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Covid-19 patients aren’t usually checking themselves into hospitals like Chris Christie, experts say

Christie’s announcement, which followed news that Trump, first lady Melania Trump and other Republican leaders had tested positive for the virus, sparked a flurry of reactions online. Chief among them: confusion.

“Regarding Chris Christie, can someone please tell me how one checks into a hospital as a ‘precautionary measure’?” one person wrote on Twitter.

Another person asked, “Can an ordinary citizen with mild symptoms just check themselves into a hospital out of an abundance of caution? Is that how this works?”

Not exactly, experts say.

“What occurred over the weekend with Governor Christie sharing on social media that he was checking himself into the hospital because of his covid-19 diagnosis, that would be extraordinarily uncommon,” said Mark Shapiro, associate medical director for hospital services at St. Joseph Health Medical Group of Sonoma County, Calif.

The process of being admitted to a hospital with covid-19, the disease caused by the virus, is much more complex than Christie’s tweet may have suggested, Shapiro added. He, and other experts, urged people who test positive for the coronavirus and are asymptomatic or exhibiting mild symptoms not to show up at hospitals seeking to be admitted for treatment.

Christie, who may have an increased chance of developing a more severe case of covid-19 because of his asthma and other potential risk factors, declined to comment on the specifics of his hospital admittance.

Atlantic Health System, which operates the hospital where Christie is receiving care, also declined to provide additional details. “Every patient we care for is carefully assessed by a physician to determine their clinical needs,” the hospital said in a statement. “Those determinations, including where care needs to take place, are based on their expert clinical judgment.”

The procedure at most hospitals, according to Shapiro, is that people who fall ill after contracting the coronavirus are admitted through emergency departments following an assessment by a team of health-care providers.

At Mayo Clinic hospitals, for instance, members of the covid-19 front-line care team, many of whom are primary care providers, call patients with positive test results and ask them questions about their condition, which helps with “risk stratification,” said John O’Horo, an infectious-disease specialist with the clinic in Rochester, Minn. In the event that hospitalization may be needed, people usually are processed through the clinic’s emergency room, where they will receive a more thorough assessment to see if they should be admitted.

“We’ll check their vitals, usually get some imaging like a chest X-ray to see if there is a clear pneumonia developing, and check some bloodwork to see how their markers of inflammation and immune function are doing,” O’Horo said. “Based on that, the sum total of looking at all of those things, plus the questions about their ability to continue this kind of care at home, a decision can be made to admit the patient to a special covid unit.”

Still, O’Horo noted, “there are no hard and fast rules really when it comes to deciding if somebody needs to be hospitalized.”

Hospitals digging in for a long winter as coronavirus patients increase

The rise in the number of infected patients is a far cry from the spring surge. Yet it is increasingly apparent among several hospitals in so-called red zones — communities determined by state health officials to have an elevated risk of coronavirus infections.

At Lowell General Hospital, which counted fewer than a handful of COVID-19 patients most days in August, the daily census is now close to three times that, between 11 and 15 patients, said Dr. Adam Weston, an infectious disease physician.

“The good news is we haven’t seen our numbers dramatically climb upward, but there’s the worry that we have ongoing community spread and that could be a harbinger of additional cases,” Weston said.

Lowell is among roughly 30 cities and towns where state officials determined Wednesday infection rates are too high to allow more business and entertainment venue reopenings.

Like a lot of hospitals, Lowell General was suddenly swamped with COVID-19 patients in March and April and had to halt many other medical tests and surgeries to stay ahead of the surge. But that peak subsided fairly rapidly, and hospitals in the summer had mostly returned to normal operations.

Now, Weston said, his hospital and colleagues in the Wellforce system, which includes Tufts Medical Center in Boston and MelroseWakefield Hospital, believe they will be shouldering an elevated plateau of coronavirus patients for months.

“Many are predicting a less tall, but much longer curve, spread out over a longer period of time,” he said.

“The hope and plan is a co-existing of COVID care and regular hospital care,” he said. “But all plans are fine until they get on the battlefield.”

At Southcoast Health, which includes St. Luke’s Hospital in New Bedford, the number of daily COVID-19 cases has nearly doubled in the last two weeks, from 10 to 18. New Bedford is among the red zone communities.

Jackie Somerville, senior vice president and chief nursing officer for Southcoast Hospitals Group, worries that too many residents are letting their guard down after months of reminders to wear masks and socially distance. The weariness comes as schools are reopening and the weather is cooling. With more activities moved inside, the risk of infection increases.

