June 13, 2020, 5:33 PM
7 min read
7 min read
For many free-spirited Americans, a face mask may feel like an uncomfortable blot on personal expression. But as states slowly begin to ease coronavirus restrictions, some medical experts are trying to put a happier face on those coverings -- touting them as a symbol of kindness and a tool in the effort to slow viral spread.
"It is really part of our social contract," said Dr. Lisa Maragakis, senior director of infection prevention at Johns Hopkins University. "It's an act that we're doing to protect other people."
Using masks as an everyday accessory has not come quickly or easily for the nation. Almost from day one, masks have been pushing political buttons.
Speaker of the House Nancy Pelosi sought to lend some old-fashioned machismo to the cloth covering this week.
"Real men wear masks," she declared in her weekly news conference on Thursday.
But on the other side of Pennsylvania Avenue, President Donald Trump seemed to think there was something un-manly about the masks. Even as his own federal health officials began strongly advising their use, he has resisted appearing in public wearing one.
"I didn't want to give the press the pleasure of seeing it," he said recently after appearing at a Detroit auto factory without one before cameras. He reportedly wore one on a private tour of the facility, where masks are required.
Donna Harkness wears a mask with "Trump 2020" printed on it at a demonstration to demand the lifting of restrictions imposed by state and local officials to fight the spread of the coronavirus in Boston, May 30, 2020.
There have been signs the face coverings could be turning into another reason for skirmish in the nation's ongoing culture war, with conservatives like Louisiana Republican Clay Higgins among a small group from Congress resisting the accessory. Higgins went on CNN recently to declare the masks a form of "dehumanization."
"Can you smell through that mask?" he asked. "Then you're not stopping any sort of a virus."
But medical experts have been increasingly vocal in their confidence that face coverings do play an important role, along with social distancing and frequent hand-washing, in keeping the coronavirus from surging across communities.
One new peer-reviewed research paper from the journal of the National Academy of Sciences reported that decisions about mandatory face coverings are central to mitigating the pandemic's impact.
With respiratory droplets being "the dominant route" for the spread of COVID-19, the researchers found that using masks "significantly reduces the number of infections."
The scientists note that other mitigation measures along, even social distancing, "are insufficient by themselves in protecting the public."
Another study, published by The Lancet medical journal earlier this month, also found that masks, in combination with social distancing and hand-washing, could help control the virus's spread.
House Speaker Nancy Pelosi of California, arrives for a news conference on Capitol Hill in Washington, Thursday, June 4, 2020.
Maragakis said she doesn't believe the material used to make the face covering is as important as keeping airborne droplets from spreading.
"If you have a cloth mask that you've made, or that was made for you, if you've taken a bandana or something to put over your face, that's going to serve that purpose of catching the respiratory droplets," she said.
Even among scientists, though, there is not uniform agreement on benefits of masks and what kinds of masks make a difference.
There is a small faction of infectious disease experts who don't believe there's sufficient data to support the mask wearing as a mandatory complement to social distancing. Dr. Amesh Adalja, of the Infectious Disease Society of America, told ABC News he has yet to see "a lot of direct evidence" to support the recommendation -- especially when those coverings are homemade.
Adalja cited New Zealand, where viral spread has largely dissipated, as a place where the infection was controlled without widespread use of masks.
"I think it's there's a lot of back and forth on this that's going on in a debate in the scientific and medical community," Adalji said. "If you can social distance then technically you don't necessarily need a mask."
Whether scientists can prevent masks from becoming prey in the culture wars remains to be seen. Dr. Jay Bhatt, former medical chief at the American Hospital Association and an ABC News contributor, said he is hoping people from all political persuasions will decide that masks make sense in the midst of this crisis.
"Wearing masks once you step outside your home is a way to keep you, your family and America safe," Bhatt said.
The coronavirus stronghold on Oregon could persist at current record-setting case counts or potentially surge to 1,000 new infections a day before the Fourth of July, according to state modeling released Friday.
Oregons top epidemiologist said hes as anxious as hes ever been since the pandemic hit here four months ago.
Thats because the states trajectory suggests many more Oregonians will soon become infected, with the potential to once again overwhelm contact tracers needed to contain spread of the highly communicable virus.
It would be very difficult for us to contain with the same level of attention that wed like to as we open up, Dr. Dean Sidelinger said of 1,000 new cases a day.
So I hope that doesnt happen.
The new modeling paints a dramatically different picture than the forecast of two weeks ago, which used data from before Gov. Kate Brown allowed most Oregon counties to reopen. Officials now say there is clear evidence that transmission has increased since May 15.
