The Morning Dispatch: Hospitals in the Danger Zone

Happy Tuesday! Yesterday, we were sad to say goodbye to James, our intern since August. But today, we are thrilled to welcome Haley Byrd to The Dispatch as an associate editor covering Congress. Haley joins us from CNN and, before that, The Weekly Standard. Everyone give her a big TMD greeting in the comments!

Quick Hits: Today’s Top Stories

• Pharmaceutical company Moderna applied for emergency use authorization (EUA) with the Food and Drug Administration (FDA) yesterday for its COVID-19 vaccine. The EUA for the vaccine, which Moderna says is 94.1 percent effective, could be granted as soon as late December.

• President-elect Biden on Monday received his first President’s Daily Brief—a top-secret document compiling U.S. intelligence secrets and natural security concerns—since winning the election.

• Biden on Monday also announced his intent to nominate several figures to top economic posts in his administration, including Janet Yellen, Cecilia Rouse, Jared Bernstein, and Neera Tanden.

• Arizona and Wisconsin became the latest battleground states to certify and finalize their election results confirming Joe Biden’s victory in their respective contests. 

• Federal Communications Commission Chairman Ajit Pai announced plans to resign come January 20, the day that President-elect Joe Biden is inaugurated. By cutting his term several months short, Pai gives Democrats a quicker path to a majority on the Commission.

• The United States confirmed 157,370 new cases of COVID-19 yesterday per the Johns Hopkins University COVID-19 Dashboard, with 9.7 percent of the 1,620,782 tests reported coming back positive. An additional 1,149 deaths were attributed to the virus on Monday, bringing the pandemic’s American death toll to 267,987. According to the COVID Tracking Project, 96,039 Americans are currently hospitalized with COVID-19.

COVID-19 Hospitalizations Continue to Surge

Readers who follow our daily COVID-19 charts have likely noticed we’re bumping up against 100,000 Americans currently hospitalized with the coronavirus, well past our previous two peaks of approximately 60,000 in both April and July. The figure more than doubled in November alone, from 47,520 on the first of the month to 96,039 yesterday. 

The middle of the country is being hit particularly hard right now. Between 20 and 25 percent of inpatient hospital beds in Illinois, Nebraska, and South Dakota are currently occupied by COVID-19 patients, according to data from the Department of Health and Human Services. More than 80 percent of ICU beds are full in Minnesota, North and South Dakota, Michigan, Missouri, Texas, Oklahoma, and Kansas, among others.

Utah’s Republican Gov. Gary Herbert issued a state of emergency a few weeks ago aimed at slowing the rate of transmission to protect hospital capacity in the state. “Our hospitals in Utah are among the best in the world,” he said in an address to his constituents. “But they cannot give the best care when hospitals are at capacity and medical professionals are exhausted and spread too thin.”

New York’s Democratic Gov. Andrew Cuomo expressed similar concerns yesterday, announcing a series of emergency actions as hospitalizations in the state surpassed levels not seen since May. “We are not going to live through the nightmare of overwhelmed hospitals again,” he told reporters.

In some ways, the geographically dispersed nature of the United States’ most recent surge—as opposed to the incredibly concentrated hotspots we saw in the spring—may be a blessing in disguise. “There are no hospitals in this country that come anywhere near the COVID hospitalizations per hospital bed as there was in New York and New Jersey, Connecticut, Massachusetts,” Dr. Howard Forman—a health policy professor at Yale University and clinician at Yale New Haven Hospital—told The Dispatch. “As bad as Illinois has gotten, as bad as Indiana has been getting, as bad as Nebraska and Nevada are getting, it is almost impossible for me to imagine them getting to the level of New York.”

New York was, of course, the epicenter of the pandemic for much of the spring and early summer, and its hospital system was overwhelmed as a result. This—along with Gov. Cuomo’s decision to send hospitalized elderly COVID-19 patients back to nursing homes—played a major role in New York City’s catastrophic death rate in March and April.

“I think that a lot of the deaths from before compared to now were just that the hospital system was overwhelmed,” said Dr. Benjamin Daxon, a Mayo Clinic anesthesiologist who has treated COVID-19 patients for months. The COVID-19 case fatality rate has fallen precipitously from its 6 percent peak in May to just under 2 percent now, but Daxon attributes that improvement more to organization than medical breakthroughs.

“We really don’t have that many new therapeutics,” he added, when we asked about the impact of emergency use authorizations for Regeneron’s monoclonal antibody treatment and remdesivir. “There’s a few things to maybe help in the early stages of COVID. But we really aren’t that much more adept at treating the [disease] now than we were several months ago. It’s just that I think we’re more composed.”

Daxon said healthcare professionals didn’t know what they were up against back in March and April. “People were confused as to what to do,” he noted. “Maybe this drug works, maybe this therapy works. But now that we’ve had some time to kind of test things out, we’ve got a better sense of ourselves. And realistically, we do what we do for every other disease: Judicious fluid management … and frankly, not overreacting to every little thing, which is a lot of what happened in the spring—and understandably so.”

