Nov 15, 2020

COVID-19 Update

World
  • New Cases:   575,845 (⬆︎ 1.07%)
  • New Deaths:      8,802 (⬆︎   .67%)
USA
  • New Cases:   157,253 (⬆︎ 1.42%)
  • New Deaths:      1,260 (⬆︎   .50%)





WaPo:

Worsening coronavirus crisis pushes leaders to take new measures

Late Friday night, North Dakota’s Republican governor — long resistant to statewide orders on masking and social distancing — acknowledged that his state and country were in dire straits.

Bars, restaurants and event venues would have to cut capacity, Gov. Doug Burgum said in a solemn video posted to social media. Most after-school activities would be put on hold. Starting Saturday, masks must be worn inside businesses, indoors in public spaces and outdoors in public when social distancing can’t be maintained, backed by potential fines of up to $1,000 for the first offense.

“Our situation has changed, and we must change with it,” the governor said, as the United States breaks records for daily new cases and North Dakota leads in recent infections per capita.

A dark reality is sinking in for officials across the country, with Burgum just the latest leader to announce new restrictions in the face of surging cases and hospitalizations that health experts have been warning about for months. But doctors and health officials worry that the urgency of the escalating crisis has not gotten through to a public weary of pandemic shutdowns. And the push for stronger measures has triggered backlash and legal fights.

Chicago on Thursday became the first major city to announce a renewed stay-at-home advisory. A day later, New Mexico Gov. Michelle Lujan Grisham (D) reinstated many restrictions, prohibiting on-site dining and requiring nonessential businesses to close their physical locations. Three Western states — California, Oregon and Washington — urged people to cancel travel that’s not absolutely necessary, and Oregon Gov. Kate Brown (D) announced a two-week statewide “freeze” Friday, which included curbing gatherings ahead of Thanksgiving.

A vaccine breakthrough has buoyed hopes — “The cavalry is coming,” as Anthony S. Fauci, the nation’s top infectious-disease expert, put it — but the country is still facing what officials say could be its grimmest months yet of the pandemic, with tough decisions ahead and thousands of lives in the balance.

Many leaders are leery of stronger measures and economically painful shutdowns, as Democrats and Republicans remain stalled over a new coronavirus stimulus package that could blunt the economic fallout. President Trump on Friday said his administration would not under “any circumstances” resort to a “lockdown.”

“Lockdowns cost lives, and they cost a lot of problems,” Trump said at a news conference where officials said they hope to see millions of people immunized against the coronavirus by the end of the year.

A vaccine could be available to the general public as early as April, Trump said, a timeline echoed by experts such as Fauci. But in the meantime, coronavirus cases are soaring to new heights, pushing past 177,000 nationwide Friday — little more than a week after the country cracked 100,000 daily infections for the first time. The vast majority of states have recorded a single-day high in new cases over the past week, as total infections in the United States approach 11 million. More than 1,300 new coronavirus-related deaths were reported in the United States on Saturday, up more than 200 from last Saturday’s total. Current covid-19 hospitalizations have risen to record heights, too, approaching 70,000.

The stakes are high, and officials are bitterly divided over how to respond in some hard-hit communities.

On Friday, a state appeals court blocked El Paso County Judge Ricardo Samaniego’s stay-at-home order shuttering nonessential businesses in an area where growing coronavirus cases have packed hospitals to capacity and led local officials to call in mobile morgues. Samaniego said the order was necessary to combat a deadly crisis.

But the measures ran afoul of Republican Texas Gov. Greg Abbott’s statewide rules. State Attorney General Ken Paxton hailed the U.S. Court of Appeals for the 8th Circuit’s decision Friday on Twitter, decrying a “tyrant who thinks he can ignore state law” and vowing not to let “rogue political subdivisions try to kill small businesses and holiday gatherings.”

Samaniego was similarly biting in his response, accusing Paxton of gloating as the county suffered. More than half of the patients flooding the county’s health system have the coronavirus, Samaniego told The Washington Post. People are being sent out of state for care.

