COVID-19 Update

Yesterday, August 11th, 2021

10,351 people were killed by COVID-19

99.997 % of them were not fully vaccinated

World

New Cases:   704,693 (⬆︎ .34%)
New Deaths:    10,351 (⬆︎ .24%)

USA

New Cases:   144,635 (⬆︎ .39%)

New Deaths:         614 (⬆︎ .10%)

USA Vaccination Scorecard

Total Vaccinations: 196.1 million (59.1%)
Fully Vaccinated:    167.1 million (50.3%)

It's not only that they're running short on space for COVID cases - they're running short on everything for every other need as well - ER and intake, available beds, equipment, and people to care for the patients. It's not just COVID. The virus is hogging all the resources, so that now they're looking at having to triage every patient to decide who gets what when.

Remember last year, when Italy was agonizing over what to do about having to choose between critical patients who didn't present with COVID vs the one who did?  Keep that in mind as we approach having our healthcare system bent to the point of collapse, with the focal point being what to do about the shortage of qualified nursing.

WaPo:

Hospitals struggle with staff shortages in coronavirus hot spots

Just north of Miami, covid-19 patients are flooding into the six Broward County hospitals run by Memorial Healthcare System, as Florida is being slammed with the highest rate of coronavirus admissions in the country. Memorial has enough beds. Not so with nurses.

The hospital system has scrambled to hire 439 travel nurses from as far away as Alaska, and it is offering some of its own nurses well-paid short-term contracts to compete with the appeal of working for lucrative outside agencies. It is beginning to pause some elective surgeries to shift staff to patients sick with covid-19, the illness caused by the coronavirus.

Even so, the large public health-care system has about 700 nursing vacancies.

“I wake up every night and ask myself, ‘What else can I be doing?’ ” said Maggie Hansen, senior vice president and chief nurse executive at Memorial, where the census of patients with covid-19 has soared from about 100 four weeks ago to 670 on Wednesday.

That predicament is echoed this second pandemic summer in other states, largely across the South, where the virus’s delta variant and relatively low vaccination rates are driving record numbers of coronavirus hospitalizations.

“Every hospital in Arkansas is having major staffing challenges,” said Chris B. Barber, president and chief executive of Jonesboro-based St. Bernards Healthcare. Barber, who is chairman of the Arkansas Hospital Association’s board, said hospital CEOs in the state hold weekly calls about the pandemic. “I can’t get on a call where that’s not the issue — how to staff their hospital,” he said.

According to hospital executives and nursing administrators in several states, the struggle to find enough workers to care for people sick with covid-19 has emerged as a critical problem as other daunting shortages, widespread early in the pandemic, have eased. Once-scarce supplies of protective gear, ventilators and coronavirus tests are now plentiful, hospital officials consistently say.

Finding ways to hire and keep nurses is the main problem, officials say, although some hospitals also are short on respiratory therapists and workers for nutritional services and housekeeping. Some hospitals could enlarge their bed capacity if they had more nurses to tend to the coronavirus patients who would fill them.

The shortages are starting to interfere with other types of care. The disruptions are not as pronounced as during the pandemic’s early months, when hospitals routinely canceled elective procedures and other patients stayed away from needed treatment for fear of contracting the virus. Still, certain hospitals in the hottest of hot spots, such as the medical centers run by Memorial, are slowing other types of care so they can redeploy staff.

“We have begun to dial back on some services,” such as screening colonoscopies and some joint surgeries, said Tracey P. Moffatt, the chief nursing officer and vice president for quality at Ochsner Health System, based in New Orleans. Louisiana has the second-highest rate of coronavirus hospitalizations.

St. Bernards Medical Center, the 440-bed flagship hospital in a system that covers nearly two dozen counties in northeast Arkansas, built a tower with 245,000 square feet for intensive care and surgical services. It opened in December 2019, shortly before the pandemic was declared.

“So, that gave us physical space,” Barber said. Soon after the coronavirus arrived, the hospital drafted a surge plan to add up to 180 beds for covid-19 patients. In the past month, it has used the plan to expand three times — by 95 beds. Barber figures the volume of arriving coronavirus patients would warrant opening perhaps three-dozen more beds, if it had workers to staff them.

