The death toll in New York, the state hardest hit by the COVID-19 pandemic, was “effectively flat” for the second day in a row, Gov. Andrew Cuomo said in his daily news conference on Monday.
The overall death toll climbed by 599 to 4,758, while Cuomo expressed cautious optimism in the daily increase of new hospitalizations (358) and new admissions into intensive care (128).
Cuomo said there were some signs that the spread of the virus in New York has slowed, but cautioned: “It could still go any way.”
The current strain on the state’s blend of public and private hospitals in New York City, he said, was “unsustainable at this rate.”
Not long after Cuomo spoke, the United States as a whole had reached a death toll of over 10,000, according to the coronavirus resource centre at Johns Hopkins University in Maryland. The U.S. has seen 10,335 die from COVID-19 causes, according to the tally, with national confirmed cases at over 347,000.
It represents unwelcome exponential growth in mortality, with the U.S. having climbed over 1,000 deaths on March 26, 11 days ago.
‘Peak death week,’ admiral predicts
The Trump administration itself is girding for a tough week in the coronavirus battle, with hopes that the physical distancing measures and stay-at-home orders seen around the country will help the number of cases and fatalities level off next week.
“It’s going to be the peak hospitalization, peak ICU week and, unfortunately, peak death week,” Adm. Brett Giroir, a physician and member of the White House coronavirus task force, told ABC’s Good Morning America on Monday.
Giroir raised particular alarm for the states of New York, New Jersey, Connecticut and the city of Detroit.
A report from the Office of the Inspector General for the U.S. Department of Health and Human Services (DHHS) released Monday indicates three of four U.S. hospitals surveyed are already treating patients with confirmed or suspected COVID-19. The report also says that hospitals expect to be overwhelmed as cases rocket toward their projected peak.
The report warns that different, widely reported problems are feeding off each other in a vicious cycle. Such problems include insufficient tests, slow results, scarcity of protective gear, the shortage of breathing machines for seriously ill patients and burned-out staffs anxious for their own safety.
“There’s this sort of domino effect,” said Ann Maxwell, an assistant inspector general at the DHHS. “These challenges play off each other and exacerbate the situation. There’s a cascade effect.”
The inspector general’s report is based on a telephone survey of 323 hospitals around the country, from March 23-27. With hundreds of new coronavirus cases daily, the situation is becoming more dire for many the nation’s 6,000 hospitals.
In most people, the coronavirus causes mild to moderate symptoms. Others, particularly older people and those with underlying health issues, can develop life-threatening breathing problems.
One issue is testing: a lack of testing and slow results mean hospitals must keep patients with unconfirmed coronavirus disease for longer.
That takes up precious beds and uses up protective equipment like gowns, masks and face shields, since doctors and nurses have to assume that patients with symptoms of respiratory distress may be positive.
The increased workload raises the stress on clinical staff, who are also concerned they may be unable to properly protect themselves.
“Health-care workers feel like they’re at war right now,” a hospital administrator in New York City told the inspector general’s investigators. They “are seeing people in their 30s, 40s, 50s dying. This takes a large emotional toll.”
Physicians making life-and-death decisions
Many hospitals are responding by improvising their own solutions. Some explored buying face masks from nail salons due to the shortage of personal protective equipment, or PPE. Others have been trying to make their own hand sanitizer by blending ultrasound gel with alcohol from local distilleries.
Overtime hours and increased use of supplies are raising costs at the same time that many hospitals experience a revenue crunch because elective surgeries have been cancelled.
WATCH | Disputes over masks, equipment emerge:
Rural hospitals could be particularly vulnerable in the event of a significant caseload because of a limited number of beds and smaller staffs.
The head of a group representing for-profit hospitals said Monday that, on top of the problems in the report, facilities are finding that COVID-19 patients take long to recover.
“We are finding that their lengths of stay are much longer than comparable illnesses like pneumonia and flu, and they are requiring a lot of drugs,” said Chip Kahn, president of the Federation of American Hospitals.
How to set priorities for the use of ventilators, breathing machines that can sustain life, is one of the most worrisome questions. Hospitals from Louisiana to New York and Michigan are already confronting projected shortages, the AP reported last week.
“Government needs to provide guidelines on ethics if health resources are limited and decisions need to be made about which patients to treat,” a hospital official in Broward County, Fla., told the inspector general’s office. “Are physicians liable for their decisions if that happens?”
More than 90 per cent of U.S. residents are under some kind of stay-at-home order.
The exceptions are eight states, all with governors from Trump’s Republican Party: Arkansas, Iowa, Nebraska, North Dakota, South Carolina, South Dakota, Utah and Wyoming. Georgia, which has recorded 6,600 cases and more than 200 deaths, ordered residents to stay home but then allowed some beaches to reopen.
In Washington, D.C., and other places, some people flouted the physical distancing guidelines over the weekend. Sunshine and warm weather brought hordes of people out to bike trails and open spaces near the Potomac River. While a number of people wore masks, some groups moved together in close proximity.