So when experts talk about a “strain on the healthcare system,” what exactly do they mean? Could the problem be solved by Congress passing an additional coronavirus relief package that provides funding for more hospital beds and personal protective equipment? Not exactly.

Daxon said the recent stress has come from shortages not of money, machines, or equipment, but of doctors and nurses. With hospitals overwhelmed, “you’re going to have people doing critical care medicine who are not trained in critical care medicine,” he noted. And even those who are trained in critical care medicine will be less effective. “If I take care of 50 people, I’m going to have a much higher percentage of people that die than if I take care of 10 people. Once you stretch me too thin, I miss a lab value, I’m not as attuned to subtleties in my patients.”

When the COVID outbreaks were more regional—the Northeast in the spring, the South and Sun Belt over the summer—health care professionals in less affected areas could travel to where they were most needed, and many of them did. Daxon, for example, uprooted from his home in Minnesota to spend a week treating COVID patients in New York City (and wrote an excellent piece for The Dispatch about his experience).

“I was able to go to New York because we had no surge in southeast Minnesota,” he told The Dispatch yesterday. “Now everybody has a surge. If we get overwhelmed, there’s no reinforcements. There’s nobody who’s able to come and help us.”

“Right now,” Forman added, “our system on a national basis is pretty tapped out.”

And Daxon worries that healthcare workers—nine months into the pandemic—are pretty tapped out emotionally as well. “I worry that the healthcare workers are going to have an unbelievable amount of burnout from all of this,” he said. “I think there’s a growing sense of frustration amongst [them] with people in the population at large who don’t appreciate that it’s a terrible disease and it’s spreading because of, in part, negligence on the part of everyday Americans who forego recommendations. And it feels like a slap in the face to a lot of people.”

Forman emphasized that—with vaccines likely to be approved in the coming weeks and distributed widely in the next couple of months—we are now in the home stretch. “Every death avoided is no longer a death deferred, it’s a death avoided,” he said. “Back in March or February, I think the arguments about how we maintain the economy was a much more resonant argument, that at least you could talk about. Right now, we’re talking about, what can you do individually, or in your community, or in your municipality to just save lives. … These lives are saveable. They’re not just deferrable. They’re saveable.”

Biden Announces Economic Team

President-elect Joe Biden unveiled on Monday a list of economic policy experts he intends to nominate to top positions in his administration, starting with Janet Yellen—erstwhile chairwoman of the Federal Reserve—as Treasury Secretary. With the exception of Neera Tanden—Biden’s pick for Office of Management and Budget Director whose unpopularity with Republicans may threaten her prospects in the Senate—most of Biden’s nominees are center-left, Obama-era bureaucrats who are unlikely to face backlash during their confirmation hearings.

Tony Fratto—founder of Hamilton Place Strategies and a former deputy press secretary in the George W. Bush administration—called Yellen Biden’s “safest bet” for Treasury Secretary, saying she speaks to the relatively moderate tenor of the incoming president’s economic policy. “There isn’t anyone in [Biden’s economic team] who’s been proposing wildly radical ideas,” Fratto told The Dispatch yesterday. Instead, he said we will see the “normal kinds of arguments on economic policy that we’ve had for a long time.”

Yellen, for example, has generally been viewed as a consensus pick (in part due to her somewhat hawkish views on the national debt) and is expected to work across the aisle with Senate Republicans if she is confirmed. “I believe she would get a favorable view,” outgoing Senate Finance chair Sen. Chuck Grassley said on Monday. Sen. John Cornyn echoed that sentiment yesterday, and Sen. Pat Toomey told The Dispatch last week that, while he and Yellen had their “fair share of disagreements” while she was at the Federal Reserve, he has “no doubts about her integrity or technical expertise.” If confirmed, Yellen would be the first woman to serve as Treasury Secretary.

The president-elect tapped Adewale “Wally” Adeyemo—who served as Deputy Director of the National Economic Council in the Obama administration—to be Yellen’s Deputy Treasury Secretary, and selected Princeton University labor economist Cecilia Rouse to serve as chairwoman of the Council of Economic Advisers (CEA), where she will work alongside fellow CEA appointees Jared Bernstein (Biden’s chief economist when he was vice president) and Heather Boushey (the president of the Washington Center for Equitable Growth). Biden has reportedly picked Brian Deese—an economic adviser in the Obama administration and more recently head of sustainable investing at asset manager BlackRock—to lead the National Economic Council.

Axios’s Alayna Treene reported last week that some Democrats are expecting Biden to choose a “sacrificial lamb” nominee for Republicans to tank, “thus easing the passage of other nominees.”

