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COVID-19 pressure mounts in the Sun Belt

States from California to Florida are seeing a spike in coronavirus cases. After weeks of declining mortality rates, the death toll is beginning to rise

COVID-19 pressure mounts in the Sun Belt

Dr. Joseph Varon, center, visits with Dorothy Webb, left, and her daughter, Tammie, while making his rounds inside the Coronavirus Unit at United Memorial Medical Center in Houston. (AP Photo/David J. Phillip)

Sherry Tutt remembers her big sister LaKecial Tutt—or Keshia to some, “Mz. Pinky” to others—combing her hair when they were little. Then as teenagers, they used to fight over the house phone. It drove their mom, Doris LaVon “Von” Sims, crazy, but the three women were close: “We were all each other had,” Tutt said. 

“Had.” Tutt’s mom and sister died of COVID-19 on the same day, June 9, at different hospitals in the Dallas–Fort Worth metroplex. Tutt contracted the virus too, but she wasn’t hospitalized. The family had been careful: They wore masks and stayed away from large gatherings. Still, they became ill mid-May, and Von and Keshia were both hospitalized by the end of that month. Coronavirus cases are on the upswing again, and Tutt is on a crusade to remind people to take the illness seriously

“It bothers me to see people being so cavalier about it, the coronavirus, but it enrages me when I see people say the death rate is so low, because that death rate affects somebody,” Tutt said. “I don’t want anybody to negate the fact that the death rate is low because it’s still someone’s loved one."

Courtesy Sherry Tutt

Sherry Tutt and her mother, Doris LaVon Sims (Courtesy Sherry Tutt)

Many states across the country—including Arizona, Texas, and Florida—are especially strained under the new upward trend in case counts: On Sunday, Florida reported record high cases, surpassing 15,000 new positive tests in a single day. Officials in major Texas cities, including Austin, San Antonio, Houston, and Fort Worth, are sounding the alarm that local hospitals are running out of available space for incoming patients. Arizona hospitals are under unprecedented strain, with the Arizona Department of Health Services reporting on July 10 that patients filled 90 percent of the state’s intensive care hospital beds. 

But scientists still have lots of questions about the coronavirus and how it’ll affect healthcare systems. I spoke with medical workers preparing for a long fight that could bleed into winter, when medical providers are busiest.

Even if a person’s chances of dying of COVID-19 are low—figures in the United States appear to show around 41 deaths per 100,000 population and of confirmed cases, slightly more than 4 percent—the virus’s novelty means scientists are just beginning to gain insight into potential long-term negative effects. A small but growing body of research indicates that some patients may experience lasting lung or vascular dysfunction, as well as neurological complications. 

Doctors are increasingly adding “COVID-19” to a list of patient comorbidities—conditions such as asthma, diabetes, and hypertension—on patients’ electronic health records so they can better monitor how that disease may affect people down the road. Tara Cavazos is a doctor of nursing practice (DNP) who runs a Dallas clinic. She and her partners have discussed how to follow up with their many COVID-19-positive patients, like performing a chest X-ray three months after infection to assess any lingering lung damage. Bottom line, Cavazos says, if you can avoid getting COVID-19, do. 

“It’s something that’s not predictable. We don’t know how you’re going to respond,” Cavazos said, citing the July 8 death of a North Texas woman in her 20s. She had no preexisting conditions. “Even though you’re young and healthy, we can’t guarantee that we can keep you well.”

Short of herd immunity or a highly effective vaccine—which likely won’t come until late 2020 at the earliest—medical practitioners are keeping their heads down and personal protective equipment (PPE) on. But caring for an influx of COVID-19-positive patients wears on doctors and nurses, making a long-term perspective important. 

Dr. Matt Bush is a Dallas emergency room physician in leadership with Questcare, a network of hospital-based providers and urgent care clinics. His organization staffs 750 providers in more than 50 facilities across multiple states. Bush said New York City was an outlier in its high volume of cases and deaths earlier this year, but it’s not unreasonable to compare some areas—such as Tucson, Ariz., and parts of Texas’ Rio Grande Valley—to former hotspots like New Orleans and Detroit. 

But it’s not just major metropolitan areas that COVID-19 may overrun.

“These rural communities maybe only have a couple of ventilators, a couple ICU beds, a couple ICU-trained nurses. And some people who live in rural areas don’t have normal access to medical attention anyway, so maybe they have chronic diseases that are unmanaged when COVID hits their town,” noted Katy Vogelaar, DNP. She runs a faith-based clinic in Dallas that serves indigent and uninsured patients.

Some hard-hit states—Texas and Florida among them—reopened their economies with gusto, which may account for some of the surge in cases. An increase in testing capabilities is part of the upward trend too. 

