Corona Virus Covid 19

citymonk

Super User
Went to his office, talked about my problem, got the paperwork done, and signed it today. Both wore our masks but that is about it
My Cousin is Heart Specialist in US and around week back he and his whole team of 14 was tested positive after a Patient they were operating turned out covid positive later. He is under home isolation nowdays, with very mild symptoms without any fever. Couple of days back he was declared non contagious and was told he can even join normal duties by 26 November.

Who is contagious and who not is very confusing too and uptil when one remains contagious is hidden from public.
 

Big Daddy

Super User
My Cousin is Heart Specialist in US and around week back he and his whole team of 14 was tested positive after a Patient they were operating turned out covid positive later. He is under home isolation nowdays, with very mild symptoms without any fever. Couple of days back he was declared non contagious and was told he can even join normal duties by 26 November.
Here is the FACT that everyone needs to know that this virus is not going away ever. The vaccines that have over 90% protection rate (Pfizer/Moderna) need to kept under -70 degrees Celcius temperature all the time. This means most developing countries cannot afford such a vaccine. The other vaccine that can be afforded (Oxford-AstraZeneca) is only 70% effective and will miss 30% of people from getting the disease. Mathematically, the virus cannot be eradicated.

When we have this fact then why are we trying to stop people from traveling and messing up the economy? This virus will have to be tolerated like the flu virus.
 

citymonk

Super User
Here is the FACT that everyone needs to know that this virus is not going away ever. The vaccines that have over 90% protection rate (Pfizer/Moderna) need to kept under -70 degrees Celcius temperature all the time. This means most developing countries cannot afford such a vaccine. The other vaccine that can be afforded (Oxford-AstraZeneca) is only 70% effective and will miss 30% of people from getting the disease. Mathematically, the virus cannot be eradicated.

When we have this fact then why are we trying to stop people from traveling and messing up the economy? This virus will have to be tolerated like the flu virus.
People are afraid of this as they are seeing people dying around them in abnormal way and this never happened before with flu viruses.

And Fear is factor wich runs pharmaceutical companies.
 

Big Daddy

Super User
People are afraid of this as they are seeing people dying around them in abnormal way and this never happened before with flu viruses.

And Fear is factor wich runs pharmaceutical companies.
People in India are always afraid. I never saw any person in the USA who is scared of this virus. This is why Fauchi keeps coming on TV to try to scare people. People in the US government are into fear-mongering and exercising their power.

I would still say that the average death rate is way less than 1%. The risk of death increases with increasing age. So overall death rate may become high when you have old people dying at higher rates, but for an average age person, the age-adjusted death rate is way below 1%.

The problem with India may be that every death may be either suspected or wrongly assigned as Covid-19 death. You would normally expect people in a rich country running scared, but what I see is exactly the opposite. America never completely shut down. NY state shuts down once in a while, but most of America keeps going despite being the leader in Covid-19 cases and deaths.
 

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Pollution played key role in high severity of third wave of COVID-19 in Delhi: Kejriwal to PM
Delhi recorded 4,454 fresh COVID-19 cases and a positivity rate of 11.94 per cent on Monday, while 121 more fatalities pushed the death toll due to the disease to 8,512 in the city.

Published: 24th November 2020 12:38 PM | Last Updated: 24th November 2020 12:38 PM



President house is seen under smog conditions in New Delhi on Monday. (Photo | Shekhar Yadav/EPS)
By PTI