Oregons bleak new forecast was one factor that went into Browns last-minute decision late Thursday to block Multnomah County from reopening and to prevent several others from moving into a second phase. Those decisions will be revisited next week, and theres a clear desire to allow Oregons most populous county to reopen in some capacity, if safe.
The forecast comes as Oregons identified infections continue setting daily highs and the number of residents sick enough to be hospitalized rises for the first time in months. Officials earlier this week said it was too early to draw conclusions about the upward trends but conceded by Friday that they were worrisome and warranted pausing reopenings.
Sidelinger, Oregons epidemiologist and health officer, said he recalled being particularly anxious in March when infections first started growing amid limited testing and scarce personal protective equipment.
He was similarly anxious about a month ago, when identified infections again spiked just before counties looked to reopen.
I remain the same way now as we see cases go up, he said.
But Sidelinger said he remains grounded because increasing infections were always anticipated upon reopening, future hospitalizations arent expected to rise as sharply as infections and Oregonians already slowed coronavirus once.
I remain hopeful that we will continue to come together like that, and we will be able to flatten this curve, he said.
Oregons modeling has long shown that Browns stay-at-home order in March reduced cases by 70% of what they could have been, preventing tens of thousands of infections. That forecasting has been regularly updated for planning purposes but officials are now more pessimistic about maintaining such reductions.
The new report used data through June 5, when identified infections were trending up but before they regularly started surpassing 100 a day.
This forecast from June 12 outlines different infection levels.
The best-case scenario outlined Friday seems almost implausible based on whats transpired since then. Its based on a 60% reduction in cases since May 15, assuming rising infections identified earlier this month were an anomaly.
It indicates that roughly 19,000 Oregonians may have been infected by June 5, with only about one-quarter of those actually identified in the official tallies reported by the Oregon Health Authority.
In that scenario, infections would continue to rise slowly, hitting more than 21,000 early next month. Actual infections per day would be about 100 by July 3 a remarkably optimistic number considering Oregon is regularly identifying far more right now.
In a second scenario, based on a 55% reduction in cases, cumulative infections would rise from 20,000 today to about 25,000 early next month. That assumes infections and hospitalizations identified earlier this month were part of a trend.
Under that scenario, daily infections would reach 270 by July 3. That too may be optimistic.
The third scenario and most pessimistic from the state assumed an even lower reduction in infections, essentially down to 45%.
Cumulative cases would jump from about 20,000 now to 35,000 early next month, a huge increase. Daily infections by July 3 could be 1,000 under that scenario.
Sidelinger said officials continue to regularly monitor data while reviewing reopening options weekly so that we can reverse course, I hope, before we get there.
They will continue to advocate for physical distancing and may need to ask Oregonians to voluntarily limit gathering sizes or put more controls on industries or sectors where outbreaks are occurring, Sidelinger said.
Everythings on the table for discussion, he said. Thats why we continue to monitor. Because it would be very hard to handle 1,000 cases a day. And do timely investigation and contact tracing on all of those cases.
Asked whether that could mean the potential to reinstate stay-at-home orders, Sidelinger said: None of us hope to get there. We know that kind of order is devastating, not only financially but also physically and mentally.
Separate from the modeling, Sidelinger also conceded other troubling indicators that have been appearing in the figures reported daily by the state.
Hospital admissions creeped up to 40 statewide last week, an increase of more than 50% from the preceding week. People dont generally require hospitalization until two to three weeks after becoming infected suggesting some people may have been infected at the same time Oregons daily infection numbers showed a rapid decline.
Given that identified infections are now increasing, does that suggest hospitalizations might be high in a few more weeks?
Im definitely concerned that could be a possibility, Sidelinger said.
But he sounded a hopeful note, saying Oregon and officials across the country are seeing a lower need for hospitalizations among workers and younger people who are now being identified with infections.
As we see this large spike, I dont think that were necessarily going to see the same magnitude of increase in the hospitalization, he said.
While maintaining the need to proceed cautiously, Sidelinger also noted pragmatically that Oregons most populous county would not stay closed indefinitely.
Officials will keep close tabs on the data to determine if Multnomah County can safely move forward with reopening as soon as next week.
I dont imagine a future where the rest of the state all has some level of reopening and Multnomah County stays in baseline, behind, he said.
That could mean Multnomah County eventually is cleared for a first phase of reopening or perhaps certain sectors get a green light while others wait, he said.
Officials will also closely monitor statewide hospital admissions, analyze whether infections can be traced back to known sources and watch the ability of public health officials to respond to multiple large outbreaks.
We want to be in a place where we look at the data and can safely move forward, Sidelinger said of continued reopening efforts in Multnomah and elsewhere. Whether thats next week or a week later, I dont know.
