Author Topic: COVID-19 in America  (Read 936 times)

Online Rick Plant

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Re: COVID-19 in America
« Reply #100 on: September 28, 2021, 11:49:48 PM »
'Rewarding them for choosing not to get vaccinated': Physicians fire back at Tennessee governor’s pandemic policies

Doctors across the state, including one who serves on Gov. Bill Lee's COVID-19 advisory panel, are challenging his COVID-19 policies and cheering three court decisions to overturn his executive order allowing parents to opt out of school mask mandates.

Dr. Erica Kaye, a pediatrician, oncologist and palliative care physician at St. Jude Children's Research Hospital in Memphis, in August drafted a letter to Gov. Lee and signed by thousands of medical professionals encouraging him to reverse course. She called the decisions by three federal judges to block Lee's executive orders in Shelby, Knox and Williamson counties, “critical steps in the right direction."

“As pediatricians and healthcare professionals, our primary mission is to save the lives of children," Kaye said. “Gov. Bill Lee has the power and the responsibility to protect the lives of Tennesseans, especially vulnerable young children who cannot yet be vaccinated. Since he has declined to do so, we are grateful that the courts have heard the concerns of those families whose children are most endangered and protected all children in these school districts. Every child, teacher and employee deserves the freedom to be safe in school, without exceptions."

U.S. District Judge J. Ronnie Greer ruled Friday that Knox County Schools must put a mask mandate in place to protect children with health risks. U.S. District Judge Waverly Crenshaw ruled the same day that Williamson County and Franklin Special school districts would be able to enforce mask mandates without exceptions.

Those decisions came in the wake of a ruling by U.S. District Judge Sheryl Lipman to block Lee's mask opt-out order and issue a preliminary injunction in Shelby County.

Lee declined to comment last week on the pending litigation and also said he isn't sure whether he will renew the executive order when it expires Oct. 5.

The majority of Tennessee school districts opened in early August without universal mask rules, except for Shelby County Schools, Metro Nashville Public Schools and a couple of rural school systems. In the past two weeks, the state has reported nearly 18,000 pediatric cases of COVID-19, and about 33% of cases statewide are found in children.

Gov. Lee said this summer on Fox News that children don't catch COVID-19. He later amended that statement to say the disease doesn't have the same effect on children that it does on older, health-compromised adults.

At least 14 public school employees, including teachers, have died from COVID-19 since the school year began, the Tennessee Lookout previously reported. More than 14,000 people have died from COVID-19 since the pandemic started, according to the Tennessee Department of Health.

Dr. Sarah Cross, Infectious Disease director at Regional One Health in Memphis and a University of Tennessee Health Sciences physician, previously criticized the governor's executive order enabling parents to opt out of school district mask mandates. Now, she's taking aim at his policy prioritizing monoclonal antibodies for unvaccinated people, or those likely to be the sickest from COVID-19 and the Delta variant.

“It's a very difficult situation," Cross said Monday. “On the one hand we are saving lives by giving monoclonal antibodies to the unvaccinated population because they are certainly at the highest risk of dying. On the other hand, we are rewarding them for choosing not to get vaccinated, thus prolonging this pandemic – the worst public health crisis of our time."

Cross pointed out only 52% of the state's residents have received at least one dose of the vaccine. She noted Tennessee has used “a lot" of monoclonal antibodies because of low vaccination rates.

“There is not an unlimited supply of these antibodies, but physicians should be the decision makers on who gets this treatment – not Gov. Lee or Dr. Piercey," Cross said of the state's health commissioner.

Cross is a member of the Governor's Coronavirus Task Force, which hasn't met since summer 2020. Yet she is critical of his executive order on masks, which she contends put people in danger, as well as the directive on monoclonal antibodies.

“Our hospitals and frontline physicians see unvaccinated patients come in every day who are critically ill, filling up our ICUs and stretching the availability of life-saving equipment like ventilators and ECMO units. And this is entirely preventable," Cross said in a statement. “The problem is that Gov. Lee and some radical politicians have made this a political issue from the beginning, seeking to divide us for political gain, instead of treating this pandemic as the health crisis that it is."

When Cross first spoke out about the danger of the Delta variant in mid-August, 11,276 cases of COVID-19 infections had been reported among school-aged children, and 50 were hospitalized. Two died at Le Bonheur Children's Hospital and eight were in the intensive care unit there.

The problem is that Gov. Lee and some radical politicians have made this a political issue from the beginning, seeking to divide us for political gain, instead of treating this pandemic as the health crisis that it is.

– Dr. Sarah Cross, Infectious Disease director at Regional One Health in Memphis

Lee continued to defend his stance last week against mask requirements as well President Joe Biden's vaccine mandate for businesses with more than 100 employees, saying he thinks mandates “counteract" the state's efforts to quell the pandemic.