The hospital and outlying parts of the St. Bernards system have 350 to 400 job postings on a daily basis out of a workforce of 4,200. That is after hiring almost 30 nurses for the hospital, mostly from the Philippines, through Guardian Healthcare Providers, which recruits workers internationally. The hospital, which never relied on outside nurses before the pandemic, also is using 67 travel nurses.

Hiring through national travel nursing agencies “has been helpful, but it’s extremely competitive,” Barber said. “They are seeing big spikes in demand.”

At Baxter Regional Medical Center, a smaller hospital of 180 beds in the Ozarks of north-central Arkansas, the pandemic was so slow to arrive that the hospital’s two pulmonologists went to help out in New York, an early hot spot, before the first local coronavirus patient arrived in late June last year. On Thanksgiving Day, Baxter hit 34 cases, the peak until late this July, when it reached 45, staying near that level.

Coronavirus patients account for 12 of the 14 people in the intensive care unit. The unit lacks the staff to care for any more, so Baxter was forced to look for another hospital where it could send a neurology patient with an aneurysm and ended up doing the transfer last weekend to a Kentucky hospital, 4½ hours away, because closer ones did not have room, according to Ron Peterson, Baxter’s president and chief executive.

“The issue is staffing, no question about it,” Peterson said.

Baxter is an independent hospital with a thin profit margin in ordinary times and, in a popular retirement area, an uncommonly large number of patients on Medicare, which pays the hospital less than most insurers. To try to keep its own nurses, it has raised their pay by $2 an hour. The dozen travel nurses it has hired, Peterson said, cost three times as much.

It is scheduled to get six more outside nurses soon. “We would . . . hire more if we could even find them,” Peterson said. “At some point, you’ve got to ask, how long can we do this?”

Ochsner, with 24 hospitals in Louisiana and into Mississippi, has 300 travel nurses from all over the country.

“Frankly we could use more — probably another 100 to 150 would help us,” said Moffatt, the chief nursing officer.

During the initial surge that hit New Orleans after Mardi Gras last year, Ochsner expanded the role of a hub that coordinates nurses who float among different hospitals in the system. The hub also became a staffing agency to hire contract nurses from elsewhere and was able to recruit about 500 at first.

“In this fourth wave, it’s become a lot harder to recruit nurses,” Moffatt said. She suspects that some travel nurses who worked through earlier pandemic surges are burned out — or have made enough income that they are taking time off.

With the pool of available travel nurses smaller and coronavirus cases flourishing, she said, hospitals in hot spots “are all at this time drinking from the same pool of people.”

Bidding wars occasionally break out. “We will sometimes see an agency nurse accept at Ochsner,” she said, “and . . . two hours later they pull out and [have] accepted a higher rate.”

The fierce competition means that already-high prices charged by companies that contract out travel nurses have risen.

At a hearing this week before a Texas Senate committee, Esmaeil Porsa, president and chief executive of Harris Health System, a large public health-care network with two hospitals in Houston, said temporary agencies that supply travel nurses typically charged $65 an hour to $145 an hour last year.

A few days ago, Porsa told the legislators, “we were approached by an agency with a rate of $286 an hour for nursing staff.” As of last week, he said, the two hospitals had 133 agency nurses and needed 132 more that the system has been unable to find.

Over the weekend, a nursing shortage prompted one of the Harris safety-net hospitals, Lyndon B. Johnson Hospital in northeast Houston, to close eight of its 24 intensive care beds, and it declared an “internal disaster” Sunday night, in which no patients were admitted for most of a day.

“I am faced with a workforce that is tired, overworked and constantly under siege,” Porsa testified. “I have lost staff to fatigue and retirement. I have lost staff to covid infection. And I have lost staff to . . . quite honestly, ridiculously high-paying jobs by temp agencies.”

Texas Gov. Greg Abbott (R) and Arkansas Gov. Asa Hutchinson (R) said in recent days that they were reactivating programs from earlier in the pandemic in which state agencies would help hospitals find staff, with reimbursements from federal coronavirus relief laws.

Note: Republicans never again get to self-promote as being shrewd business folk - not when they make stupid politically calculated decisions that needlessly drive up the cost of something as vital as healthcare. These idiots have no fucking clue how an economy actually works. They only care about the part that rewards their big-dollar contributors and puts money in their own pockets.