-- Brad Schmidt; bschmidt@oregonian.com; 503-294-7628; @_brad_schmidt
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Updated at 4:18 p.m.: Revised to include additional counties.
Dallas County reported 345 new cases of the coronavirus Saturday the fourth single-day record it has reported this week and three deaths.
Those who died are an Irving man in his 50s, a Seagoville man in his 60s, and a Mesquite woman in her 90s who was a resident of a long-term care facility.
The county ended the week with its highest seven-day average of daily cases 300 after seeing a record 300 new cases Wednesday, 312 cases Thursday and 328 on Friday.
The county has reported 13,930 cases of COVID-19 and 283 deaths overall. It does not report the number of recoveries.
County Judge Clay Jenkins said in a written statement that while Saturdays cases are another record for a single-day high, increased testing contributes to the increased case count.
He said rising hospitalizations are of greater concern because they are at their highest point since the pandemic began in the county, region and state.
For three consecutive days, Dallas County has reported more than 370 people have been hospitalized with the coronavirus. Hospitalizations for the virus had stayed between 300 and 350 for several weeks.
Think of hospitalizations as the tip of the iceberg, Jenkins said. "There is much more ice under the water out of the hospital and that portion of the iceberg is growing as more and more people get infected from one another.
According to the county, 24% of all emergency-room visits 489 were also for COVID-19 symptoms.
County officials and health experts have focused on hospitalizations, ICU admissions and emergency room visits to determine guidelines for everyday activities during the pandemic.
Jenkins said the rising trends are why people should focus on their health and take precautions such as practicing good hygiene, avoiding large crowds, wearing a mask and maintaining a 6-foot distance from people when outside the home.
There are other important things to focus on, but we cannot take our focus off our health, Jenkins said.
The county reported 133 new coronavirus cases Saturday, raising its total to 7,253.
The county also reported three new deaths: a Hurst man in his 50s, and a Mansfield woman and an Arlington woman both in their 80s. All but one had underlying health conditions.
Tarrant County now has 194 confirmed deaths and 3,110 recoveries.
Collin County had 78 new COVID-19 cases, 17 new recoveries and no additional deaths on Saturday, according to data from the Texas Department of State Health Services.
The county has had a total of 1,638 cases, 37 deaths and 1,288 recoveries.
On Saturday, the county reported 32 new coronavirus cases and four recoveries.
The county has seen a total of 1,719 cases, 36 deaths and 940 recoveries.
The county reported two new coronavirus cases Saturday, raising its total to 235. One case is from Rockwall and the other is from Royse City. One person is younger than 20, the other is in his or her 50s.
There have been 15 deaths all among residents of the Broadmoor Medical Lodge in Rockwall.
County officials said previously that they did not receive an update on recoveries from the state this week because of a change in reporting.
Ellis, Johnson and Kaufman counties have not reported new numbers today. According to Fridays numbers for the counties:
A Colombian Huitoto man sails on a raft along the Takana river in Leticia, Amazonas department, Colombia, on May 20, during the coronavirus pandemic. Tatiana de Nev/AFP via Getty Images hide caption
A Colombian Huitoto man sails on a raft along the Takana river in Leticia, Amazonas department, Colombia, on May 20, during the coronavirus pandemic.
With nearly 40,000 deaths, Brazil has registered the world's third-highest COVID-19 death toll and the second-highest confirmed caseload. Its neighbors fear the disease is spilling across Brazil's borders. Indeed, one Colombian frontier town has already turned into a coronavirus hot spot.
Located at the southern-most tip of Colombia, Leticia is an Amazon River port abutting Brazil and Peru. There are few flights and no roads connecting the town to the rest of Colombia. So, Leticia's 50,000 people get the vast majority of their food and supplies from the neighboring South American countries.
Jess Galdino, the governor of Colombia's Amazonas department or state, which includes Leticia, says this economic reality made it impossible for Colombia to seal its border when the coronavirus began sweeping through Brazil.
In addition, many Colombians live in Tabatinga, a Brazilian town next to Leticia, and they frequently cross to the Colombian side to work, shop or visit relatives. In some neighborhoods, the street forms the dividing line between the two nations.
"It would have been futile to try to set up a blockade," Galdino said in a telephone interview from Leticia. "And with COVID making such a huge impact in Brazil, the number of cases here has also been massive."
Colombian Huitoto Indigenous people pose for a photograph in Leticia. Tatiana de Nev/AFP via Getty Images hide caption
Colombian Huitoto Indigenous people pose for a photograph in Leticia.
Now, nearly 2,000 people in and around Leticia are sick with COVID-19. About 70 have died. That might not sound like a colossal death toll at first. But because the surrounding state of Amazonas is sparsely populated, this amounts to the highest per-capita death rate in all of Colombia, according to figures from Colombia's Health Ministry.
