June 24, 2020

It is officially summer and yet we are still seeing the ravages of a winter flu-like ailment that continues to defy expectations and confound epidemiologists.  Many had hoped the effects of COVID-19 would dissipate with the beginning of warmer weather.  Now that we’re in late June, one would think that a seasonal virus would be well on its way to dormancy, if only for a time; but there seems to be no letup in COVID’s mission to seek and destroy—at least in certain sectors.

The Path More Traveled?

According to the New York Times, coronavirus cases have actually been increasing in 19 states, with more than 30,000 new infections being reported for June 19.  This reflects the nation’s highest daily total since May 1.  So, we continue to travel down an uncertain path with this unpredictable disease; and, in some locations, the path is getting more precarious.  Becker’s Hospital Review recently released a list of four indicators that allow us to at least partially track the course of this virus:

1. Single-day COVID-19 cases hit a record high worldwide on June 21, according to the World Health Organization (WHO).  Total known infections jumped by 183,020 in 24 hours, with nearly 9 million global cases reported June 22.  The previous record was 181,232 new cases on June 18, when WHO Director-General Tedros Adhanom Ghebreyesus, PhD, warned that “the world is in a new and dangerous phase.”
2. Twenty-nine U.S. states and territories recorded rising seven-day averages of new COVID-19 cases, as reported by the Washington Post.  Florida and South Carolina each broke new case records for the third consecutive day, while Missouri and Nevada reported record case counts for June 20, according to the New York Times.
3. The White House is preparing for a possible second wave this fall, Peter Navarro, PhD, director of trade and manufacturing policy, said during a June 21 interview on CNN’s “State of the Union.”  The federal government is working to replenish the national stockpile of medical supplies “in anticipation of a possible problem this fall,” Dr. Navarro said.  “We don’t necessarily expect a second wave but prudence dictates that we plan for it,” he said in a later statement cited by the Wall Street Journal.
4. The American Hospital Association (AHA) is urging the U.S. Department of Health and Human Services (HHS) to extend its public health emergency declaration, which is set to expire July 25. The declaration grants healthcare providers certain resources and flexibilities to care for COVID-19 patients, which will be needed past July, AHA President and CEO Richard Pollack said in a letter to HHS Secretary Alex Azar.  Mr. Pollack asked HHS to extend the declaration until various criteria are met related to supply chain, testing volume, intensive care unit capacity and death figures.

A Road Less Bumpy?

While cases are clearly increasing in certain areas of the country, others seem to be plateaued or in actual decline.  Furthermore, in those states that are showing an increase, there are hopeful signs that the severity of COVID symptomology may be easing.  As an example, Becker’s released the following disease status provided by George Ralls, MD, CMO of Orlando Health:

The central Florida area began to see significant community spread of COVID-19 in mid-March.  Orlando Health experienced a steady but manageable volume of COVID-19 patients that peaked April 8, of which 40 percent required a ventilator.  The COVID-19 mortality during this surge was significant, accounting for more than 80 percent of the total COVID-19-related deaths in our system.  The second surge of COVID-19 patients has been a different experience.  We have again seen a steady increase in COVID-19 hospitalizations, mirroring the new case counts in the community that began in mid-May.

Patients have not demonstrated the level of severity and mortality that we saw with the first surge. Eleven percent are being managed in an intensive care unit, and only 4 percent require a ventilator. Although patient characteristics such as age and comorbidities may play a role, the differences in first and second surge outcomes are likely attributable to more effective clinical care, including respiratory management, and use of emerging therapies such as remdesivir and convalescent plasma. (Emphasis added.)

Most would agree that age and physical fitness appear to be playing a role as far as the level and extent of symptoms.  One ESPN outlet just passed on a statement coming out of Baton Rouge, Louisiana where the defending national college football champions revealed that 30 of their players are currently under quarantine for COVID.  However, it was pointed out that none of these athletes are experiencing severe symptoms.

While all this anecdotal in nature, there would seem to be a basis for at least hoping that, while COVID is on a rampage in certain regions of the country, the ability of the virus to inflict debilitating effects on the human body may be waning during this particular period.  Only further research will be able to confirm if this is correct; and, if so, the reasons for the easing of symptoms, despite the increase in cases.

Meanwhile, CNN is reporting that the following states are actually seeing a decline in new COVID cases: Alabama, Alaska, Connecticut, Illinois, Louisiana, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Dakota and Vermont.  Is there a connecting pattern that can explain why these states are seeing a slowing of the virus?  Is it due to their local governmental policies on, and timing of, lockdowns, mandatory mask usage, etc.?  Is there a reason a state like Louisiana is seeing a decline in cases whereas next-door Texas is seeing a massive increase?

For the time being, we will have to continue to go down this strange and perilous path, uncertain of its upcoming twists and turns, as well as its ultimate terminus.  If you would be willing to share with us what your facility is seeing as far as the increase or decrease in COVID cases and the acuity of such cases, we would love to hear from you.  You can contact us at info@miramedgs.com, being sure to provide us your city and state.  Thank you!