Letters to the Editor: A COVID-19 advisory board without nurses won’t do much good

To the editor: Thanks to Stacy Torres and Andrew Penn for addressing a significant issue by citing the need for nurses to be included on President-elect Joe Biden’s COVID-19 advisory committee.

As a retired intensive care unit registered nurse, I couldn’t agree more that nursing input at this juncture would be an asset.

So far, nurses have had to strike to ask for more protective equipment and better working conditions. It breaks my heart knowing they have had inadequate protection when treating coronavirus patients.

It is the nurses who run the daily activities of most hospital units and are at the front lines of assessing patient care. Many doctors understand this and respect nurses’ contribution to patient care.

Perhaps Biden’s “preeminent public health experts” will recognize nursing expertise and insist nurses are included on their team. Our country needs them, and we need to give them respect and recognition they deserve.

Jackie Sarlitt, Irvine

Nurses have an understanding that is distinct from that of physicians and administrators of how care is organized and delivered. They know the weaknesses and opportunities for improvement both in the institutions they serve and in caring for individual patients. Their insight and engagement is critical to improving care and protecting patients.

Any board or task force trying to analyze and improve care that does not include the expertise of nurses is frankly incompetent to do its work.

Jack Needleman, Los Angeles

The writer chairs the department of health policy and management at the UCLA Fielding School of Public Health.

Covid-19 Updates: Los Angeles County Bans Private Gatherings of Multiple Households
Los Angeles County, where the virus is surging, urges residents to stay home.

Shoppers crowded around displays at a Walmart in Pico Rivera, Calif., east of Los Angeles, on Friday, as Los Angeles County announced tougher restrictions.
Shoppers crowded around displays at a Walmart in Pico Rivera, Calif., east of Los Angeles, on Friday, as Los Angeles County announced tougher restrictions.Credit...Etienne Laurent/EPA, via Shutterstock
The Los Angeles County Department of Public Health on Friday called on residents to stay home as the virus continues its rapid surge, barring gatherings both in public and at private homes if people are from different households.
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The restrictions announced Friday were not unexpected. Los Angeles County officials have been gradually tightening health restrictions, though not yet to the shutdown levels imposed early in the pandemic.

The county had set a threshold for the restrictions of an average of 4,500 daily cases over five days. That threshold was crossed earlier than expected: The five-day average of new cases reported Friday was 4,751. Nearly 400,000 people in the county have had the virus, more than in most states.

The directive allows for church services and protests, noting that both are constitutionally protected rights. It sets maximum occupancy rates for various businesses, including nonessential retail, libraries and recreational activities, and leaves in place a countywide prohibition on in-person dining at restaurants and bars because patrons can’t wear face masks while eating or drinking.

Takeout and delivery services for dining establishments, however, will still be allowed.

The directive is less severe than Gov. Gavin Newsom’s statewide order in March, which closed schools and most businesses and limited public movement with exceptions for essential workers or essential activities like acquiring groceries and medications.

“We know we are asking a lot from so many who have been sacrificing for months on end,” Barbara Ferrer, the public health director, said. “Acting with collective urgency right now is essential if we want to put a stop to this surge.”

The temporary order will take effect Monday and remain in effect through Dec. 20.

For businesses allowed to remain open, patrons must wear face masks and remain at least six feet apart.

Schools and day camps can remain open, according to the directive. However, day camps as well as schools at the high school level and below must close for two weeks if they report an outbreak, which the county defined as three or more cases over 14 days.

Last week, California officials announced a curfew prohibiting nearly all residents of the state from leaving their homes to do nonessential work or to gather from 10 p.m. to 5 a.m.

The new stay-at-home order was described as more limited than the governor’s spring order; in addition to applying only overnight, it has a built-in expiration date for now and applies only to so-called purple-tier counties, which are under the state’s most stringent restrictions in its reopening plan. It is in place until the morning of Dec. 21.

“We are sounding the alarm,” Gov. Gavin Newsom said as the order was issued. “It is crucial that we act to decrease transmission and slow hospitalizations before the death count surges. We’ve done it before and we must do it again.”

On Sunday, the county issued orders for most restaurants to end outdoor as well as indoor dining starting on Wednesday, limiting those businesses to take out, drive-through and delivery services and sparking a backlash among restaurant owners, whose businesses have been slammed.

Los Angeles County is home to some of the most densely populated neighborhoods in the country, many of which have residents living in multigenerational homes and workers who cannot telecommute, according to The Associated Press.

— John Ismay and Shawn Hubler
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Worldwide coronavirus cases
U.S. coronavirus infections shoot past 13 million as officials plead with Americans to spend Black Friday online.
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The number of coronavirus infections in the United States shot past 13 million on Friday, worsening the world’s largest outbreak. The milestone came as Americans embarked on a Black Friday that looked different from holidays past.

The U.S. has had one of the world’s highest per capita caseloads in the past week. And every day for more than two weeks, the country has set records for the number of people in the hospital, with the latest figure surging past 90,000 for the first time on Thursday.

