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Coronavirus pandemic in the US
By Meg Wagner, Mike Hayes and Melissa Macaya, CNN
Nebraska Gov. Pete Ricketts said the state's health care system “remains in very good shape.”
He said 48% of the hospital beds in the state are available, 41% of the beds in intensive care units are available and 76% of the ventilators are currently available.
“So what are we doing something now obviously we want to loosen those restrictions to the point where we're managing a way that preserves a hospital capacity and allows much of a normal return to life as possible,” he said.
Coronavirus killed nearly 40% of critically ill patients treated at two New York City hospitals in the early days of the pandemic, doctors reported Tuesday.
An in-depth look at more than 1,100 patients treated at two Columbia University hospitals showed a high rate of severe illness and death in March, when New York was suffering the worst outbreak in the US.
“As of 28 April 2020, almost 40% of the critically ill patients had died and more than one third remained in hospital. Less than one quarter had been discharged alive,” Dr. Natalie Yip of Columbia University Irving Medical Center and colleagues wrote in the Lancet medical journal.
Yip and colleagues examined the cases of 1,150 adults admitted to Columbia’s two hospitals in northern Manhattan in March. Of them, 257 or 22% were critically ill.
“The majority of critically ill patients were men (67%),” they wrote. While most critically ill patients were on average 62, 1 in 5 were under 50.
“More than 80% of critically ill patients had at least one chronic illness,” they added. More than 60% had high blood pressure and 36% had diabetes. Close to half were obese. These have all been noted in other studies to raise the risk of severe disease.
Most of the critically ill patients, 79%, needed ventilators to breathe and they stayed on those ventilators for an average of 18 days, the team reported. And 31% needed dialysis because of kidney damage.
“This has important implications for resource allocation in hospitals, where access to equipment and specialized staff needed to deliver this level of care is limited,” Dr. Max O’Donnell of Columbia University Irving Medical Center, who led the study team, said in a statement.
While 81% of the patients got either hydroxychloroquine or remdesivir, the study could not show whether either drug helped.
Many of the patients belonged to ethnic minorities. “Specifically, our cohort included a high proportion of Hispanic or Latino and black or African American patients who are known to have higher prevalence of cardiometabolic comorbidities and socioeconomic vulnerabilities that may make social distancing and access to care more difficult,” the team wrote.
Doctors described growing evidence Tuesday that inflammation is causing the severe effects of Covid-19 disease in patients, and said reducing those effects may be key to helping people get better.
Teams across the country are testing a variety of immune-modulating drugs that are often already prescribed to treat conditions such as rheumatoid arthritis and cancer, Dr. Vincent Marconi of the Emory University School of Medicine told a briefing organized by the Centers for Disease Control and Prevention.
Marconi described more than a dozen drugs, most of them monoclonal antibodies, that are being tried out in severely ill Covid-19 patients. Various drugs attack inflammation from different angles and might tamp down the so-called cytokine storm that appears to be causing the worst damage in advanced patients, Marconi said. They include sarilumab, sold under the brand name Kevzara, to treat rheumatoid arthritis; adalimumab, or Humira, also a rheumatoid arthritis drug; siltuximab, or Sylvant, used to treat cancer; and others.
He said a three-stage process takes patients from mild disease to extreme symptoms that affect the whole body, and said inflammation underlies the most serious stage.
Many people infected with Covid-19 may not have any symptoms at all, and most have mild symptoms. Marconi said the mild stage has common symptoms, including a dry cough, fever and a headache. “The vast majority of individuals will recover at this point and will not progress to the pulmonary phase,” he said. That second phase is marked by lung inflammation and trouble breathing.
After that, patients can get worse quickly.
“At this point, patients tend to progress very rapidly to a hyperinflammatory stage,” Marconi said.
That’s when doctors see symptoms of shock, acute respiratory distress syndrome, and the “terrible” clotting problems that cause organ damage, blockages and strokes.
The Department of Homeland Security inspector general is undertaking two new investigations into the department's response to the coronavirus outbreak due to concerns that federal agencies mismanaged the pandemic.