“We are definitely seeing COVID fatigue in all the communities,” Somerville said. “It’s critical more than ever to be meticulous in terms of using [personal protective gear] inside our hospital and also to be ambassadors for Southcoast to role model what vigilance looks like.”

For the first time, Southcoast is now mandating all employees get flu shots, something many other hospitals did several years ago, to protect patients and workers from spreading that virus. Health leaders say flu shots are imperative this year to avoid concurrent outbreaks of influenza and COVID-19 that could overwhelm the state’s health care system.

“We don’t want to see individuals potentially get both because we don’t know what that will look like,” Somerville said.

At UMass Memorial Medical Center in Worcester, there has also been a slow increase of COVID-19

Rural Hospitals Teeter on Financial Cliff as COVID Medicare Loans Come Due

David Usher is sitting on $1.7 million he’s scared to spend.

The money lent from the federal government is meant to help hospitals and other health care providers weather the COVID-19 pandemic. Yet some hospital administrators have called it a payday loan program that is now, brutally, due for repayment at a time when they still need help.

Coronavirus cases have “picked up recently and it’s quite worrying,” said Usher, chief financial officer at the 12-bed Edwards County Medical Center in rural western Kansas. Usher said he would like to use the money to build a negative-pressure room, a common strategy to keep contagious patients apart from those in the rest of the hospital.

But he’s not sure it’s safe to spend that cash. Officially, the total repayment of the loan is due this month. Otherwise, according to the loan’s terms, federal regulators will stop reimbursing the hospitals for Medicare patients’ treatments until the loan is repaid in full.

The federal Centers for Medicare & Medicaid Services has not yet begun trying to recoup its money, with the coronavirus still affecting communities nationwide, but hospital leaders fear it may come calling for repayment any day now.

Hospital leaders across the country said there has been no communication from CMS on whether or when they will adjust the repayment deadline. A CMS spokesperson had not responded to questions by press time.

“It’s great having the money,” Usher said. “But if I don’t know how much I get to keep, I don’t get to spend the money wisely and effectively on the facility.”

Usher took out the loan from Medicare’s Accelerated and Advance Payments program. The program, which existed long before the pandemic, was generally used sparingly by hospitals faced with emergencies such as hurricanes or tornadoes. It was expanded for use during the coronavirus pandemic — part of billions approved in federal relief funds for health care providers this spring.

A full repayment of a hospital’s loan is technically due 120 days after it was received. If it is not paid, Medicare will stop reimbursing claims until it recoups the money it is owed — a point spelled out in the program’s rules. Medicare reimburses nearly $60 billion in payments to health care providers nationwide under Medicare’s Part A program, which makes payments to hospitals.

More than 65% of the nation’s small, rural hospitals — many of which were operating at a deficit before the pandemic — jumped at the Medicare loans when the pandemic hit because they were the first funds available, said Maggie Elehwany, former vice president of government affairs for the National Rural Health Association.

CMS halted new loan applications to the program at the end of April.

“The pandemic has simply gone on longer than anyone anticipated back in March,” said Joanna Hiatt Kim, vice president of payment policy and analysis for the American Hospital Association. The trade association sent a letter to CMS in late July asking for a delay in the recoupment.

On Monday, the

Czech health care under pressure; hospitals hit virus record

PRAGUE (AP) — A record surge of new coronavirus infections in the Czech Republic in September has been followed by a record number of virus patients being hospitalized, putting the nation’s health care system under serious pressure for the first time in the pandemic.

After relaxing almost all virus restrictions in the summer, the Czech government has responded to the new spike by declaring a state of emergency on Wednesday. That has been accompanied by strict restrictions ranging from limiting public events to a ban on singing at churches and schools.

The Czech Republic faced a record surge of new COVID-19 cases two weeks ago with more than 3,000 testing positive in one day. On Wednesday, it hit almost 3,000 new cases again.

On Tuesday, 151 COVID-19 patients were admitted at hospitals across the country, bringing the total number of those hospitalized to 976. Of them, 202 needed intensive care. All three categories are records.

“(The outbreak) is not under control at this very moment,” Petr Smejkal, chief epidemiologist at the Institute of Clinical and Experimental Medicine in Prague, told The Associated Press.

September was by far the worst month for the country of nearly 10.7 million people. The number of all infected went up by more than 46,000 from 24,616 to 70,771, according to government figures released Thursday. A month ago, only 172 virus patients were being treated in hospitals and 35 were in intensive care wards.

