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Bethel hospital enacts crisis standards of care; Alaska stays on upward COVID-19 trajectory as Lower 48 sees decline

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A large rural Alaskan hospital is issuing standards for crisis care, the newest facility employing the worst-case scenario and assisting doctors deciding which patients to treat due to lack of staff, beds, or equipment.

Yukon-Kuskokwim Health Corp. announced a move to crisis care mode on Wednesday, saying the tribal health organization’s Bethel Hospital is at full capacity and struggling to maintain normal levels of care as COVID-19 cases continue to rise in the region and the state.

At least one other hospital in Valdez is also using new crisis management guidelines to make treatment decisions with oxygen, which is in short supply due to demand from COVID-positive patients.

Providence Alaska Medical Center began occasionally rationing care to patients beginning September 11, using state guidelines and an in-house triage team to help make tough decisions when needed.

Despite an apparent peak and decline in cases nationally, Alaska is continuing a steep upward trend, with more than 1,000 new COVID-19 infections reported on Wednesday.

The state epidemiologist Dr. Joe McLaughlin said Wednesday that Alaska has the highest 7-day case rate in the country – five times the national average and twice the rate in the second highest rate state, West Virginia.

“We’re definitely on a steep, steep upward trend,” said McLaughlin.

Several places in the nation showed declining case numbers and appeared to be showing spikes and case numbers this week, McLaughlin said.

[Delayed shipments of monoclonal antibodies stress supply of time-dependent COVID-19 drug for some in Alaska]

Governor Mike Dunleavy and top health officials activated crisis care standards last week, giving every hospital the ability to set standards and protect providers from liability. Officials also announced a federal contract to bring up to 470 health workers, including many nurses or respiratory therapists, to Alaska starting this week.

Yukon-Kuskokwim Health Corp. has made the crisis care decision as many of the hospitals that normally accept patient transfers in Anchorage and elsewhere remain busy, officials there said Wednesday. Outskirts hospitals are already saying they need to treat more difficult patients in-house because they can’t move them out for a higher level of care.

Health organization Yukon-Kuskokwim developed crisis guidelines at the start of the pandemic, including activating a medical committee to help providers make clinical decisions, officials say. The change in operations could result in delayed patient transfers, fewer nurses and longer waiting times for elective procedures such as cancer screening or dental procedures on children.

Wednesday’s decision was not triggered by specific bottlenecks and does not mean the kind of supply rationing the Providence Doctors in Anchorage doctors have described is happening at Bethel, said YKHC Chief of Staff Dr. Ellen Hodges.

It means such decisions are possible unless the strain on the state’s hospital system subsides, Hodges said.

“The nuances of this and how to explain it to the public is really difficult,” she said. “It sounds and feels really dramatic, but it’s really about getting the best possible care for our patients. The people in the hospital are fine. “

Hospital managers urged Yukon-Kuskokwim residents to get vaccinated against COVID-19, wear a mask in indoor public areas, practice social distancing, and take extra steps to avoid injuries that could bring them to the emergency room.

According to Dr. John Cullen, chief of staff at the 11-bed hospital, doctors at Providence Valdez Medical Center are already using state crisis guidelines to ration oxygen. The hospital works with 50% of the workforce amid a local COVID-19 surge that has sparked a wave of patients in need of high levels of oxygen.

“We don’t give as much oxygen to get patients to what we would call normal,” said Cullen on Wednesday. Usually the hospital wants patients to reach 93% oxygen saturation, he said. Currently the providers accept 90% according to the guidelines of the state crisis standard.

The hospital is struggling with “really sick” COVID-19 patients, said Cullen. One died recently after being transferred to another hospital.

He wrote a letter to the Mayor of Valdez and the city council last week warning that the state’s limited hospital capacity would allow transfers from their small hospital to Anchorage, despite government programs to relieve staff pressures, including more workers entering the city , “Difficult to impossible” could make.

Cullen described the likelihood of a much higher death rate “similar to a battlefield scenario” until COVID-19 cases decline.

“When you reach crisis levels of care, it means you expect a higher level,” he said on Wednesday. “It really depends on how bad that particular wave is. I was really hoping that we would see a significant drop in the numbers last weekend. “

This week, the city of Valdez issued a disaster declaration in view of the deteriorating situation in the municipality. A city council meeting on Wednesday will consider an extension of the disaster declaration as well as a mask mandate, said Allie Ferko, the city’s public information commissioner.

The declaration contains specific calls for more hospital staff and the continuation of tests and vaccinations. The statement also needs to be in place to issue an emergency mandate such as masking requirements, Ferko said.

On Wednesday, Alaska reported 1,009 new cases and four more virus-related deaths. As of March 2020, 546 Alaskan residents and 21 non-residents have died from the virus.

The deaths reported on Wednesday involved Anchorage residents: two men in their 40s, one woman in their 60s and another in their 70s.

Alaska reported 207 virus hospital admissions on Wednesday, and COVID-19 patients – mostly unvaccinated – made up more than a fifth of all hospitalized people in the state. Others who may still be hospitalized because of the virus but are no longer actively infectious are not counted in this total.

