The Morning Jolt

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Some Good News from the Nation’s Hospitals

A medical worker makes a phone call at Maimonides Medical Center during the outbreak of the coronavirus in Brooklyn, N.Y., April 14, 2020. (Caitlin Ochs/Reuters)

The traditional tax day is almost here, but this year, the Internal Revenue Service is allowing Americans to file until July 15. You can also defer federal income tax payments due on April 15, 2020, to July 15, 2020, without penalties and interest, regardless of the amount owed. But if you’re getting a refund, you’ll want to file as soon as possible.

On the menu today: A look at hospitals in our worst-hit cities . . . and some pretty good news.

Tentative but Extremely Promising News in the Nation’s Hospitals

Let’s begin today with the best possible news: As of this writing, it appears that the vast majority, if not all, of the states and localities in the United States have expanded their hospital capacity in excess of what is current expected to be needed for the coronavirus outbreak. Reuters offers this surprising figure: “New York, which ramped up its hospital bed capacity to around 90,000, has had only about 18,000 patients hospitalized for the past several days.”

Before everyone jumps on the “ah-HA! This outbreak wasn’t as those eggheads said it was going to be” train, keep in mind that the death toll in New York state is now beyond 10,000 people, and for a while, some New York City hospitals indeed received more patients than they could handle. Physician Helen Ouyang writes a first-person essay in the New York Times about the worst moments at one city hospital:

I happened to have been assigned to work at one hospital for a chain of shifts, so I hadn’t been inside one of our other hospitals in over a week. As soon as I open the E.R. doors there, I shrink from the sights and smells. Patients are now triple-bunked into single-person spaces, curtains pushed aside. In one room, three men, who appear to be in their 80s or so, are side by side in their stretchers, each one pulling at his oxygen mask, confused, their frail limbs swinging in the air. Some have sat in their own feces for a day. Puddles of urine have pooled around the wheels of some patients’ stretchers. Nurses are out sick; the remaining ones are coping the best they can. I have gotten texts from colleagues about the chaos here, but I thought that those were just about one bad day, that they had already gone through the worst.

The bad news is that the nightmare scenario did strike certain hospitals for several days. But the good news is that, at least for now, these facilities don’t seem overwhelmed anymore. Generally, New York City hospitals are now finding the pace of incoming patients manageable — not easy, but manageable:

Once considered the epicenter of the coronavirus outbreak for the city, the city’s Elmhurst Hospital saw 13 deaths within a 24-hour period and lines of people along adjacent streets waiting for testing at the end of last month.

Now, the hospital’s CEO says they are seeing fewer people for testing and treatment. The volume of patients is growing at a slower rate every day.

“I think that means we are starting our peak,” said Israel Rocha, CEO of Health + Hospitals/Elmhurst. “That means very soon here in Elmhurst in Queens we will start our trajectory down and that means our community is on the road to recovering from COVID-19.”

Staten Island has taken over the Bronx for the highest rate of cases per 100,000 people, according to health officials. That could be caused by the state’s efforts to increase testing.

The executive director of Staten Island University Hospital says they are seeing a leveling off in the number of new cases. Between the two campuses, Dr. Brahim Ardolic says they get around 60 new patients related to the coronavirus a day.

Across the Hudson River in New Jersey, the general sense is that the state is keeping up with the demand for care — there’s not a ton of excess capacity, but there’s just enough where it is needed most.

“We’re all cautiously optimistic,” said Dr. Stephen Brunnquell, president of the physician network at Englewood Health, referring to his daily call with the chief medical officers of hospitals in Bergen and Passaic counties. “We’re getting the job done.”

Admissions fluctuate from day to day, but the trend line is flatter. More patients are being sent home. Test results come back more quickly. Ventilators to help the most critically ill have arrived from the state’s central repository. Personal protective equipment is in hand for a few days, a previously alarming timeline that now seems reassuring.

“When the water keeps rising, we keep finding higher ground,” said Brunnquell.

At The Valley Hospital in Ridgewood, Paul Simon’s “Homeward Bound” emanates from the public-address system 15 or so times a day — every time a COVID-19 patient is discharged.

New Jersey Health Commissioner Judith Persichilli reported Tuesday that 8,185 residents statewide were hospitalized with confirmed or presumed COVID-19, an increase of 4 percent from the previous 24 hours. A quarter of the patients were in intensive care, as of 10:30 p.m. Monday, and 20 percent — 1,626 people —  needed ventilators to breathe.

Hospital chiefs in the Garden State now say the “main challenge now is neither hospital beds nor ventilators, but staff to put them into use.”

After New York City and northern New Jersey, Detroit might be the part of the country hardest hit by the virus. This particular anecdote is disturbing:

Photos shared among emergency room staff at Sinai-Grace Hospital in Detroit show bodies being stored in vacant hospital rooms and piled on top of each other inside refrigerated holding units brought into the hospital’s parking lot.

CNN acquired the photos from an emergency room worker.

Two other emergency room workers confirm the photos are an accurate portrayal of the scene taking place at the hospital during early April, during one 12-hour shift they describe as overwhelming.

The two sources tell CNN that at least one room, which is typically used for studies on sleeping habits, was used to store bodies because morgue staff did not work at night, and the morgue was full.

But that was early April, and at least right now, hospitals in the state are keeping pace with the outbreak.

Michigan doctors and other health experts say they’re beginning to see signs that Michigan is turning a corner in its battle with coronavirus COVID-19, especially in southeast Michigan.