At Memorial, the public health-care system in Broward County, the number of coronavirus patients this week tied the record set in its hospitals during the pandemic’s surge last summer.

In the year that has elapsed, the system has tried to innovate, seeking ways to train and retain its own staff, and bringing in nurses licensed to work in Florida from Seattle, Vermont and Canada, said Hansen, the chief nurse executive. Some have come from New York. Memorial has already offered a nursing residency program in coordination with a local university. Next week, it is beginning a fellowship program to provide fledgling nurses a year’s specialized training with classes and a mentor.

Training nurses to be specialists, Hansen said, is particularly important because, even before the pandemic, nurses in the baby boomer generation were retiring, and the outflow has quickened because of the rigors of caring for desperately ill people with covid-19.

Memorial furnishes its staff with mental health services — coaching on how to stay resilient, especially as a growing portion of the patients filling hospital beds in this latest surge are younger than before and probably would not be in a hospital if they had been vaccinated against the virus. Memorial’s nurses “are experiencing PTSD already,” Hansen said. “They are seeing things they can’t unsee when they go home.

“It sounds dire, but we are going to get through it,” she said. “It’s just going to be a long haul. We’ve become accustomed to the uncertain aspect of covid.”

Today's GIF(s)

Just when we thought we had a handle on it.

 

"This Year's Virus"

Catherine O'Neal, MD, CMO Our Lady Of The Lake Reg'l Med Ctr, Baton Rouge

Today's GIF

It's a little 1980s-ish, but if the guy can do this shit when he's 78 years old, I'm OK with it.

Today's Pix

click

Today's Tweet

Today's TikTok actually, but hey

Watch all of this.pic.twitter.com/ruwjQjHt0V

— Brian Tyler Cohen (@briantylercohen) August 11, 2021

COVID-19 Update

Yesterday, August 10th, 2021

10,103 people were killed by COVID-19

99.99 % of them were not fully vaccinated

World

New Cases:   610,169 (⬆︎ 30%)
New Deaths:    10,103 (⬆︎ .23%)

USA

New Cases:    124,205* (⬆︎ .34%)
New Deaths:          775* (⬆︎ .12%)

*FL, NE, MI, IA, KS, SD posted no numbers yesterday, so I've added their combined 7-day Rolling Averages (about 23,000 Cases & 115 Deaths per day).

USA Vaccination Scorecard

Total Vaccinations: 195.6 million (58.9%)
Fully Vaccinated:    166.9 million (50.3%)

And BTW, if the Delta Wave continues at this pace, we should be over 700,000 dead Americans by Thanksgiving. Happy Holidays.

WaPo:

‘Goldilocks virus’: Delta vanquishes all variant rivals as scientists race to understand its tricks

The variant battle in the United States is over. Delta won.

Since late last year, the country has been overrun by a succession of coronavirus variants, each with its own suite of mutations conferring slightly different viral traits. For much of this year, the alpha variant — officially known as B.1.1.7 and first seen in the United Kingdom — looked like the clear winner, accounting for the majority of cases by April. In second place was iota, B.1.526, first seen in New York City. A few others made the rogue’s gallery of variants: gamma, beta, epsilon.

Then came delta — B.1.617.2. It had spread rapidly in India, but in the United States, it sat there for months, doing little as the alpha advanced. As recently as May 8, delta caused only about 1 percent of new infections nationally.

Today, it has nearly wiped out all of its rivals. The coronavirus pandemic in America has become a delta pandemic. By the end of July, it accounted for 93.4 percent of new infections, according to the Centers for Disease Control and Prevention.

The speed with which it dominated the pandemic has left scientists nervous about what the virus will do next. The variant battles of 2021 are part of a longer war, one that is far from over.

Delta is sending thousands of people into hospitals every day and has knocked the Biden administration back on its heels. In a few short weeks, the delta variant changed the calculations for what it will take to end the pandemic.

Epidemiologists had hoped getting 70 or 80 percent of the population vaccinated, in combination with immunity from natural infections, would bring the virus under control. But a more contagious virus means the vaccination target has to be much higher, perhaps in the range of 90 percent.