At the same time, the nation saw a steep drop-off in new cases on Thursday, but it was a mirage, not progress, because many states did not report data on the Thanksgiving holiday. More than 103,000 cases and more than 1,100 deaths were recorded on Thursday — compared with 187,000 cases and 1,962 deaths that had been recorded the prior Thursday, Nov. 19.

For that very reason, the numbers were artificially high on Friday, when many states reported two days’ worth of data. That pushed the country past 200,000 cases in a single day for the first time, with more than 203,000 reported as of late Friday night, along with more than 1,400 deaths.

And the blurry data could persist longer. Health officials in Vermont have said they would forego reporting on both Thursday and Friday. Additionally, access to testing was likely to decrease for a few days, meaning more infections could go uncounted. In Louisiana, testing sites run by the National Guard were slated to be closed both Thursday and Friday. In Wisconsin, some National Guard testing sites are closed all week.

“I just hope that people don’t misinterpret the numbers and think that there wasn’t a major surge as a result of Thanksgiving, and then end up making Christmas and Hanukkah and other travel plans,” Dr. Leana Wen, a professor at George Washington University and an emergency physician, told The Associated Press.

Public health experts repeatedly warned Americans to stay home on Thanksgiving, and many heeded the advice. But while overall travel within the country was down significantly from prior years, the Transportation Security Administration reported that more than half a million people flew on Thursday alone, in addition to the approximately four million who had already traveled since Sunday. AAA had projected a downturn in road travel, and still expected tens of millions of people to drive to celebrations.

Similarly, the Centers for Disease Control and Prevention list of higher-risk activities for spreading Covid-19 included “going shopping in crowded stores just before, on, or after Thanksgiving,” an attempt to persuade people to sit tight — or make purchases online — on Black Friday.

The latest virus surge began accelerating across much of the country in mid-October. The nation went from eight million cases to nine million in just over two weeks in October; from nine to 10 million in 10 days; from 10 million to 11 million in just under seven days; and from 11 million to 12 million in just five days, hitting that milestone on Nov. 20. The pace to the 13 millionth case slowed, coming after seven days.

— Lauren Wolfe, Mitch Smith and Lisa Waananen Jones
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Covid is slamming U.S. hospitals with patients and robbing them of staff, pushing health systems to the edge.

Despite months of planning, many of the nation’s hospital systems are now slammed with a staggering swell of patients, no available beds and widening shortages of nurses and doctors.
Despite months of planning, many of the nation’s hospital systems are now slammed with a staggering swell of patients, no available beds and widening shortages of nurses and doctors.Credit...Lauren Justice for The New York Times
From New Mexico to Minnesota to Florida, hospitals are teeming with record numbers of Covid-19 patients, and the overflow is not limited to people with the virus.

One non-Covid patient in Madison, Wis., lay in excruciating pain on a gurney for 13 hours in an emergency room hallway. She could hardly get the attention of the overwhelmed doctors and nurses. A Missouri resident with a brain abscess had to wait a day before flying to another state for surgery.

Nurses say they are forced to care for too many patients at a time because there is not enough staff. Some hospitals have had to turn away transfer requests for patients needing urgent care or incoming emergencies.

Smaller hospitals have had to beg larger medical centers repeatedly to take just one more patient, but many of the bigger hospitals, their own halls and wards overflowing, have sharply limited the transfers they will accept.

Despite months of planning, many of the nation’s hospital systems have no available beds and are seeing widening shortages of nurses and doctors. And rising coronavirus infection rates among nurses and other frontline workers have doubled the patient load on those left standing.

Health care systems “are verging on the edge of breaking,” Dr. Michael Osterholm, a member of President-elect Joseph R. Biden’s Covid-19 advisory council, warned in a podcast.

The public does not realize how dire the situation is, Dr. Osterholm said, and may respond only “when people are dying, sitting in chairs in waiting rooms in emergency rooms for 10 hours to get a bed, and they can’t find one, and then they die.”

— Reed Abelson
HOSPITALS ON THE EDGERead the full article about U.S. hospitals’ crisis-level shortages of beds and staff.
Nursing homes in the U.S. account for roughly 40 percent of Covid-19 fatalities.

The United States’ first wave of Covid-19 deaths in nursing homes started in March at the Life Care Center in Kirkland, Wash.
The United States’ first wave of Covid-19 deaths in nursing homes started in March at the Life Care Center in Kirkland, Wash.Credit...Grant Hindsley for The New York Times
More than 101,000 people living and working at nursing homes and other long-term care facilities in the United States have died after contracting the coronavirus, a New York Times analysis of federal, state and local data has found, as the country’s daily death toll from the virus has risen above 2,000 Americans in recent days.

Nursing home populations are particularly vulnerable to the virus, which is especially lethal to older adults who have underlying health conditions, and which can spread easily in congregate facilities.

The Times analysis has uncovered more than 724,000 coronavirus cases infecting people at some 27,000 long-term care facilities. Deaths related to Covid-19 in these centers account for about 40 percent of the country’s pandemic fatalities.

The American Health Care Association and National Center for Assisted Living, a trade group, has warned that cases have been surging in long-term care facilities in recent weeks.

Many nursing homes, which have also struggled with the damaging effects of isolation on their residents, have tried to plan special events for Thanksgiving for those who may not be able to see their families.