NEW DELHI:
At a meeting with Prime Minister Narendra Modi, Delhi Chief Minister Arvind Kejriwal on Tuesday said the high severity of the third wave of COVID-19 in the national capital is due to many factors, pollution being an important one, sources said.
Kejriwal told the prime minister that Delhi saw the peak of 8,600 coronavirus cases on November 10 during the third wave and since then, the number of cases as well as the positivity rate are steadily decreasing, the sources said.
The chief minister hoped that the trend would continue in the national capital.
"The high severity of the third wave is due to many factors. Pollution is an important factor. The chief minister sought the prime minister's intervention to get rid of the pollution caused by stubble-burning in adjoining states, especially in view of the recent bio-decomposer technique," a source said.
At the meeting with the prime minister, Kejriwal also sought the reservation of the additional 1,000 ICU beds in the central government-run hospitals in Delhi for coronavirus patients till the third wave of the infection lasts in the city, the source said.
Modi on Tuesday interacted via video-conferencing with the chief ministers of the states that are witnessing a surge in the number of coronavirus cases to review the pandemic situation.
Delhi recorded 4,454 fresh COVID-19 cases and a positivity rate of 11.94 per cent on Monday, while 121 more fatalities pushed the death toll due to the disease to 8,512 in the city.
This was the sixth time in 12 days that the daily number of deaths crossed the 100-mark in the national capital.
Authorities reported 121 deaths due to COVID-19 on Sunday, 111 on Saturday, 118 on Friday, 131 on November 18, the highest till date, and 104 on November 12.



Pollution played key role in high severity of third wave of COVID-19 in Delhi: Kejriwal to PM
 

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Congress Veteran Ahmed Patel Dies at 71 After Battling Covid
Congress veteran Ahmed Patel passes away: The politician had been in a Gurgaon hospital since his health worsened after a Covid infection.

All India
Reported by Sunil Prabhu, Edited by Shylaja Varma
Updated: November 25, 2020 11:11 am IST



Video | Congress Veteran Ahmed Patel Dies at 71 After Battling Covid


1606285395781.png

Senior Congress leader Ahmed Patel died at 3.30 am. (File)





Gurgaon:
Senior Congress leader Ahmed Patel, one of Sonia Gandhi's closest political advisers, died at a Gurgaon hospital this morning. He was 71. The veteran politician had been at Medanta Hospital since his health worsened after a Covid infection. In a tweet at around 4 am, his son, Faisal Patel, said that the Rajya Sabha MP from Gujarat died at 3.30 am
"With profound grief & sorrow, I regret to announce the sad and untimely demise of my father, Mr. Ahmed Patel at 25/11/2020, 03:30 AM. After testing positive for COVID-19 around a month back, his health worsened further due to multiple organ failures. May Allah grant him Jannatul firdaus, inshallah," he tweeted, requesting all their well-wishers to adhere to the COVID-19 regulations by avoiding mass gatherings.
"...also maintain social distancing norms at all times," Faisal Patel said in the statement.

Messages of condolences and tributes poured in soon after the announcement of Mr Patel's death.
Mourning the death of Mr Patel, Congress chief Sonia Gandhi said she has lost an "irreplaceable comrade, a faithful colleague and a friend". "I have lost a colleague, whose entire life was dedicated to the Congress party," Mrs Gandhi said.
Prime Minister Narendra Modi remembered the seasoned politician, saying "his role in strengthening the Congress Party would always be remembered".
"Saddened by the demise of Ahmed Patel Ji. He spent years in public life, serving society. Known for his sharp mind, his role in strengthening the Congress Party would always be remembered. Spoke to his son Faisal and expressed condolences. May Ahmed Bhai's soul rest in peace," PM Modi tweeted.

Top Congress leader Rahul Gandhi called Mr Patel a "pillar of the Congress party". "He lived and breathed Congress and stood with the party through its most difficult times. He was a tremendous asset. We will miss him. My love and condolences to Faisal, Mumtaz & the family," Mr Gandhi tweeted.

On October 1, Mr Patel, while disclosing that he was tested positive for coronavirus, had urged all those who came in contact with him in past few days to undergo self-isolation.
Ahmed Patel is the second senior Congress leader to have died due to Covid-related complications, as his death comes two days after former Assam Chief Minister Tarun Gogoi died in Guwahati.

