May 18, 2021

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The Health 202: It’s been one year since the first U.S. coronavirus patient was hospitalized

8 min read

But more than 400,000 Americans haven’t survived it — and that number is growing by about 3,300 every day. Responding to the pandemic is the foremost task for President-elect Joe Biden, who invited the nation to join him last night in memorializing the lives lost. “Lanterns surrounding the Reflecting Pool next to the Lincoln Memorial shone to represent the dead, and buildings across the nation lit in a united effort to honor those lost,” Matt Viser and Annie Linskey report. 

Providence’s chief clinical officer calls the scope and scale of the pandemic “shocking.”

I spoke yesterday with Amy Compton-Phillips, chief clinical officer for Providence Health, a network of 51 hospitals concentrated along the West Coast. The group includes the medical center that cared for “Patient Zero.” 

I asked her to reflect on the past year, as the hospital group faced three separate surges of coronavirus cases. Here’s some of our conversation, lightly edited for clarity and brevity.

H202: Can you recall what it felt like as that first patient arrived at your facility?

“The response wasn’t ‘Ahhhh!’ It was ‘Okay, it’s go-time, let’s do it.’ Because we knew it was possible, we were ready when it did happen. The scope and scale was still pretty shocking, the fact [the pandemic] kept going and going and going. The fact that it spun out of control was the shocking part.”

H202: How did you treat him?

“Because it was this unusual, brand-new germ, we got the patient into the hospital and watched him there in isolation like 10 days or so. He did well, did well, did well and then started to go downhill, started to need more oxygen. The [Centers for Disease Control and Prevention] connected us with the drug remdesivir. We used the novel drug for the first time in a clinical trial, and the patient turned around really rapidly. The next day, his fever broke.”

H202: Describe what it was like dealing with multiple patient surges over the past year.

“We divided it into three big buckets: the reaction, the response and the recovery phase. Now we seem to be moving back and forth between those phases. We thought at first it would be linear. 

H202: How many covid-19 patients did your hospitals have for at any one time?

“We’ve had three peaks. In April we got to 450 patients. [It was] about 700 in August, and then over the holidays we were up to 2,500.”

H202: How are things looking right now?

“We’re down. Yesterday’s numbers were at 2,000. I don’t want to declare victory because 2,000 is three times as bad as the horrible peak this summer.”

H202 Did you run short on personal protective equipment (PPE)?

“We used about 200,000 surgical masks across Providence in 2019, and we used that many surgical masks in two months at one hospital [during the pandemic], so we were burning through our PPE in that initial phase. At one point, anyone not touching patients was gluing masks and face shields together. We got a stash of this surgical sheeting and ended up being desperate enough to go to Joann Fabrics and Michaels and buy every bit of plastic they had. 

“The community opened their arms and started helping — we had a furniture manufacturer in town say, ‘We’re not making couches right now, we’re making PPE,’ and started cutting out the masks templates for us. So we got a whole alternative supply chain very rapidly.”

H202: How were you able to improve care for covid-19 patients over the course of the year?

“It’s lots of different things. There are the medical treatment: blood plasma and the antibody cocktail for highest-risk patients. Remdesivir, which we do believe makes a difference.

“When this first happened, we were on the phone quite a bit with docs in China and docs in Italy, and we figured out you don’t put people on the ventilators immediately, like you would for other kinds of infections. Instead you use a lot of oxygen, a high-flow nasal cannula, use masks that push oxygen into the lungs. We learned they actually do better on their stomach.”

H202: Have any of your staff died of covid-19?

“I know of three. One was a housekeeper in administrative offices whose husband had covid. We had a doc in an ER in Texas. And we’ve had one in Oregon, and I don’t know her story as well.”

H202: What has the year felt like overall?

“What fundamentally shifted, in my view, is in April everyone around us was going, ‘How can we help? Let’s stop this together.’ [Then] this schism happened. It’s felt like urban warfare; every community is doing it differently, and we’re trying to put out little brush fires and we felt like we can never get truly ahead of it.”

Ahh, oof and ouch

AHH: Trump awarded presidential commendations to officials involved in Operation Warp Speed.

Recipients included Health and Human Services Secretary Alex Azar, National Institute of Allergy and Infectious Diseases Director Anthony S. Fauci, and the president’s son-in-law, Jared Kushner.

“We produced not one, but two vaccines with record-breaking speed, and more will quickly follow. They said it couldn’t be done, but we did it,” Trump said of the vaccine effort during a taped farewell address on his final full day in office.

President Trump released a recorded farewell message that contained several falsehoods on Jan. 19. He is not attending the inauguration of President-elect Joe B (The Washington Post)

Some top health officials also had another opportunity to celebrate the fruits of their efforts over the past year. Fauci, Azar and National Institutes of Health Director Francis Collins received their second doses of the coronavirus shot.

OOF: Biden’s presidential transition is behind schedule.

“The forthcoming Senate impeachment trial of President Trump, set to begin as early as this week, threatens to delay hearings for President-elect Joe Biden’s top political appointees, further upsetting a transition already beset by extraordinary delays and facing generational challenges,” Harry Stevens reports.