“Here we are in a really critical situation, he says, people, you can go to Thanksgiving?” Samaniego said of Paxton in an interview Saturday. “Just a complete disregard for our situation.”

“We MUST fight back a second wave to keep our schools open,” he said.

Many are skeptical that leaders across the country will take serious new measures amid pushback. The changes announced Friday in Oregon drew an outcry from businesses.

“We were already hearing from members they were concerned about what another shutdown would do to their chances of staying open,” Jason Brandt, president of the Oregon Restaurant and Lodging Association, said in a statement, adding that the new rules “will trigger an unknown amount of permanent closures.”

Veronica Miller, a professor at the University of California at Berkeley School of Public Health who signed an open letter this summer urging renewed shutdown measures, said she worries public health experts’ strident warnings are not getting through “to that extent that we need.”

“You can just see the graphs, they’re just really over the top, and it’s so much worse. And it’s going to get worse, and I do not see at the national level — I do not see any sense of urgency,” she said.


- and -

Leslie K. Finger and Michael T. Hartney

What determined if schools reopened?
How many Trump voters were in a district.
Union power also played a role, but covid-19 rates didn’t.

Debates about whether to open schools have raged since the summer. Whatever else might shape these decisions, it would make sense that the local intensity of covid-19 spread would play a major part: School districts with low rates of cases would be more likely to open than school districts with high rates. Those districts would likely stick with a more cautious, online-only approach.

But a new study we conducted, examining some 10,000 school districts across the country — some 75 percent of the total — remarkably finds essentially no connection between covid-19 case rates and decisions regarding schools. Rather, politics is shaping the decisions: The two main factors that determined whether a school district opened in-person were the level of support in the district for Donald Trump in 2016 and the strength of teachers’ unions. A third factor, with a much smaller impact, was the amount of competition a school district faces from private schools, in particular Catholic schools.

The finding is a testament to how the nationalization of partisan politics affects governance at all levels. Traditionally, local governments — and particularly school boards, whose members are often elected in nonpartisan, unusually timed elections — have been more technocratic than their state or federal counterparts. Public officials at the local level concentrate on problems like keeping streets paved and deciding whether to build a new elementary school or buy new buses. Yet this study suggests that the polarizing politics of red and blue caused school boards to drift away from a dispassionate analysis of covid-19 numbers toward the political preferences of their constituents.

The “nationalization” of local politics at all levels has been observed for years by political scientists, but this may be the first time it has been documented so starkly in school boards.

The database of school districts we used included information about whether school districts opened — and to what extent. To capture the prevalence of covid-19 cases, we drew on information from Johns Hopkins University; we focused mainly on the number of new cases per 10,000 in the last two weeks of August in each district, when many school boards were making their first decisions about whether to open in-person. The measure indicating support for Trump was straightforward: the share of votes in each district for Trump.

The link between covid-19 cases and a decision to open was minuscule and inconsistent: We found no statistical link between the level of cases and a decision to teach in an online-only mode (as opposed to hybrid or in-person). We did, however, find a slight statistical relationship between cases and the decision to open schools in-person (as opposed to hybrid or online-only); the relationship, however, was so tiny that it suggests almost no effect.

But the effects of partisan politics were consistent and large. As Trump’s share of the vote in 2016 went from 40 percent to 60 percent, across districts, for instance, the proportion that remained in remote-learning mode dropped 17 points: from 27 percent to 10 percent. Conversely, a rise from 40 percent support for Trump to 60 percent was associated with a substantial increase in the likelihood of returning to fully in-person schooling: The probability of opening in-person increased from 7 percent to 16 percent.

One striking detail is that neither pro-Trump nor anti-Trump districts changed their minds about opening even when they were located in areas with the very highest levels of infection: Even then, the partisan effect trumped the covid-19 numbers. (Throughout the study, we controlled for differences across states, to account for state-level policies that shape districts’ decisions. We also controlled for the density of a district to ensure that suburban and urban districts were not being inappropriately compared.)

