The show from December 17, 2020, featured guest host, Jennifer Smith.
The first batch of Pfizer’s COVID vaccine arrives in Washington state, and distribution will start on December 15. Although this is good news for the future, we won’t be taking our masks off any time soon, and without widescale acceptance, herd immunity will be delayed.
Editor comment: The video of the Olympia, Washington protest has the wrong date on it of December 10, 2020. The correct date is December 12, 2020. We apologize for the error.
Chris Rojas, our partners at Converge Media, and Concrete Reporting contributed to this program
North King County and Snohomish County hospitals are nearing maximum ICU capacity, and a few have already hit that point. In Kirkland, Washington, the first significant outbreak site in the United States, Evergreen Hospital is currently at 90% ICU usage. Further north in Everett, Washington, Providence Hospital ICU is at 100% capacity.
In contrast, Seattle and Bellevue are reporting more available beds, but a worsening situation. Seattle is at 70% utilization while Overlake Hospital in Bellevue is at 64%. The utilization number at Overlake doesn’t tell a complete picture. The facility has a staffing crisis due to a low number of available specialists and many nurses sick with COVID. Traveling nurses are making as much as $10,000 a week to work at hospitals in COVID hotspots. Nurses are offered such high pay due to the dire need, long hours, and overall risk of infection. In Seattle, Harborview Medical Center has more patients with COVID than at any time since the pandemic started.
Area capacity to treat patients is reaching a critical breaking point. Seattle only has 121 ICU beds available as of this writing, based on a seven-day rolling average. With almost 1,100 patients in Washington hospitals with COVID, the governor’s office predicted that a “better case” scenario would be 2,000 hospitalized by the end of the year.
The central issue isn’t available hospital beds, but the staff to support sick patients. A COVID patient in ICU requires an extensive care team of three to four people per patient. Hospitals are optimized from a staff and revenue standpoint to operate at 60% to 80% capacity. The excess capacity is available for short term surges due to accidents, natural or humanmade disasters. To sustain above 80%, hospitals need additional staffing, which isn’t widely available.
Earlier today, the United States reached another grim milestone. Officials reported 3,054 COVID deaths, the most single-day fatalities in the United States since the pandemic started.
The New York Times, US Department of Health and Human Services, and The COVID Tracking Project provided some of this article’s data.
Rebecca Herman-Kerwin contributed to this story.
A graphic that has been making the rounds on the Internet provides a list of the eight deadliest days in United States history. How accurate is that list, and what is the reality?
We pulled meteorological, military, and disaster records for a list of fatalities on US soil, including US territories. We reviewed data from The COVID tracking project provided by The Atlantic. Our conclusion? The graphic isn’t accurate based on available data.
The graphic gets the first one right with the 1900 Galveston Hurricane, the deadliest single day tragedy in United States history. The battle of Antietam is more complicated. If you count both Union and Confederate deaths, it is the second on the list. If you count Union forces only, it falls out of the top ten, with 2600 fatalities. The numbers fall apart after that. The San Francisco Earthquake, the San Ciriaco Hurricane, Hurricane Maria, and the 1928 Okeechobee Hurricane are all left off. Although you could argue that almost all of the deaths associated with Hurricane Maria and the San Ciriaco Hurricane of 1899 deaths were in Puerto Rico, they are Americans. In 1899 Puerto Rico was occupied by the United State military after the island was invaded, and the horrors of Hurricane Maria are well documented.
As for the COVID numbers, the variations in daily death counts occur because each state reports its data differently and at different times. Aggregating this data by various sources uses different methodologies, creating the daily variances from the other sources.
There are several multiday historical events, particularly during the Civil War such as the Battle of Gettysburg that produced a total fatality count that was higher. However, this wasn’t on a single day, and when daily fatalities of these battles are considered, the incidents don’t crack the top ten.
The sharing of factual data for COVID is critical to not fuel misinformation and further erode trust in the data. Finally, without accurate records for daily deaths attributed to the 1918 Flu Pandemic, it is difficult to determine if any single day would move into this chart.
Governor Inslee held a press conference today where he announced additional grants for small businesses, a potential unemployment extension for up to 100,000 citizens, and a continuation of statewide COVID restrictions. The governor cited 80% ICU utilization, 1,094 people hospitalized for COVID statewide, and over 10,500 new cases reported in the last 48-hours as the reasons for the extension. The state projects that 2,000 Washingtonians will be hospitalized with COVID under a “moderate” scenario by the end of December.
Part of today’s press conference announced an additional $50 million in grants to assist small businesses most impact by COVID-related closures. The Department of Commerce is prioritizing businesses such as yoga studios, fitness centers, entertainment venues, and bars to receive the new grants. The maximum amount a company can receive is $20,000. The number of approved applicants will determine that final sum.
Officials in Washington D.C. remain deadlocked on a second stimulus package for Main Street and citizens. Benefits from the CARES Act in the form of unemployment extensions and unemployment for 1099 employees, also called gig workers, is set to expire on December 31. For most people, the actual expiration date is December 26. Governor Inslee announced that for a subset of people collecting unemployment, extensions would continue into January.