The percentage of tests that returned positive over the past week in Alaska was 9.2%, which is nearly double the state’s 5% target, according to McLaughlin.

By Wednesday, 63% of Alaskans ages 12 and older had received their first dose of the vaccine, while 60% were considered fully vaccinated.

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Pandemic

Utah’s COVID-19 death toll is nearly 3,600

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More than 3,400 new cases have been reported in the past three days.

(Francisco Kjolseth | The Salt Lake Tribune) Nurse Ashley Hafer fills syringes with the Moderna vaccine for people waiting in line on Thursday, March 18, 2021.

Editor’s note: The Salt Lake Tribune offers free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter sent to your inbox every morning. To support journalism like this, please donate or become a subscriber.

The Utah Department of Health reported 32 more COVID-19 deaths on Monday, bringing the state’s death toll since the pandemic started to 3,595.

Twenty-one of the deaths occurred on Friday, Saturday, and Sunday; 11 occurred before November 1 and was only recently confirmed to be caused by COVID-19 after further testing.

16 of the deceased were under 65 years of age. Of these, three were between 25 and 44 years old and 13 were between 45 and 64 years old.

The Ministry of Health reported 3,457 new coronavirus cases in the past three days – 912 on Friday, 1,166 on Saturday and 1,452 on Sunday, an average of just over 1,152 per day. The 7-day rolling average of the new positive cases is 1,550.

The number of children being vaccinated continues to rise – 74,363 children ages 5-11 have received at least one dose of the COVID-19 vaccine since it was approved; That’s 20.4% of children that age in Utah, according to the Department of Health.

The intensive care units in the state remain almost fully utilized. UDOH reported Monday that 95.4% of all ICU beds in Utah and 97.5% of ICU beds in major medical centers in the state are occupied. (Hospitals consider anything above 85% functional). Of all intensive care patients, 42% are being treated for COVID-19.

Vaccine Doses Delivered / Total Doses Delivered In Last 3 Days • 41,000 / 4,237,422.

Number of Utahns Fully Vaccinated • 1,834,977 – 56.1% of the total Utah population. That’s an increase of 17,425 in the last three days.

Cases reported in the last three days • 3,457.

Cases in School-Age Children • K-12 children accounted for 653 of the new cases reported Monday – 18.9% of the total. In children aged 5 to 10 years, 361 cases were reported; 132 cases in children 11-13; and 160 cases in children between the ages of 14 and 18.

Tests Reported in Last Three Days • 23,888 people were tested for the first time. A total of 49,052 people were tested.

Deaths reported in the past three days • 32.

Six of the dead were Salt Lake County residents – men between the ages of 25 and 44; a man and a woman 45-64; a man and a woman 65-84; and a man over 85.

Weber County also reported six deaths – one man and two women between the ages of 45 and 64; a man 65-84; and two women over 85.

Five Davis County residents died – two women 45-64; a man and a woman 65-84; and one woman over 85. And there have been four deaths in Utah County – a woman between the ages of 25 and 44; a man 45-64; and a man and a woman 65-84.

Three Washington County residents also died – a woman 64-84 and a man and woman 85-plus. And two Sanpete County residents died – a woman 45-64 and a woman over 85.

Four counties each reported a single death – a Box Elder County man aged 45 to 64; a man from Cache County 25-44; a man from Iron County 65-84; and a man from Sevier County 45-64.

Two men between the ages of 45 and 64, whose whereabouts were unknown, also died.

Hospital stays reported on the last day • 502. That is 11 fewer than reported on Friday. Of the current hospital admissions, 204 are in the intensive care unit, five more than reported on Friday. And 41% of patients in intensive care units are being treated for COVID-19.

Percentage of positive tests • According to the original state method, the rate over the past three days is 14.5%. That’s less than the 7-day average of 15.3%.

The state’s new method counts all test results, including repeated tests on the same person. On Monday, the rate was 7%, below the seven-day average of 10%.

[Read more: Utah is changing how it measures the rate of positive COVID-19 tests. Here’s what that means.]

Risk Rates • In the past four weeks, unvaccinated Utahners were 14 times more likely to die from COVID-19 than vaccinated people, according to an analysis by the Utah Department of Health. Unvaccinated people were nine times more likely to be hospitalized and 3.6 times more likely to test positive for the coronavirus.

Total numbers so far • 605,409 cases; 3,595 deaths; 26,268 hospital stays; 4,030,046 people tested.

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Pandemic

Innovative Testing Gives Virginia Department of Corrections a Jump on COVID-19 — Virginia Department of Corrections

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Press release

Innovative testing gives the Virginia Department of Corrections a leap on COVID-19

December 06, 2021

RICHMOND – Last year, as part of its response to the COVID-19 pandemic, the Virginia Department of Corrections (VADOC) used an innovative method: examining wastewater samples at 40 of its facilities.

VADOC facilities offer unique tracking benefits as they provide small, controlled, relatively immutable populations that can quickly and clearly identify trends.