The governor noted he has encouraged people to be vaccinated, with more than 112,000 getting the shot in the past week. But he declined to be photographed taking the vaccine and said he would not be involved in commercials encouraging people to take the vaccine.

In addition, Lee stood by his administration's directive for monoclonal antibodies to be used on the unvaccinated but gave himself an out on two fronts.

He noted the state is following guidelines set by the National Institutes of Health but said the ultimate decision about who receives monoclonal antibodies lies with clinicians.

“The good news is that the supply we're receiving from the federal government exceeds our demand for it right now and has so for the last several weeks. We believe that will continue because our case counts are dropping and our need for monoclonal antibodies will drop as well as hospitalizations do, or as infections do," Lee told reporters.

Asked why the state is following the guidelines if there is no shortage of monoclonal antibodies, Lee reiterated that the state gives guidelines to clinicians, who make the decision whether to use them.

“So the state has not directed that clinician to follow a guideline. They have given and passed along the National Institutes of Health guidelines."

The number of cases in Tennessee jumped by 5,638 Monday from the previous day, and deaths went up by 85. Hospitalizations, in contrast, dropped by 142 from the previous day, although 2,957 remain in the hospital for COVID-19 treatment.

Testing increased by 30,124 since Sunday with a 15.9% positive rate. More than 9.7 million tests have been taken.

Online Rick Plant

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Re: COVID-19 in America
« Reply #101 on: Today at 12:08:38 AM »
The right wing owned media and GOP politicians are fueling this deadly anti vaccine and mask rhetoric. As a result, they are killing off their own voters in mass numbers at a record pace. 

Republicans warned their self-destructive COVID behavior is 'killing off their voters faster than they think'

When COVID-19 was overwhelming New York City hospitals during the 2020 spring, a silly talking point in right-wing media was that residents of red states didn't need to worry about the pandemic because it only posed a threat to Democratic areas. But COVID-19, just as health experts predicted, found its way to red states in a brutal way. And the current COVID-19 surge is especially severe in red states that have lower vaccination rates. Journalist David Leonhardt, in an article published by the New York Times this week, examines a disturbing pattern: red states where residents are more likely to be anti-vaxxers and more likely to be infected with COVID-19 and die from it.

Leonhardt explains, "A Pew Research Center poll last month found that 86% of Democratic voters had received at least one shot, compared with 60% of Republican voters. The political divide over vaccinations is so large that almost every reliably blue state now has a higher vaccination rate than almost every reliably red state."

According to the Centers for Disease Control and Prevention, 75% of U.S.-based adults have been at least partially vaccinated for COVID-19. But vaccination rates can vary considerably from one state to another. The Mayo Clinic reports that rates for at least partial vaccination range from 77% in Vermont to 49% in Mississippi, 46% in Idaho and 52% in Alabama. Vermont is a deep blue state with a moderate Republican governor, while Mississippi, Idaho and Alabama are deep red states that former President Donald Trump won by a landslide in 2020.

"It's worth remembering that COVID followed a different pattern for more than a year after its arrival in the U.S.," Leonhardt explains. "Despite widespread differences in mask wearing — and scientific research suggesting that masks reduce the virus' spread — the pandemic was, if anything, worse in blue regions. Masks evidently were not powerful enough to overcome other regional differences, like the amount of international travel that flows through major metro areas, which tend to be politically liberal. Vaccination has changed the situation."

Leonhardt continues, "The vaccines are powerful enough to overwhelm other differences between blue and red areas. Some left-leaning communities — like many suburbs of New York, San Francisco and Washington, as well as much of New England — have such high vaccination rates that even the unvaccinated are partly protected by the low number of cases. Conservative communities, on the other hand, have been walloped by the highly contagious Delta variant."

The Times reporter notes that in many other developed countries, the pandemic hasn't been politicized to the degree that it has in the United States.

"What distinguishes the U.S. is a conservative party — the Republican Party — that has grown hostile to science and empirical evidence in recent decades," Leonhardt observes. "A conservative media complex, including Fox News, Sinclair Broadcast Group and various online outlets, echoes and amplifies this hostility. Trump took the conspiratorial thinking to a new level, but he did not create it."

Epidemiologist Eric Feigl-Ding, in a Twitter thread posted over the weekend, argues that Republicans are "killing off" their own voters by promoting anti-vaxxer and anti-masker views:

MISCALCULATION BY GOP—As an epidemiologist, I think Republicans might be killing off their voter base faster than they think. The #COVID19 death rate since June 30 in counties where Trump got >90% of the vote are 9.5x higher than where he got <10%—pretty strong. HT @charles_gaba

2) To be clear, as an epidemiologist, I present this because I am worried for all public health. There are plenty of people of both political parties dying. But clearly there is a strong geographic political skew. People need to vaccinate and mask, or else it will hurt us all.