Congress Veteran Ahmed Patel Dies at 71 After Battling Covid
 

cat

Senior Billi
I do not understand do Dead bodies spread it too. If not touched can it infect others.
I have seen dead bodies of even non covid persons being burned with masks .
Covid positve dead bodies are not given to relatives and are cremated by Hospital itself.

Lot of information is missing in links.
They touch.
However, the main point is the people gather in confined space, in the house, they may stay overnight, they wait for people to come from far, then they gather and hug each other at the funeral service.
That last is standard precaution with infectious diseases. Hospitals do not do cremation. Only incineration of materials and body parts etc. removed in surgery.
The virus particles remain infectious/alive for time period depending on the surface and exposure to other substances. (e.g. solvents/alcohol/soap/UV rays.)

And however [to first post]...I get your point, though. It is natural to think one is safe - or safer - at a remote small village. But here is an example of how it is not so simple.

There is one problem, and it is basically the same thing as how the virus first enters a country, or a region - it is brought in. And it is the way this virus spreads, the way infection happens - it takes just one person...and lack of precautions. It spreads to the community, the local community, the community of workplace, and so on. It spreads exponentially, that is why one important analysis of data shows how many people get infected by each infected person. It is one of the determinants used in deciding on lockdown measures.

 

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Night Curfew In Punjab Cities From Dec 1-15 Over 2nd Covid Wave Worry
Coronavirus: Punjab imposes night curfew from 10 pm-5 am in all cities, towns from December 1 to 15; doubles fine for not wearing masks and social distancing.
All India
Reported by Mohammed Ghazali, Edited by Nandini Gupta
Updated: November 25, 2020 4:15 pm IST


New Delhi:
Amid the grim Covid situation in Delhi and its neighbouring districts, and apprehensions of a second wave in Punjab, Chief Minister Captain Amarinder Singh on Wednesday ordered a series of fresh restrictions, including night curfew. He has also told private hospitals to take stock of bed availability amid patient inflow from Delhi, and immediately appoint more doctors and nurses to meet future needs.
Punjab has re-imposed night curfew between 10 pm and 5 am in all its cities and towns starting December 1. "Hotels, restaurants and marriage venues will shut down at 9.30 pm," Mr Singh said.
With this, Punjab has become the sixth state to impose a night curfew because of a fresh infection spike after Rajasthan, Himachal Pradesh, Gujarat, Chhattisgarh and Madhya Pradesh.
The fine for not wearing masks and social distancing in public places has also been doubled to ₹ 1,000, a government spokesperson said after a high-level state Covid review meeting.
All curbs would be reviewed on December 15.
In view of "inflow of patients from Delhi for treatment", Chief Secretary Vini Mahajan has been directed to work towards optimising bed-availability, including those with oxygen and in ICUs, in private hospitals, an official statement read. The state has also asked more private hospitals to earmark beds for Covid care.
Emergency appointment of specialists, super-specialists, nurses and paramedics has been ordered in addition to the recent recruitment of 249 doctors and 407 medical officers.
As back-up workforce, the Health and Medical Education department has been told to consider preparing 4th and 5th year MBBS students.


Night Curfew In Punjab Cities From Dec 1-15 Over 2nd Covid Wave Worry
 
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2 Companies Say Their Vaccines Are 95% Effective. What Does That Mean?
You might assume that 95 out of every 100 people vaccinated will be protected from Covid-19. But that’s not how the math works.