“Wastewater testing provides a highly reliable snapshot of a facility’s health for COVID. If someone has COVID-19, sewage tests tell us immediately, ”said Meghan Mayfield, VADOC’s energy and environmental administrator.

Under normal circumstances, patients may not show symptoms of COVID-19 for eight to ten days after exposure. Regular wastewater testing gives health officials a potential head start in fighting an outbreak and greatly improves their ability to monitor infection rates in the facility.

“The program is designed to detect COVID as early as possible to prevent the spread and suffering among inmates, employees and the public,” said Robert Tolbert, VADOC plant administrator.

The department was among the first state prison systems to conduct wastewater tests. It began testing last October and worked with the Hampton Roads Sanitation District and the Virginia Department of Health (VDH) to conduct and monitor Virginia prison facilities on a weekly basis.

“We are always ready to work with our community partners to keep everyone in our community and our world safe,” said Harold Clarke, director of the Virginia Department of Corrections. “This is in line with our public safety mission to help people get better.”

Wastewater testing is also significantly more cost-effective than many other types of testing. Prior to its launch, health officials relied on point prevalence testing, an expensive, labor-intensive nasal swab measure that can cost up to $ 180,000 for a one-time test of all inmates and staff in an average-sized facility. For comparison, wastewater tests for a similar facility cost about $ 200.

“We have abolished the planned point prevalence tests at VADOC. Sewage tests are a much cheaper and extremely accurate predictor, ”Mayfield said. “We can use this data as a preliminary indicator of the presence of COVID-19 in a facility. By taking into account other factors such as community prevalence and existing COVID infections in the facility, we can use these results to make better decisions about running targeted point prevalence tests in each facility. “

The sewage process was developed after the pandemic broke out and may be used to track other viruses in the future.

VADOC’s approach worked so well that the Water Environment Federation (WEF) and Centers for Disease Control and Prevention (CDC) asked VADOC to help validate the results of a new one biological diagnostic test device. This device, LuminUltra, is being tested in five state prison facilities across the Commonwealth and will help other state prisons and smaller rural communities monitor wastewater for COVID-19.

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S.Korea’s COVID-19 rules put some vaccinated foreigners in limbo

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A woman wearing a mask to prevent contracting coronavirus disease (COVID-19) takes a nap at Incheon International Airport in Incheon, South Korea on November 30, 2021. REUTERS / Kim Hong-Ji

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SEOUL, Dec 6 (Reuters) – South Korea on Monday imposed stricter measures to curb the growing coronavirus infections and the Omicron variant, effectively banning some foreign residents who have been vaccinated abroad from places like restaurants, cafes and movie theaters are.

South Korea recognizes the vaccination status of Korean citizens who have been vaccinated abroad, but not foreign nationals unless they entered the country under quarantine.

Some foreign residents, particularly those from Europe and the United States, were vaccinated earlier this year, when South Korea had not yet made vaccines available and not eligible for the quarantine exemptions granted to certain individuals in business, education, or humanitarian reasons became.

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How many people are affected is unclear, but the problem has caught the attention of several foreign embassies, which have been campaigning for a change for weeks without success.

“We continue to advocate an urgent review of the guidelines to ensure fair treatment of foreign and Korean citizens who have been vaccinated abroad,” Stephen Burns, a spokesman for the UK embassy in Seoul, told Reuters.

The Australian embassy is in constant contact with the South Korean government on this matter and continues to advocate a change in its policy, said Ambassador Catherine Raper in a post on Twitter on Monday.

The Korean Disease Control and Prevention Agency says the directive affects a small number of people and is necessary in the face of rising COVID-19 cases.

“A cautious approach is needed at this point as there are locally and globally confirmed cases of the Omicron variant and the possibility of further spread in the community,” a spokesman said, adding that officials are reviewing the rules depending on the domestic outbreak situation will.

The KDCA reported 4,325 new COVID-19 infections on Monday, a total of 477,358 since the pandemic began, with a total of 3,893 deaths. The country has discovered 24 cases of the new variant of Omicron.

In response to the daily growing number of cases, South Korea has suspended previous efforts to “live with COVID-19”, instead imposing new vaccination record requirements and ending quarantine exemptions for all travelers arriving from overseas.

The problem for foreigners with unregistered vaccines will be exacerbated as previous rules that required a state vaccination certificate or a negative COVID-19 test to enter gyms, saunas and bars now apply to cafes, restaurants, cinemas and other public places Rooms were expanded.

Unvaccinated people or people without proof of vaccination can still dine in restaurants, but only if they are sitting alone.

“An example that South Korea is not yet a truly global, international country,” tweeted Jean Lee, Korean affairs analyst at the US Wilson Center.

In March, authorities sparked a riot in several major cities, including Seoul, by ordering that all foreign workers be tested for coronavirus. Some of these measures were dropped following complaints from embassies and a human rights investigation.

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Editing by Jacqueline Wong

Our Standards: The Thomson Reuters Trust Principles.

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