News reports have suggested that teachers’ unions have tended to resist in-person education. We investigated whether such stances affected districts’ decisions by evaluating whether districts with stronger unions were less likely than others to reopen in person. We used two measures for union strength. Previous research has shown that the larger the district, the more potent the union, so that was our main metric. Next, where possible, we checked whether districts and unions bargained collectively — another sign of union potency. That data, however, was available to us in only 1 of 5 districts. Regardless of the measure used, the stronger the union, the more likely a school was to close, controlling for other factors.

Competition with private schools also mattered, although less than partisanship and union strength. Parents, after all, can “vote with their feet” if they disagree with a local district’s decisions and have other options. We concentrated on whether public schools had to compete for students with Catholic schools, which enroll some 37 percent of all private-school students and are often the only affordable private-school options for middle-class families. Private schools have tended to open at a higher rate than public schools, and their presence did affect public-school decisions, we found. When the share of Catholic schools in a district went from zero per 10,000 students to four per 10,000, the probability of public-school districts opening rose by 4 percentage points — from 14 to 18 percent.

It may be that where the private sector threatens the public system’s market share, districts find that they have to compromise the partisan preferences of the community to keep their wealthier families invested in the public system.

The implications of national and partisan disputes pervading local education governance offers something of a political Rorschach test: On the one hand, it shows that schools are responsive to voters and to local interest groups. That is, by one measure, how democracy is supposed to work, and so it might be applauded. At the same time, some observers may regret that scientific data hasn’t so far played a large role in schools’ response to this massive public health crisis.

There's a fair amount of Both-Sides bullshit here.

Intentionally or not, the authors invite the inference that the Teachers Unions' support for staying out of the classroom was just as politically motivated as the redhats' resistance to masks and quarantines and other restrictions.

Where's the statistical analysis that looks at how often one side or the other lines up with the clinical consensus of the local health departments? - or the CDC guidelines? - or the vaunted "common sense" that these Trump-lodytes are supposed to posses in massive quantities but never mange to demonstrate?

wear your mask
keep your distance
wash your hands

what's so fuckin' hard about this?

And why can't we count on the Press Poodles to get that one right?

Three Seconds

A video from Spencer Sharp featuring Prince Ea:

Nov 14, 2020

Today's Tweet


Brent Terhune - god of redneck satire

COVID-19 Update

World
  • New Cases:   656,533 (⬆︎ 1.23%)
  • New Deaths:      9,951 (⬆︎   .76%)
USA
  • New Cases:   183,629 (⬆︎ 1.69%)  🥳  New Record!!  🎉
  • New Deaths:      1,397 (⬆︎   .56%)




New Mexico at ‘breaking point’ as U.S. shatters coronavirus case record again

New Mexico Gov. Michelle Lujan Grisham (D) said the state is at a “breaking point” and reinstated the country’s most restrictive statewide measures since the fall surge began, while Oregon Gov. Kate Brown (D) announced a two-week statewide “freeze” on Friday, which included curbing gatherings ahead of Thanksgiving.

Other states are trying to avoid full-blown shutdowns by enacting almost every other kind of restriction, as the United States reported more than 177,000 new coronavirus cases, a record high for the third straight day.

How covid-19 is ripping us apart - Helaine Olen

Many of us initially believed the coronavirus pandemic would lead to greater support for American workers and increased generosity on a societal scale. To some extent, that did happen — we praised essential workers as “heroes,” and we took the unprecedented step of closing down our economy for months to protect one another from illness. In concert with similar lockdowns around the world, Jamil Zaki wrote for Trends in Cognitive Sciences, we participated in “perhaps the most populous act of cooperation in history.”

That was then. As a third wave of covid-19 bears down on the United States, we are increasingly a society of defensive, self-protective winners and angry and resentful losers.