Caseloads are easing in Henry Ford hospitals, according to the CEO of the Henry Ford Medical Group in Detroit.

An emergency room doctor for Detroit Medical Center told MLive she’s seeing “significantly” fewer patients than just a week or two ago, while a McLaren Health Care doctor says he’s “cautiously optimistic” about the trend in metro Detroit.

The number of new coronavirus cases reported Monday, April 13, was 997, down considerably from the peak of 1,953 on April 3. On Tuesday, April 14, Michigan reported 1,366 new cases.

There’s a quote in that story that is useful to keep in mind: ‘The peak is only halfway there.”

One other location worth keeping an eye on in the coming weeks is Prince George’s County, Md.: “Prince George’s County hospitals have been inundated with critically ill coronavirus patients and are sending some to facilities outside the county when they run out of beds, hospital officials warned Tuesday. The majority-black suburb of 900,000 residents had 72 covid-19 deaths and 2,356 confirmed cases as of Tuesday — more than any other county in Maryland or in the neighboring District.”

Across the river in northern Virginia, the outlook is brighter. “‘This changes every day and will change significantly every week, but their current modeling at the hospital, and this is for all of Northern Virginia, is that they have the capacity to handle any surge that is currently modeled,’ said Dr. Stephen Haering, director of the Alexandria Health Department, in an online meeting Tuesday night of the mayor and city council.”

In Washington State, the situation is similar to New Jersey: Hospitals can manage the current pace of incoming patients. “Although we are still at a plateau, we haven’t seen a decrease in the number of COVID-19 patients,” Dr. Timothy Dellit, UW’s CMO, told KOMO News after the presentation. “The hospitals are able to manage the current level of surge, and hopefully it won’t get worse. We don’t think that it will as long as we stick with the current measures in the state.”

A few weeks ago, people were really worried about New Orleans turning into the next New York, but so far, that hasn’t happened.

The state had raced to surge its medical capacity, especially in the New Orleans area, as modeling over the past month showed the region on track to run out of hospital beds in ventilators. But a 1,000-bed temporary hospital facility at the Ernest N. Morial Convention Center only housed 84 patients Tuesday, which Edwards’ administration said was good news and indicated the state’s stay-at-home order was working as intended.

One theory worth further study: We know viruses are affected by humidity and very generally speaking, high humidity is worse for their spread than dry environments. Also, wind disperses viruses. Did the weather help give Louisiana a break?

Chicago and the surrounding areas in Illinois have a lot of cases, but thankfully they have a lot of capacity — or so far, enough.

As of April 13, 4,283 known COVID-19 patients and suspected COVID-19 patients were hospitalized. COVID-19 patients in an intensive care unit (ICU) totaled 1,189, and 796 patients are on a ventilator. Suspected COVID-19 patients are individuals under investigation and assumed to have COVID-19 for the purpose of medical treatment.

As of April 13, Illinois has a total of 30,134 hospital beds, 2,987 of which are intensive care unit (ICU) beds. The state has 33 percent of all ICU beds available, 994 of 2,987, and 58 percent of ventilators are available, 1,742 of 3,140.

It’s a similar story in Florida, where the Miami area is starting to creep up in cases.

As of Monday afternoon, there were 59,809 staffed hospital beds statewide and 34,708 were filled, according to numbers self-reported by hospitals. That leaves 25,101 (or 41.97 percent) of the beds available. That’s an increase in availability since Friday afternoon, when just 33.16 percent of Florida’s hospital beds were available.

Miami-Dade’s hospital bed availability — which has dropped to 14.67 percent on Friday afternoon — is back up to 40.66 percent (3,363 beds available out of 8,271).

Of the state’s 6,088 adult ICU beds, 3,874 are filled, leaving 2,214 (36.37 percent) available. Of Florida’s capacity of 592 pediatric ICU beds, 258 (43.58 percent) remain available.

Around the rest of the country, the use of hospital and ICU beds is well below capacity.

Massachusetts has about 5,000 non-ICU beds, 2,000 ICU beds, and 1,000 beds in field hospitals remaining unused. Wisconsin hospitals have about 500 ICU beds still available.

Keeping in mind that all models are projections, not predictions — meaning they tell you where things are, and where they are most likely but not certain to go, based upon what it known at the time — by one estimate, half of the United States has reached its pandemic peak. That’s really good news!

But as we learned from the Joker, Jeffrey Meier, and Wayne Chrebet, there’s always a catch. As we’ve seen from workplaces like the Smithfield plant, various supermarkets and grocery stores, and Amazon warehouses, if Americans go back to work, more Americans will catch the coronavirus. Workers can wear masks and gloves, but human error will inevitably arrive in some form or fashion: Some workers won’t wear the masks all the time, or they won’t wear them tightly enough, and so on. Some workplaces can adapt to trying to keep people six feet apart, but a lot of jobs require workers to be closer together on assembly lines and such.

So the question is, even under a gradual reopening of the economy, does that increase the number of cases beyond what the country’s hospitals can handle?

We have to reopen the economy, and fairly soon. The Saint Louis Federal Reserve president estimates the United States is losing $25 billion in lost output every day. But if we don’t do this carefully and wisely, we end up right back in the high-spread, overwhelmed-hospital mess we’ve been trying to avoid.

ADDENDUM: I’m scheduled to chat with Larry O’Connor around 1 p.m. Eastern today; he wrote some kind words about my coverage in his recent Townhall column.

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