Globally, that could take years. In the United States, the target may be impossible to reach anytime soon given the hardened vaccine resistance in a sizable fraction of the country, the fact that children under 12 remain ineligible and the persistent circulation of disinformation about vaccines and the pandemic.

With so many people unvaccinated, in the United States and around the world, the virus has abundant opportunity not only to spread and sicken large numbers of people, but to mutate further. Some scientists have expressed hope that the virus has reached peak “fitness,” but there is no evidence this is so.

“To see delta just running laps around these other strains is very concerning,” said Benjamin Neuman, a virologist with Texas A&M University. “It’s like ‘Jurassic Park,’ the moment you realize the dinosaurs have all got loose again.”

Delta’s meteoric takeover of the pandemic in the United States brought a jarring, premature end to a summer of relative freedom from the global viral emergency. Just as schools and workplaces were ready to hit reset and embrace a level of normalcy, indoor mask-wearing is back in much of the country, regardless of vaccination status.

Hospitals in states with low vaccination rates are struggling to cope with a flood of patients. At the same time, vaccination rates are jumping as the reality of the pandemic and the efficacy of the vaccines overcome fear, inertia and disinformation.

A dangerous brew

Several factors have played a role in the rise of delta:

Behavior. This is almost impossible for researchers to quantify. As infection numbers started dropping in mid-April, people began returning to crowded gyms, restaurants, ballparks, indoor theaters, dance clubs. The CDC said vaccinated people didn’t need to wear masks. Human nature took over. Only the hypervigilant refused to behave as if the pandemic had ended.

Vaccine resistance. When the United States was reporting 3 million inoculations each day, it appeared plausible that by July 4 the Biden administration would reach its goal of 70 percent of adults with at least one shot. But in May, the rate of vaccination slowed dramatically. As of today, more than 90 million people nationwide who could get a shot haven’t. Tens of millions of children remain ineligible because the vaccines do not have approval for those age groups yet.

The delta variant itself. The rapid ascendancy to total domination is the real-world proof that this variant is different. For virologists studying the coronavirus up close, that difference remains somewhat mysterious. Scientists are racing to understand what makes this variant so successful. They are studying it in animal models and in petri dishes, and scrutinizing the genomes of thousands of closely related lineages.

What’s most sobering to scientists is how the coronavirus keeps getting better at jumping from person to person.

The original strain that emerged in Wuhan, China, had an estimated reproductive number — an “R-naught” — of roughly 2.5. That’s the average number of new infections generated by each infected person in a population without immunity or mitigations. Any number above 1 means that outbreaks will expand and spread. But the CDC and other scientists say delta has a reproductive number greater than 5.

The result is what the United States has endured this summer: viral explosion.

'Sicker quicker'

Although the greater transmissibility of delta is clear at this point, scientists are less certain about whether it has enhanced virulence — that is, whether it’s more likely to make a person severely ill. The evidence on disease severity is limited and largely anecdotal.

Stephen Brierre, chief of critical care at Baton Rouge General in Louisiana, said the onset of respiratory failure requiring ventilation seems to be more rapid: “This is observational and anecdotal at this point: They get sicker quicker.”

Emily L. Tull, a nurse practitioner in the covid unit at Willis-Knighton Medical Center in Shreveport, La., said she is encountering more renal failure, more liver damage and more blood clots in patients since delta took over. More patients are unable to get off ventilators, she said.

Under normal circumstances, one nurse manages two patients in intensive care. In recent weeks, Tull said, “these patients are so sick they’re requiring one-on-one care.”

Patients are younger compared with earlier in the pandemic, perhaps because fewer young people are vaccinated. Tull said health-care workers are “having to make the decision of do we start dialysis on a healthy 25-year-old?”

In Alabama, where about 43 percent of adults are fully vaccinated and virtually all 67 counties are reporting high levels of community transmission, health officials are seeing inpatient data supporting that “delta may be more harmful,” according to Jeanne Marrazzo, director of the infectious-diseases division at the University of Alabama at Birmingham School of Medicine.

At the 1,200-bed UAB hospital, patients hospitalized for covid-19 are younger, the patients who have died are younger, and there appears to be greater use of a last-resort treatment, called ECMO, that can mechanically substitute for badly damaged lungs. The heavy use of ECMO “connotes truly serious systemic illness,” Marrazzo wrote in an email.