Let’s start with something fun, simple, and previously popular: dining out — an increasingly important part of Americans’ lives, especially in cities, in the years leading up to the present crisis. Now? Restaurants are implicated in the spread of covid-19, and — after carefully emerging from the first round of lockdowns — are being ordered to again reduce or entirely shut down their indoor spaces. Many former customers, petrified, avoid them even where they are fully open. (OpenTable reports that restaurant reservations are down by double digits from this time last year.) The result? Despite headlines like Eater New York’s “Where to Eat in Williamsburg Right Now,” and well-meaning Go Fund Me campaigns, a hospitality survey of more than 400 New York City restaurants found almost 9 out of 10 respondents were unable to pay the entirety of their October rent.

The first rounds of government stimulus last spring only offered small-business owners such as restaurateurs an inadequate package of loans and grants through the complicated Payroll Protection Program as part of the Cares Act. After that expired, negotiations between Democrats and Republicans over further economic stimulus went nowhere. If you’re wondering whom to blame, remember: Senate Majority Leader Mitch McConnell (R-Ky.) laughed when Democratic challenger Amy McGrath confronted him about inaction during a debate. Without adequate relief, we are, essentially, sentencing to death neighborhood restaurants that entrepreneurs poured their savings and passions into, while allowing their corporate rivals — chains specializing in cheap takeout — to make gains. McDonalds, for instance, is doing gangbusters business.

Don’t imagine that these restaurants and other small, local businesses will be able to simply start up again when the pandemic passes (yes, it will pass). Where will they get the money? If anything, many have cleaned out their savings. A survey conducted in September by Lending Tree found almost three-quarters of small-business owners racked up debt in the struggle to keep their enterprises alive. That’s not simply bad for us shoppers and consumers and diners. Empty storefronts and angry business owners aren’t good for a society’s stability.

Neither is shutting down schools. Remote learning is a pale substitute for in-person instruction. Children, especially those coming from lower-income and minority homes, are likely to suffer the impact of it for the remainder of their lives. Wealthy people, on the other hand, are forming pods with privately hired teachers, or sending their children to private schools in districts where public schools are closed. This number includes California Gov. Gavin Newsom (D). That we’ve accepted vast inequality of educational experience with hardly a peep of complaint does not bode well for our society’s ability to tackle our ever increasing wealth inequality.

Or let’s take the status of women. They’ve suffered the majority of the job losses during the coronavirus-caused recession. No small amount of this is driven by the need to take care of children who are now attending school remotely, either part-time or full-time. Women, as sociologist Jessica Calarco told the Culture Study newsletter this week, are the social safety net of the United States.

So what is in store for these women? Standards for what makes up good parenting have been rising for decades, and it has mostly fallen to mothers to keep them up. It seems likely that as even more women find themselves the primary hands-on-parent, that much-decried trend will get even worse. In a fascinating piece entitled “The Pandemic Exposes Human Nature,” published last month in the Proceedings of the National Academies of Science, a group of academic researchers led by Benjamin Seitz at UCLA attempted to game out what the pandemic will do to our society. One conclusion: it could “lead to a backslide in economic independence for women” as pandemic social norms lead to a more conservative society over time, one that encourages women to scale back their career ambitions, and pushes men to prioritize theirs.

I could go on. Many cities, bereft of much of their normal economic activity, are seeing at least a temporary end of a much-touted urban revival — as well a significant rises in their murder rates. The politicization of such interventions as mask-wearing reflects increased partisanship, making it even harder for us to unite to beat back the virus — never mind restore our economy to health.

The virus, which many once hoped might at least help bring our fractured society together, has turned into yet another way to divide us. Should we have really ever expected anything else?

Nov 13, 2020

Today's Tweet



Finally - real life voter fraud found out!

Today's GIF

45* is so seldom in the office doing any work, that he gets a little confused when he just kinda wanders in.

