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.
Angela Rozmyn believes in taking action whenever she sees a community in need. As part of the Planning Commission for Kirkland, she is acutely aware of the challenges that businesses and families are facing due to the pandemic. Inspired by a program the city of Palmdale, California implemented, she decided to donate a single gift card to a local restaurant and a family in need. In less than 24 hours, her simple gesture generated an outpouring of support.
When Rozmyn isn’t blogging, working, serving on the Planning Commission, or with her family, she is an administrator for the Eastside Restaurant Support (Kirkland, Redmond, Bellevue, and Surrounding) Facebook group. “I would see comments in the support group of I would love to go to this restaurant, but money is tight,” she explained. “A city in California was doing a thing where you take a picture of your takeout, and you could win a $25 gift card. So I thought, I’m just going to give away a $50 gift card to help a local restaurant and people struggling in the community.”
That simple gesture quickly grew into something bigger. Within an hour, 20 people had jumped in, making the same offer. “When I saw the responses, I thought, wow, maybe we can cover everyone who needs a gift card.” In 24 hours, $4000 flowed in. It would be enough to support 80 families while keeping that money in the local business community. “We were able to provide a gift card to every family that asked.” It’s not over, as donations continue to come in with community members wanting to start a program for holiday season meals and a toy drive.
Restaurants across the United States have been hard hit due to restrictions to curb the spread of COVID. Across the country, dining-in restrictions, limited alcohol sales, and economic recession have hit the hospitality industry hard. Locally, a new ban on indoor dining due to a record-shattering increase in COVID infections came just as seasonal rains arrived, making outdoor seating a challenge. At the same time, support organizations like food banks and homelessness prevention services have been overwhelmed with the number of people in need.
When asked, Rozmyn explained how her small gesture broke through giving fatigue. “What made this so successful is people were already in a group to support local restaurants. So their heads are already in a space to support our struggling eateries.”
Families get to decide what restaurant they want to support. Supported businesses aren’t limited to the eastside, with a few requests for restaurants in the south sound and one in West Seattle.
People have continued to donate, inspiring a coming second round of restaurant support. If you would like to help, you can Venmo @Angela-Rozmyn with the comment, Eastside Restaurant Support.
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.
Math
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.
Washington state COVID cases have exploded in November. For those hospitalized, 26.5%
A new strain
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.
A worse spike than April
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.
Unknowns add complexity to treating non-COVID patients
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.
The coming crisis
When you add it up:
2,000 cases a day results in
134 new hospitalizations in one to three weeks
36 deaths from that group in three to six weeks
Hospitalization lasts 10 days conservatively
Equals 1,340 COVID patients in the hospital, conservatively
26% of those patients critically ill
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.
One America News Network, a pro-Trump alternative news source, has received a one week ban and demonetization of all content posted on YouTube. The network ran afoul of a YouTube policy on posting false COVID-19 information. In the now-deleted video, OANN claimed there was a “guaranteed COVID cure.”
There is no “cure” for COVID, and a small number of promising therapies are not widely available to the public.
YouTube spokesperson Ivy Choi stated the suspension comes from receiving a “strike” against their account. The demonetization may be a more significant blow, as OANN will have to reapply for YouTube Partner status.
OANN, once an obscure fringe network, has come to the forefront among the most ardent Trump supports for pedaling election conspiracy theories. NewsMax, another alternative far-right news network, has also enjoyed a significant boost in ratings in the weeks after the election. Iconic right-wing network FoxNews has struggled to straddle the line of reality and fantasy in their post-election coverage, resulting in outrage and defections with their audience.
OANN received another black eye earlier this month when a video showed their reporters allowed actress Maria Bakalova to coattail into a White House press briefing. Bakalova was in character, playing the 15-year old daughter of Borat, a character created by Sacha Baron Cohen. Bakalova was only feet away from the President and engaged in a conversation with his son, Donald Trump Jr., at a reception. She was allowed access without a security screening or COVID test. The White House nor OANN would comment on the lapse in security.
