The Washington Post - USA (2021-11-11)

(Antfer) #1

A4 EZ SU THEWASHINGTONPOST.THURSDAY,NOVEMBER 11 , 2021


thecoronaviruspandemic


standardsof carefor staffing,an
emergencymeasurethat allows
hospitalstoreassignstaffand be
moreflexiblein thefaceof an
influxofpatients. Thestate’s chief
medical officerthisweekalso
urgedanyoneover18toget a
booster shot if it hasbeensix
months since theirsecond Pfizer
or Moderna shot,or twomonths
since their Johnson&Johnson
vaccine.
“I wouldnever have guessed
that,” Gonzalessaid of the hospi-
talization spike. “... This has been
quite asurprise and atwistinthe
whole pandemicthathas been
quite achallengefor our commu-
nityand hospitals.”
Cases in Colorado beganrising
in Augustbut moreslowly thanin
other regionsofthe country. Hos-
pitalizationsstayedrelativelyhigh
in September,without fluctuating
muchupordown.After amonth,
theystarted to swing upward
again.Areportreleased lastweek
estimated that1inevery48people
in thestate are infectious.
“After thatplateau, mostofthe
states hadstartedcomingdown
and we hadsomesimulations sug-
gesting it wouldstartcoming
downinColorado,”said Jude Bay-
ham,aneconomistatColorado
State Universitywho workswith
theteammodeling the state’sout-
break. “Wesaw the opposite.”
Many of thesamefactorsplay-
ing out in Michigan are thought to
be drivingthe uptickin Colorado
—coolerweatherpushing people
indoors,easing up on maskswith
no statewide mandate andlarge
pockets of unvaccinated people,
even in astate where 72 percentof
people over age12havegotten the
shots.
Bayhamsaidthatafew weeks
beforethe surgebeganthissum-
mer,mobilitydatafromcell-
phonesshowed thatpeoplehad
returned to pre-pandemicpat-
terns of activity—and wereeven
exceedingthem in some cases.
Colorado’s trajectorymay not
augurthe winter everywherein
the country, but it doeshighlight
thatregionaloutbreaks,drivenby
asometimes-mysteriousmixture
of forces,will likely continueto
occur as longaspocketsofpeople
remain unprotected.
Vaccinations remain the most
powerful weapon, andreaching
people whohaven’tbeenvaccinat-
ed is crucial.But immunitycan
waneinagradualwaythatvaries
from one personto the next,influ-
encedby multiple factors,includ-
ing howthey respondedto the
vaccine and even whichshotthey
received.
“The modeling hasgotten so
muchharder becauseof all the
dimensions,withpeoplevaccinat-
ing and thebooster pieceand how
longdoes immunity last,”Bayham
said. “Insomeways, we feel just as
lostasinthe early days of the
pandemic.”
[email protected]
[email protected]
[email protected]

“Everyonewas like, ‘No, not
again, please,’” Gonzales said.
“There’ve beenlots of twists and
turns in this pandemic where
we’rereallysurprised—and this is
the biggest surprisefor me.”
Colorado’s setbackisnotanout-
lieronthenationallandscape.The
late-summer andearlyautumn
easing of the nation’sburden of
newcoronavirusinfections has
cometo ahalt overthe past two
weeks,accordingtohealthdepart-
mentdata analyzed by TheWash-
ington Post.Dramatic dropsin
caseloads in the Deep South,in-
cluding the high-population
states of Florida andTexas,have
beenoffset by increases in the
MountainWestand thenorthern
tierofthe country.
Twenty-threestates have seen
at leasta5percentincreasein
casesover thepasttwo weeks,
with Illinois,Minnesotaand Ver-
montreporting50 percentmore
caseson average. Theaggregate
national caseload, having eased
fortwo months,began tickingup
after hittingalow of about69,
newcasesaday inlateOctober.On
Wednesday, thataverage topped
76,000.
Thelooming question is wheth-
erthisisthestartofwhatwouldbe
the fifthnational wave of infec-
tions sincethe startofthe pan-
demic —and if so, whatthe ampli-
tudeofthatwavemightbe.
No onecan reliablypredictthe
answer.Somepandemicmodelers
havestopped forecasting cases
more than aweek intothe future
becausethey’ve been wrongso
manytimes.Infectious-diseaseex-
perts sayawinter surgeisvery
unlikelytobeassevereas last
year’s,whichat onepoint in Janu-
arywas killing morethan 4,
people aday.Mostpeopleare now
vaccinated, school-agekids are
getting shotsfor the firsttimeand
the waning of immunitycan be
offsetthroughnewlyauthorized
boosters. Doctors arelikely to
havenewdrugsat theirdisposalto
prevent mostcovid-19casesfrom
becoming severeor even fatal.
But the diseaseburden has nev-
er beenevenlydistributedacross
the country. Theplaces hardesthit
recentlytendto have low vaccina-
tionrates andinclude muchof
rural America.
Ayearago,newsthattwo vac-
cines wereremarkably effective
against thecoronavirus seemed
like alightatthe end of the tunnel.
Butthe picturethathas emerged
since is morecomplex.
Asizablechunk of thepopula-
tionisardently opposed to getting
vaccinated. And the vaccines,
thoughextremelyeffective, can-
not provide aperfectshield


