Excellent Links

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As COVID19 surges across the US, it’s hard to describe the situation inside hospitals for healthcare providers & patients.

We made this video depicting 1 day in the ER to show the painful reality & to remind us why we must remain vigilant. Please watch.pic.twitter.com/JzxcHJKFuP

— Craig Spencer MD MPH (@Craig_A_Spencer) November 29, 2020

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States With Few COVID-19 Restrictions Are Spreading the Virus Beyond Their Borders https://t.co/BB0N64foea pic.twitter.com/Gvk9GzSsvf

— Talking Points Memo (@TPM) December 1, 2020

Finally, something red states are willing to share with their more prudent neighbors…

… As the number of COVID-19 cases skyrockets nationwide, the extent of the public health response varies from one state — and sometimes one town — to the next. The incongruous approaches and the lack of national standards have created confusion, conflict and a muddled public health message, likely hampering efforts to stop the spread of the virus. The country’s top infectious disease expert, Dr. Anthony Fauci, said last month that the country needs “a uniform approach” to fighting the virus instead of a “disjointed” one.

Nowhere are these regulatory disparities more counterproductive and jarring than in the border areas between restrictive and permissive states; for example, between Washington and Idaho, Minnesota and South Dakota, and Illinois and Iowa. In each pairing, one state has imposed tough and sometimes unpopular restrictions on behavior, only to be confounded by a neighbor’s leniency. Like factories whose emissions boost asthma rates for miles around, a state’s lax public health policies can wreak damage beyond its borders.

“In some ways, the whole country is essentially living with the strategy of the least effective states because states interconnect and one state not doing a good job will continue to spread the virus to other states,” said Dr. Ashish Jha, dean of the Brown University School of Public Health. “States can’t wall themselves off.”…

The degree of coronavirus regulation tends to track political lines. President-elect Joe Biden carried blue Washington state with 58% of the vote, while President Donald Trump easily won red Idaho with 64%. Trump has helped to fuel the patchwork response to the pandemic, criticizing the approaches of some states, praising others and at times contradicting the advice of his own coronavirus task force and Fauci.

“What really struck me [is] how hard it is to take the pandemic strategy as laid out by the White House with every state on its own and … implement it because every state is not on its own, they are all interconnected,” Jha said.

Biden has said he wants to implement national standards, such as required mask wearing, to help blunt the spread of COVID-19 while acknowledging the federal government lacks little power to do so. He hopes to work with governors and local officials to establish consistent standards across the country.

A lack of such consistency is affecting eastern Washington, which appears to be absorbing some of the costs — both human and economic — of Idaho’s more laissez-faire approach to the virus. The rate of new cases in and around Spokane, near the Idaho border, is far higher than in Seattle and western Washington, which experienced one of the earliest outbreaks in the country in February. Although slightly more than half of recent COVID-19 cases in Spokane spread among households or personal contacts, Spokane Regional Health District epidemiologist Mark Springer said, “people bringing back COVID-19 from larger events in Idaho” has been a problem. And with Idaho’s rate of new cases now doubling Washington’s, Idahoans who commute to the Spokane area pose an outsized danger. At the same time, Washington’s shuttered businesses have ceded customers to their Idaho competitors….

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From an NBC News reporter:

THREAD: I just spent 3 days with frontline workers at hospitals in a part of Appalachia where hospitalizations have more than doubled in the last month. But hospital staff say many in their hard-hit communities still don’t believe COVID is real. Misinformation is rampant.

— Dasha Burns (@DashaBurns) November 28, 2020

One nurse told me stories of otherwise healthy 30 year-olds coming in short of breath and not understanding why. She tries showing them chest x-rays and explaining evidence of the disease, but often they don’t believe they have COVID until they’re in critical condition.

Another nurse told me some come in severely sick with COVID, but when they test positive they blame the hospital for giving it to them. There’s a popular conspiracy theory that hospitals are benefitting financially from COVID. But in fact, many are struggling to stay afloat.

Ultimately, politicization and misinformation around COVID are having tragic real-world consequences. People are dying because they don’t seek medical care when they begin having symptoms. They don’t believe they’re sick. And by the time they get to the hospital it‘s too late.

This is heartbreaking for families and also for health workers who often treat people they know personally in these small, tight-knit communities. They are watching neighbors die because they were told by leaders they trust that this virus is a hoax.

These frontline workers see multiple deaths during a single shift…then go out into a world where people downplay the virus, say masks infringe on their civil liberties, and tell stories of big gatherings. And they know they will make more calls to the funeral home tomorrow.

Huge thank you to @BalladHealth staff for taking the time to talk to me about your experiences. It’s not easy. But what you do every day is much harder. Your resilience is staggering.

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COVID-19 may continue to circulate in rural areas into 2021 and beyond, even as cities get the virus under control through a combination of vaccination and nonpharmaceutical interventions, @aetiology writes.https://t.co/pTRIdZT6g0

— Foreign Affairs (@ForeignAffairs) November 23, 2020

… In May, I warned in Foreign Affairs that the coronavirus pandemic in rural America would lag behind the pandemic in urban areas and that it would be “slower, steadier, and likely to continue for a longer period of time.” That is what has happened so far. After initial outbreaks in the spring that were mostly clustered around specific industry-related hot spots—including meatpacking plants, nursing homes, and jails—many rural areas are now experiencing widespread community transmission. The virus took longer to reach these areas, but now it is making up for lost time. Although cases are rising across the country, the highest per capita infection rates tend to be in rural areas and small towns. In Ohio, for instance, nine of the 12 counties with the highest per capita incidence of COVID-19 have populations of less than 50,000.

Geography alone does not explain this discrepancy. Rural areas are less likely to have mandated that residents wear masks, and even in those areas that have mask mandates, residents are less likely to comply…

The situation in rural areas is likely to get worse before it gets better. Hospitals in these regions (if there are hospitals at all) are smaller and have fewer resources than metropolitan facilities. As a result, a flood of COVID-19 patients can easily overwhelm them. And with rising infection rates straining the health-care system across the country, rural hospitals may not be able to transfer critically ill patients to larger, more urban ones…

Vaccine distribution also presupposes that people are willing to be vaccinated. But potential COVID-19 vaccines have been highly politicized. Just as President Donald Trump’s promise to roll out a vaccine prior to the election sowed distrust among Democrats, the Biden administration’s likely effort to distribute one early next year could meet with skepticism among Republicans, especially in rural areas where Trump supporters will have heard over and over that Biden and the Democrats “stole” the election. Black Americans in both rural and urban environments may also be suspicious of any new vaccine after years of mistreatment by the medical establishment, even though they are at high risk for severe COVID-19 infections…