The Morning Dispatch: The Early Hospital Squeeze

Happy Wednesday. We hope the absence of ordinary St. Patrick’s Day revelry helped ensure that fewer of you than usual are nursing post-festive hangovers this morning. It’s important to look on the sunny side these days! 

Quick Hits: Today’s Top Stories

• As of Tuesday night, there are now 6,362 confirmed cases of COVID-19 in the United States (a 36.5 percent increase over yesterday) and 108 deaths (a 27 percent increase over yesterday).

• The Democratic presidential primary is all but over. Joe Biden swept Bernie Sanders in the three states that voted yesterday, winning Florida, Illinois, and Arizona handily. 

• The Senate is slated to vote on the House’s coronavirus-response package, which includes expanded paid leave and unemployment benefits, as well as free COVID-19 testing. Separately, Republicans in Congress’ upper chamber are also working on $800 billion legislation that would—among other things—issue $1,000 checks directly to Americans.

• The Chinese Communist Party’s Ministry of Foreign Affairs announced it was expelling New York Times, Washington Post, and Wall Street Journal reporters from the country as tensions between China and the United States escalate.

• Rep. Dan Lipinski of Illinois—a relatively conservative, pro-life Democrat in the House—became the first incumbent of the 2020 election cycle to be defeated by a primary challenger, losing to progressive entrepreneur Marie Newman.

• Duncan Hunter—a former congressman from California—was officially sentenced to 11 months in prison after he pleaded guilty to stealing campaign funds.

• Tom Brady announced he is leaving the Patriots after 20 seasons with the team. He is expected to sign with the Tampa Bay Buccaneers when the NFL league year begins today.

• Former NBA MVP Kevin Durant was one of four Brooklyn Nets players to test positive for COVID-19. 

• An NPR/PBS NewsHour/Marist Poll poll found 37 percent of Americans trust information they hear about the coronavirus from President Trump, compared to 50 percent who trust the news media, 72 percent who trust state and local governments, and 84 percent who trust public health experts.

An Early Struggle for Doctors: Is My Patient a COVID Carrier, or Just a Smoker?

As the coronavirus crisis has spread in America, we’ve explained that the daily tick-tock of the case numbers come to the public on a sizable delay, thanks to the logistical challenges of our national testing regimen. The paucity of testing kits means that, as a general rule, only those who are showing serious symptoms can get a test. This means that the delay between infection and confirmation can stretch as long as two weeks: Approximately five days for symptoms to appear, about a week for them to worsen enough to require potential hospitalization, and several more days for a lab to process the test results.

Each new day’s results, therefore, are actually a reflection not of the current status of the pandemic, but of what the status of the pandemic was about two weeks ago. So although the U.S. finally started to get serious about ubiquitous social distancing nearly a week ago, we’ve still got at least one more week of spreading that’s yet to manifest itself visibly in the numbers. That means that even if social distancing were 100 percent effective in preventing new cases—which of course it won’t be—we would still expect to see dramatic exponential growth of new cases for at least one more week. And the reality, of course, is that growth will likely continue far beyond that.

For the moment, then, total U.S. cases still remain far short of where they are expected to be in the coming weeks. But the pressure is already mounting in hospitals and medical centers, and medical professionals are already starting to feel the strain.

In Tuesday’s Morning Dispatch, we discussed what that pressure looks like in areas that are already heavily affected, like Washington and New York. But hospital difficulties already extend far beyond those areas, for one major reason. With no way of knowing how far the virus has spread, and confirmed cases now cropping up in every state, fighting COVID-19 doesn’t just mean treating positive test cases. In hospitals across the nation, it’s already started to mean treating all patients who come in with respiratory issues like potential coronavirus patients.

“Our ER docs and nurses are getting slammed with people with respiratory illnesses, and the trouble is we don’t know in the ER whether or not someone is infected,” Dr. Megan Ranney, an emergency physician and professor at Brown University, told The Dispatch. “Even if we can do a test, which we can’t always, but even if we can do a test, we don’t necessarily get answers for days until after they’ve already left our ER. So we have to treat all of these patients as if they have COVID-19. So it is totally overwhelming for our providers.”  

Under ordinary circumstances, people suffering from a wide range of breathing problems—bad colds, asthma, complications from smoking—are relatively easy for hospitals to treat. Doctors dealing with such patients don’t need to wear protective equipment, and there is a wide range of convenient treatment options to ease patients’ difficulties, from nebulizers to BiBAP assisted breathing machines.

But all that changes if there’s the possibility the patient in your ER is infected with a deadly virus. Among the biggest challenges is time.

“If we don’t know if they have COVID or not, then we have to use protective equipment,” Ranney said. “It’s emotionally and physically exhausting for providers to be constantly wearing protective equipment. It takes a lot of time to put it on and off, and it wastes it. If we’re taking care of patients that aren’t actually sick, and we’re putting this protective equipment on and off, then we’re wasting it.”

If a sufferer is a potential coronavirus patient, that also changes the types of treatments you can give them. Both nebulizers and BiBAP machines are out, as both actually increase the risk of spreading virus-laden droplets.

“So, because we don’t want to make all the health care providers sick, we would just go straight to putting this patient on a ventilator, instead of doing these other things.” Ranney said.

These are pressing problems. As coronavirus cases ramp up, we’ll need all the protective equipment for doctors and ventilators we can get.

Increased testing will help. Finally getting our sluggish national testing apparatus up and running will help address this problem before the real coronavirus wave hits. An even better outcome would be developing a test, like our current flu tests, that can be performed onsite, relieving pressure from emergency rooms and urgent care clinics by letting them know which patients need isolating and which treatments are safe to use.