VIRUSFROMA1 againstinfection. Antibodies
wanenaturallyovertime, afact
driving thegovernment’s pushfor
boosters among the mostvulner-
ablepopulations—and the poten-
tialexpansion of eligibility to ev-
eryadult. Thehighly transmissi-
ble delta varianthasshownits
power,fuelingrapidsurges that
burnout quickly,but alsoout-
breaks thatgrowmore gradually,
likethe pattern seenin Colorado.
“I think we’reall disappointed
thatwe’rehere today,”ScottBook-
man,covid-19 incident command-
er for theColorado Department of
Public HealthandEnvironment
saidatanewsconferencelastFri-
day. “Whenthe firstvaccines ar-
rived in the stateinthe middle of
Decemberoflastyear,Ireally did
think we weremoving beyond this
partofthe pandemic.”
Thegood news is thathospital-
izationsand deathsstill appearto
be declining nationally.Progress
in vaccinations and improved
clinical carehave madethe virus
lesslethal.Still,the virusistaking
morethan 1,200 liveseveryday on
average.
If amajorwinter wave of infec-
tions doesmaterialize—some-
thing diseasemodelers sayisnot a
certainty—itwillarriveintandem
withthe seasonalflu. Influenza
was virtually unknownlastyear, a
factexperts attributetomasking,
social distancingandother pre-
cautionsagainstinfection.
“I thinkwe’veall learned to
respect this virus andhow rapidly
circumstancescanchange,”said
JamesM. Musser,chairofthe De-
partmentof Pathology andGe-
nomicMedicineat HoustonMeth-
odist Hospital. Theflu has barely
registeredtheresofarthisfall,and
the number of patients hospital-
izedwithcovid-19 hasdropped
from800 in Septemberto125 now,
he said.
WithThanksgiving,Christmas
and otherholidays looming,respi-
ratoryviruseswillhaveabundant
opportunities to makeacold-
weatherrun throughthe popula-
tion. Thesocial landscape is
changingas peoplerenewtheir
pre-pandemichabits —including
indoor dining, travel, familygath-
erings,parties and concerts.
“Thesevaccinesdefanged the
virus for the majorityofindividu-
als.Thatisawonderful thing,”
saidMonicaGandhi, an infec-
tious-disease doctor at the Univer-
sityofCalifornia at SanFrancisco.
“The endgameof coronavirus is to
makeitinto acirculatingrespira-
toryvirusthatdoes not cause se-
veredisease, and then we livewith
it.”
Another factor confounding
predictions is thatimmunity
wanes over time, necessitating
boosters.The virushasdemon-