The government watchdog is examining management of the Covid-19 response at Customs and Border Protection and Immigration and Customs Enforcement facilities, related to detainees in their custody and to the staff, according to the inspector general.
This coronavirus-related investigation — as well as one into the Federal Emergency Management Agency, a component of DHS — are listed as "new" on the inspector general's list of ongoing investigations.
Some background: In April, a group of 26 senators called for the inspector general to immediately review concerns over conditions in ICE detention facilities, asking for site visits to determine whether the facilities were sufficiently addressing the threat of Covid-19 to migrants and staff.
"Not only are detainees at higher risk because they are in such close proximity to others, people in detention and incarceration are more likely to have other preexisting health conditions, which places them at even higher risk for mortality from the virus," the senators wrote in a letter to the inspector general.
DHS and CBP did not immediately respond to CNN's request for comment.
At the time of the letter, 360 detainees, 35 ICE employees at detention facilities and 89 ICE employees not assigned to detention facilities, tested positive for Covid-19, according to the senators, who wrote that some contract employees also died of the virus.
As of this month, more than 1,000 immigrants in ICE custody have tested positive for coronavirus, according to the agency's latest statistics, and the number of cases in custody has gradually climbed in recent weeks. ICE has said that it's working to release detainees it deems are vulnerable to the virus.
Along the border, customs officials and the US Border Patrol have turned away asylum seekers and denied entry to migrants who illegally cross the border, citing a risk of coronavirus spread in its detention facilities.
Testing for Covid-19 is a “critical” part of Missouri’s economic recovery, Gov. Mike Parson said Tuesday.
“As we move forward, testing will be critical to Missouri’s full economic recovery and giving Missourians more confidence. We have the testing capacity, and now we must find ways to use that capacity to test as many people as we can,” Parson said. “Once our testing numbers are up, we can really start to ramp up our focus on the economy.”
The state has tested 158,296 people for Covid-19 since March 7. According to a statement from the state, approximately 90% of these tests have been negative.
Parson said an increase in tests likely means an increase in the number of positive cases in the state.
“By increasing testing, we can continue to slow the spread by identifying positive patients and isolating them as quickly as possible,” he said.
Montana will increase the number of people allowed in restaurants and gyms on June 1, as the state begins its next reopening phase.
“The first gradual phase of our reopening gave us the time that we needed,” Gov. Steve Bullock said in a press conference Tuesday.
Starting next month:
- Dine-in restaurants and bars will be able to accommodate up to 75% of their normal capacity.
- Gyms and pools also can operate at 75% capacity.
- Bowling alleys, and other places of assembly, may operate with reduced capacity, and if they adhere to strict physical distancing guidelines.
- People are discouraged from having gatherings larger than 50 people unless they coordinate their plans with their local health department.
The governor is also canceling the 14-day quarantine that is currently required of people traveling to Montana from out-of-state as of June 1.
Arkansas Gov. Asa Hutchinson announced Tuesday that the state plans to test every nursing home resident and staff starting next month.
"Beginning June 1, our goal is to test every nursing home resident and staff person in a nursing home facility in Arkansas," Hutchinson said in a news conference. "This will result in approximately 40,000 to 50,000 new tests."
Arkansas Executive Director of Health Rachel Bunch said private labs and the Health Department are also working together on the appropriate plan for statewide testing.
"Our state has taken a proactive approach to testing and long-term care that is different than many other states. Anytime we have a positive worker or resident, we test the entire building, not waiting for other people to become symptomatic," Bunch said. "This approach has allowed us to identify positive asymptomatic workers and patients early so that we can move patients to areas that are unaffected and send those workers home until they get well."
Kentucky Gov. Andy Beshear announced today that certain educational and cultural activities will be allowed to resume starting June 8.
- Outdoor attractions
Beshear said the state is still working on the specific guidance for these reopenings, but noted that there will be capacity limitations everywhere.
In places like distilleries, there will also be sub-limitations like there are in restaurants.
Right now, restaurants have overall capacity limitations, as well as limitations to the size of each party, being 10 persons and under. Beshear said tours, for instance, will follow the same guidelines.