An informed guide to the pandemic, with the latest developments and expert advice about prevention and treatment. |
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 | | Daily reported coronavirus cases in the United States, seven-day average.The New York Times |
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Agonizing decisions for Alaska's doctors |
Emergency rooms are overwhelmed statewide, testing supplies are depleted, patients are being treated in hallways, and doctors are rationing oxygen. |
 | | The New York Times |
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While many states have approved crisis care guidelines, few have formally carried them out. Alaska has done so. On Saturday, the state said it had activated crisis standards for 20 health care facilities in cities both large and small. |
"I never thought I'd see it," said Dr. Steven Floerchinger, a physician at Alaska's largest hospital. "We are taxed to a point of making decisions of who will and who will not live." |
In one case, his hospital in Anchorage had one more I.C.U. bed coming available, but several Covid-19 patients in line. And there was also someone from one of the state's isolated rural communities who needed to be flown in for emergency surgery. |
The medical staff had a better chance of saving one of the patients in the emergency room, Dr. Floerchinger and his colleagues determined, than the rural patient. Then, the rural patient died. |
"Alaska is going through a really dire situation right now," Mike Baker, our colleague who spoke with doctors across Alaska, told us. "It's isolated in unique ways, so hospitals that are overwhelmed don't have easy relief valves." |
Overloaded hospitals in the lower 48 states have more flexibility to transfer patients, Mike said. But in Anchorage, the closest help is in Seattle, 1,500 miles away. |
"In Alaska, if you have someone who needs critical care, you're almost always going to end up in Anchorage," Mike said. "So as the hospitals in Anchorage run out of space, more patients are staying in their home communities, even though they would otherwise be getting a higher level of care." |
Gov. Mike Dunleavy, a Republican, has also resisted restrictions, like a statewide mask mandate, to curtail the virus. In Anchorage, our colleague Mike Baker went to a city assembly meeting on a proposed mask mandate and saw angry demonstrators heckling doctors who had come to share their experiences and convey how dire the situation was. |
"It was really jarring to see just this huge disparity in what is going on inside the hospitals, and what is going on outside the hospitals," Mike said. |
This spring, Alaska was the first state to open vaccinations to all people over 16, and a legion of planes, ferries and sleds brought doses to far-flung communities. Still, only about half the state's residents are fully vaccinated. |
After a brutal second wave this spring, India is now reporting its lowest case counts and death totals in about six months. While the country's virus statistics have been drastically understated throughout the pandemic, the new numbers suggest a positive trend. To understand more, we spoke to our colleague Mujib Mashal, who covers South Asia. |
Why did cases and deaths decline? |
Two things. The first is that the virus had a remarkably efficient run in the first couple of waves. The Indian government did some studies that showed two-thirds of the population showed antibodies. The sample sizes were small, and some have questioned the survey, but even if it's not hard evidence, it's an indication, backed up by what experts were saying, that the official numbers were undercounting the infections. So if you take the findings from the government survey at face value, the first and second waves reduced the population vulnerable to infection. So that, coupled with a pretty impressive push in vaccinations after a start that was deeply mismanaged — they've now administered about 900 million doses so far — has resulted in the downward trend of daily cases. |
The mood and mentality is still one of caution. The second wave was ridiculously bad. It was like the worst thing India had seen in a long time — oxygen running out, people dying in parking lots, people dying on the streets. So when things started opening up, there was fear of a third wave. But because people have decently embraced vaccination and because the case numbers haven't returned, there's less and less talk of a third wave now, at least in major population centers like Delhi. |
But the message from the government is still one of caution. Warnings are still being put out about festivals, for example, to say: "Listen, we may feel like we've turned the corner, but remember how badly things went in the second wave?" |
What are the possible pitfalls ahead? |
Looking forward, I think there are the two concerns. One is watching for new variants and studying the changing nature of the virus, because that wasn't watched as closely before the second wave. The second is political complacency. India is a country of festivals and politics. Diwali is coming up in November, and there are a couple of big elections around the corner, and there will be a build up to that election with big campaigns and rallies. So looking forward, the fear is how much festival season and campaign season will play into creating another wave of cases, because they were certainly a factor in driving the second wave. |
What else we're following |
Life is slowly returning to some level of "normal." For the first time since the pandemic began, going back the office is not scary anymore. Seeing colleagues face to face and having meaningful conversations has reminded me of how remote work has deprived us of these connections and the value of these interactions. The past weekend spent hiking and eating out at the Magaliesburg with family reminded me of precious liberties from the past that had been long forgotten. I am double jabbed since early September, after months of consideration and prayer. Slowly but surely, I am beginning to dream again and plan ahead, for myself and my children — without the constant feeling that my plans will never materialize. I am hopeful. — Veronica, South Africa |
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