That sacrificial lamb may be Tanden, Biden’s nominee for director of the Office of Management and Budget (OMB). Tanden is the current President and CEO of the Center for American Progress, a center-left think tank in Washington, and has for years drawn criticism from both sides of the aisle for her personal attacks on elected officials and unwavering devotion to Hillary Clinton.

Sen. Rob Portman expressed hope that Biden would withdraw Tanden and pick someone else. Cornyn on Monday called Tanden Biden’s “worst nominee so far.”

“I think, in light of her combative and insulting comments about many members of the Senate, mainly on our side of the aisle, that it creates certainly a problematic path,” he added. Sen. Susan Collins said she doesn’t know much about Tanden, other than “she is a prolific user of Twitter.” The prospective OMB head seems to have deleted more than 1,000 tweets over the past few weeks, many of them critical of Republican senators. 

It would, of course, be a bit silly for GOP members of Congress to tank a nominee for mean tweets given all the mean tweets they’ve overlooked the past four years. But Tanden’s red flags extend beyond social media. While serving as a top aide for then-presidential candidate Hillary Clinton in 2008, Tanden reportedly punched (Tanden says “pushed”) a ThinkProgress reporter in the chest for asking her boss a question about the Iraq War. Following Clinton’s loss in 2016, Tanden floated unsubstantiated conspiracy theories that Russian hackers manipulated actual vote totals in Donald Trump’s favor.

Criticism of Tanden doesn’t just come from the right: Her Clinton support in 2016 earned her no goodwill with the Bernie Sanders wing of the Democratic Party. The Vermont senator sent CAP a letter in 2019 accusing the think tank of “mudslinging” and “personal attacks,” writing that “Tanden repeatedly calls for unity while simultaneously maligning my staff and supporters and belittling progressive ideas.” 

But generally speaking, the economic picks Biden announced yesterday continue the trend of the national security team he revealed last week: Relatively uncontroversial, establishment Democrats. Yellen and Co. will likely advocate aggressive fiscal stimulus and a return to boilerplate liberal tax-and-spend policies. 

“This group is decidedly progressive, and I am certain I will disagree with many of their policy objectives and conclusions,” conservative economist Michael Strain of the American Enterprise Institute said yesterday. “But they are an excellent team for a Democratic administration, and each of these nominees deserves to win Senate confirmation. They are expert, competent professionals—and that is what Biden will need to help get the economy back on track.”

The president-elect is expected to formally introduce his nominees in Wilmington, Delaware later today alongside Vice President-elect Kamala Harris.

Worth Your Time

• Chris Krebs, President Trump’s former head of the Cybersecurity and Infrastructure Security Agency, was fired earlier this month after he publicly pushed back against the president’s baseless and conspiratorial claims that the election was rigged against him. Krebs recently spoke to 60 Minutes’s Scott Pelley about Team Trump’s ongoing efforts: “It was upsetting, because what I saw was an apparent attempt to undermine confidence in the election, to confuse people, to scare people. It’s not me, it’s not just CISA. It’s the tens of thousands of election workers out there that had been working nonstop, 18-hour days, for months. They’re getting death threats for trying to carry out one of our core democratic institutions, an election.” 

• The editors over at National Review don’t hold back in their latest editorial criticizing President Trump’s barrage of legal challenges aimed at altering the presidential election’s outcome. “The Trump team (and much of the GOP) is working backwards, desperately trying to find something, anything to support the president’s aggrieved feelings, rather than objectively considering the evidence and reacting as warranted,” they write. “Flawed and dishonest assertions like this pollute the public discourse and mislead good people who make the mistake of believing things said by the president of the United States.”

• The Washington Post dove into court records, interviews, and physical evidence to detail the life of Samuel Little, the country’s most prolific serial killer. Little, who claims to have killed at least 93 people across 19 states and 30 years, was able to evade detection by targeting women on the margins of society, whose absence would go unnoticed. “Little’s decades of impunity underscore a troubling truth about the U.S. criminal justice system: It is possible to get away with murder if you kill people whose lives are already devalued by society.”

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Toeing the Company Line

• Over the Thanksgiving break, the Supreme Court struck down New York Gov. Andrew Cuomo’s coronavirus-inspired occupancy limits on places of worship. David and Sarah break down the decision on yesterday’s episode of Advisory Opinions, before turning to a host of abortion-related lawsuits and the U.S. census case.

Let Us Know

Have you, or someone you know, been hospitalized with COVID-19? What was your/their experience like?

Are you, or someone you know, a healthcare professional treating COVID-19 patients? What has your/their experience been like?

Reporting by Declan Garvey (@declanpgarvey), Andrew Egger (@EggerDC), Haley Byrd (@byrdinator), Audrey Fahlberg (@FahlOutBerg), Charlotte Lawson (@charlotteUVA), and Steve Hayes (@stephenfhayes).

Photo by Al Seib / Los Angeles Times via Getty Images.