December 16, 2020 - ICU Capacity: Robbing Peter to Pay Paul
ICU Capacity - Robbing Peter to Pay Paul
December 16, 2020
Alabama’s case count climbed above 4,000 again for the first time since Saturday - 4,107, to be exact (incl. 1,261 probables). The daily average of new cases for the last 7 days is now 3,636 per day. It is alarming that there were only 8,922 reported tests, so the one-day positivity rate is a sky-high 46% and the weekly average is 33.9%. Only Idaho, South Dakota, Pennsylvania and Kansas have higher 7-day positivity rates.
It is also alarming that 74 additional deaths were reported, which is the 2nd highest death toll for a single day since the pandemic began. Statewide hospitalizations actually declined by 32 patients (106 reporting hospitals) to 2,310 in all. It is too early to say whether this decline is a fluke or a sign that hospital rates are stabilizing. I’m hoping for the latter but fear it’s the former.
ICU bed utilization is becoming a critical data point now. According to the HHS Dept, 92% of Alabama’s ICU beds are currently in use. At UAB Hospital, 96% of ICU beds are in use and 91% are occupied at Huntsville Hospital. In Montgomery, all three Baptist hospitals (including the one in Prattville) are reporting 100% occupancy, while Jackson Hospital is at 99%. The two hospitals in Dothan report ICU bed use at 106% and 105%, respectively. To be fair, some hospitals can expand their ICU capacity by taking space used for other purposes, but it’s unclear how long that can go on. At the least, such “robbing Peter to pay Paul” has other negative consequences.
Now that the first shipments of vaccines are reaching hospitals, public health experts and ethicists are considering who should take priority for vaccination after health care workers and residents of long-term care facilities. For instance, with limited supplies of vaccines, should the next focus be on independent elderly people and those with serious medical conditions, or on essential workers, such as teachers or transit and grocery employees? How should “essential workers” be defined (CDC’s current definition includes 70% of the workforce)?
According to Dr. Scott Gottlieb, former FDA Commissioner, the choice comes down to whether your goal is to maximize the preservation of human life (in which case, the bias should be the elderly) or your goal is to reduce the rate of infection (in which case, the bias should be essential workers). There is more to it than that, of course, but you see the problem. Alabama’s plan currently puts the elderly ahead of essential workers, but the CDC has yet to issue its final recommendations. This is a topic that will be the subject of great debate in the coming days. The totals:
12/3 - 3531
12/4 - 3840
12/5 - 3390
12/6 - 2288
12/7 - 2335
12/8 - 4436
12/9 - 3522
12/10 - 4735
12/11 - 3853
12/12 - 4066
12/13 - 2790
12/14 - 2264
12/15 - 3638
12/16 - 4107
Jefferson County witnessed a new single day record for any county in the State with 771 cases today. The County’s 14-day positivity rate also was higher than ever: 35.63%. Madison County also set a new individual mark, with 355 new cases. Fourteen counties reported more than 100 new cases - also a record - including DeKalb County with 135 cases, a new milestone for that county.