People collecting Pandemic Unemployment Assistance (PUA) will continue to received benefits if the federal government does not come up with a stimulus package. This extension benefits approximately 60% on unemployment and would represent a flat payment versus the current sliding scale. The governor did not state how much each qualified individual would get, only saying that for “a few,” it would be less. The governor indicated that funds were available for him to extend the program through executive order and that Employment Security was already working on implementing the plan. Officials stated there were insufficient funds to expand PEUC, impacting as many as 172,000 people if benefits expire.
Governor Inslee did not take further business restrictions off the table and announced businesses not complying could receive fines up to $10,000 a day. Multiple state officials stated that we would better understand the number of new COVID cases created by Thanksgiving travel and celebrations in the next one to two weeks. The change in those numbers will dictate if the state needs to issue another extension after January 4 or take more robust measures.
State officials indicated that 62,000 doses of the Coronavirus vaccine would arrive in the state of Washington on December 15. Frontline healthcare workers and residents of nursing homes would get top priority. An additional 182,000 doses would come by the end of December, with more “likely” in January. Immunization requires two doses, 28 days apart, and takes a total of 60 days to become effective. The amount of vaccine arriving in December will not be enough to immunize everyone at the head of the line. Washington will receive vaccines from AstraZeneca and Moderna.
Governor Inslee’s office has reached out to business and union leaders across the state by e-mail, requesting input on broader COVID-related restrictions starting after December 15. Washington state continues to add 2,000 or more COVID cases daily with no sign of slowing down, with a record number of people in hospitals and on ventilators. The state reported 31 deaths from COVID yesterday, the highest number since a summer spike.
Despite significant evidence that social distancing, limiting indoor interactions to essential needs, and wearing a mask is highly effective in slowing the spread, growing COVID fatigue works against these efforts. Hospital officials at a local, state, and federal level are concerned about wave upon wave of COVID patients as hospitalizations reach record levels. The looming issue isn’t beds or ventilators, but doctors, nurses, and specialists to staff the incoming waves of patients. In Washington state, Snohomish County reported that their 911 system is almost overwhelmed with calls for ambulances, and patients are arriving at hospitals in worse shape than the spring.
With the CARES Act set to expire on December 31, 2020, the spike in cases, hospitalizations, a looming shutdown couldn’t come at a worse time. Hundreds of thousands of Washingtonians will see their unemployment benefits end, and 172,000 families will face eviction or foreclosure without federal government intervention.
This is a breaking story and will be updated when more information is available.
Sunday saw another air travel record in the United States, with 1.18 million passengers going through TSA checkpoints on Sunday. It was the highest number to go through security since March 16, 2020, and only 8,100 short of the mid-March milestone. Over 13 times more passengers flew on Sunday versus April 14, 2020, basement, when COVID infections numbers were near their spring peak.
In stark contrast, 90,000 Americans are in the hospital with COVID and 6,000 on ventilators, both records since the first infection in January 2020. In some parts of the country, infection rates are the worst recorded. In Denver, a group of 10 or more had a 53% chance of at least one person being infected. In Bismark, North Dakota, it was a 92% chance, while Miami and Seattle had a 26% chance.
Regionally on the roads, traffic was relatively light across the passes and not choked with holiday travelers. Stevens Pass had an advisory for traction tires, but there were no significant issues. Blewitt and Snoqualmie Passes were clear and dry with free-flowing traffic.
In Chelan and Grant County, where the worst infection rates are in the state, mask compliance was low, particularly in Chelan. Further to the north in Okanagon County, mask compliance was high, particularly in Twisp despite the numerous Culp signs.
The CDC is advising anyone who traveled over the extended holiday weekend to get a COVID test. However, many states are still struggling with adequate test kits, lab facilities, and staff. In Washington state, people have been advised not to get a test unless they are symptomatic, with wait times stretching into the hours.
Officials and data scientists have warned that a drop in overall test numbers from Thursday to Sunday will create a false dip in positive test numbers. Many test facilities were closed during part of the long weekend, and labs are dealing with a backlog.
Washington state officials reported that 80 people were admitted to hospitals with COVID-19 yesterday. Detected cases have spiraled to over 2,000 a day, a seven-day moving average. Lines to get tested now stretch for a mile at some locations. Officials have started appealing that only symptomatic individuals get tested. The surge in hospitalization has begun. In a few weeks, the number of fatalities will also begin to increase.
As of this writing, 6.7% of people with a positive test will end up in the hospital, according to the Washington State Department of Health COVID-19 Dashboard. Of those who end up in the hospital, 26.52% will die. We are approaching hospital utilization numbers that are rivaling March-April of 2020 now.
King County is reporting that available resources remain adequate, as does Clark County. In our backyard, Evergreen Hospital has seen the number of hospital patients decline in the last week. Snohomish County is reaching capacity, as are many hospitals in the eastern part of Washington.
