The Day – The US largely averted the Christmas coronavirus surge, however specialists warn the menace might intensify
The United States appears to have avoided the worst of the coronavirus scenarios that officials feared would overwhelm hospitals after the Christmas and New Years gatherings. However, experts warn that the threat posed by the virus has not decreased and could intensify as new variants emerge.
Even as hospital stays begin to stabilize, they do so from record highs. The country’s hospitals treated an average of more than 130,000 COVID-19 patients per day for seven days this month, well above the summer and spring fluctuations. The death toll from cases contracted before and after the vacation extends into February. Authorities reported nearly 4,500 deaths on Wednesday, a new daily record.
Cases skyrocketed in early 2021 and approached a 7-day daily average of 250,000 around January 10 before declining. However, the burden on the health system was less than expected.
Hospitals had braced themselves for tremendous spikes in patients who could have forced rationed care, depleted already limited beds and sparked a nationwide shortage of health workers. But officials across the country said those terrible predictions – a wave of severe Christmas falls weeks after Thanksgiving spiked rapidly – did not materialize in most places.
“The wave over a wave that could have happened didn’t actually happen,” said Erin Bromage, professor of biology at the University of Massachusetts at Dartmouth. “We dodged a bullet and did better than we could have, but we’re still in a pretty terrible place.”
Anthony Fauci, the nation’s leading infectious disease expert, said at a news conference at the White House Thursday that cases appeared to be reaching a plateau, but warned that it could be a temporary slowdown.
Hospital managers and experts are still nervous. Variants of the coronavirus, including the UK-native strain B.1.1.7, which is believed to be 50 to 70% more contagious, could spike further in cold weather months as the likelihood of humans increasing increases are located indoors. And the availability of the vaccine, while offering millions of life-saving protections, could also create a false sense of complacency, especially since it can be difficult to obtain.
“It’s like a pot of boiling water, so the temperature may have been lowered a bit, but it’s still dangerously hot,” said Carmela Coyle, executive director of the California Hospital Association. “Plateauing is not a good thing.”
After Thanksgiving, infections spiked, and some feared an even bigger spike after successive Christmas and New Year celebrations, where people would gather with family and friends and then travel home, potentially causing the virus to spread at every step. The Transportation Security Administration recorded the highest number of air travelers since the Christmas pandemic, exceeding 1 million daily.
Experts have put forward several theories as to why the holiday season did less damage than expected. Some people may have changed their behavior after seeing the Thanksgiving spike, such as: B. by partying outdoors, restricting gatherings to immediate family or quarantine before Christmas. More people infected with the virus could be treated at home while the sickest patients are hospitalized.
Robert Kaplan, a medical professor at Stanford University who was among those who raised the alarm about an increase in vacation time, said hospitalizations seem to be increasing in high-case states and in low-case states.
“There may be some places in the country where fewer people can get sick because they are already infected,” Kaplan said.
Los Angeles County is facing one of its worst crises. Officials are taking steps to conserve oxygen, which is needed to treat COVID-19 patients who have difficulty breathing, and 11% of ICU beds are still available.
Researchers and health officials in the county released new projections on Wednesday that offer some good news: hospital admissions have leveled off with enough ventilators to treat patients, and admissions are projected to decline, even under conservative estimates.
The bad news: Even if the number of cases falls, the burden on hospitals will be so high that the bed shortage will persist. Those who have been admitted come in with more severe cases of COVID-19 and are more likely to die.
Roughly one in eight COVID patients in Los Angeles died between September and November – a number that doubled to one in four after November 3.
Roger Lewis, head of the Los Angeles Department of Health’s modeling team, said the numbers suggest hospitals are more selective about who to admit.
“Given this hospital demand, clinicians need to be very careful about reserving hospital resources for patients who clearly need them to ensure resources are available for those whose lives depend on it,” said Lewis. “It is now decided to send people home with instructions instead of admitting as a precaution.”
Nicholas Testa, chief medical officer of Dignity Health, which operates four hospitals in Los Angeles County and two in neighboring San Bernardino County, said the hospitals were experiencing a Christmas spurt with admissions peaking 15 days after the vacation. He said the health system partially handled the surge because length of stay was shorter and county and state officials offered additional resources. Still, the hospitals were on the verge of rationing.
“We got as close to the edge of care as I would ever want to be,” Testa said. “When you get to what you call emergency care, you have to start making decisions about who gets beds and ventilators in the intensive care unit. Thank goodness we didn’t get to that point. It got damn close.”
The American Hospital Association says others have reported similar experiences.
“Nobody should be fooled that we are at an easy time right now,” said Nancy Foster, vice president of the quality and patient safety group. “The cold hard data is saying that in many places, in many churches across the country, we were on the sidelines.”
California appears to be in a stronger position nationwide as Northern California avoids the brunt of the crisis. Mark Ghaly, the state’s chief health officer, welcomed an 8.5% decrease in hospital admissions and 2.8% in intensive care admissions over two weeks Tuesday as a sign that the post-vacation increase was “not as bad” as forecast .
Arizona was another major coronavirus hotspot, having the highest per capita rates of new illnesses, hospitalizations and deaths in the country through January. The hospitalization rate is now 65 per 100,000 inhabitants, a slight decrease compared to the beginning of the month.
Marjorie Bessel, clinical director of Banner Health, Arizona’s largest healthcare system, said the January 11 peak, although lower than expected, left hospital workers working in overcrowded conditions under tremendous stress. Hospitals forced patients to share their rooms and reuse labs and other areas, while corporate headquarters staff were moved to the front lines.
“Yes, it could have been worse and better if there had been more mitigation and more enforcement of the mitigation,” said Bessel, who criticized Republican Governor Doug Ducey for refusing to introduce new restrictions to the spread to slow down the virus. “Let’s just hope the worst is really behind us and we can spend the next many, many months recovering from what we just went through.”
Parts of the country that were not as badly hit as the southwest at Christmas time avoided a new crisis.
“We’re behind the boom that could have come from Christmas and New Years,” said Illinois Democratic governor JB Pritzker last week after lifting restrictions. “I say that with a little fear, because you know, there is always the possibility that we will see an upturn in it. But I think with an incubation period after New Year’s Eve, New Year’s Eve, our numbers look like good news.”
Louisville Democratic Mayor Greg Fischer told town hall residents last week that hospitals avoided “extreme stress” during the vacation. In an interview, he said weekly cases hit 4,100 last week, a slight increase from a previous high, but those newly infected were disproportionately young and less likely to be hospitalized.
“We’re seeing an increase in the number of cases, but we’re not seeing a massive run to the hospitals,” said Fischer.
In Pennsylvania, the University of Pittsburgh Medical Center system prepared for hospital stays at all facilities to approach 3,000 in January, more than double the mid-December 1,200. Instead, they’ve dropped to around 600 this week – a possible sign that residents have learned a lesson after a Thanksgiving surge.
“We prepared for the worst, but we’re dealing with today’s realities,” said Donald Yealy, the system’s chief medical director. “I wouldn’t be surprised if there was one final surge. I don’t expect the COVID-19 infection and disease to simply evaporate.”
Almost 3,900 deaths were reported on Friday, suggesting the peak on Wednesday may not be an anomaly. The 7-day average of deaths in the weeks after Thanksgiving was 2,500.
“We’re going to be numb to the numbers in some ways,” said John Brownstein, chief innovation officer at Boston Children’s Hospital. “The number of hospitalizations, cases and deaths is still incredibly high. Even if we see a withdrawal, those numbers are still incredibly scary.”