Among the first to fall ill in Leticia was Antonio Bolvar, a member of the Ocaina Indigenous tribe and a part-time actor. He became a local celebrity following his starring role in the 2015 movie Embrace of the Serpent, the first-ever Colombian film nominated for an Oscar.
In the movie, set in the early 20th century, Bolvar plays Karamakate, a shaman and the last survivor of an Amazonian tribe who frets that he is losing touch with his culture. He deals with rapacious rubber barons and religious fanatics as he guides a German scientist and, much later, an American botanist through the jungle to find a sacred healing plant.
Antonio Bolvar and director Ciro Guerra at the Academy Awards at Samuel Goldwyn Theater on Feb. 27, 2016, in Beverly Hills, Calif. The film Embrace of the Serpent was nominated in the foreign language category. Omar Vega/Invision/AP hide caption
Antonio Bolvar and director Ciro Guerra at the Academy Awards at Samuel Goldwyn Theater on Feb. 27, 2016, in Beverly Hills, Calif. The film Embrace of the Serpent was nominated in the foreign language category.
In real life, Bolvar was the one who needed to be cured. In April, he came down with a high fever and had had trouble breathing, according to his son, Cristian Bolvar.
"We were treating him with natural medicine," the younger Bolvar says. "But things took a turn for the worse so I called an ambulance to take him to the hospital."
Indigenous people, who make up the bulk of Amazonas' population, are especially vulnerable to COVID-19. Some live on reservations near Leticia and lack Internet access to get information about the disease. What's more, their communal traditions can increase contagion, says Germn Palacio, a university law professor in Leticia.
"It's like a cultural thing. You share with others," Palacio says. "Food. Drinking. Everybody is drinking from the same source, or from the same glass. You put yuca in the middle of your table and everyone shares it."
For those who fall ill there are few options in Leticia. The town should be home to a brand-new public hospital. But corrupt government officials pocketed much of the money and it was never built. In March, three former governors linked to the scandal were jailed.
"The problem is that everyone is dependent on the public health system. But after three decades of corruption, the system is a disaster," Palacio says.
That's apparent at Leticia's 60-year-old public hospital, which lacks basic medical equipment and features a leaking roof and broken sinks and toilets. In April, about 30 of its doctors and nurses resigned over the lack of medical equipment and because they hadn't been paid in months. That prompted federal authorities to intervene and take over management of the hospital. Some of the staff have since returned.
This was the hospital where Cristian Bolvar brought his father, the film actor. But he says doctors there lacked a device to measure the oxygen level in his father's blood. So, he took his father to an expensive private clinic but it was full.
After several more hours lying in the back of an ambulance, Antonio Bolvar was finally taken back to the public hospital where he was admitted.
Four days later, Leticia's movie star died at the age of 75.
Residents of Fayetteville, Arkansas, wait in line to file for unemployment on April 6, 2020.
Nick Oxford | Reuters
Arkansas Gov. Asa Hutchinson said on Friday that the state reported 731 new coronavirus cases since Thursday, the largest daily jump since the outbreak began.
The newly reported cases represent a near 6.8% increase compared to Thursday as outbreaks continue across the state, bringing the total to at least 11,547. Hutchinson said 207 of those cases were reported at state correctional facilities.
Its previous highest daily jump in cases was just over 450 in mid-May, according to a graph Hutchinson presented at a press briefing.
"As I look into next week, I do expect the cases to continue to increase," Hutchinson said. "I think that is natural whenever we see the pattern we've seen over the last week, particularly in northwest Arkansas, I expect that to continue to increase until we can get a handle on that and reduce that spread."
Arkansas has more than 3,700 active cases in the state, he said.There are now more than 200 people hospitalized with suspected Covid-19, and the health department reported an additional five deaths since Thursday, bringing the total to 176.
"We've gone over 200 hospitalizations in Arkansas, which is significantly higher than when we were really at what I thought was the first peak in April," Hutchinson said.
Arkansas is one of a handful of states reporting a recent spike in Covid-19 cases. The state is still scheduled to move into its phase two reopening on Monday, which will allow restaurants and other businesses to increase capacity, Hutchinson said.
"I don't see that what we're doing is not working. We might not be doing it well enough. I think the strategy is the right strategy," he said.
The state hasn't seen any evidence that lifting its phase one restrictions had a correlation with an increase in cases but recommends residents continue social distancing, Hutchinson said.
However, Hutchinson said that he wouldn't mandate residents wear a face mask when venturing out in public because it wouldn't be enforceable and "it's just not Arkansas."
Many health experts have said that wearing a face covering can reduce the spread of Covid-19, and the U.S. Centers for Disease Control and Prevention suggests wearing a face covering to reduceasymptomatic transmission among family members and in nursing homes and other facilities.