The problem isn’t beds; the problem is staff and PPE. The strategic reserve for PPE remains woefully under-supplied despite nine months to prepare. At hospitals, nursing homes, and doctor offices across the country, staff continues to reuse “disposable” PPE items. In Washington, doctors and staff went on strike at MultiCare due to a lack of PPE and officials ignoring even basic safety protocols. Auburn MultiCare, Everett Providence, and Harborview have all had outbreaks within the hospitals and among staff.
The state is adding more than 2,000 cases a day (roughly) 7-day moving average.
Two-thousands cases with 6.7% being hospitalized equal 134 people landing in hospital beds every day in the coming weeks. Hospitalization doesn’t happen instantly but lag one to three weeks behind a detected case. We won’t see the peak of hospitalizations for the cases detected this week for another 7 to 21 days.
Twenty-six-and-a-half percent of hospitalized patients will end up dying from COVID, based on the Washington State Department of Health numbers. That’s 36 people a day when you reach 2,000 detected cases a day. The spike in deaths takes two to six weeks after hospitalization.
The primary strain of COVID-19 spreading across the United States is more contagious than the initial strain that arrived here in January. This strain is also apparently less lethal, but it still makes patients extremely sick. Additionally, our understanding of coronavirus has improved. Doctors now approach treatment through the lens of a clotting and inflammation disease, not a pulmonary disease.
While helping improve survivability, it is a double-edged sword. Those who land in the hospital are experiencing prolonged hospitalization, taking up more resources (beds, PPE, staff, medication, equipment) than patients in March.
For the medical community, the smallest mistake around PPE can result in an infection. Those who work with intubated patients face the most dangerous conditions when it comes to exposure.
An anonymous but respected source reported an alarming number of critical care patients on ECMO in Puget Sound. ECMO is the last defense line for the sickest COVID patients, where the lungs have failed, and a machine must replace their function. ECMO is reserved for individuals who were in peak condition before being infected and have some chance of a meaningful recovery.
In another two to three weeks, the Washington state hospitals will likely be overwhelmed when you do the math. Complicating things will be Idaho, Montana, and Alaska wanting to fly the sickest of their patients into our region, as they have even fewer resources. By Christmas, the number dying in this state will exceed our worst numbers in March-April. The IHME forecasts that by March 1, 2021, 6,015 Washingtonians will die of COVID, and we’ll experience peak deaths in mid-January.
Business leaders at the major hospital networks are concerned that if capacity is reached, government officials will mandate an end to all elective procedures. COVID taught us that hospitals receive most of their revenue from treating people, not curing people. When treatment programs and elective surgeries were canceled earlier in the year, hospitals faced massive budget shortfalls and were forced into layoffs. All while experiencing a massive increase in costs.
In Washington, hospitals are already deferring some procedures to keep bed utilization lower. So on paper, things look good. The reality is the people being turned away are not people needing hernia repairs, tonsils removed, or cataract surgery. People being turned away right now need heart valve replacements or, in some cases, cancer surgeries.
People need to realize that if you are rushed to the emergency room due to a car accident, the staff must assume you are COVID-19 positive when you arrive. Rapid tests are woefully inaccurate. A nasal swab test can take 12 to 24 hours to come back in a hospital setting, under ideal conditions. Until your test results come back, the staff must follow donning and doffing procedures and use up PPE. A doctor wearing a puffer helmet treating an emergency room patient can’t go and examine another patient until they remove the equipment. For anesthesia, a doctor might move between three different rooms under normal circumstances. With COVID, they are anchored to one room if they don’t know the patient’s COVID status. Now another doctor has to be called in to support any other patients. This is the same for nurses, technicians, and specialists.
When you add it up:
That’s conservative math based on the existing information we have. It’s too late (which isn’t to say we should do nothing) to stop this COVID train.
The grim reality is you don’t want to get sick around the third week of December. To get ill with COVID around that time indicates your exposure was around Thanksgiving. You may find yourself or a loved one in a rationed care situation. When care is rationed, patients are given a score based on their age, comorbidities, condition, and how much lifespan they have left. If you don’t get a good enough score, your treatment may be a morphine drip to provide a comfortable end of life. When care is rationed, you or a loved one could end up in the hospital for something non-COVID related, such as an accident, stroke, or heart attack. The same formula will be applied, not because of a lack of beds, but a lack of staff.
They are doing rationed care in Utah, parts of Texas, and North Dakota. In North Dakota, COVID positive medical personnel who are asymptomatic can continue to work because of staffing shortages. When staff who have coronavirus continue to work, they endanger the non-infected team working with them, creating a cycle of shrinking resources. Idaho is on the brink of rationing care, with no political will to slow the surge in their state. Part of the plan in Idaho is to send their patients to Seattle and Portland, Oregon, straining resources further.
There is no way to prevent the coming tidal wave of patients for Washington state, but we can avoid going to rationed care as we inch closer to the end of the year. Everyone needs to choose very wisely in the next 24 hours.