Scorecard

Biden: 78,142,359

Trump: 72,770,754


...and still counting

COVID-19 Update

World
  • New Cases:   643,042 (⬆︎ 1.22%)
  • New Deaths:      9,669 (⬆︎   .75%)
USA
  • New Cases:   161,541 (⬆︎1.51%) 🥳  NEW RECORD!!  🎉 
  • New Deaths:      1,190 (⬆︎  .48%)




Lockdowns possible as Illinois, Maryland and Washington governors weigh more restrictions

Some state officials mused aloud about the possibility of a fresh round of shutdowns, measures that health experts said could be avoided with widespread use of face coverings and stronger social distancing habits.

The warning came as the United States set new highs for cases and hospitalizations, with more than 152,000 daily infections and 66,000 hospitalizations, according to The Post’s latest data.

- and then -

Rand Paul says millions of covid-19 survivors should throw away their masks: ‘We should tell them to celebrate’

As coronavirus infections surge again across the country, Sen. Rand Paul (R-Ky.) has a call to action for the millions of Americans who have recovered from covid-19.

“We should tell them to celebrate,” Paul said during a Fox News interview on Thursday evening. “We should tell them to throw away their masks, go to restaurants, live again, because these people are now immune.”

That medically suspect comment from Paul, who tested positive for the virus in March, contradicts widespread public health guidance as well as consistent messaging from many doctors and scientists: There is no evidence that people who have already contracted the virus are now immune to it, they have repeatedly said. And there is a possibility they can still spread the virus to others.

“I don’t know why he would say that,” Vin Gupta, a pulmonologist at the University of Washington Medical Center, told MSNBC of Paul’s comments. “There is no evidence that if you’ve been infected with covid-19 that you are immune from reinfection for any period of time.”

Peter Hotez, an infectious-disease specialist at Baylor University College of Medicine, wrote on Twitter that Paul’s remarks amounted to “anti-science disinformation.”

- and the kicker -

Justice Alito says pandemic has resulted in ‘unimaginable’ restrictions on individual liberty

Justice Samuel A. Alito Jr. told the Federalist Society on Thursday night that the coronavirus pandemic has resulted in previously “unimaginable” restrictions on individual liberty.

“We have never before seen restrictions as severe, extensive and prolonged as those experienced for most of 2020,” Alito said in a speech webcast to the legal society’s national lawyers convention, which was virtual this year because of the pandemic.

Justice Samuel A. Alito Jr. told the Federalist Society on Thursday night that the coronavirus pandemic has resulted in previously “unimaginable” restrictions on individual liberty.

“We have never before seen restrictions as severe, extensive and prolonged as those experienced for most of 2020,” Alito said in a speech webcast to the legal society’s national lawyers convention, which was virtual this year because of the pandemic.

He added: “The covid crisis has served as sort of a constitutional stress test.”

Alito said he was not criticizing officials for their policy decisions — “I’m a judge, not a policymaker” — and said before launching into the speech that he hoped his remarks would not be “twisted or misunderstood.”

Alito, one of the court’s most conservative members, said it would be hard to imagine before the pandemic that speeches and concerts would be off-limits and that churches would be empty on Easter and synagogues vacant on sacred holidays. The Supreme Court itself has been closed to the public since March, and the justices hold their meetings and hear oral arguments via teleconference.

Rand Paul has always been a legacy puke who's so caught up in the frat-house-kegger fuck-'em-if-they-can't-take-a-joke mode that there's no surprise when he shows his true colors as someone who has absolutely no fucking business being a US Senator.

And Sam Alito? What the fucking fuck. I think I get the drift - he thinks he's just trying to be observational. But how tone-deaf can a guy get?

Look, Sam - if the wife has a baby, then you have to forestall boys' night out for a while, and you don't send messages that indicate you resent the restrictions that are fucking necessary now that you have some added responsibilities - responsibilities that encompass something beyond your own self-centered desires to "live free".

Yes - for the team to win, each individual has to step up his game. But as often as not, "stepping up your game" means that you pass the ball, and set the screen, so somebody else can sink the fucking shot - you stoopid grade school snot-faced brats.

Goddamn, how I hate this radical libertarian bullshit.