The CDC warned on Friday that states may need to reimplement the strict social distancing measures that were put in place earlier this year if U.S.coronaviruscases rise "dramatically." However, the agency didn't specify what would be considered a significant increase in cases and it left decision-making up to local areas for now.
"Unless you're in the vulnerable age category or have health conditions, we need to be out, we need to do our business, we need to live life, just do it safely and carefully," Hutchinson said.
Even with theaters scheduled to reopen in July, this will surely be the quietest summer became synonymously with movie-going.
Social distancing will reduce the number of patrons per theater, and nobody knows how consumers will balance their enthusiasm to see these films against health concerns.
Some of that will depend on how different people assess risk. Based on early indications, some have clearly determined that the odds of contracting coronavirus -- and having a bad outcome from it -- aren't that bad.
Nevertheless, the odds of experiencing a shark attack are awfully low, which didn't keep a generation that saw "Jaws" in theaters from eyeing the ocean warily. Such fears aren't always rational, and speaking personally as a kid who had an active imagination, just jumping in a pool that summer felt like an act of courage.
If you're currently apprehensive about venturing out to a confined space with strangers for hours, to paraphrase the tagline from another Steven Spielberg movie, you are not alone.
The World Health Organization had just declared COVID-19 a pandemic when intensive care units in the United States started to see an influx of severely ill patients. It was mid-March, and though coronavirus cases had been mounting in countries including China, South Korea and Italy, in the U.S. there was still a dearth of knowledge about how the virus spread, how it affected patients, and what type of threat it posed to the doctors treating them.
Within three months, critical care physicians across the country received a crash course on a disease that didn't exist in the U.S. before this year, and are more prepared in the event of a second wave of the illness. Now, in June, doctors have a better sense of which medicines and interventions to use or avoid, how the virus affects the body, and how to face their own COVID-19 fears.
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In the beginning, "everyone had the concern of getting infected," Dr. Francis Castiller, medical director of critical care at UNC REX Hospital in Raleigh, North Carolina, said. The new disease was spreading rapidly, before many ICUs were able to prepare for the surge or protect their staff appropriately.
Dr. Josh Denson, a pulmonary medicine and critical care physician in New Orleans, said he diagnosed the first critically ill COVID-19 patient in Louisiana. But the hospital did not yet have strict protocols for quarantining patients.
"They hadn't isolated this patient appropriately, so my team members and I were exposed," said Denson, who works at Tulane Medical Center but was at a different hospital when he was exposed to the virus. "We had real concerns about whether we were going to get this or not."
He never got sick, and has since tested negative for COVID-19 antibodies.
But it was those fears, in part, that affected how critically ill patients were cared for in the beginning of the outbreak in the U.S.
COVID-19 notoriously wreaks havoc on the lungs, leaving severely ill patients struggling to breathe. As cases started emerging in the U.S., doctors looked to their colleagues in Italy, who were already in the middle of a huge influx of extremely sick patients.
For patients with severe breathing problems, the Italian doctors were using a type of therapy called high flow nasal oxygen, a much less invasive approach than putting a patient on a mechanical ventilator. Patients can get 100 percent oxygen through the nose without having to have a breathing tube put in place.
But an unusually high number of health care personnel in Italy 20 percent, according to an editorial in The Lancet medical journal were becoming infected with the coronavirus. They blamed the high flow nasal oxygen, figuring the treatment was aerosolizing the virus, spreading it to doctors and nurses.
As a result, many doctors in the U.S. were initially wary of using high flow oxygen for COVID-19 patients.
"We were very concerned, so we didn't use it," said Dr. Hugh Cassiere, director of critical care medicine at Northwell Health's North Shore University Hospital on Long Island, New York.
Instead, patients were intubated and put on ventilators, often right away. "Reports from other places was that you should put people on the ventilator early, because the disease was so rapidly progressive," Dr. Todd Rice, an associate professor of medicine at Vanderbilt University Medical Center, said.
But putting patients on ventilators comes with risks, too, including infection and unintentional damage to the lungs. Very often, patients require heavy sedatives to paralyze them so doctors can get the breathing tube into the patients' windpipe. That procedure, called intubation, also carries the risk of infection and lung complications, and can expose health care workers to virus-filled respiratory droplets.
That's a big deal. If you can prevent someone from being intubated, that could change their whole course.
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What's more, the longer a person remains on a ventilator, the greater the chances for blood clots, gastrointestinal bleeding, pneumonia and death.
