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Hospital ICU bed capacity isn’t the only issue with critical Covid care – Vox.com

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As of mid-December, hospitals on average had just 22 percent of their intensive care unit (ICU) beds available across the country, and many were completely full. As the Covid-19 surge continues to intensify, lack of ICU beds can have dire consequences, including not being able to properly care for the sickest patients, potentially rationing lifesaving care.

But even these bed capacity numbers don’t tell the whole story.

Adding extra critical-care beds in other departments or buildings takes precious time, resources, and space. But adding trained staff is much more difficult, especially deep into a pandemic.

When trained staff are in short supply, it’s even harder for hospitals to best meet the needs of critical-care patients. These patients include people very sick with Covid-19, but also many who need to be in the ICU for other reasons, such as those who have had a heart attack or stroke, are recovering from major surgery, or are sick with the flu, among others.

The number of people with Covid-19 currently in the ICU in the US reached an all-time high in mid-November and has been climbing ever since.
Our World in Data, with data from COVID Tracking Project and COVID19 Tracker

Only about a dozen states had more than 30 percent ICU capacity left on December 15, and coronavirus case numbers have only accelerated since then. And the reality on the ground in many areas is much worse, as reporting by the New York Times has shown.

From the Times’s data, gathered from the US Department of Health and Human Services, of about 100 hospitals in the Los Angeles area, more than 65 reported ICU occupancy at 90 percent or higher. Cedars-Sinai Medical Center had an occupancy at 112 percent of its capacity.

In Dallas, the fourth-largest metropolitan area in the country, of the 47 hospitals with more than 20 Covid-19 patients, 80 percent of them had zero or just one ICU bed left. The most open beds any hospital had was five.

In the Minneapolis-St. Paul area, half of the hospitals with more than 20 Covid-19 patients were at more than 95 percent ICU bed capacity.

In Oklahoma, which has the third-highest per capita new case rate in the country, of the hospitals with more than 20 Covid-19 cases, the majority were at more than 90 percent ICU bed occupancy.

Nancy Nagle, a pulmonologist and critical-care physician at Integris health system in Oklahoma City, which reported full ICU occupancy in the most recent data to the HHS, says they have turned regular patient rooms into ICU rooms to try to handle the rush of severely ill people. Even so, she said, “occasionally Covid-19 patients must remain in the emergency department for several hours waiting for a bed to become available.”

And there is little sign of relief in many places around the country, with an average of more than 200,000 new Covid-19 cases reported daily since early December.

“Patients keep coming, and we have to take care of them regardless of our staffing levels,” Gisella Thomas, a respiratory therapist at Desert Regional Medical Center in Palm Springs, California, wrote to Vox in an email. “I worry that there is only so long staff can hold up before breaking, which ultimately, in itself, could limit capacity” further.

The sickest Covid-19 patients can linger in the ICU for weeks — or longer. And although we have learned a lot since the spring about how to better treat severely ill Covid-19 patients, the disease itself is still challenging to address, and we don’t have a cure for it. Which means the 2 percent of people who get Covid-19 and end up needing critical care are often in ICUs until either they are able to recover — which often includes invasive intubation treatment — or die.

One of the reasons ICUs have been filling up is that once a patient with Covid-19 gets that sick, they are not likely to stabilize very quickly. A September study found that an average ICU stay for a Covid-19 patient was about a week — almost double the typical stay of 3.8 days for other ICU patients. Other anecdotal reports show that many patients can be in the ICU for weeks or even months. And pinning down this number is crucial for projecting how many beds might be available in the future if cases continue to climb.

As an October study pointed out, if an average length of stay in the ICU is 10 days, that means that every day there is only a 10 percent chance of a new bed opening up. So when admissions exceed that rate, ICUs are likely to get overwhelmed.

This is something those working with critically ill coronavirus patients have to contend with every day. “Covid-19 patients unfortunately stay in the ICU for a long time,” Nagle said. “The course of the disease is very slow, and this contributes to the shortage of available beds.”

And while Covid patients are there, meeting their needs can be extremely labor-intensive. “Covid-19 patients can be incredibly ill, with multiple machines to watch and adjust, multiple medications to give, and lab results to draw and results to watch,” Nagle said. And although we now have a better understanding of possible treatments for seriously ill patients, “patients still respond in varying ways, and their progress and possible outcome is always unpredictable.” This is another reason hospitals don’t always have a good projection for how many ICU beds they might have in the coming weeks or days.