An internal CDC document, first disclosed late last month by The Washington Post, cited several studies from other countries showing that infections with delta are more likely to result in hospitalization. The document concluded that greater disease severity is “likely” with delta — one reason the authors said the agency needed to “acknowledge the war has changed.”

CDC Director Rochelle Walensky said Thursday that such research is preliminary. She noted that the delta variant spread rapidly in a time when mitigation efforts such as masking and social distancing had been relaxed. That has led to many more people being exposed and made it difficult for researchers to disentangle the severity of the virus from important changes in how people are exposed to it.

A mystery story

At the CDC, the war has indeed changed. The agency has often acted at the pace of an academic institution. It can be glacial in putting out new guidance. Delta forced it to accelerate its normal process when evidence emerged that vaccinated people with breakthrough infections are spreading the virus. The agency changed its masking guidance without initially publishing the data that incited the change.

A “full-court press” to understand the delta variant is underway at the agency and will continue “until we break this surge,” said one official, who spoke on the condition of anonymity because he wasn’t authorized to speak publicly on the matter.

Vaccinations remain key. All three vaccines with emergency use authorization in the United States are highly effective at preventing severe illness or death from delta or other variants. Vaccinated people rarely need hospitalization for covid-19, the disease caused by the virus. Delta is spreading fastest in areas with low vaccination rates. Vaccination lowers the risk of infection eightfold and the risk of hospitalization or death 25-fold, according to the CDC.

But vaccinated people are getting sick, too. Delta appears to be slightly more capable than some other variants at causing breakthrough infections, which are usually mild to moderate cases that do not require hospitalization.

The rising number of breakthrough infections isn’t surprising: As the number of vaccinated people increases, and delta swarms the nation, it’s inevitable that the virus will sometimes sneak past the enormously robust shield of protection afforded by vaccines.

The recent Provincetown, Mass., outbreak that drew national attention illustrates the point. The people who flocked to the tourist town at the tip of Cape Cod were overwhelmingly vaccinated. Hundreds of people became infected, three-fourths of them with breakthrough cases. But the vaccines kept them from becoming severely ill: Only four people with breakthrough infections were hospitalized. What alarmed the CDC were tests showing that vaccinated people with delta infections had viral loads similar to those among unvaccinated people. That suggested vaccinated people could spread the virus.

There is limited data on how common breakthrough cases are. The CDC has published only its tally of breakthrough hospitalizations and deaths, not infections. Vaccinated people who have mild symptoms of covid-19 may think they have a summer cold and never get tested.

Walensky and Surgeon General Vivek H. Murthy have said in recent weeks that 97 percent of people hospitalized with covid-19 were unvaccinated. A document posted Aug. 2 by the White House stated, “Virtually all U.S. Hospitalizations and Deaths are Among Unvaccinated People.” The document cited that in Ohio, 99.5 percent of deaths and 98.8 percent of hospitalizations were among the unvaccinated.

But officials have relied on older data that does not capture the current impact of the delta, Walensky acknowledged Thursday when questioned at a White House covid-19 task force briefing.

The Ohio health department, contacted by The Post, confirmed the numbers for the state but noted that the data covers Jan. 1 to July 21. Walensky said she had been relying on data from January to June. The use of figures from early in the year skews the picture by including a large number of people sickened and killed by the virus before vaccinations were widely available.

Walensky said Thursday that her agency plans to update the breakthrough data.

The uncertainty about breakthrough infections “is disconcerting, and I think the reality is it’s humbling as a medical community,” said William G. Morice II, chair of the department of laboratory medicine and pathology at the Mayo Clinic.

“Even with the whole world being focused on covid, we still don’t truly understand the intricacies of the virus and its interplay with the immune system,” he said.

A numbers game

A Colorado county, perched on the western slopes of the Rocky Mountains, tells the story of delta’s swift spread.

In early May, five cases of the delta variant were reported in Mesa County. The extent of the threat was still emerging, but public health officials urged residents to get vaccinated. They noted that only 36 percent of people eligible for a shot had been fully vaccinated. In late May, the county announced the first pediatric death from covid-19 — a child infected with delta and too young for a vaccine.