The first few months were a learning experience. Now, doctors are trying to avoid ventilators if possible. Both Rice and Cassiere said more current data show high flow oxygen does not put health care workers at increased risk. And experience has shown them that not all patients require a ventilator. When possible, doctors see if patients improve with the high flow oxygen first.
"That's a big deal," Cassiere said. "If you can prevent someone from being intubated, that could change their whole course."
Despite attempts to move away from ventilators, some COVID-19 patients still need them. As the pandemic has progressed, it's become apparent that coronavirus patients on ventilators need special care.
When patients are put on a ventilator, they're often given diuretics to get rid of extra fluid in the body. Lungs that need help need to be "dry" to function properly. When they're wet, "they can't move oxygen as well," Denson said.
But the coronavirus has since proved it's not a simple respiratory illness. It can affect the lungs, the brain, the blood and, critically for patients on ventilators, the kidneys.
Unlike lungs, kidneys prefer to be hydrated. The longer patients are kept dehydrated, their chances of kidney failure increase. Denson said he's changed his treatments for COVID-19 patients to give additional hydration if they're showing damage to the kidneys.
"I'm targeting the kidneys a little bit more," he said. "I'm less aggressive up front getting people dry, and I'm more willing to use fluids if needed."
It's a balancing act that requires extreme attention on the part of ICU doctors and their staff. Too much hydration hurts the lungs. Too little hurts the kidneys. "It's a constant battle," Denson said.
When doctors faced the first surge of severely ill COVID-19 patients, no drugs had been shown to work against the virus, making treatment more challenging. As a result, doctors were willing to try certain medications based on limited evidence.
Early on in the pandemic, the drug hydroxychloroquine emerged as a potential treatment, following two studies that suggested it might be beneficial. As a result, many patients were given the drug, which is already approved for malaria and rheumatoid arthritis. But doctors soon found the drug was not useful in treating COVID-19, and subsequent research has shown it does not appear to help.
Now, doctors in ICUs are turning to the drug remdesivir. It's not a cure, but it's the only treatment that's been shown in a clinical trial to have an effect on the illness so far.
Some physicians are also finding success with other pharmaceutical approaches, though evidence remains anecdotal.
Cassiere has given ventilated patients steroids to reduce inflammation in the lungs.
"I was gun-shy up front about doing that, because I was concerned I could be doing more harm," Cassiere said, citing research from the 2003 SARS outbreak that suggested steroids cause coronaviruses to linger longer in patients. He found that combining the steroids with convalescent plasma, an antibody-rich blood product of recovered COVID-19 patients, appeared to cancel out that risk.
Cassiere also said he's changed his methods of sedating patients who need to be put on a ventilator, opting for fewer narcotics like fentanyl in favor of other drugs such as benzodiazepines or ketamine.
"My experience has been that the narcotics hang around longer, and may have something to do with the prolonged awakening some of these patients have," Cassiere said, referring to those who take an unusually long time to wake up from a coma after being removed from a ventilator.
That COVID-19 patients tend to be sick for a long time, spending weeks in the intensive care unit in some cases, is another factor physicians are getting used to in dealing with COVID-19.
"Taking care of patients requires a lot of patience," Dr. Steve Stigler, director of the medical intensive care unit at the University of Alabama at Birmingham, said. He coaches his physicians to stay the course with treatment and supportive care.
Patients "improve up to a point, and then it can be several weeks before we would see them continue to improve," Stigler said.
Castiller, of UNC REX Hospital in Raleigh, also said it's critical for ICU physicians to communicate that to families of COVID-19 patients.
One of the biggest lessons we've learned is the importance of human contact.
"Families need to prepare for that, as well as peaks and valleys" seen so often in the sickest patients, Castiller told NBC News. To offer support, Castiller said his staff calls patients' families daily with updates.
Rice's team at Vanderbilt does the same. "Every day, we call families and say, 'Here's the update on your loved one.' It's gone really, really well, and it's something we're proud of," he said. The staff also uses videoconference technology, like Zoom, so the family can visit with patients.
"One of the biggest lessons we've learned is the importance of human contact," Castiller said. Hospital restrictions that prohibit visiting COVID-19 patients have been major stressors for families, as well as those in the hospital. "We make sure to address that by using technology to maintain some level of communication."
Early fears that critical care physicians had about becoming infected with the coronavirus have eased significantly. Cassiere, who said he was terrified at the beginning of bringing the virus home to his family, has tested negative for antibodies. He credits appropriate use of personal protective equipment, such as masks, gloves and gowns.
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"All my protection I've had has helped. I'm confident that I'm not bringing it home. I'm confident that if I'm protected, I'm not going to get infected," Cassiere said. "And now, I'm armed with the knowledge and different approaches I have for battling COVID-19."