Nov 12, 2020

Today's Tune

Kings Return - God Bless America.

The last chord is killer. It sounds just the right kind of tension. Because even though this America is a truly amazing and beautiful and majestic place, there's lots of work to do. Because there's always lots of work to do in a country founded on the basic premise of just moving the thing forward - towards "a more perfect union". Not perfect - more perfect.

We're never done with that work because we were never supposed to be done with it. There's always an expectation - it's always "OK, what's next?"

Our song is never done.

COVID-19 Update

World
  • New Cases:   618,399 (⬆︎ 1.19%)
  • New Deaths:    10,178 (⬆︎   .79%) 
USA
  • New Cases:   142,906 (⬆︎ 1.35%)  🥳  NEW RECORD!  🎉
  • New Deaths:      1,479 (⬆︎   .60%) 



And away we go. Again.

At today's growth rate (1.0062)...
  • By Inauguration Day: 378,600 Dead Americans
  • By April 1:                  588,900 Dead Americans

As coronavirus soars, hospitals hope to avoid an agonizing choice: Who gets care and who goes home

The coronavirus pandemic is rolling across America like a great crimson wave.

In Illinois, the rate of new infections is so high that a group of doctors sent an urgent letter to the governor. “We’re having to almost decide who gets treatment and who doesn’t,” said one of its leaders.

In Ohio, the rapid spread of the virus has pushed the state health-care system to the brink. Expressing deep concern, Gov. Mike DeWine (R) vowed to enforce his statewide mask mandate and issued new restrictions on social gatherings. “We can’t surrender to this virus. We can’t let it run wild,” he said.

And in Iowa, where a record number of new infections in a day coincided with a record number of deaths, the White House coronavirus task force issued a dire warning about “the unyielding covid spread” throughout the state.

The number of new daily coronavirus cases in the United States jumped from 104,000 a week earlier to more than 145,000 on Wednesday, an all-time high. Nearly every metric is trending in the wrong direction, prompting states to add new restrictions and hospitals to prepare for a potentially dark future.

“We’re at a fairly critical juncture," said Dave Dillon, a spokesman for the Missouri Hospital Association. The day will soon come when hospital staffing will fall below standards that are normally required, he said.

“While we have beds, those beds are only as good as the staff that you can place around them. There are hospitals at this point that have, at a given time, been unable to do admits,” Dillon said.

This fall surge comes at a moment when President Trump is fighting to remain in office while paying little attention to the deadly spread of the coronavirus. The president on Wednesday repeatedly tweeted combative messages that contested his election loss to Joe Biden, but did not address the coronavirus pandemic.“The worst of this crisis is playing out in the next six to eight weeks,” said David Rubin, director of PolicyLab at Children’s Hospital of Philadelphia. “The irony is, this is the time we most need our public leadership. Right now.”

The number of patients hospitalized nationally with covid-19 — more than 64,000 as of Wednesday — is near the peak of the first wave in the spring, and has already surpassed the numbers driven by infections in the Sun Belt during the summer surge.

Of the hospitalized patients, nearly 3,000 are on ventilators — more than double the number of ventilated patients as of Oct. 1, according to The Post’s coronavirus tracking data.

With the rise in infections came more disturbing news: a significant uptick in the number of people who have died: 1,408 more deaths were reported as of Wednesday evening. Tennessee, Alabama and Minnesota all reached new highs in their daily death tolls.

In Illinois, there was a new high of infections again — 12,657 — marking a toll of at least 10,000 cases each day over the past week. The state’s number of hospitalized covid-19 patients is at 5,042, topping the old high set near the end of April. Its 153 deaths was just short of a record set in late May.

In Ohio, more than 2,745 people are hospitalized with covid-19, a number that has doubled in the last 16 days, according to health department data analyzed by The Post. The state also reported 76 additional deaths and 5,874 new test-confirmed infections.

In Iowa, a record number of patients are in intensive care. The state had a record high of new cases, 4,764, along with 26 new deaths, according to The Post’s tracker.