Rising cases fuel worry


in North, Mountain West


BYMARISAIATI
ANDLINDSEYBEVER

Themoment April Lowe
learnedthatacoronavirusvac-
cinehadbeenrecommended for
childrenages5to11,shecalledher
kids’pediatrician.
Beforefederal healthauthori-
ties gave the greenlight, Lowe, 36,
of JacksonSprings,N.C., had tried
unsuccessfully to persuadethe
doctor to vaccinate her oldestson,
explainingthathewas almost
andthathis historywithasthma
andotherrespiratoryissuesput
himat higher riskfor severedis-
ease.She also attemptedto gether
childrenintoaclinicaltrial.So
whenshe gotthe doctor’s office on
the phonelastweek,she booked
the earliestappointmentandgot
her 7- and11-year-old sons vacci-
nated.
Andwhenavaccinebecomes
available for her 2-year-old,she
saidshe will not hesitate.
“I knewbeyondashadowof a
doubtthatassoonas theywere
approved, we weregetting them,”
she saidof Pfizer-BioNTech’s vac-
cine.
As parents likeLowehave
soughtto immunizetheir5-to-11-
year-oldchildren, pediatricians
saydemandsfor theirtimehave
surged to strain the capacitiesof
theirpractices,manyofwhichare
experiencingshortages of nurses
and supportstaff in linewith
national labortrends.Pediatri-
ciansnationwidedescribeacrush
of appointmentrequests thathas
bothoverwhelmedand energized
themas theyseek to keep children
fromcontracting or spreadingthe
virusthatcausescovid-19.
Thedelugeofphone callsbe-
ganin the summer,whenplum-
meting coronavirus infections
spurreddaycaresandschoolsto
reopen in person, sometimes
without mask requirements.
Common respiratoryviruses


surged, andafloodof patients
returned for regular checkups
andvaccinations thattheyhad
delayedat the pandemic’s apex.
Pediatriciansalsocontinuedto
monitorthementalhealthoftheir
patients,manyofwhomhave ex-
periencedheighteneddepression,
anxiety or behavioral issues since
the pandemicbegan,doctors said.
Then the highlyinfectiousdel-
ta variantof the coronavirusfu-
eledanew wave of cases,which
increased theneed for testing.
Pediatriciansquicklyfoundthem-
selves“underwater,” saidMichael
Martin, presidentof the Virginia
chapterof the AmericanAcademy
of Pediatrics.In a“call for help”
sharedon Facebookin Septem-
ber,Martin wrotethatpediatri-
cians’offices couldnot keep up
withdemandfor visitsbecauseof
staffshortages, health-carework-
ers’ burnoutandasignificant in-
creasein coronavirustestingre-
quiredby daycaresand schools.
Now, thosepediatriciansare
alsoracingto vaccinate theirpa-
tientsagainstthe diseasethathas
claimedthelivesofmorethan 600
children in the United States
sincethe startof2020.Although
schoolsand pharmaciesare help-
ingwith distribution, pediatri-
ciansfacemostofthe responsibil-
ityfor vaccinatingkids.
“We’reexcitedfor childrento
getthe vaccine,”said Christoph
Diasio,apediatricianin Southern
Pines,N.C. “It’shardwork,but
doinghardworkis whatwedoin
primarycare.”
LeeSavio Beers, president of
the AmericanAcademyofPediat-
rics,saidthe speedwithwhich
dosesare beingallocated depends
on thestate. Alabama, Florida
and Oregon have beenparticular-
ly slow,anAAP spokesperson
said.
TheWhite House has saidthat
the rolloutof vaccinesfor chil-
drenages 5to11, whichcomein

smallerdosesanddifferentvials,
wouldnot be fullyoperational
untilthis week.
In astatement,Florida’shealth
departmentsaidthatitordered
an initial supply of morethan
90,000 dosesfrom thefederal
governmentandexpects themto
be deliveredto doctorsthis week.
TheOregon Health Authoritysaid
thatithad deliveredto doctors
roughly94,000of the 250,
dosesin its orderas of Monday
and thatitexpected moredosesto
be delivered throughout the
week.
Representativesof Alabama’s
health departmentdid not re-
spondto arequestfor comment.
More than 900,000children
ages 5to11will have gotten their
firstvaccinedose by the endof
Wednesday, andanother700,
appointmentshavebeensched-

uledat pharmacies,WhiteHouse
coronavirusresponse coordina-
tor Jeff ZientssaidWednesday.
Beerssaidotherdoctors weretell-
ing her thatparents’interestwas
high,even in areasof the country
withlow adultvaccinationrates.
Pediatricians fromCalifornia
toVirginiasaytheyhavealonglist
of namesof parentswhowantto
gettheir younger childrenimmu-
nized.Somedoctorshave office
staffersdedicated to makingthe
appointments. And mostare
holdingvaccineclinics,often af-
ter businesshours,to getshotsin