Experience matters. "Being a good critical care doctor is a lot of experience," Rice added. "Now we've seen this, and we've done this, and it will result in us providing even better care for our patients."
"We know we don't know everything about it, but we know the spectrum of disease and what it does to the body," Cassiere said. "I didn't know that back in March. I have all that knowledge behind me. I'm a COVID-19 warrior now. We're totally prepared for it."
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HONOLULU (KHON2) -- Theres only one week left until movie theaters, arcades, museums and bowling alleys reopen.
However, with the COVID-19 pandemic, it will be a different experience. For one thing, many of the businesses reopening next week are recommending calling and reserving in advance.
We're making coronavirus coverage available without a subscription as a public service. But we depend on reader support to do this work. Please consider joining others in supporting local journalism in Alaska for just $3.23 a week.
Susan Peck will remember her father, George Smith, as the practical joker who could fix just about anything.
Smith died Thursday at age 81 after becoming infected with the coronavirus at a transitional care center in Anchorage.
He arrived at Providence Transitional Care Center in late February after a fall that caused a brain hemorrhage and, later, a stroke from surgery. He was making some progress and was starting to use the left side of his body, Peck said in an interview Saturday, though she isnt sure whether he would have been able to eventually come home to the Kenai Peninsula.
Smith had arrived at the Providence facility roughly a week before it stopped allowing visitors due to coronavirus concerns, Peck said. At first, his family would call him and approach the window of the facility.
He was so lonely. That was so hard, Peck said. And it was really hard on my mother too.
Pecks mother would FaceTime Smith every day and Peck would call him too. She and her siblings would use Zoom to talk to him together on the weekends.
In late May, Smiths family received crushing news: He had tested positive for COVID-19. Smith was one of several people with COVID-19 at the center, where by Saturday evening, the virus had infected a total of 27 caregivers and 18 residents.
Smith was transferred to the Providence hospital, and nurses there made certain Smith could get on video calls with his family, Peck said. The communication between Smiths family and the physician was phenomenal, Peck said.
Then we knew that there was no hope left for him," Peck said. "And we decided to do comfort care. Because he really went downhill fast. And then shortly thereafter, he died.
Diane Smith, George Smith's wife, wears personal protective equipment for a visit with her husband. Smith, who died Thursday, June 11, 2020, is the 12th Alaskan with COVID-19 to die since the pandemic began. (Courtesy Susan Peck)
Pecks mother was able to visit Smith before he died Thursday, she said. Geared up in full personal protective equipment, Pecks 78-year-old mother was able to hold the hand of her husband whom shed been married to for 60 years the day before he died.
He knew she was there, Peck said.
Pecks death is the second among Providence Transitional Care Center residents this week. He is the 12th Alaskan with COVID-19 to die since the pandemic began.
"We are saddened by this loss and extend our condolences to all of their loved ones during this difficult time, Providence spokesman Mikal Canfield said in an emailed statement Friday.
Sadly, we are announcing the death of another Alaskan today and I want the individuals loved ones to know we are thinking of them, Alaskas chief medical officer, Dr. Anne Zink, said in a statement Friday. Since the beginning of the COVID-19 pandemic, we have been especially focused on the extra precautions that are needed to prevent the spread of this disease into our more vulnerable populations, including those in skilled nursing facilities like the PTCC."
Initially, Smiths family didnt know that he was showing symptoms of COVID-19 or that he had been tested for the virus, Peck said. She said that she and her mother didnt find out that Smith had COVID-19 until the day after he had tested positive, when they called to check on him which they did frequently.
It was not out of any malice. I do not believe that," Peck said of the timing of the notification. "I think they were just trying to figure out what to do, how to notify people, how to take care of the situation, Peck said.
Once Peck and her mother asked what was happening, she said, they were both told he had the virus.
Carlie Franz, a spokesperson at Providence Health and Services Alaska, said they are required to notify families of a resident who tested positive by 5 p.m. the following day.
However, we make every attempt to make notifications within 24 hours, Franz said in an email.
George Smith during a visit with his family through the window at Providence Transitional Care Center. Smith, 81, died Thursday, June 11, 2020, and he is the 12th Alaskan with COVID-19 to die since the start of the coronavirus pandemic. (Courtesy Susan Peck)
Peck will remember her dads humor. He would play practical jokes on his wife, who still fell for them even after so many years together. He had quite the sense of humor putting pine cones down on the floor and pretending that it was their dogs poop, or short-sheeting the bed while his wife was up in the middle of the night.
And Smith could fix everything, Peck said. When he was 70 years old, he and Pecks mother built a log cabin where they continued to live at the end of Funny River Road, Peck said.
And the two were still affectionate, even after 60 years together, she said.
Every time youd see them walking, theyd be holding hands, Peck said.