Experts say it’s easy to misconstrue early results because the language vaccine researchers use to talk about their trials can be hard for outsiders to understand.Credit...EPA, via Shutterstock

Carl Zimmer
By Carl Zimmer
  • Nov. 20, 2020
The front-runners in the vaccine race seem to be working far better than anyone expected: Pfizer and BioNTech announced this week that their vaccine had an efficacy rate of 95 percent. Moderna put the figure for its vaccine at 94.5 percent. In Russia, the makers of the Sputnik vaccine claimed their efficacy rate was over 90 percent.
“These are game changers,” said Dr. Gregory Poland, a vaccine researcher at the Mayo Clinic. “We were all expecting 50 to 70 percent.” Indeed, the Food and Drug Administration had said it would consider granting emergency approval for vaccines that showed just 50 percent efficacy.
From the headlines, you might well assume that these vaccines — which some people may receive in a matter of weeks — will protect 95 out of 100 people who get them. But that’s not actually what the trials have shown. Exactly how the vaccines perform out in the real world will depend on a lot of factors we just don’t have answers to yet — such as whether vaccinated people can get asymptomatic infections and how many people will get vaccinated.
Here’s what you need to know about the actual effectiveness of these vaccines.

What do the companies mean when they say their vaccines are 95 percent effective?
The fundamental logic behind today’s vaccine trials was worked out by statisticians over a century ago. Researchers vaccinate some people and give a placebo to others. They then wait for participants to get sick and look at how many of the illnesses came from each group.

In the case of Pfizer, for example, the company recruited 43,661 volunteers and waited for 170 people to come down with symptoms of Covid-19 and then get a positive test. Out of these 170, 162 had received a placebo shot, and just eight had received the real vaccine.
From these numbers, Pfizer’s researchers calculated the fraction of volunteers in each group who got sick. Both fractions were small, but the fraction of unvaccinated volunteers who got sick was much bigger than the fraction of vaccinated ones. The scientists then determined the relative difference between those two fractions. Scientists express that difference with a value they call efficacy. If there’s no difference between the vaccine and placebo groups, the efficacy is zero. If none of the sick people had been vaccinated, the efficacy is 100 percent.

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A 95 percent efficacy is certainly compelling evidence that a vaccine works well. But that number doesn’t tell you what your chances are of becoming sick if you get vaccinated. And on its own, it also doesn’t say how well the vaccine will bring down Covid-19 across the United States.

Coronavirus Briefing: An informed guide to the global outbreak, with the latest developments and expert advice.


What’s the difference between efficacy and effectiveness?
Efficacy and effectiveness are related to each other, but they’re not the same thing. And vaccine experts say it’s crucial not to mix them up. Efficacy is just a measurement made during a clinical trial. “Effectiveness is how well the vaccine works out in the real world,” said Naor Bar-Zeev, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
It’s possible that the effectiveness of coronavirus vaccines will match their impressive efficacy in clinical trials. But if previous vaccines are any guide, effectiveness may prove somewhat lower.

The mismatch comes about because the people who join clinical trials are not a perfect reflection of the population at large. Out in the real world, people may have a host of chronic health problems that could interfere with a vaccine’s protection, for example.
The Centers for Disease Control and Prevention has a long history of following the effectiveness of vaccines after they’re approved. On Thursday, the agency posted information on its website about its plans to study the effectiveness of coronavirus vaccines. It will find opportunities to compare the health of vaccinated people to others in their communities who have not received a vaccine.

What exactly are these vaccines effective at doing?
The clinical trials run by Pfizer and other companies were specifically designed to see whether vaccines protect people from getting sick from Covid-19. If volunteers developed symptoms like a fever or cough, they were then tested for the coronavirus.
But there’s abundant evidence that people can get infected with the coronavirus without ever showing symptoms. And so it’s possible that a number of people who got vaccinated in the clinical trials got infected, too, without ever realizing it. If those cases indeed exist, none of them are reflected in the 95 percent efficacy rate.