smallarms.
Several pediatricianssaidthey
expected demandto alignwitha
KaiserFamilyFoundationsurvey
fromlastmonththatfoundthat
about27 percent of parentswere
eager to gettheir childrenvacci-
nated as soonas possible.Doctors
said they anticipate thatthe ini-
tial surgewilleventuallygiveway
to alowervaccinationrate, as
anotherthirdof parentssaythey
planto takeawait-and-seeap-
proach.
“I have someparentsbasically
vibratingwith excitement be-
causetheywantit rightaway,”
Diasiosaid.“Thereare definitely
familieswho are alittle hesitant,
whodon’t wanttheirchildrento
getthe shot Week 1and wantto
see howit goes. But we have alot
of parentswho are reallyexcited
to getitfor theirkids.”
There are exceptions to the
trend.Children’s NationalHospi-
tal in the Districtisexperiencing
hesitancy,said ClaireBoogaard,
medicaldirector of the hospital’s
coronavirusvaccineprogram. She
saidthe hospitalhas offeredmore
than 15,000 appointments but
bookedonly afew hundred.
While the hospital’s vaccine
clinicstargeting high-risk chil-
dren have been well-attended,
Boogaard said many parentsat
the medicalcenter’s 14 primary-
carelocationsare less sureabout
whetherto vaccinate.
“The primary-carephysicians
ownalot of the hesitantgroup,so
thepeoplewho need personal
reassurance,someoneto answer
theirdirectquestions,”she said.
Forpediatriciansstrugglingto
meetthe demand,amongthe big-
gest challenges has beenanation-
wideshortageofthe nurses,medi-
cal assistantsand supportstaffers
whokeep theiroffices running.
Open administrative positions
have complicatedthe logistics of
distributinganew vaccine,and

manypediatriciansare adminis-
tering those immunizations
themselves becauseof alackof
the nursesand medicalassistants
who would normally takethe
lead.
“Weall wentintothisfield to
takecare of kids,”said Kate Wil-
liamson,apediatricianin Orange
County, Calif.“Andwe knowthat
this is justatimefor us to step up
andworkalittle moreto save
lives.”
In Virginia,Martin said91 per-
centof 262pediatricianshe sur-
veyed wereshortonstaffinSep-
tember.Nearly three-quarters
saidtheyhad turned away or
redirected sickpatients in the
pastmonth,and 38 percentsaid
theycould not complete the
amountof coronavirustestingre-
quested by familiesand schools.
Some primary-care facilities
wouldnot necessarily be short-
staffed if theywere facinganor-
mallevel of demand,Boogaard
said,buttheyare strugglingto
hireextrahelptomeetthe current
need.Thenumber of traveling
nursesthatcouldnormallystep in
has decreased because of the
same burnout affecting other
health-careworkers, she said,and
mostofthose whoremainhave
alreadybeenhired.
Some doctors’ offices have
managed to find temporaryor
as-needed staffmembersto fill
gaps. Others have temporarily
condensed their locations. At
leastone office wroteto parentsto
askfor boththeirpatienceand
suggestions of job candidates.
They receivedseveral leadsin re-
sponse,Beerssaid.
But mostpediatricians said
they are focusingon maximizing
theirremainingemployees’effi-
ciencywhiletryingnot to over-
workthemand drivethemto quit.
More than450,000 health-care
workers have left theindustry
sinceFebruary2020,the Bureau

of Labor Statisticsreported this
month.Last month,the Depart-
mentof HealthandHumanSer-
vicescommitted $100million to
recruitand retainclinicians.
Pediatriciansin somestates ap-
pearalreadyto have passedtheir
busiestperiodof thefall.Sally
Goza, whopracticesin Fayette-
ville,Ga.,saidshe experienceda
big uptickin covid-19 patientsin
Augustand September,asstu-
dentsreturnedto schoolswhile
the deltavariantspread.
Demand hassince subsided,
Goza said,but doctors at her prac-
tice are still fillinggaps left by a
shortageofnursesandtryingto
meetinitial requests for pediatric
vaccines.Avaccine clinicsched-
uledfor thiscomingSaturdayis
alreadyfull.
“Itreallyis almostacall to
action for pediatricians that
now’s our timeto step up to the
plate,”Gozasaid.
LuciaBenzoni,adoctor with
Hartford HealthCare Medical
Group Pediatrics in Litchfield,
Conn., saidincreasingnumbersof
herpatientshave recently been
testingpositivefor the coronavi-
rus,whichshe expects willbe “a
big impetus”for parentsto get
theiryounger childrenvaccinat-
ed.
Theefforttoget shotsto kidsin
the comingmonthsis likely to be
“all handson deck”for pediatri-
cians,Diasiosaid.
“Yes, it’s hard.Yes, it’s difficult.
No,Ican’t makemore staffap-
pear,” he said.“But at the endof
the day, this is an incredibly im-
portantthingfor thehealthof
childrenin our communities.And
we willfind away to getitdone,
becausewe do difficult thingsall
daylong.”
[email protected]
[email protected]

KatieShepherdcontributedtothis
report.