Despite surging COVID cases and record hospitalizations, 3.97 million Americans passed through TSA checkpoints from November 20 to November 23. On CBS “Face the Nation,” Dr. Anthony Fauci appealed for people to do a risk-benefit assessment. In his interview, Fauci stated, “people at airports…are going to get us into even more trouble than we are in right now.”
Over three-million COVID cases have been reported in the United States between November 1 and 22. The dizzying increase in positive tests represents almost 25% of all COVID cases in the United States since January 21. According to Johns Hopkins, 9.6% of tests are coming back positive, indicating significant under testing.
Multiple departments of transportation officials reported near-normal levels of pre-holiday traffic across the United States on the roads. AAA had predicted 50 million Americans would travel by car, a 10% reduction from 2019. Although many Americans are opting to stay home, too many are traveling to mitigate significant spread.
Although being on an airplane wearing a mask is considered to have moderate risk, passengers have no control over who is masked. Additionally, the airport themselves and queues for security, check-in, restrooms, and retail are higher-risk activities. Travel by car with members of the same household is safer than air travel, but using the bathroom and fuel and meal stops introduces a higher risk.
To compound the problem, anti-science protesters have events planned in Washington, Oregon, Illinois, and Connecticut. In Washington, protesters are calling for a potluck outside of the governor’s residence.
Washington state continues to add to grim milestones in the battle against COVID, with 762 patients now in hospital, a state record. Despite only 1,440 new cases logged on November 21, 2020, the weekend typically produces lower numbers with delays in reporting and testing. The number is an improvement from the record-breaking 3,327 new cases identified on November 16.
Late last week, at Swedish First Hill, they admitted ten new COVID patients in five hours. In Kirkland, Evergreen Hospital, once ground zero in the United States for COVID, has held steady with 25 patients hospitalized through the week. UW Medicine has seen an expanding number of patients, including several on ECMO, a last line of defense where an infected person’s lungs have essentially failed.
In Auburn, MultiCare Auburn Medical Center is suffering a COVID outbreak on the fourth-floor unit that has sickened over two-dozen. A patient died on November 10, and another died on November 16. In October, Harborview Medical Center experienced an outbreak resulting in one patient death. Providence Hospital in Everett also reported an outbreak on November 11 but did not provide specific information on the number of infections.
In eastern Washington, the situation isn’t much better. Deaconess and Valley Hospitals, Sacred Heart and Holy Family Hospitals, and Pullman Regional Hospital did not comment on how many patients were under their care. All spokespersons made similar statements around expanding patient load but available capacity. In the Idaho panhandle, Kootenai Health reported 54 patients in their care on Thursday, up from 46, with 10 requiring critical care.
In southwest Washington, Clark County reports 75% ICU utilization as of mid-week, while overall COVID patient numbers are low. Legacy Salmon Creek and PeaceHealth Southwest have a combined 56 patients in the hospital.
As wait times for COVID tests in the Puget Sound region expanded to hours, doctors started advising people not to test unless they are displaying symptoms. A lack of available tests and lab capacity continues to plague the nation, and UW Medicine reports their testing systems are overwhelmed. Last week, the University of Washington started canceling booked tests due to a lack of capacity and resources.
In western Washington, UW Medicine and Swedish are reporting they are deferring surgeries to provide capacity for a growing caseload of COVID patients. In eastern Washington, Deaconess and Valley Hospitals are under similar conditions, and Pullman Regional Hospital implemented their surge plan.
The regional healthcare system is also straining due to a shortage of PPE, therapeutic drugs, and staffing shortages. Officials report the question isn’t hospital beds, but the staff to support critically ill patients, who can require three to four full-time caregivers to keep them stabilized. Additionally, states such as Idaho send their sickest patients to Seattle and Portland, Oregon, for advanced treatment.
By the numbers, COVID in Washington state continues to be brutal on the BIPOC community. Hispanic communities have seen the worst numbers, representing 36% of cases and 27% of hospitalizations while representing 13% of the total state population. In south King County, the Black and persons of color communities report over a 300% increase in detected infections over the more white communities north of Seattle.