The Road to a Coronavirus Vaccine
Words to Know About Vaccines
Confused by the all technical terms used to describe how vaccines work and are investigated? Let us help:
    • Adverse event: A health problem that crops up in volunteers in a clinical trial of a vaccine or a drug. An adverse event isn’t always caused by the treatment tested in the trial.
    • Antibody: A protein produced by the immune system that can attach to a pathogen such as the coronavirus and stop it from infecting cells.
    • Approval, licensure and emergency use authorization: Drugs, vaccines and medical devices cannot be sold in the United States without gaining approval from the Food and Drug Administration, also known as licensure. After a company submits the results of clinical trials to the F.D.A. for consideration, the agency decides whether the product is safe and effective, a process that generally takes many months. If the country is facing an emergency — like a pandemic — a company may apply instead for an emergency use authorization, which can be granted considerably faster.
    • Background rate: How often a health problem, known as an adverse event, arises in the general population. To determine if a vaccine or a drug is safe, researchers compare the rate of adverse events in a trial to the background rate.
    • Efficacy: A measurement of how effective a treatment was in a clinical trial. To test a coronavirus vaccine, for instance, researchers compare how many people in the vaccinated and placebo groups get Covid-19. The real-world effectiveness of a vaccine may turn out to be different from its efficacy in a trial.
    • Phase 1, 2, and 3 trials: Clinical trials typically take place in three stages. Phase 1 trials usually involve a few dozen people and are designed to observe whether a vaccine or drug is safe. Phase 2 trials, involving hundreds of people, allow researchers to try out different doses and gather more measurements about the vaccine’s effects on the immune system. Phase 3 trials, involving thousands or tens of thousands of volunteers, determine the safety and efficacy of the vaccine or drug by waiting to see how many people are protected from the disease it’s designed to fight.
    • Placebo: A substance that has no therapeutic effect, often used in a clinical trial. To see if a vaccine can prevent Covid-19, for example, researchers may inject the vaccine into half of their volunteers, while the other half get a placebo of salt water. They can then compare how many people in each group get infected.
    • Post-market surveillance: The monitoring that takes place after a vaccine or drug has been approved and is regularly prescribed by doctors. This surveillance typically confirms that the treatment is safe. On rare occasions, it detects side effects in certain groups of people that were missed during clinical trials.
    • Preclinical research: Studies that take place before the start of a clinical trial, typically involving experiments where a treatment is tested on cells or in animals.
    • Viral vector vaccines: A type of vaccine that uses a harmless virus to chauffeur immune-system-stimulating ingredients into the human body. Viral vectors are used in several experimental Covid-19 vaccines, including those developed by AstraZeneca and Johnson & Johnson. Both of these companies are using a common cold virus called an adenovirus as their vector. The adenovirus carries coronavirus genes.
    • Trial protocol: A series of procedures to be carried out during a clinical trial.



People who are asymptomatic can still spread the virus to others. Some studies suggest that they produce fewer viruses, making them less of a threat than infected people who go on to develop symptoms. But if people get vaccinated and then stop wearing masks and taking other safety measures, their chances of spreading the coronavirus to others could increase.
“You could get this paradoxical situation of things getting worse,” said Dr. Bar-Zeev.

Will these vaccines put a dent in the epidemic?
Vaccines don’t protect only the people who get them. Because they slow the spread of the virus, they can, over time, also drive down new infection rates and protect society as a whole.
Scientists call this broad form of effectiveness a vaccine’s impact. The smallpox vaccine had the greatest impact of all, driving the virus into oblivion in the 1970s. But even a vaccine with extremely high efficacy in clinical trials will have a small impact if only a few people end up getting it.

“Vaccines don’t save lives,” said A. David Paltiel, a professor at the Yale School of Public Health. “Vaccination programs save lives.”
On Thursday, Dr. Paltiel and his colleagues published a study in the journal Health Affairs in which they simulated the coming rollout of coronavirus vaccines. They modeled vaccines with efficacy rates ranging from high to low, but also considered how quickly and widely a vaccine could be distributed as the pandemic continues to rage.
The results, Dr. Paltiel said, were heartbreaking. He and his colleagues found that when it comes to cutting down on infections, hospitalizations and deaths, the deployment mattered just as much as the efficacy. The study left Dr. Paltiel worried that the United States has not done enough to prepare for the massive distribution of the vaccine in the months to come.
“Time is really running out,” he warned. “Infrastructure is going to contribute at least as much, if not more, than the vaccine itself to the success of the program.”