“We have quite a robust health care system,” Smejkal said. “But the bottleneck of the system is not the ventilators and the machines. The bottleneck is the staff.”

Hospitals in the country have 6,000 beds assigned for COVID-19 patients and another 1,000 at intensive care wards.

“So, you can estimate that at the end of October, with only 1,000 ICU beds empty, they can easily fill up. (Then) all of the ICU capacity could be filled up and then you won’t have staff and you won’t be able to take care of other things besides COVID,” he said.

Some 1,700 Czech medical personnel have been infected, while others have been quarantined or remain home with their children.

Health care labor unions have urged hospitals to re-employ former staffers and to ask medical students for help. A major hospital in Uherske Hradiste county, the hardest hit area in the country with over 256 people infected per 100,000 inhabitants in the last seven days, has postponed all non-urgent operations for next week and was planning to send some coronavirus patients to nearby hospitals.

After health authorities acknowledged they could not properly trace the contacts of those infected in Prague, the capital, 250 police officers will be trained to help.

Smejkal said testing also needs to be increased because currently up to 12% of all those tested are positive.

“This should be down to 5%. If not, you’re still missing a lot of people who are positive and who can spread the disease,” he added.

Of the country’s 658 confirmed virus deaths, 217 of them

Wisconsin sets COVID-19 deaths record as hospitals fill up

MILWAUKEE (AP) — Wisconsin set a new record for COVID-19 deaths on Wednesday and the surge in cases in the state threatened to overwhelm some hospitals.

Health officials reported 27 new deaths, breaking the state’s old record of 22 deaths set on May 27. The disease has killed or played a role in the death of 1,327 people in the state since the pandemic began.

Health officials reported 2,319 newly confirmed cases, bringing the total number of cases in Wisconsin to 122,274 since the pandemic began.

Wisconsin had the third-highest positivity rate of any state as of Wednesday. Hospital officials in some areas said they were close to being overwhelmed by COVID-19 patients — a scenario that health officials have been warning could happen since the pandemic began but that only now seems like it could happen.

The number of people hospitalized in Wisconsin reached a record-high of 737 on Wednesday, according to state health officials and the Wisconsin Hospital Association. Case spikes in northern and northeastern Wisconsin were causing many of the hospitalizations, the Milwaukee Journal Sentinel reported.

Officials at ThedaCare in the Fox Valley said they had exceeded capacity in the COVID-19 unit at their Appleton medical center and had started sending patients to Neenah and hospitals in Berlin, Shawano and Waupaca.

“If it’s growing the way that it has for the past week or so, we’re going to be in a dire situation in two, three, four weeks,” said Michael Hooker, vice president and chief medical officer for acute care at ThedaCare. “Yes, we saw this coming, but didn’t expect it to be quite so rapid.”

Matthew Heywood, president and CEO of Aspirus HealthCare in Wausau, said that hospital has started putting patients on waiting lists, with wait times ranging from several hours to a full day. The system had 61 patients Tuesday who had or were believed to have COVID-19, which was a 30% increase from Monday, when it had 47.

“The problem is, how do we care for you when you have an accident when we have an overflow of COVID patients?” Heywood said. “There’s only so much you can do before you start to overwhelm the system.”

Officials at Bellin Hospital in Green Bay said their facility was at 94% capacity on Tuesday, with 31 patients being treated for COVID-19, up from 26 last Friday. CEO Chris Woleske said the hospital hopes to convert part of its campus into another space for beds and is teaching nonclinical workers, such as athletic trainers, how to deliver supplies and move patients so that nurses can focus on duties only they can perform.

State Health Services Secretary Andrea Palm and Dr. Ryan Westergaard, Wisconsin’s chief medical officer, said Tuesday that they hadn’t received any reports of patients being turned away from hospitals or not getting care. They said if cases don’t subside, patients could be directed to a 530-bed field hospital that the U.S. Army Corps of Engineers built on the state fairgrounds in West Allis in

Hospitals feel squeeze as coronavirus spikes in Midwest

MILWAUKEE (AP) — The coronavirus tightened its grip on the American heartland, with infections surging in the Midwest, some hospitals in Wisconsin and North Dakota running low on space and the NFL postponing a game over an outbreak that’s hit the Tennessee Titans football team.

Midwestern states are seeing some of the nation’s highest per capita rates of infection, and while federal health officials again urged some governors in the region to require masks statewide, many Republicans have resisted.