There are some silver linings. The mortality rate in Washington is drifting downward, now at 1.9%. By age group, 83% of cases discovered are now people 59 and younger. The younger age groups tend to have lower mortality.
Detected cases are a leading indicator of hospitalizations and deaths. Peak hospitalization will likely come in the next two weeks if the number of new cases can stabilize and start to drop. Peak deaths would follow two to four weeks after peak hospitalizations.
Update: An edit was made to reflect that the SBA estimates one-third of all small businesses will fail by June of 2021.
With growing signs that the economic recovering is stalling out and a fresh set of COVID-based lockdowns across the United States, federal benefits will end on December 26 with no extension in sight. The Federal CARES Act provided additional unemployment benefits in Pandemic Unemployment Assistance (PUA) and Pandemic Emergency Unemployment Compensation (PEUC). For thousands of Washingtonians depending on these lifelines, the looming deadline is a body blow.
PUA provides for an additional 13 weeks of unemployment compensation above and beyond state benefits. PEUC provides unemployment compensation for gig workers, the self-employed, and others who rely upon 1099 pay. Recipients of PEUC typically would not be eligible for traditional unemployment compensation, with millions of Americans dependent on the “gig economy” for work.
Congressional leaders, the White House, and the Federal Reserve have been bickering over a new COVID stimulus package since the summer with no progress. The White House has favored a $2.4 trillion package, including small business and individual relief, which the House has supported. The Senate prefers a far smaller package of $500 billion, which provides almost no individual relief and corporate protections that are a non-starter for the House.
Federal Reserve Chairman Jerome H. Powell issued a very rare rebuke to Treasury Secretary Mnuchin, who ordered the Fed to wind down CARES Act programs and return all unspent funds to Treasury. Chairman Powell indicated that the economy is still fragile, and ending these programs prematurely as COVID surges could extend the ongoing recession. Despite the public dust-up, the Fed agreed to wind down these programs over the weekend in a letter to Mnuchin.
The unemployment rate has dropped to 6.9% in October. However, the U3 unemployment figure doesn’t include people who have exhausted their unemployment benefits. The broader U6 unemployment figure consists of those who have used up unemployment compensation, given up looking for work, or, most critically, are underemployed. The U6 for October was 12.1%, down from a high of 18% earlier in the year.
White House and GOP leaders are distracted, attacking the national election results with baseless fraud claims, indicating they have no interest in focusing on economic security. The Small Business Association estimates one-third of all small businesses will fail by June of 2021. So far, in 2020, 40% of all black-owned small businesses have collapsed.
Also looming in early 2021 is the end of eviction, foreclosure, and energy bill deferments. Over 12 million American households are $5,000 or more behind on rent or mortgage payments.
Ignoring warnings from the Center for Disease Control (CDC), some Americans have taken to the skies and roads to travel for Thanksgiving. According to the Transportation Security Administration (TSA), 1,019,836 travelers went through security on November 20, the largest number of travelers in a single day since March 16.
Trip Advisor predicted that more Americans would take the road for Thanksgiving versus flying. On November 12, AAA predicted that 50 million Americans would drive to a different location for Thanksgiving. If that prediction holds, 15% of Americans will take to the road to celebrate Thanksgiving somewhere else.
Although many Americans are heeding the pleas of federal, state, and local officials to have a virtual Thanksgiving, evidence shows that small and medium gatherings can turn into superspreader events. Poor air circulation, sitting close together with masks off while eating and drinking, and a sense of false safety create additional risks.
Under this backdrop, the United States experienced a record 193,000 new COVID cases in a single day and has over 82,000 people in the hospital with COVID. Detected cases are a leading indicator for hospitalizations, which is a leading indicator of fatalities. Hospitalizations are expected to continue to grow into December, with deaths moving to a new peak by Christmas.
There are positive signs that some Americans and listening to the warnings to stay home. Tiny turkeys, those that weigh 10 to 14 pounds, are in short supply across the country. Severely impacted states like Utah, Iowa, and North Dakota have taken additional action to curb spiraling infections.
