Bracing for the COVID-19 surge

MEGAN BASHAM, HOST: It’s Thursday the 16th of July, 2020. Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Megan Basham.

NICK EICHER, HOST: And I’m Nick Eicher. First up: hospitals brace for a rise in COVID-19 cases.

Sun Belt states, from California to Florida, are seeing more COVID-19 activity. And after weeks of steady mortality rates, the death toll is again rising. The relentlessness of this disease has hospitals in some areas already at capacity.

BASHAM: WORLD correspondent Katie Gaultney reports on the strain that’s placing on doctors and nurses.

KATIE GAULTNEY, REPORTER: Sherry Tutt remembers her big sister Keshia combing her hair when they were little. As teenagers, they used to fight over phone privileges. 

TUTT: Keshia used to hog the phone. We used to have one phone back in the day, the house phone. And that’s what we were mostly at odds about, like, “You had your time on the phone!”

It drove their mom, Von Sims, crazy. But the three women were close—especially Sherry and Von. They called each other several times a day, often making plans to go to different dollar stores around town.  

TUTT: My mom was my best friend. We did just about everything together.

Now Tutt is reeling from a double, devastating loss. Both her mom and her sister died of COVID-19 on June 9th, at different North Texas hospitals. Tutt contracted the virus too, but never had to be hospitalized. She said the family was careful, wearing masks, avoiding crowds, and really only going out for essentials. 

She’s urging people to take the virus seriously: 

TUTT: 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, but that death rate affects somebody, and it affected me double, my mom and my sister. 

Many states across the country are feeling the pressure as coronavirus cases surge. Officials in Tutt’s home state of Texas are sounding the alarm that local hospitals are running out of available space for incoming patients. Florida’s positive COVID test rates over the last week have ranged between 11 and 18 percent. That means about 1 in 8 Floridians may have the disease. And in Arizona, 90 percent of the state’s intensive care beds are full.

Dr. Matt Bush is an emergency room physician in Dallas.

BUSH: The tricky question is, when does overcapacity become unsafe? There’s real true data that’s been there for a long time that when hospitals are crowded, patients don’t do as well. 

Bush works with Questcare, a network of hospital-based providers and urgent care clinics. It staffs 750 doctors and nurses in more than 50 facilities across multiple states. Bush says New York City was an outlier in its high volume of cases and deaths, but it’s not unreasonable to compare some areas—like Tucson, Arizona and parts of Texas’ Rio Grande Valley—to former hotspots in New Orleans and Detroit. 

And it’s not just metropolitan areas that may become overrun with COVID-19 cases. Katy Vogelaar is a doctor of nursing practice, or DNP, in North Texas.

VOGELAAR: I think where a lot of people are concerned is these rural communities that maybe only have a couple of ventilators, a couple ICU beds, a couple ICU trained nurses. 

Vogelaar says rural patients often don’t have convenient access to medical care. That might mean a higher incidence of unmanaged chronic disease that could make COVID outcomes worse. 

For weeks, the mortality rate held steady or even declined, even as cases climbed. Now, deaths are ticking up, though not yet at the same rate as cases. U.S. data appear to show about 41 deaths per 100,000 population. If you look at confirmed positive cases, the mortality rate is slightly more than 4 percent. 

Bush notes doctors and nurses have become more adept at treating critically ill COVID-19 patients. 

BUSH: But I think what we need to realize is that it is a day to day learning process in the medical community. If you get it today, you have a better chance of surviving than you did, you know, three months ago.

Another possible reason deaths haven’t spiked at the same rate as cases: Younger people—ages 20 to 40—are getting the disease, and they tend to have better outcomes. But Vogelaar warns we might see the fatality rate skyrocket in the weeks to come. 

VOGELAAR: If you look at the data, um, our cases are going to be lagging a little bit too, cause usually it’s about two weeks behind when someone’s going to get infected. 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 kind of lagging in our mortality, based on current reporting and the trends that we have now.

Even if mortality is relatively low, it is on the upswing. And the novelty of this virus means scientists are just beginning to have insights 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. 

That’s why 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 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. 

CAVAZOS: It’s something that’s not predictable. We don’t know how you’re going to respond. Even though you’re young and healthy, we can’t guarantee that we can keep you well.

That’s a message Sherry Tutt hopes hits home for people. She’s been sorting through her mother’s belongings, fighting a flood of memories with each unopened dollar store purchase she comes across. She keeps absentmindedly picking up the phone to call her mom, or trying to tag her sister on a Facebook post she would enjoy. And then Tutt remembers: they’re gone. 

TUTT: So I don’t want anybody to negate the fact that the death rate is low because it’s still someone’s loved one. And until, I guess 2 percent, you know, didn’t affect you. But someone in the world that 2 percent was their world and it was mine. 

Reporting for WORLD, I’m Katie Gaultney in Dallas, Texas.

(AP Photo/David J. Phillip, File) In this July 6, 2020, file photo, a ventilator helps a COVID-19 patient breath inside the Coronavirus Unit in a Houston hospital. 

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