Like other states, health officials in Wisconsin had warned since the pandemic began that COVID-19 patients could overwhelm hospitals. That’s now happening for some facilities as experts fear a second wave of infections in the U.S.

A record number of people with COVID-19 were hospitalized in Wisconsin. Of those 737 patients Wednesday, 205 were in intensive care, with spikes in cases in northern parts of the state driving up the numbers. The state also reported its highest single-day number of deaths — 27 — raising the toll to 1,327.

Officials at ThedaCare, a community health system of seven hospitals, said they have exceeded capacity in the COVID-19 unit at their medical center in Appleton, about 100 miles (160 kilometers) north of Milwaukee. It’s started sending patients to other hospitals some 40 miles (64 kilometers) away.

Wisconsin health officials reported 2,319 new infections, bringing the total number to 122,274.

In North Dakota, hospitals are adding extra space amid concerns from employees about capacity. Nearly 678 COVID-19 infections per 100,000 people have been diagnosed over the past two weeks, leading the country for new cases per capita, according to the COVID Tracking Project.

A new Sanford Health hospital unit opened in the capital of Bismarck to add 14 more beds, with nearly half of those for intensive care patients. The space isn’t exclusively for coronavirus patients but could be used to treat them if needed.

Overall, North Dakota has reported 21,846 infections and 247 deaths. There are 89 people now hospitalized.

The upswing has been seen throughout the Midwest. Iowa also reported a spike in people hospitalized with the virus, to 390. Last week, the state had the nation’s sixth-highest rate of coronavirus infections per 100,000 people, according to a White House coronavirus task force report dated Sunday. It again recommended Iowa require masks statewide, which Republican Gov. Kim Reynolds has said is unnecessary.

Similarly, Oklahoma Gov. Kevin Stitt, a Republican, has said he won’t impose such a requirement. The task force report found his state is among the worst in the United States for positive coronavirus tests per 100,000 people, up 15% from a week ago.

The number of reported coronavirus cases in Oklahoma increased by 980 on Wednesday, with 13 additional deaths, state health officials said. A total of 1,031 people have died of the virus there.

The strain of the virus in the Midwest comes as President Donald Trump and his Democratic rival, Joe Biden, sparred over the pandemic during the first presidential debate. Trump defended his handling of the

Cape Cod Hospitals In Need Of Blood Donations

FALMOUTH, MA — Over the past few months, blood center inventories have fallen to their lowest levels since before the coronavirus pandemic. Cape Cod Healthcare officials said nationwide, blood centers have experienced a significant drop in donations which is limiting the ability for the overall blood supply to be adequately replenished.

Locally, health officials said the Cape Cod Healthcare blood program is experiencing the same challenge as the organization transitions back to a new normal.

Hospital officials said they need at least one week’s worth of blood on hand at all times, since each unit collected or purchased only lasts 42 days.

If you’d like to help replenish the supply, please consider taking part in one of the following blood drives:

  • October 1: 11 a.m. – 5 p.m., Bass River Rod & Gun Club, 621 Route 6A, Yarmouthport

  • October 5: 11 a.m. – 5 p.m., Grace Chapel Assembly of God, 25 Lieutenant Island Rd, Wellfleet

  • October 9: 11 a.m. – 5 p.m., Sandwich Masonic Lodge, 175 Main Street, Sandwich

  • October 13: 12 noon – 6 p.m., Chatham Works, 323 Orleans Rd, N. Chatham

  • October 14: 10 a.m. – 4 p.m., Barnstable Police Community Blood Drive at the Cape Codder Resort and Spa, 1225 Iyannough Rd, Hyannis

  • October 15: 11 a.m. – 5 p.m., John Wesley United Methodist Church, 270 Gifford Street, Falmouth

  • October 19: 11 a.m. – 5 p.m., Christ the King Church, 3 Jobs Fishing Rd, Mashpee

  • October 20: 9 a.m. – 3p.m., Harwich Community Center, 100 Oak Street, Harwich

  • October 26: 11 a.m. – 5 p.m., Orleans Police Station, 99 Eldredge Parkway, Orleans

  • October 27: 11 a.m. – 5 p.m., John Wesley United Methodist Church, 270 Gifford Street, Falmouth

  • October 28: 11 a.m. – 5 p.m., Eastham Library, 190 Samoset Rd, Eastham

  • October 30: 10 a.m. – 4 p.m., Cape Cod 5 Community Blood Drive at the Cape Codder Resort and Spa, 1225 Iyannough Rd, Hyannis

This article originally appeared on the Falmouth Patch

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