“The cat’s already out of the bag,” said Albert Ko, an infectious-disease physician at the Yale School of Public Health who’s treating covid-19 patients. “We’re having widespread transmission. It’s going to get worse, certainly for the next month.”

A group of Illinois health-care workers wrote an open letter to Gov. J.B. Pritzker (D) and Chicago Mayor Lori Lightfoot (D) on Monday predicting that “Illinois will surpass its ICU bed capacity by Thanksgiving.”

Two leaders of the group, the Illinois Medical Professionals Action Collaborative Team (IMPACT), said Illinois is “on a bad trajectory.”

“Cases have been rising really sharply, especially in Illinois, where for the past four days we had more than 10,000 cases, which was the highest number of cases that a state had experienced,” said Vineet Arora, chief executive of the team.

Arora, who is also a hospitalist at the University of Chicago, is afraid the rate of infection will reach a point similar to New York at the height of its spring surge, “where physicians were having to decide, does this patient have a higher chance of surviving, or this patient?”

Anticipating a further surge in coronavirus patients, the Cleveland Clinic hospital system decided to postpone most nonessential surgeries requiring a hospital bed, according to an internal memo circulated Wednesday.

The University of Kansas Health System has begun taking steps to manage capacity, said David Wild, vice president for performance improvement. Physicians have been asked to determine which procedures are "deferrable,” to make space, and they’ve had to turn down some transfer requests.

The university’s medical center often receives transfers from across the area because it provides specialty services other hospitals don’t, including reattaching limbs, specialized burn care and leukemia treatment.

“We routinely have to say, ‘Maybe not today,’ or make a decision about whether the patient can stay where they’re at because we’re close to our capacity," Wild said. “To add to that ... we’ve seen an increasing number of calls from hospitals in Missouri and Kansas that are outside of our normal referral patterns.

“We’ve also seen a rapid increase in the number of calls from Oklahoma, Texas, Arkansas, Iowa, Nebraska. We don’t normally see calls from those places, but we are getting them now. And they are saying, ‘We’ve called every place between your hospital and ours. And they can’t help us right now.’ So there are definitely signs that capacity in the Midwest is an issue,” Wild said.

In May, the health system denied about 40 total transfers. In October, it denied 140 transfers. Steve Stites, executive vice president of clinical affairs and chief medical officer for the health system, said he expects the rate of denials has gone up even more since Nov. 1.

“It hurts the rural areas a lot because they often don’t have the resources to take care of patients and so they make seven or eight calls to try to get a patient transferred,” Stites said. “So they spend an average of four or five hours, which is what we’re hearing from our rural colleagues, before they can find someone to accept a patient.”

Hospitals are being forced to make hard decisions to relieve exhausted doctors and nurses, said Janis Orlowski, chief health-care officer at the Association of American Medical Colleges.

Many hospitals are relying on visiting nurses to supplement their staffs. “We might see in the ICU that people are so busy and had so many shifts they need a break,” Orlowski said. So anesthesiologists who are experts at using ventilators are being relocated to intensive care. Technicians are being asked to replace nurses, and workers in ambulatory care are taking shifts in hospitals.

As in the spring, hospitals are complaining about shortages of personal protective equipment, such as gloves, masks and face shields.

“It’s a grave concern,” Orlowski said. “When we first saw the pandemic start in the spring, it was on a rolling basis — some cases in Washington, others in New York. Now we’re seeing increases everywhere. We are seeing hospitals being strained across the country. What we’re seeing is not only burnout but a lot of complications having stress on medical professionals for an extended period of time.”

Some doctors see a return to the dismal days of the spring, when the coronavirus tore through nursing homes, causing hundreds of deaths.

“Obviously, there’s a lot of attention on hospitals, but I think the big pressure points are going to be our nursing homes,” Ko said. “If there’s a place that’s going to buckle under because of the covid epidemic, it’s going to be a nursing home. You only have a limited number of skilled nursing staff that know how to do proper infection prevention.”