Carl Zimmer writes the “Matter” column. He is the author of thirteen books, including “She Has Her Mother's Laugh: The Powers, Perversions, and Potential of Heredity.” @carlzimmerFacebook
A version of this article appears in print on Nov. 21, 2020, Section A, Page 10 of the New York edition with the headline: What Does It Mean if 2 Companies Report 95% Efficacy Rates?. Order Reprints | Today’s Paper | Subscribe


2 Companies Say Their Vaccines Are 95% Effective. What Does That Mean?
 

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Hospitals Know What’s Coming

“We are on an absolutely catastrophic path,” said a COVID-19 doctor at America’s best-prepared hospital.

Ed Yong
November 20, 2020

A yellow warning sign hangs above a gurney.


Getty / The Atlantic


Editor’s Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.
Perhaps no hospital in the United States was better prepared for a pandemic than the University of Nebraska Medical Center in Omaha.
After the SARS outbreak of 2003, its staff began specifically preparing for emerging infections. The center has the nation’s only federal quarantine facility and its largest biocontainment unit, which cared for airlifted Ebola patients in 2014. The people on staff had detailed pandemic plans. They ran drills. Ron Klain, who was President Barack Obama’s “Ebola czar” and will be Joe Biden’s chief of staff in the White House, once told me that UNMC is “arguably the best in the country” at handling dangerous and unusual diseases. There’s a reason many of the Americans who were airlifted from the Diamond Princess cruise ship in February were sent to UNMC.


In the past two weeks, the hospital had to convert an entire building into a COVID-19 tower, from the top down. It now has 10 COVID-19 units, each taking up an entire hospital floor. Three of the units provide intensive care to the very sickest people, several of whom die every day. One unit solely provides “comfort care” to COVID-19 patients who are certain to die. “We’ve never had to do anything like this,” Angela Hewlett, the infectious-disease specialist who directs the hospital’s COVID-19 team, told me. “We are on an absolutely catastrophic path.”

To hear such talk from someone at UNMC, the best-prepared of America’s hospitals, should shake the entire nation. In mid-March, when just 18 Nebraskans had tested positive for COVID-19, Shelly Schwedhelm, the head of the hospital’s emergency-preparedness program, sounded gently confident. Or, at least, she told me: “I’m confident in having a plan.” She hoped the hospital wouldn’t hit capacity, “because people will have done the right thing by staying home,” she said. And people did: For a while, the U.S. flattened the curve.

But now about 2,400 Nebraskans are testing positive for COVID-19 every day—a rate five times higher than in the spring. More than 20 percent of tests are coming back positive, and up to 70 percent in some rural counties—signs that many infections aren’t being detected. The number of people who’ve been hospitalized with the disease has tripled in just six weeks. UNMC is fuller with COVID-19 patients—and patients, full stop—than it has ever been. “We’re watching a system breaking in front of us and we’re helpless to stop it,” says Kelly Cawcutt, an infectious-disease and critical-care physician.


Cawcutt knows what’s coming. Throughout the pandemic, hospitalizations have lagged behind cases by about 12 days. Over the past 12 days, the total number of confirmed cases in Nebraska has risen from 82,400 to 109,280. That rise represents a wave of patients that will slam into already beleaguered hospitals between now and Thanksgiving. “I don’t see how we avoid becoming overwhelmed,” says Dan Johnson, a critical-care doctor. People need to know that “the assumption we will always have a hospital bed for them is a false one.”