Amid vaccine rollout, pediatricians are overwhelmed but eager to help


“We knowthat this is


just atime for us to step


up and workalittle


moretosave lives.”
KateWilliamson,apediatricianin
OrangeCounty,Calif.

tracted surge, saidNickGilpin,
Beaumont’smedicaldirector for
infectionprevention.
“This has beenatwo-and-a-half
to three-monthslowburn,”Gilpin
said, notingthatprevious spikes
tendedtoplayoutrelativelyquick-
ly.“This is different. This is way
moreof amarathon thanasprint.
It feelslikewe’regoingto be con-
tinuingthisslowburnthroughthe
winter months, and that’sgoingto
be exhaustingfor alot of our peo-
ple.”
Thereasonsfor the uptick in-
clude colder weather, increased
indoorgatheringandrelaxationof
precautionsinthe wake of news
reports showing declining nation-
al infection rates. Vaccination
rates in Michiganare relatively
low.And immunityiswaning
among vaccinatedpeople who
rushed to gettheir shotsearlyin
the year,Gilpinsaid. Anecdotally,
mostofthe breakthroughcases
resulting in hospitalizationare
among those with chronichealth
problems andcompromised im-
munesystems,hesaid.
In LarimerCounty, Colo.,mean-
while,the arrival of fall and cooler
weathercoincidedwithasurgein
viral infections thatstrainedthe
health-care system.Thereare not
enough bedsforthe sickestcovid-
19 patients, with intensive-care
bedsfull, saidGonzales,the public
health director.BylastFriday,the
numberofcoronavirus patients in
the hospitalshad tied the all-time
highinDecember—whenvac-
cineswerenot yetavailable —
althoughthe numberdecreased
earlythis week.
ColoradoGov. Jared Polis (D)
signedanexecutiveorder in late
October allowinghospitals to turn
away patients andtransfer them
toother hospitals. On Tuesday
evening,the stateactivated crisis

strated that it is quitecapableof
breakthrough (post-vaccination)
infections, andalthough suchcas-
es typically aren’tsevere,theycon-
tribute to the spreadof thedis-
ease.
Europe,where vaccineshave
beenwidely embraced,has seen a
massivewaveofnew infections,
and it hasoftenbeenabouta
month ahead of the United States
during the pandemic.
“Now with theholidaygather-
ings coming in, you’regoingtosee
nationalincidencerise.The ques-
tionishow much,” saidDavid Ru-
bin, apediatricianand director of
PolicyLabatChildren’sHospitalof
Philadelphia.“Anditall depends

on whathappensin these large
populationcenters, which are
highly vaccinated.”
Michiganis nowexperiencing
its fourth wave of rising hospital-
izationssince the startofthe pan-
demic. On Tuesday, Beaumont
Health,which operates eight hos-
pitals in metropolitanDetroit,
counted373 hospitalizedpatients
withcovid-19, abouttwo-thirdsof
themunvaccinated.
Althoughthose numbers ha-
ven’t yetapproachedthe levelsof
previouswaves—thelastone,
fueled by the alpha variant,
peaked at 800 patients this spring
—the steadyincreasesince Au-
gustsuggeststhiscouldbe apro-

0

50k

100 k

150 k

200 k

250 k

300 k

7-dayavg.

0

2k

4k

7-dayavg.

0

1m

2m

3m

4m

Jan. 2021

Jan. 2021

Jan. 2021

Nov.1 0

Nov.1 0

Nov.1 0

Feb.29, 2020

Feb.29, 2020

Feb.29, 2020

Asof8p.m.Wednesday

46,572,
97,

434,486,

756,
1,

1,330,

Yesterday

Yesterday

Total

DEATHS

Total

VACCINE DOSESADMINISTERED

Newcoronaviruscases, deaths and
vaccinedosesin the U.S., by day

Total

CASES

Yesterday

7-dayavg.

CALLAGHANO’HARE/REUTERS
NicoleThompson,obscured at right, holds herson,whowastreatedfor covid-19 in St.Louislast
month. Experts worrylowvaccinationrates in rural areas andcoldweathercould drive afifth wave.
Free download pdf