To know how to deploy resources, government officials and public health experts constantly monitor data: test results, available hospital beds, ICU beds, and ventilator availability. But there are difficulties in projecting which municipalities may be next for a flare-up. Experts attribute the magnitude of the disease in New York to several factors—transportation, population density, international travel to the city—but that doesn’t explain why similar large cities like Chicago or London haven’t seen the same level of rapid and widespread COVID-19 infection. Bush conceded “there’s a lot we still just don’t know” about the disease.

Social media has been rife with harrowing tales of overrun medical facilities and dwindling resources. But Bush said most hospitals will be hesitant to raise the “‘we’re overwhelmed’ flag.” The same goes for providers. Many may be used to caring for 12-15 patients a day, but now they find themselves caring for 22-25 patients in a 12-hour shift. 

“The tricky question is, when does ‘over capacity’ become ‘unsafe?’ There is real, true data that’s been there for a long time that shows when hospitals are crowded, patients don’t do as well,” Bush said. 

When they’re overburdened, doctors transition into a triage mentality: “You do the interventions that matter most, but you have to kick up the pace of your work,” Bush said. And with all hands on deck, there’s not a team on standby to relieve stressed or weary clinicians during their shifts. Add to that the discomfort of wearing PPE for 12 hours straight, and you’ve got a recipe for burnout. 

One nurse practitioner in a major healthcare system in Arizona, whom WORLD is not naming because she is not authorized by her employer to speak to the media, told me that during a recent 13-hour shift, she personally attended to 56 patients—about triple her usual load. She thinks some of those patients are using—or misusing—hospital resources for COVID-19 testing instead of going to their primary care physician or a drive-thru testing site. Still, she said COVID-19 has thrown off the “medical gut” she has been trained to develop as a nurse practitioner. 

“The crazy thing about COVID has been that we’ve seen some people with very normal oxygen saturations and without a fever, but then you take a chest X-ray,” and the results are troubling, she said. The key symptoms keep changing, too: “At first, we were trained to look for fever, fever, fever,” but now she said that’s not always a reliable indicator of COVID-19 infection. 

She and her colleagues are exhausted. And it’s not even winter yet, when patient volumes routinely increase due to flu and respiratory viruses. 

AP Photo/Ross D. Franklin

A healthcare worker at a coronavirus testing site in Phoenix (AP Photo/Ross D. Franklin)

Vogelaar described the medical community’s general annual rhythm: gearing up for flu season in October, staying focused through a slog of respiratory illnesses in January and February, then breathing a sigh of relief in March. “But this year, we are anticipating our [winter patient volume] is going to increase drastically with COVID,” she said. 

She and her colleagues are concerned that there’s not a “reliable point of care test” that would quickly and accurately help providers determine which patients have flu and which have COVID. On the one hand, the protocol doesn’t change: treat the symptoms. But patient anxiety is real. Vogelaar said her practice is expecting the “fear factor” seen in a typical cold and flu season to “increase tenfold.” 

We’re far removed now from the “healthcare heroes” appreciation events that seemed commonplace in April, when entire cities would take to balconies and front steps to cheer on medical industry professionals at predetermined times. Bush’s organization is trying to coach its providers that this is a “marathon, not a sprint.” They’re expecting COVID-19 to be an “18-month run,” and they’re taking steps to keep patients and providers safe. That means equipping doctors and nurses with adequate PPE and educating them on the latest coronavirus techniques and therapies, which seem to be changing “month to month, week to week, day to day right now,” Bush said. 

He’s also focused on keeping his physician teams agile and ready for deployment to hotspot regions, as he did earlier this month in Tucson. When an ICU in the city became overwhelmed, Bush pulled together a team of doctors from throughout Questcare’s network and sent them to relieve busy hospital workers. They did the same when COVID-19 overran New York and New Jersey hospitals earlier this year.

After weeks of plateauing mortality rates, the uptick in COVID-19 cases around the country is just beginning to correspond to an increase in deaths. Both Bush and Vogelaar agree that doctors and nurses have become more adept at treating critically ill COVID-19 patients. “If you get it today, you have a better chance of surviving than you did three months ago,” Bush said. Another possible reason deaths haven’t matched spikes in positive cases: Younger people are getting the disease. The Arizona-based nurse practitioner I spoke with said she’s seen a noticeable jump in 20- to 40-year-old patients who have fewer complications and better outcomes. 

But Vogelaar warned it’s possible we may see the death toll rise significantly in the weeks to come. 

“Mortality is a lagging indicator,” she said. “And the typical stay of someone in the ICU with COVID is about three weeks. So we are going to be maybe a month to five weeks lagging in our mortality, based on current reporting and the trends that we have now.” 

Back at Von Sims’ home, daughter Sherry Tutt is sorting through the belongings of her deceased mom and drowning in a flood of memories. Each object reminds her of some connection Tutt now misses, as when she came across dozens of unopened dollar store purchases. They used to go deal-hunting together. 

Tutt’s mother would call her multiple times a day: “And she’d say, ‘I’m coming over to your house today when I get off work. We’re going to go to the Dollar Tree by your house.’ And I don’t have a person to call like that now. I just feel this void.”