Caring for Covid-19 patients also requires many more steps and precautions than when ICU staff work with other patients, further jamming units. All staff entering an ICU Covid-19 room must don full gowns and PPE each time, which is resource-intensive. “This also creates real difficulties if someone crashes because it slows down our response,” Thomas said. “The need to more thoroughly clean all equipment also creates delays and makes normal staffing levels inadequate for the pandemic.”

In the meantime, doctors, nurses, and other health care workers are struggling to provide the best care they can while being asked to handle more and more patients. “Critically ill patients are very complex,” said Orlando Garner, a pulmonary critical-care physician at Baylor College of Medicine. “There are a lot of moving parts at the same time that require the same amount of priority.” But, he said, “when you are stretched out beyond capacity, you can’t deliver the same quality care unless you create more skilled health care workers, and as we have found out, these are a scarce resource.”

Although hospitals can often somewhat expand the number of beds and amount of supplies, staff are in much shorter supply. “The most precious resource in any hospital are the human beings who are knowledgable and capable of caring for patients,” Sarah Delgado, an acute care nurse practitioner and clinical practice specialist with the American Association of Critical-Care Nurses, wrote to Vox in an email. “It is the limiting factor.” Without enough of these people to care for all of those who are very sick, “patient outcomes are likely to suffer,” she said.

And it is not just ICU physicians and nurses who are in short supply. “Critical care is more of a team sport,” Garner said. “This means physician-delivered care and interventions, but also careful medication selection dosage with pharmacists, skilled nursing care, respiratory therapists, midlevel providers, nutritionists, early mobilization with physical therapists.” To that list, Nagle also adds all of the other hospital staff needed to perform other essential tasks in ICUs, including bathing patients, changing linens, and other functions.

To accommodate surges of very ill Covid-19 patients, many hospitals have had to rework their staffing structure. At Christiana Hospital in Delaware, critical-care nurse Lauren Esposito and her colleagues typically work with critical cardiac patients. But this year, her unit has served as overflow for critical Covid-19 cases. “At first it was a little uneasy,” she wrote for the American Association of Critical-Care Nurses.

Their hospital implemented a tiered staffing strategy in which cardiac nurses would work under trained ICU nurses. “During the shift, if a patient was crashing, we were able to flex and have the ICU nurse go to that patient to provide care,” she wrote. They were also able to provide quick training to nursing staff, for example, on working with intubated patients. Still, the overflow duties were straining, and they weren’t made easier given the intensive isolation these patients are in to stop the spread of infection. “I remember the first time I walked into a patient’s room, it really hits you that you are the primary caregiver and no one else can come in.”

Also, staff now often have to attend to more patients at a time. In California, where last week an average of more than 44,600 people each day tested positive for the coronavirus, Gov. Gavin Newsom dropped the state’s nurse-to-patient ratio from 1:2 to 1:3 in an effort to meet the surging numbers of Covid-19 hospitalizations.

In Oklahoma, Nagle notes that although the ICU nurses she works with usually take care of one to two patients during a shift, “with the shortage of critical-care nurses, each nurse may have three, and under very extreme conditions, even four patients to care for.”

This increase in patients each nurse is seeing — especially in a complex illness like Covid-19 — is a major adjustment. “Nurses are at the patient’s side every hour of every day, administering lifesaving medications, collaborating with other health care team members, translating information to families, and providing end-of-life presence when those families cannot visit due to strict isolation requirements,” Delgado said. “This work cannot be done when the number of patients exceeds staffing capacity.”

And staff themselves often fall ill with the virus. According to a November report, as many as a quarter of Covid-19 infections in some states are among health care workers.

Garner, whose whole family got sick with Covid-19 earlier this year, including his 4-month-old daughter, says getting the illness himself gave him a new perspective on the patients now flooding into local Texas ICUs.

“It could have been me, my wife, or one of my kids on that ICU bed,” he said. “It’s easy to rationalize the amount of sick patients by thinking, ‘oh, well they weren’t distancing,’ or, ‘they weren’t wearing masks,’ but the fact is that nobody deserves to catch this virus and get sick from it, not even the people who doubt it. As the spike continues to grow, compassion is the only thing that can keep us from becoming jaded and burned out.

The flip side of that is remembering compassion for the health care workers caring for these patients, especially as the holidays approach. Not only will many of these workers continue long shifts through the holidays, they will do so knowing that many people are disregarding public health warnings to avoid gatherings.

“We need the public to do its part,” Delgado said. “Stop nonessential travel, adhere strictly to mask-wearing and social distancing guidelines, and limit gatherings with those outside your household,” Delgado said.

Katherine Harmon Courage is a freelance science journalist and author of Cultured and and Octopus! Find her on Twitter at @KHCourage.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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