Feigl-Ding points out that under far-right President Jair Bolsonaro, Brazil — not unlike red states in the U.S.— has suffered high COVID-19 infection rates:

3) This mass death trend in areas voting for authoritarians like Trump is also true in parts of Brazil 🇧🇷 that voted more of Bolsonaro. Not a coincidence conservatives in both US and Brazil are more often anti mask and anti vax.

4.) vaccine rates heavily differ by red vs blue states. This is a main driver for sure. But also anti mask sentiments.

PUERTO RICO is now the most-vaccinated state/territory in the United States!

--Vermont falls to 4th as PR, CT & ME bypass it
--Oregon breaks 60%
--Am. Samoa breaks 50%
--Nevada on verge of 50%
--Louisiana on verge of 45%

Leonhardt notes that the Delta variant has been especially deadly in Republican areas.

"Since Delta began circulating widely in the U.S.," according to Leonhardt, "COVID has exacted a horrific death toll on red America: In counties where Donald Trump received at least 70 percent of the vote, the virus has killed about 47 out of every 100,000 people since the end of June, according to Charles Gaba, a health care analyst. In counties where Trump won less than 32 percent of the vote, the number is about 10 out of 100,000."

Online Richard Smith

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Re: COVID-19 in America
« Reply #102 on: Today at 01:23:42 AM »

Online Rick Plant

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Re: COVID-19 in America
« Reply #103 on: Today at 05:05:26 AM »
Americans are dying because no hospital will take them

During the current delta-driven Covid-19 wave, Americans are being transported hundreds of miles from their homes because no nearby hospital has room for them. Some of them have even died waiting for medical attention.

In other words, US hospitals are being forced — in the middle of a public health emergency — to ration health care for their patients.

Rationing has long been a dirty word in US health policy, used as an attack on any socialized health program that more centrally determines which medical services will be covered and for whom. The US health system has always rationed care through cost: It’s de facto rationing when a patient doesn’t get the medical care they need because they can’t pay out-of-pocket costs or because they live in a rural community without a facility nearby.

“We’re so used to rationing by ability-to-pay in this country that classic capacity rationing feels a bit foreign,” Hannah Neprash, a health economist at the University of Minnesota, said in an email.

The delta variant, more contagious and virulent than its predecessors, and America’s lagging vaccination rates are driving the current crisis.

The states with the worst outbreaks in confirmed cases per capita right now — Tennessee, Kentucky, Alaska, Wyoming, and West Virginia, according to the New York Times’s tracker — have either set new hospitalization records in the last several weeks or are near their previous highs from the winter wave. All of them have vaccination rates below the national average. Throughout the South, hospitals are reporting they have more patients in need of ICU care than ICU beds available, as the Times reported on Tuesday.

America, the richest country in the world, is not supposed to be a place where patients are left at the door to die. Yet that is exactly what’s happening now — 18 months into the pandemic.

The US health system wasn’t built to withstand a pandemic

Many parts of the American health system have struggled to handle the pandemic. The current hospitalization crisis is just the latest iteration of an institutional failure.

The United States still has a lot of unvaccinated people who are fully vulnerable to the delta variant of the novel coronavirus, which is more transmissible and may cause more virulent disease. One in four people over 18 still haven’t received any dose of a Covid-19 vaccine, and younger age cohorts have lower vaccination rates than their elders. As a result, there has been a shift in who’s being hospitalized: People over 65 made up more than half of hospitalizations in December and January; now they are about a third. Children under 12 still are not eligible for the vaccines, and pediatric hospitals are seeing their highest number of Covid-19 patients ever.

But while the demographics of the people being hospitalized may have shifted, the sheer number of people getting severely ill with Covid-19 and ending up in the hospital is almost as high as it has ever been.

Texas, to give one example, has nearly matched its winter peak with more than 14,200 people currently hospitalized with Covid-19. More than 90 percent of the state’s ICU beds are occupied, according to Covid Act Now. In Idaho, with about 88 percent of ICU beds in use, hospitals had to activate what is known as “crisis” standards of care. That gives them more discretion to prioritize the patients most likely to survive for ICU beds and other treatment.

In Bellville, Texas, 46-year-old military veteran Daniel Wilkinson was rushed to the emergency room. He was diagnosed with gallstone pancreatitis, which is treatable but which his local hospital was not equipped to treat, according to KPRC. The doctor called all over the region — to hospitals in Texas, Oklahoma, and Arkansas, among others — but could not find a hospital that would take him. Those states currently have some of the highest Covid-19 hospitalization rates in the country.