In late June, the Country Jam music festival opened. Public health officials sent a bus to administer vaccines on-site, and used signs and messages on the Jumbotron to warn concertgoers about delta.

By early August, there were nearly 900 known cases of infection caused by the delta variant. Vaccines remained the best protection against severe illness, but about half of known cases were in fully vaccinated people.

The national numbers are similarly vertical. The seven-day rolling average of cases used by The Post showed about 13,000 new cases a day July 1. On Friday, that figure topped 100,000, and there is no sign of the curve flattening. Deaths are rising sharply as well: The daily average jumped from 209 on July 6 to 489 on Friday, a month later.

Because the delta variant replicates so well when it gets inside human cells, the infectious dose may be lower. Infected people may also begin shedding the virus sooner and in greater quantities. It’s a numbers game, and delta has numbers on its side. Rapid replication of the virus has probably shortened the period between a person getting infected and becoming infectious, to perhaps two or three days rather than five or six.

The flip side is that the delta surge is expected to peak faster. A more contagious virus finds susceptible people quickly and burns through that “fuel” faster. This may explain why the United Kingdom and India have both experienced surprisingly swift drop in cases after recent delta surges.

'Delta surprised me'

Human beings have never before seen viral evolution in such vivid scientific detail. Genomic sequencing technologies developed in recent years allow scientists to witness the evolution of a pandemic virus in real time, as one lineage evolves into another.

Scientists say the delta variant’s mutations look, at first glance, unremarkable compared with the mutations in variants it has outcompeted. It lacks some of the immunity-evading mutations seen in gamma and beta, for example.

But one mutation, P681R, may play an outsize role in boosting delta. The coronavirus requires two steps to get into the cell, akin to putting a key into a lock and turning it to open the door. Most of the mutations identified in the other “variants of concern” seem to improve the key’s fit to the lock, said Vineet D. Menachery, a scientist who studies coronaviruses at the University of Texas Medical Branch in Galveston. The P681R mutation seems to improve how the key is turned, making it better at getting into cells.

Most laboratory research has focused on the spike protein the virus uses to enter cells. But delta has mutations that affect other regions — and little is known about what they do.

Nevan Krogan, a senior investigator at the Gladstone Institute of Data Science and Biosciences, found this year that the highly contagious alpha variant may have derived some of its advantage from being able to suppress a person’s innate immune response. That’s the first line of defense against an infection. He and colleagues are exploring whether something similar helps delta.

“When these variants started, everybody was talking ‘spike, spike, spike,’ ” Krogan said. “Obviously, spike is involved in this, getting virus into cells more effectively . . . there’s other mutations that are somehow suppressing the immune response.”

Menachery said he regularly debates with people in his laboratory and other scientists about the evolutionary potential of the virus. He describes this coronavirus as a “Goldilocks virus” — many things have to be just right for it to remain successful. A mutation that helps the virus enter a cell, for example, might come with an Achilles’ heel, making it less stable.

That leaves the open question of whether delta is the fittest — that is, the worst — version of the virus, or whether it could acquire some new mutations that make it even more formidable.

“Nobody knows what tricks the virus has left,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School. “It’s possible we’ve seen all of its chess moves, or its poker tricks, but it’s got a very big complicated genome and it probably still has some space to explore.”

Like everyone else, scientists are wondering when SARS-CoV-2’s contagiousness will peak.

“Delta surprised me,” said Trevor Bedford, an expert on viral evolution at the Fred Hutchinson Cancer Research Center. “This doesn’t happen with an influenza pandemic. It doesn’t happen with Ebola. It doesn’t happen with most other things.”

He knows it can’t keep evolving to become more transmissible forever. Eventually, the virus will hit a ceiling, he said.

“But it’s not exactly clear what that is.”

COVID Supplemental

 Dr Catherine O'Neal CMO, Our Lady Of The Lake Reg'l Med Ctr

Today's Beau

Justin King - Beau Of The Fifth Column

People who thump their chests about how they won't toe the line complaining bitterly about a guy who won't toe their line.

Here's the Garth Brooks tune in case you're interested.

We Shall Be Free

Today's Trae

Trae Crowder on the Texas Follies