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As cases of COVID-19 surge in Nebraska, a University of Nebraska Medical Center pandemic expert is forecasting dark months ahead for the state without more stringent public health measures or better compliance with the measures already in place.
Dr. James Lawler, a director at UNMC’s Global Center for Health Security, looked at what occurred in such places as New York, Belgium and Italy’s Lombardy region, where cases surged early in the pandemic and overwhelmed hospitals.
Some of those locales reached overall fatality rates of 1,000 per 1 million people.
Lawler then did some calculations based on Nebraska’s population. At that rate, by January, the state could add 1,900 deaths from COVID-19 — in addition to the 637 the state already had tallied by Friday, a number that continues to grow.
“If the outbreak continues at this pace, and we don’t implement much more stringent public health interventions — or at least if we don’t get people to adopt those behaviors, which ultimately is the most important thing — I think we could easily see three times the total we’ve seen so far,” he said Friday.
The forecast, and the warning, came as the state on Thursday recorded a record spike of 1,605 new coronavirus cases. The spike came as Nebraska has seen steady increases in cases and hospitalizations, including posting record numbers of new cases each week for four weeks in a row, with a significant portion of new cases coming in rural counties. On Friday, it was closing in on a fifth.
In addition, 528 Nebraskans were hospitalized Friday with COVID-19, more than double the spring peak of 232.
Nebraska sets record for new daily COVID-19 cases
Lawler said Nebraska’s health systems are on track to be overwhelmed, as were those in New York, Belgium and Italy, if the state continues at its current pace.
Health systems already have become strained in a number of states as their hospitalizations have increased. Doctors at a hospital in El Paso, Texas, last week started airlifting some patients as far away as San Antonio and treating others in a field hospital, the New York Times reported.
While Nebraska hospitals have beds available, as well as some they could call into service, they could run short of critical care nurses, Lawler said. The medical literature indicates that patient outcomes worsen if the number of critical care nurses to patients reaches a ratio of 1 to 3 or higher (not necessarily for COVID-19).
Critical care teams in health systems have gotten much better at saving patients hospitalized with COVID-19, Lawler said. But those outcomes won’t be as good in the face of overwhelming numbers of patients. In New York, health systems turned to kidney and cancer specialists to provide care.
Nebraska Gov. Pete Ricketts has pledged up to $40 million to help hospitals hire traveling staff to bolster hospitals’ ranks or to pay overtime to existing staff. Locally headquartered medical staffing agencies say they have traveling nurses and other staff to send.
But a crunch appears to already have begun. Lincoln’s Bryan Health system announced Friday that it will decrease elective procedures requiring an overnight stay by 10% after exceeding predetermined metrics for three consecutive days.
Lawler said the metro area’s COVID-19 patient census as of Friday had risen 12% over the preceding 24 hours. “That’s not sustainable,” he said.
To be sure, most people recover from COVID-19. The state lists 43,516 Nebraskans as having done so.
However, the virus’s mortality rate so far is higher than that of influenza. Some 393 Nebraskans died of influenza in 2017, according to the federal Centers for Disease Control and Prevention, ranking flu the state’s No. 8 cause of death.
Of the 68,150 cases of COVID-19 diagnosed in the state, Nebraska’s 637 deaths through Oct. 25 represent a mortality rate of .93%. Flu in recent years has come in at .1%. And while the state recorded 110 COVID-19 deaths for October through Oct. 25, that doesn’t appear to be all for the month. The New York Times had listed 37 additional deaths through Oct. 29.
Lawler’s warning wasn’t the first he and other UNMC experts have issued. Two weeks ago, Lawler stood with Ricketts as the governor announced new directed health measures. The directives scaled back on capacities for some venues, required hospitals to preserve 10% of bed and ICU capacity for COVID-19 patients and urged Nebraskans to mask up. Ricketts told Nebraskans to avoid close contact, confined spaces and crowded places.
Those steps have worked in Japan, Lawler said, stressing that he is not calling for lockdowns. If the state can achieve the goals behind them, and everyone wears a mask, he said, the state will be able to dampen viral transmission.
Dr. Deborah Birx, coordinator of the White House Coronavirus Task Force, in a Friday call with the nation’s governors, also called for Americans to follow recommended health measures. Birx warned of a “broad surge” of COVID-19 cases across the country, CBS News reported.
Birx said nearly a third of the nation is in a COVID-19 hot spot that isn’t improving as people turn to indoor activities.
“We’re learning from the far north about how dramatic that spread can be,” she said on the call, which was obtained by the TV network. “And we do not see yet improvements in Montana, North Dakota, South Dakota or Wisconsin.”
World-Herald staff writer Jeffrey Robb contributed to this report.
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