Katie Gaultney

Katie Gaultney

Comments

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  • Steve Shive
    Posted: Tue, 07/14/2020 06:48 am

    Not a very helpful article. Of course we should be concerned. But an article that begins with a single story (two relatives), anecdotal evidence, and laced with phrases such as  "it's possible", "is just beginning", "we are going to be maybe a month", "they're expecting", "her practice is expecting" all lead to more speculation. I could open an article with an anecdote from a friend in his 8th decade who had COVID19. His wife, who does live with him in a good marriage, did not get the virus. He did well. Pretty much just the flu. His younger relative, an EMT, had it as well. He also did well.

    We should mourn when someone dies of anything. When it happens to a loved one all diseases change in our minds. “I don’t want anybody to negate the fact that the death rate is low because it’s still someone’s loved one." It has now become a 100% issue. But that doesn't change data and how we should proceed or enact public policy. Nor should this be the focus of an article purportedly to give guidance.

    Maybe this article was meant to add a face, a story, to the statistics. We should certainly do that. Nevertheless, adding conjecture and surmises and guesses is not helpful. ​There are equally plausible explanations or maybe we could say mitigating explanations for what you report on. But, we do have good reason to  ask questions and probe many of these baffling issues.  

  • catalystken
    Posted: Tue, 07/14/2020 08:04 am

    As always with Covid, lots of maybe's and conjecture about what might happen this fall or winter so not sure how helpful that is.  One correction the death rate you listed is not 4 percent but 4 one hundredths of a percent or 04 percent.  4 percent would be 4 people out of 100 dying from Covid. 40 out of 1000, 400 out of 10,000 and 4,000 out of 100,000.  To get to a 4 percent death rate 12 million people in a population of 300 million would need to have died to date.  Thank goodness that is not the case.  

    Ken Ludzack 

  • KG
    Posted: Tue, 07/14/2020 08:14 am

    Ken, the death rate is 4 percent of confirmed cases in the U.S., according to Johns Hopkins statistics. It's 41 per 100,000 total U.S. residents. 

  • Narissara
    Posted: Tue, 07/14/2020 09:42 am

    Why do we keep getting hammered about so-called herd immunity?  All that means is that the weak, the sick, the old and the very young – the most vulnerable members – will die off – must die off – to preserve the health and wellbeing of the majority.  It's a euphemism for survival of the fittest.  It's Darwinian evolution.  And it's contrary to a biblical worldview.  Even the term itself is offensive.  We're not cows; we're human beings.  There will always be individuals who are susceptible to disease among us, and new lives being born daily with no immunity.  That's why disease can never be completely eradicated.  It's a result of the curse.  God is still sovereign and our best efforts to contain COVID-19 and find a cure notwithstanding, it's ultimately up to Him who contracts it and who recovers.  

  • RC
    Posted: Tue, 07/14/2020 12:57 pm

    Whoa! Take a chill pill. I can’t disagree with your rejection of the word “Herd” when used in this context referring to humans.  While your Herd immunity definition is correct as it applies to animals. From the human perspective, the definition has more to do with the virus dying out because enough people have developed immunity to it. So, if those who are more at risk, and have avoided exposure to it before, can’t get it after the virus has died out.  Yes, totally agree God is ultimately in control.       

  • Narissara
    Posted: Tue, 07/14/2020 01:52 pm

    What guarantee do have this virus will ever die out completely?  The number of asymptomatic cases directly correlates to an incidence of natural immunity.  If the number of asymptomatic cases is increasing, so is the incidence of natural immunity.  Yet it seems as the number of asymptomatic cases increase, the knee jerk reaction by elected officials is to tighten restrictions, not loosen then.  Yes, individuals who are naturally immune can still be carriers and transmit it to those vulnerable individuals.  That's the case with any disease.  Again, a result of the curse.  Vaccines, even if one doesn't have moral reasons to oppose them, are not 100% effective.  The only way to completely eradicate disease is to adopt a survival of the fittest mentality and ignore God's sovereignty. 

  • Sun shine
    Posted: Tue, 07/14/2020 03:07 pm

    We seem to be living with the mentality that there is a fix.  Whether it's herd immunity, social isolation, masks, or a vaccine.  But what if there's not? I'm not sure the US church is prepared for that reality and instead we are living in hope of science.  We should strive for solutions but remember that "the wages of sin is death".  Mass death and disease should not surprise us, should drive us to personal repentance and should force us to depend on our savior and worship our God.  May we not forget that "to live is Christ and to die is gain."

  • Narissara
    Posted: Tue, 07/14/2020 05:43 pm

    Good points.  

  • DGKloost
    Posted: Tue, 07/14/2020 07:10 pm

    If you look at the bigger picture (which is not comforting to someone who is sick or who has lost a loved one) Texas still is 36th in the nation for deaths per million for this whole time and Florida is somewhat worse at 26th in the nation.  They did not have a bad time with it at the start when some of the other states did.