What makes this “nightmare” worse, he adds, “is that it was preventable.” The coronavirus is not unstoppable, as some have suggested and as New Zealand, Iceland, Australia, and Hong Kong have resoundingly disproved—twice. Instead, the Trump administration never mounted a serious effort to stop it. Whether through gross incompetence or deliberate strategy, the president and his advisers left the virus to run amok, allowed Americans to get sick, and punted the consequences to the health-care system. And they did so repeatedly, even after the ordeal of the spring, after the playbook for controlling the virus became clear, and despite months of warnings about a fall surge.
Not even the best-prepared hospital can compensate for an unchecked pandemic. UNMC’s preparations didn’t fail so much as the U.S. created a situation in which hospitals could not possibly succeed. “We can prepare over and over for a wave of patients,” says Cawcutt, “but we can’t prepare for a tsunami.”
A full hospital means that everyone waits. COVID-19 patients who are going downhill must wait to enter a packed intensive-care unit. Patients who cannot breathe must wait for the many minutes it takes for a nurse elsewhere in the hospital to remove cumbersome protective gear, run over, and don the gear again. On Tuesday, one rapidly deteriorating patient needed to be intubated, but the assembled doctors had to wait, because the anesthesiologists were all busy intubating four other patients in an ICU and a few more in an emergency room.


None of the people I spoke with would predict when UNMC will finally hit its capacity ceiling, partly because they’re doing everything to avoid that scenario, and partly because it’s so grim as to be almost unthinkable. But “we’re rapidly approaching that point,” Hewlett said.
When it arrives, people with COVID-19 will die not just because of the virus, but because the hospital will have nowhere to put them and no one to help them. Doctors will have to decide who to put on a ventilator or a dialysis machine. They’ll have to choose whether to abandon entire groups of patients who can’t get help elsewhere. While cities like New York and Boston have many big hospitals that can care for advanced strokes, failing hearts that need mechanical support, and transplanted organs, “in this region, we’re it,” Johnson says. “We provide care that can’t be provided at any other hospital for a 200-mile radius. We’re going to need to decide if we continue to offer that care, or if we admit every single COVID-19 patient who comes through our door.”

Read: How many Americans are about to die?
During the spring, most of UNMC’s COVID-19 patients were either elderly people from nursing homes or workers in meatpacking plants and factories. But with the third national surge, “all the trends have gone out the window,” Sarah Swistak, a staff nurse, told me. “From the 90-year-old with every comorbidity listed to the 30-year-old who is the picture of perfect health, they’re all requiring oxygen because they’re so short of breath.”
This lack of pattern is a pattern in itself, and suggests that there’s no single explanation for the current surge. Nebraska reopened too early, “when we didn’t have enough control, and in the absence of a mask mandate,” Cawcutt says. Pandemic fatigue set in. Weddings that were postponed from the spring took place in the fall. Customers packed into indoor spaces, like bars and restaurants, where the virus most easily finds new hosts. Colleges resumed in-person classes. UNMC is struggling not because of any one super-spreading event, but because of the cumulative toll of millions of bad decisions.

When the hospital first faced the pandemic in the spring, “I was buoyed by the realization that everyone in America was doing their part to slow down the spread,” Johnson says. “Now I know friends of mine are going about their normal lives, having parties and dinners, and playing sports indoors. It’s very difficult to do this work when we know so many people are not doing their part.” The drive home from the packed hospital takes him past rows of packed restaurants, sporting venues, and parking lots.
To a degree, Johnson sympathizes. “I don’t think people in Omaha thought we could ever have something that resembles New York,” he told me. “To be honest, in the spring, I would have thought it extremely unlikely.” But he adds that the Midwest has taken entirely the wrong lesson from the Northeast’s ordeal. Instead of learning that the pandemic is controllable, and that physical distancing works, people instead internalized “a mistaken belief that every curve that goes up must come down,” he said. “What they don’t realize is that if we don’t change anything about how we’re conducting ourselves, the curve can go up and up.”