Julie Beckert, a spokeswoman for ProMedica Senior Care, which operates more than 400 care facilities, said that staff have organized a “turkey trot” through the halls and have asked families and communities to arrange holiday parades outside of their facilities, so residents can watch from the windows.

— Alex Lemonides, Jordan Allen, Alex Leeds Matthews and Barbara Harvey
NURSING HOMESRead more about the spread of the coronavirus in U.S. nursing homes.
Britain moves to quickly approve a coronavirus vaccine with unclear test results.

A researcher in a laboratory at the Jenner Institute in Oxford, England, working on the coronavirus vaccine developed by AstraZeneca and Oxford University.
A researcher in a laboratory at the Jenner Institute in Oxford, England, working on the coronavirus vaccine developed by AstraZeneca and Oxford University.Credit...John Cairns/University of Oxford, via Associated Press
Britain asked its drug regulator on Friday to consider AstraZeneca’s coronavirus vaccine for emergency approval, forging ahead in the face of considerable uncertainty about the vaccine’s effectiveness as the government tries to corral a pandemic that has killed more than 66,000 people in the country.

The request was one of a series of steps that Britain has taken to put itself near the front of the pack of countries hurrying to assess coronavirus vaccine candidates. The country’s drug regulator said on Monday that it intended to decide on an emergency approval for a vaccine made by the American pharmaceutical giant Pfizer and a German company, BioNTech, “in the shortest time possible.”

The degree to which AstraZeneca’s vaccine, which was developed by the University of Oxford, is effective across all age groups remains unclear.

After AstraZeneca announced this week that the vaccine appeared to be up to 90 percent effective, the company has acknowledged a key dosing error. The study participants in whom the vaccine was 90 percent effective had mistakenly been given a half dose of the vaccine, followed a month later by a full dose. Among those who received two full doses, the effectiveness dropped to 62 percent. And the people who received the smaller dosing regimen were 55 years old or younger, making it difficult to know if the more promising results would hold among older people, who are especially vulnerable to Covid-19.

That has eroded the confidence of some scientists and created uncertainty about whether additional testing would bear out the apparently spectacular results.

“I can understand why they’ve taken it forward; it still works,” Stuart Neil, a professor of virology at King’s College London, said of the British regulators. “But we’ve still got no idea whether it works well enough.”

— Benjamin Mueller
COVID VACCINESRead more about the United Kingdom’s move to quickly approve a coronavirus vaccine.
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‘Unprecedented learning loss’: U.S. students rack up failures as grading returns to pre-pandemic standards.

School districts around the country are reporting more failing grades among students who are distance learning. Angel Medrano, 8, got help with math from his sister Cassandra, 16, while distance learning in Phoenix in October.
School districts around the country are reporting more failing grades among students who are distance learning. Angel Medrano, 8, got help with math from his sister Cassandra, 16, while distance learning in Phoenix in October.Credit...John Moore/Getty Images
When the coronavirus forced an abrupt switch to remote learning in the spring, many U.S. school districts made major changes in student report cards — dropping letter grades, guaranteeing A’s or ensuring that performance during the pandemic would not count against students.

That changed this fall. Although some schools continue to be lenient, many others have returned to their normal grading policies. And in at least some large districts, more students are failing than in past years, with the most vulnerable seeing the biggest declines.

In Houston, the nation’s seventh-largest public school district, which started the fall remotely, 42 percent of students failed two or more classes in the first grading period, compared to 11 percent in a normal year, The Houston Chronicle reported.

In Chicago, the nation’s second-largest district, 13 percent of high school students failed math in the fall quarter, compared to 9.5 percent last fall, The Chicago Tribune reported. Students will return to classrooms there in January, according to the city’s current plan.

And in Northside Independent School District in San Antonio, one of the nation’s 30 largest, the share of students failing at least one course in the first grading period increased from 8 percent last year to roughly 25 percent. More than half of students have opted to remain remote, and those students are disproportionately poor, said the superintendent, Brian T. Woods.

“We’re obviously dealing with unprecedented learning loss and course failure,” he said, “and it’s going to take years to mitigate.”

At the Fairfax County Public Schools, the largest district in Virginia and 11th-largest in the country, an internal analysis found that the percentage of middle school and high school students earning F’s in at least two classes had jumped from 6 percent in the first quarter a year ago to 11 percent this year. Fairfax County has brought back only a small fraction of its 188,000 students for in-person instruction.

Already disadvantaged students appear to be faring worse in remote classes, putting them at increased risk of long-term disengagement and dropping out.

Fairfax County found that students who had performed well before the pandemic were still doing well — better than predicted, in fact — while those who had struggled before were doing even worse now. Among students learning English and students with disabilities, the rate of failure had more than doubled.

The district said it had made adjustments to try to help struggling students complete assignments, including allowing schools to offer “catch up” days and setting limits on much homework. But one critic thought the district and teachers needed to change their approach.

“Where’s the grace?” tweeted Melinda D. Anderson, an education journalist, suggesting that teachers needed to adjust their expectations and work differently with students during the pandemic, and that the district should restructure its grading to reflect the “current learning reality.”