The delays could mean the incoming administration will be tasked with coordinating the largest vaccination drive in the country’s history, amid surging coronavirus cases, without a health secretary.

The pace of nominations is far behind the schedule set during previous transitions. The first confirmation hearings for the incoming Biden Cabinet took place yesterday. In previous transitions, Senate committees were already well underway with hearings for nominees by Inauguration Day.

“Even the Trump administration, which took longer than usual to get its Cabinet in place, had its defense and homeland security secretaries confirmed on Inauguration Day. And President Trump’s five immediate predecessors had at least five Cabinet heads in place within a week of inauguration,” Stevens writes.

Biden is expected to ask for the resignation of Trump’s Surgeon General Jerome Adams after being sworn in today, The Post’s Dan Diamond reports. 

Biden has already nominated Vivek Murthy as surgeon general, but it was unclear whether Adams would continue in the role until the Senate confirms Murthy. Biden’s decision is “a symbolic break with his predecessor’s covid-19 response,” Dan writes. Adams’ four-year term didn’t expire until September.

“The anesthesiologist and former Indiana health commissioner — a political independent who crafted a close relationship with then-Indiana Gov. Mike Pence — had emerged as a key spokesman for Trump’s coronavirus response, regularly appearing on national TV and using social media to advocate for public health measures like social distancing,” Dan writes. “However, Adams’ visibility also made him a target last spring for Democrats, who accused him of defending Trump’s statements.”

The incoming administration may choose an acting surgeon general as soon as today, but will bypass Deputy Surgeon General Erica Schwartz, a career civil servant, Dan reports.

OUCH: Elderly people are dropping out of clinical trials for experimental vaccines to get Pfizer and Moderna shots.

“States have responded to the confusing, uneven and slow rollout of coronavirus vaccine by expanding eligibility for the shots ahead of schedule, quickly moving from the goal of immunizing front-line medical workers and long-term care residents into much broader populations of millions of elderly people,” Christopher Rowland reports. “But the moves have instantly made it more difficult to recruit and retain test subjects for clinical trials of vaccines that have yet to win emergency authorization.”

Researchers coordinating the vaccine trial for Novavax, an experimental vaccine made by a Maryland biotechnology company, are fielding calls from participants who want to know if they received the placebo. If so, they plan to get the Pfizer and Moderna shots, which have already received emergency authorization. Novavax had 9,000 subjects of its 30,000 goal last week and is having particular difficulty in recruiting and retaining participants over the age of 65.

“The future of large-scale trials [for coronavirus vaccines] is in doubt,” said Arthur Caplan, a clinical trial specialist at the New York University Langone medical center. “The more vaccines appear with either emergency approval, expanded criteria or plain licensing, there’s no way that people are going to sign up for trials with placebo controls.”

Sanofi, which partnered with GlaxoSmithKline to develop a vaccine, has already opted to forgo a placebo-controlled trial. 

Instead, it will recruit patients to a trial that compares the efficacy of its vaccine against one of the previously authorized vaccines. This type of study, known as a non-inferiority study, is likely to have an easier time attracting patients. A Food and Drug Administration official told The Post that regulators would look at not just the efficacy of an experimental vaccine in such a study, but also if it had comparative advantages such as only needing one shot. 

More in coronavirus

Most Americans say the coronavirus is not under control.

Just over 1 in 10 Americans believe the coronavirus is mostly under control, according to a Washington Post-ABC News poll. Large majorities of people from all political affiliations said that the virus was only partially or not at all under control.

“[T]he findings from the poll, conducted from 10 days to a week before Trump leaves the White House on Wednesday after one term, suggests that most Americans are not giving much credence to his persistent attempts to play down the pandemic,” Amy Goldstein and Emily Guskin report.

Still, perception of the virus was marked by notable partisan differences. Nearly 8 in 10 Democrats are very or somewhat worried that they or an immediate member of their family will contract the virus, compared to 4 in 10 Republicans. Democrats were also almost twice as likely to say that they were willing to get a vaccine compared to Republicans, despite the fact that vaccines were developed rapidly during his administration. 

Overall, about 40 percent of Americans say that they will definitely get a shot when it is offered to them, and another 23 percent say they probably will.

Incoming coronavirus adviser Andy Slavitt cut ties with a mask manufacturer before joining Biden’s team.

“The company, a Swiss firm called Livinguard, manufactures medical-grade masks with material it says can repel bacteria and virus particles,” Axios reports. It has paid for on-air promotions on Slavitt’s podcast “In the Bubble,” which focuses on the coronavirus pandemic.

“Why I like the Livinguard masks and why I wear them is ‘cuz they actually deactivate coronavirus thanks to their incredible patented technology that’s been shown to mitigate the spread of microorganisms like bacteria and viruses,” Slavitt said on one episode.

Slavitt told Axios that he is stepping back from his podcast and that the recorded endorsements would no longer air on the program.

Sugar rush

Paige Winfield Cunningham

2021-01-20 07:34:25

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