Speaking on Tuesday afternoon, Nebraska Governor Pete Ricketts once again refused to issue a statewide mask mandate. He promised to tighten restrictions once a quarter of the state’s beds are filled with COVID-19 patients, but even then, some restaurants will still offer indoor dining; gyms and churches will remain open; and groups of 10 people will still be able to gather in enclosed spaces. Ricketts urged Nebraskans to avoid close contact, confined areas, and crowds, but his policies nullify his pleas. “People have the mistaken belief that if the government allows them to do something, it is safe to do,” Johnson said.
Read: The pandemic safety rule that really matters
There are signs that citizens and businesses are acting ahead of policy makers. Some restaurants are ceasing indoor dining even without a prohibition. Parents are pulling their children out of schools and sports leagues. “I have heard from more friends and family about COVID-19 in the last two weeks than I have in the previous six months, expressing support and a change in attitudes,” Johnson said.

But COVID-19 works slowly. It takes several days for infected people to show symptoms, a dozen more for newly diagnosed cases to wend their way to hospitals, and even more for the sickest of patients to die. These lags mean that the pandemic’s near-term future is always set, baked in by the choices of the past. It means that Ricketts is already too late to stop whatever UNMC will face in the coming weeks (but not too late to spare the hospital further grief next month). It means that some of the people who get infected over Thanksgiving will struggle to enter packed hospitals by the middle of December, and be in the ground by Christmas.
Officially, Nebraska has 4,223 hospital beds, of which 1,165—27 percent—are still available. But that figure is deceptive. It includes beds for labor and deliveries, as well as pediatric beds that cannot be repurposed. It also says nothing about how stretched hospitals have already become in their efforts to create capacity. UNMC has postponed elective surgeries—those which could be deferred for four to 12 weeks. Patients with strokes and other urgent traumas aren’t getting the normal level of attention, because the pandemic is so all-consuming. Clinical research has stopped because research nurses are now COVID-19 nurses. The hospital is forced to turn down many requests to take in patients from rural hospitals and neighboring states that are themselves almost out of beds.

Empty hospital beds might as well be hotel beds without doctors and nurses to staff them. And though health-care workers are resilient, “many of us feel like we haven’t had a day off since this thing began,” Hewlett says. The current surge is pushing them to the limit because people with COVID-19 are far sicker than the average patient. In an ICU, they need twice as much attention for three times the usual stay. To care for them, UNMC’s nurses and respiratory therapists are now doing mandatory overtime. The hospital has tried to hire travel nurses, but with the entire country calling for help, the pool of reinforcements is dry. “Even before COVID-19 hit, we were short-staffed,” says Becky Long, a lead nurse on a COVID ICU floor. Of late, there have been days when the hospital had 45 to 60 fewer nurses than it needed. “Every time I’ve been at work, I’ve thought: This is going to be the final straw. But somehow we continue to make it work, and I truly have no idea how.”

Before COVID-19, Long worked in oncology. Death is no stranger to her, but she tells me she can barely comprehend the amount she has seen in recent weeks. “I used to be able to leave work at work, but with the pandemic, it follows me everywhere I go,” she said. “It’s all I see when I come home, when I look at my kids.”
Long and other nurses have told many families that they can’t see their dying loved ones, and then sat with those patients so they didn’t have to die alone. Lindsay Ivener, a staff nurse, told me that COVID-19 had recently killed an elderly woman whom she was caring for, the woman’s husband, and one of her grandchildren. A second grandchild had just been admitted to the hospital with COVID-19. “It just tore this whole family apart in a month,” Ivener said. “I couldn’t even cry. I didn’t have the energy.”
Until recently, Ivener worked in corporate America as a retail buyer and inventory manager. Wanting to help people, she retrained as a nurse and graduated this May. “I’ve only worked as a nurse during a pandemic,” she told me. “It’s got to get better, right?”



Ed Yong
is a staff writer at The Atlantic, where he covers science.


Hospitals Know What’s Coming
 
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