining intertwined health care systems. In a conservative state where many people are resisting pandemic restrictions, overworked staff members are getting sick themselves or quitting to escape the stress.
Idaho’s attempt to hold the coronavirus in check is failing, health officials say. More than 1,000 people have died so far, four to five times the number of annual deaths from flu and pneumonia. Confirmed infections have surpassed 100,000.
Elective surgeries have mostly been halted to conserve bed space and staff. Covid-19 patients have been sent home with monitoring devices to care for themselves. Officials fear a surge of infections that could force difficult choices about what to do with patients when there’s no more room or anyone available to treat them.
“When would we reach absolute capacity? I just don’t know. But we’re nervous,” said Barton Hill, vice president of St. Luke’s Health System, which has hospitals in southwestern and central Idaho.
RATIONING CARE
In New Mexico, the governor had been sounding the alarm for more than a month. But by mid-November, it was clear to Michelle Lujan Grisham that she would need to take extreme measures to head off the “most serious emergency that New Mexico has ever faced.”
With covid-19 cases rising exponentially and hospital beds dwindling, she dragged her state back to the darkest days of spring, when restaurant dining was banned, nonessential businesses were closed and residents were ordered to stay inside unless absolutely necessary.
She hoped it might be enough to avert catastrophe this winter.
“New Mexico has crushed this virus before — twice,” she told her state’s 2 million residents. “We’re going to do it again.”
Three weeks later, victory remains a distant prospect. Instead, Lujan Grisham, a Democrat, is on the verge of acknowledging just how grim conditions have become: She will, she said in an interview, soon allow hospitals to ration care depending on survival chances.
It is a step that she and other governors have avoided through nine months of battling the pandemic, and one that doctors dread.
“That’s a physician’s nightmare,” said Jason Mitchell, chief medical officer at Presbyterian Healthcare Services, one of the state’s largest providers. “We want to save every life we can.”
But given the strain on medical systems statewide and the lack of available ICU beds as covid-19 hospitalizations near 1,000 statewide, Mitchell said there was probably no other choice.
“We’re headed there very quickly,” he said. “There’s no more room at the inn.”
CALIFORNIA MEASURES
In California, faced with a shortage of hospital beds, health officials announced Saturday that the vast region of Southern California and a large swath of the Central Valley will be placed under a sweeping new lockdown in an attempt to slow the rapid rise of coronavirus cases.
The California Department of Public Health said the ICU capacity in both regions’ hospitals had fallen below a 15% threshold that triggers the measures, which include strict closures for businesses and new controls on activities. They will take effect this evening and remain in place for at least three weeks, meaning the lockdown will cover the Christmas holiday.
Much of the state is on the brink of the same restrictions. Some regions have opted to impose them even before a mandate kicks in, including five San Francisco Bay Area counties where the measures also take effect today.
With a new lockdown looming, many people rushed out to supermarkets Saturday and lined up outside salons to squeeze in haircuts before the orders take effect.
San Francisco resident Michael Duranceau rushed to a market to prepare.
“I’m just stocking up before Sunday — the basics, bread, eggs,” he told KGO-TV, clutching a heavy grocery bag and a baguette.
Gov. Gavin Newsom announced the plan Thursday. It is the most restrictive order since he imposed the country’s first statewide stay-athome rule in March.
The order divides the state into five regions and uses ICU capacity as the trigger for closures.
The measures bar on-site restaurant dining and close hair and nail salons, movie theaters and many other businesses, as well as museums and playgrounds. Newsom also said people may not congregate with anyone outside their household and must always wear masks when they go outside.
The 11-county Southern California region, which includes Los Angeles and San Diego, had only 12.5% of its ICU beds available, the California Department of Public Health reported Saturday. The figure was 8.6% for the San Joaquin Valley region, composed of a dozen counties in the agricultural Central Valley and rural areas of the Sierra Nevada.
Together the two regions are home to more than half of California’s population.
“We are at a point where surging cases and hospitalizations are not letting up,” said Dr. Salvador Sandoval, public health officer for the Central Valley city of Merced. “I can’t emphasize this enough — everyone must take personal steps to protect themselves and protect others.”
ST. LOUIS HOSPITALS
In Missouri, St. Louis children’s hospitals have started treating adult patients as area hospitals struggle to keep up with rising coronavirus cases.
Both St. Louis Children’s Hospital and SSM Health Cardinal Glennon Children’s Hospital opened their doors to adults, the St. Louis Post-Dispatch reported. Staff at SSM Health and BJC Healthcare children’s hospitals have also started volunteering to work at other overwhelmed hospitals.
St. Louis Mayor Lyda Krewson on Friday announced that the city reopened a temporary morgue, the Post-Dispatch reported.
Meanwhile, the St. Louis County health department shut down a fifth business for serving customers inside. The agency suspended the license of Whalen’s Bar for violating a public health order limiting indoor dining, according to the newspaper.
County health officials have warned that there’s a higher risk of spreading the coronavirus when people remove masks to dine indoors. Health department Director Randall Williams said any possible upticks in cases caused by family gatherings on Thanksgiving is likely to start showing up this week.
GUARD’S HELP
In Tennessee, Gov. Bill Lee has authorized medically trained National Guard soldiers to fill nursing roles, drive ambulances and perform coronavirus testing for hospitals that are overstretched.
Friday’s order allows the adjutant general to send hospitals reinforcements from the Tennessee National Guard. The state is focusing on troops who are actively assigned, including those serving in virus testing roles statewide, but not those currently serving in civilian jobs in health care.
State health officials declined to identify which hospitals have expressed interest, but they say there is need statewide.
OFFICIALS SCRUTINIZED
In Oregon, the state Medical Board has suspended the medical license of a doctor who said at a rally for President Donald Trump that he doesn’t wear a mask at his clinic.
KGW-TV reported Friday that Dr. Steven LaTulippe also said at the November rally that he encourages others not to wear masks.
A state order requires health care workers to wear masks in health care settings.
The Medical Board voted to suspend LaTulippe’s license immediately out of concern for patient safety.
Meanwhile, an official in Wyoming’s Department of Health involved in the state’s response to the coronavirus is questioning the legitimacy of the pandemic and describing a forthcoming vaccine as a biological weapon.
The Casper Star-Tribune reported that Igor Shepherd called covid-19 a “so-called pandemic” at a November event in Loveland, Colo. It said Shepherd described efforts to develop a vaccine as a plot by Russia and China to spread communism worldwide.
Information for this article was contributed by Mark Scolforo, Paul Davenport, Jonathan J. Cooper, Ken Miller, Brian Witte, Corey Williams, Keith Ridler, Jocelyn Gecker, Olga R. Rodriguez, Juliet Williams, Robert Jablon, Brian Melley and staff members of The Associated Press; and by Griff Witte of The Washington Post.