An ICU bed was eventually located at a Houston Veterans Administration hospital, more than an hour away from Bellville. But Wilkinson’s organs started failing on the helicopter ride there and he died. It had been more than seven hours since his mother first brought him to the local ER.

There are more stories like Wilkinson’s across the United States. On Monday, the Washington Post reported that a 73-year-old Alabama man died of a cardiac emergency after being turned away from more than 40 hospitals. The closest hospital that would take him was 200 miles away in Mississippi. Alabama is currently experiencing the second-most Covid-19 hospitalizations per capita in the nation.

Hospitals are trying to balance handling a new Covid-19 surge with providing medical care to all of the other patients who need their attention. But that has required them to make some hard choices.

Karen Joynt Maddox, a practicing physician and health policy researcher at Washington University in St. Louis, said her local hospital was instructed during the pandemic not to take patients from small rural facilities unless absolutely medically necessary, which at times has meant rejecting transfer requests made by family members.

The US does not have a lot of hospital beds compared to many other wealthy countries; about 2.9 per 1,000 people compared to the average of 4.6, according to the Peterson-Kaiser Health System Tracker.

There are some good reasons for that: Over the decades, more medical services have been shifted from inpatient to outpatient settings in order to save costs. But that still ended up shrinking the number of hospital beds available in a once-in-a-lifetime emergency.

We wouldn’t necessarily want the US health system to always be flush with excess hospital capacity, some experts contend. It would cost substantial funding to maintain. But even in normal times, urban hospitals will operate at near 100 percent capacity while rural hospitals sit with half their beds open.

“We have beds, just not in the right places,” Joynt Maddox said, “and with no system to try to use the available beds as rationally as possible.”

The current crisis has revealed how disorganized the US health system truly is. American hospitals don’t have a reliable revenue stream, as hospitals do in countries with budgets that pay providers a predictable amount of money every year.

And there is no central authority to help manage the patient load when US hospitals are overwhelmed; Daniel Wilkinson’s doctor made those calls on his own. As NPR reported, local hospital leaders across the country have been left making desperate pleas to other facilities hundreds of miles away.

Other wealthy nations were better equipped to handle their Covid-19 surges

That disorganization is what distinguishes the US from other wealthy countries with different health systems — and arguably contributed to some of these terrible outcomes.

America is not alone in being tested by the coronavirus. Other wealthy nations saw their hospitals strained in the pandemic, especially early on, when countries like Italy endured some of the worst initial coronavirus outbreaks.

But a year and a half into the pandemic, those other countries appear better equipped to handle the load, aided by both higher vaccination rates and more cohesive health systems.

The US is mediocre in terms of hospital capacity, but it’s not at the bottom among its economic peers. Both Canada and the United Kingdom, with government-run health programs for every citizen, actually have slightly fewer hospital beds per capita.

And they neared their limits during the worst waves of the pandemic. The UK’s National Health Service was forced to transfer ICU patients to less congested areas during the fall and winter surges. In Ontario, more than 2,500 patients have been moved to other cities in order to receive lifesaving care. Even in France, which has significantly more hospital beds per capita than the US, more than 100 Covid-19 patients had to be evacuated as Paris hospitals ran low on beds.

These are not quite the same horror stories as we are seeing in the US, however, because there was a stronger level of coordination among the hospitals. In all of these international cases, either the national or local government managed the movement of patients.

No such system exists in the US; it is largely done informally. I spoke with a California hospital executive last summer who had to call a nearby hospital himself, looking for a ventilator when his facility was running low on those lifesaving machines.

Other countries appear to have avoided unnecessary deaths because they have a real system to coordinate care. In Britain, hospitals are currently able to handle more emergency care than the average volume prior to the pandemic, according to recent research by the Nuffield Trust, though elective surgeries are still sometimes being canceled.

“Hospitals have been incredibly stretched but have always been able to offer urgent and emergency care,” Nick Scriven, a UK doctor and past president of the Society of Acute Medicine, told me. “People were not turned away if they needed a hospital bed.”

The pandemic laid bare how disastrously disorganized the US health system is. But that’s always been true. It just usually reveals itself in more subtle ways.

An overwhelmed ER in a downtown urban setting might lead to some patients leaving without being seen. Low staffing at certain times — US hospitals stand out from their international peers because they have more administrative staff and less medical staff — appears to lead to worse outcomes. And then you have the higher out-of-pocket costs borne by Americans, which have been shown to lead to people skipping or postponing necessary medical care.

As Ezra Klein wrote for Vox last year, in covering the UK’s National Health Service, every health system rations care. There are not unlimited resources. But while in the US that rationing occurs in subtle and haphazard ways, other countries have tried to build a more rational system for managing their medical capacity.

That left them better positioned to handle surges of sick patients during the pandemic. America is paying the price for its failure to do the same thing.


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