Because the U.S. was so slow in rolling out tests in the first place, we’ve largely missed the window for the first thing they’re useful for: doing pervasive contact tracing of infected individuals to keep the bug from escaping into the population at large. At this point, there’s no changing that history. And with new problems looming—a lack of protective equipment for health care providers, a potential ventilator shortage, hospital capacity challenges—the time to address them is now.

Biden Slams the Door

Joe Biden won big in Florida, Illinois, and Arizona last night—the former vice president beat Bernie Sanders by almost 40 points in the Sunshine State.

After Ohio postponed its primary late Monday night, three other states pressed forward despite social distancing recommendations from health officials and mandatory closures put in place to prevent the further spread of COVID-19. Short on volunteers to staff polling places, officials in Chicago, Illinois “ask[ed] ‘able bodied voters’ to act as last-minute poll workers” and “‘wav[ed] all training requirements’ for applicants who wanted to serve as election judges.” And in Palm Beach County, Florida, officials reported that “800 volunteers back[ed] out as of Monday, with just 100 new volunteers offering to take their place.”

Although the Chicago Tribune boasted that the city had set a new record for early voting, overall turnout appeared to be down substantially from 2016 in the state—maybe by as much as 40 percent. Florida’s turnout was down as well, though not as dramatically.

Biden needs 1,991 delegates to secure the nomination. After the contests last night, he now has 1,147 and leads Sanders by nearly 300 delegates.

Will Sanders bow out? Not according to those close to him. Despite continued hand-wringing from party leaders looking to refocus their energy on the general election, aides and allies from the Sanders campaign were signaling that they “see a benefit in amassing as many delegates as possible in order to influence the party platform at the Democratic National Convention this summer—even if Sanders himself can’t win the nomination.” 

Worth Your Time

• An Iraqi man pseudonymously named Ted served as an interpreter to a Marine reconnaissance unit in Iraq in the 2000s. In 2008, Ted applied for a Special Immigrant Visa, a program for those who helped the United States in Iraq and Afghanistan and were not safe to remain in their home countries. After 12 years, Ted has finally arrived in the United States. The Omaha World-Herald has Ted’s full story about how America’s SIV program failed him and others like him.

• You’ve heard of social distancing. Well, political scientist Andrew Michta wrote a piece for The American Interest arguing that it’s time for economic distancing between the United States and China. “Should the fallout from the Wuhan Virus prove to be as damaging as it looks like it might be, the first casualty should be China’s quest to become the premier manufacturing center for the world,” Michta writes. “Few corporations will want to again risk being caught in a situation where their entire supply chain has been locked into one country—much less a palpably hostile dictatorship.”

• With universities around the world shuttering for the coronavirus and likely to remain closed through the semester, seniors are missing out on many end-of-year traditions at their schools, including the biggest of them all: graduation. Wellesley students decided they couldn’t let this happen, and held their own unofficial ceremony. New York Times reporters were on the scene and assembled a moving series of images and interviews.

Presented Without Comment

Also Presented Without Comment

Something Fun

As we’re all very quickly learning, social distancing isn’t much fun. But some people are trying to make it better. Musical artists like John Legend, Chris Martin, Keith Urban, and Ben Gibbard—the lead singer of Death Cab for Cutie—have been holding virtual “concerts” fans can tune in to throughout the day.

Gibbard, for example, has promised to perform every day at 4 p.m. PT.

“I know you are all really freaked out right now,” he wrote. “I am too. And while I’m proud that we’re all doing the necessary things at the moment to help flatten the curve, I know it has left us all incredibly isolated. … I have always been grateful for the honor you have bestowed upon us by choosing to congregate en masse around our music.  Some of you have traveled great distances and/or shelled out large sums of money to see us play and that has never been lost on me. So in this crazy and unprecedented time, I’d like to return the favor by coming to YOU.”

Something Anxiety-Inducing

Toeing the Company Line

• In his most recent French Press (🔒), David looks at the Trump administration’s handling of the COVID-19 pandemic through the “fog of war” lens—acknowledging “the difficulty discerning the truth in times of conflict or crisis.” He continues: “God willing, this crisis will pass. And when it does, there will be increasingly precise accountings of complex events. In the meantime, reporters should and must continue to do their vital work. We can do our best to understand rapidly unfolding events. But the entire time, we should remind ourselves that the fog of war is real, and many things we think we know today may turn out to be wrong tomorrow.” Check out the whole thing here.

• Jonah had fan-favorite Chris Stirewalt back on The Remnant to discuss COVID-19’s impact on the 2020 election: What’s left for Bernie Sanders? Should Joe Biden run a front-porch campaign?

• If you’re so inclined, The Dispatch was the subject of pieces in Nieman Lab and TechCrunch yesterday. A profound thank you all for your continued support these past several months; we think we’re building a pretty special community here.

Let Us Know

Social distancing guidelines have your Morning Dispatchers working from home rather than going into the office; we’re very lucky our line of work allows for it.

But our new, temporary set-ups are not without drawbacks. Sarah’s been recording podcasts under a blanket in her room to get the audio quality just right. Andrew, temporarily home with his parents, is engaged in a perpetual battle over Wi-Fi bandwidth with his five siblings. Declan’s two roommates are also working from the apartment and things are getting … cramped. Managing editor Rachael Larimore has three sons who officially start online learning today. (Wish her luck.)

If you’re also taking some time away from the office, let us know the benefits and drawbacks of your current arrangement.

Reporting by Declan Garvey (@declanpgarvey), Andrew Egger (@EggerDC), Alec Dent (@Alec_Dent), Sarah Isgur (@whignewtons), and Steve Hayes (@stephenfhayes).

Photograph by Erin Clark/Boston Globe/Getty Images.