On November 17, South Dakota earned the distinction of being the only state left without some form of a mask mandate for their citizens. Kristi Noem (R), state governor, has refused to implement any COVID-based restrictions. Many believe the staunch Trump ally has aspirations to run for President in 2024 or 2028.
In South Dakota, the seven-day moving average positivity rate for COVID-19 is 57.5%. Anything over 5% is problematic, and over 20% is considered a public health crisis. Only Wyoming has a higher rate of 62.9%. Of the top ten states in the country for positive results, only one, Pennsylvania, voted for Joe Biden in the 2020 election.
Jodi Doering, a Sioux Falls emergency room nurse, wrote in a Twitter thread that has gone viral that patients deny they are infected with COVID-19 to their dying breath. “I can’t stop thinking about it. These people really [sic] think this isn’t going to happen to them. And then they stop yelling at you when they get intubated. It’s like a fucking horror movie that never ends. There’s [sic] no credits that roll. You just go back and do it all over again.”
I have a night off from the hospital. As I’m on my couch with my dog I can’t help but think of the Covid patients the last few days. The ones that stick out are those who still don’t believe the virus is real. The ones who scream at you for a magic medicine and that Joe Biden is
According to Forbes, in May of 2020, the rural state of South Dakota had 159 ICU beds to support the state. Governor Noem claimed that capacity had been expanded to 607 beds but later admitted that it included pediatric and NICU beds. ICU utilization in South Dakota is up to 87%, with staffing a major issue. A COVID patient in ICU typically requires a team of 3 or 4 caregivers to keep them stabilized.
But in western South Dakota, there is a different story on the Cheyenne River Reservation. Earlier this year, tribal officials implemented roadblocks into the reservation, including on state highways. At the checkpoints, tribal officials prevented leisure travel and non-essential visitation. In May, Governor Noem threatened to sue the tribe in court (along with tribal leaders of the Pineridge Indian Reservation). In June, she made good on the threat, with federal officials refusing to intervene. Tribal land is considered sovereign.
Tribal leaders decided to lockdown the reservation because they believed the federal government would provide ineffective assistance, and they lacked medical resources to deal with widespread COVID transmission. Additionally, they had long prepared for supply chain disruptions due to the centuries-long history of dealing with the federal government.
Their actions appear to be paying dividends, but the efforts are showing cracks. While South Dakota has a positivity rate of 57.5%, the Cheyenne River Reservation rate is 17.9%. The percentage indicates significant under testing but is well below the catastrophic rate of infection ravaging South Dakota.
In Indigenous culture, the respect and care of the elderly is a core value. Tribal members have set up support networks to assist families who have to quarantine and care for sick relatives. The tribe supports each other by providing meal and supply deliveries, adequate fuel for heating, and check-ins multiple times a day. Creating a system and safety net to help families dealing with infection can further isolate the sick and asymptomatic carriers.
With neighboring North Dakota issuing a mask mandate and Iowa taking further steps to curb infections, governor Noem is under increasing pressure to do something to curb the infection rates in her rural state.
It was deja vu for Washingtonians who flocked to grocery and department stores to buy – everything – with looming COVID restrictions announced on Sunday. Even before Jay Inslee made his 11 AM announcement, lines stretched for more than a block outside Costcos throughout the state. Untrue rumors that grocery stores would be ordered to shut down drove dazed residents into a buying frenzy. Once again, toilet paper and paper towels appeared to be the critical supplies needed to survive a pandemic.
On Sunday, restrictions announced would require all retail stores to limit their capacity to 25%, including grocery stores. Even in the hardest-hit regions of the world, a government shutdown of grocery stores has not happened. Government officials and industry experts appealed to people not to panic-buy, stating the supply chain was strong. Shoppers found empty isles across the state, with some shouting and pushing matches over paper products reported at some stores.
Washington is earthquake country, and residents should have a 7 to 14 day supply of required goods on hand at all times. Emergency preparedness experts chimed in, stating that properly prepared homes would not have to buy any goods to prepare for potential disruptions if they have a good earthquake plan already in place.
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