And now, their family must mourn their loss in the middle of a pandemic, when large gatherings can be another venue for the spread of the virus.
Theyll have a socially distanced graveside service in Soldotna next week, Peck said, but one sibling cannot attend because of health risks associated with travel.
Theres so much to consider now, Peck said. Do you hug each other? If you cry, can you touch your face?
You want to comfort each other and you cant, Peck said. You cant all be together because of this virus.
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The state of Alaska recently implemented a testing-based policy that provides more flexibility for travelers from out of state who want to avoid a 14-day quarantine upon arrival. Hours before that took effect June 6, Anchorage released its own plan to help prevent travelers from spreading the coronavirus.
Anchorages plan lays out restrictions on what indoor spaces travelers can access for the first two weeks after they arrive, unless they pass an additional round of testing.
Part of what we did was try to translate the state guidelines into words that we felt individual travelers and residents thinking about traveling ... could understand, said Anchorage city attorney Kate Vogel.
The citys policy is a reflection of the states, as well as information relayed in state news conferences, on the states website and in conversations with state officials. The city tried to centralize and clarify that information in its own version of the policy, Vogel said.
I think we can all acknowledge this is a complicated plan, and the simpler plan of quarantine for 14 days was easier to understand but provided less flexibility, Vogel said.
Right now, airlines are informing travelers of the state policy. Vogel said the city feels that the states policy is compatible with its own. The city is working on creating its own educational material, but Vogel said she doesnt know when that effort will be launched.
The state and the citys policies say basically the same thing about what travelers should do when they land first in Anchorage.
If travelers show negative results from a test taken within 72 hours of their departure time in another state, they will not have to be tested in an Alaska airport. They may need to get a second test seven to 14 days after arriving, according to the state, and may receive a voucher to offset the cost of that test. Theyll need to minimize interactions until 14 days have passed since their arrival; until they test negative in the second COVID-19 test; or until they leave Alaska, whichever comes first.
Those who get tested upon arrival at an Alaska airport rather than before travel will have to quarantine until they get their results. They will also need to take a second test at least a week later, and will have to minimize interactions until their second test results come back negative. This includes Alaska residents who have been out of state for five days or fewer.
But compared to the state, the city of Anchorage lays out what it means to minimize interactions in greater detail.
Under Anchorages order, people during the first 14 days after their arrival cannot visit indoor entertainment venues, like theaters or museums, or dine in at restaurants. The policies are compatible, Vogel said, but the city created its own definition of minimize interaction." The citys definition is in part based on comments from state officials and state educational materials.
On the states frequently asked questions page about the travel requirements, it explains minimized interaction similarly.
When you buy food, eat in outdoor settings. Order delivery if possible. Wear a face covering if you go into public areas. Take part in outdoor recreation (such as fishing) instead of visiting a museum. Postpone attending gatherings until after this window is over.
If someones second test comes back negative, they can stop minimizing their interactions with others before the end of that 14-day period.
Vogel said its important for travelers to understand the risks before leaving on a trip to Alaska. If they test positive for the virus here, they cannot return home until they are no longer sick. They will have to isolate in Alaska at their own expense.
Businesses are able to refuse service to anyone who is supposed to be quarantining or minimizing interactions. State law dictates that businesses are always able to refuse service to someone, as long as its not discriminatory, Vogel said.
The state in its health mandate describes the testing to occur as molecular based while Anchorage refers to PCR tests. Theyre describing the same thing: viral tests intended to determine whether someone is currently infected (these usually involve a nasal swab, or a saliva sample). Antibody or serology tests, which determine whether someone was previously infected, do not meet the city and state requirements.
There are a couple of key differences between the city and state policies, Vogel said.
Under city rules, a traveler must inform their hotel, rental lodging host, and/or roommates of their quarantine status or whether they are required to minimize in-person interactions during the 14 days after arriving in Alaska.
Also, under the citys policy, people in the minimized-interaction stage are required to wear a face covering anytime they are around non-household members.
Vogel said there is no requirement that places like restaurants ask customers if they have traveled. But businesses might want to post the rules near the entrance to remind customers, she said.
We think empowering businesses to understand their rights in this situation can help with the public information campaign, which we think is the key to enforcement, Vogel said.
Vogel said the policy essentially relies on the honor system, though a fine or criminal charge could be used if someone is aggressively running afoul of the policy. Having a separate mandate allows the city to impose a civil fine, rather than a criminal charge that can be levied under the state policy, she said.
While the different language in the state and the citys travel policies could lead some to believe they are markedly different, thats not the case, Vogel said.
If someone doesnt like Anchorages plan, they probably dont like the states plan, they just maybe havent dug deep enough into it, Vogel said.
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