Dr. Box is back

Indiana State Health Commissioner Dr. Kris Box returned to the state’s weekly COVID-19 press conference in person on Oct. 28 after spending the last two weeks at home in isolation after becoming infected with the coronavirus.

INDIANAPOLIS — Hoosiers 60 years old and older have always been at the highest risk for serious symptoms or death for COVID-19.

And now, the state is reporting the largest percentage ever of new hospitalizations are also coming from that older age group.

It’s an ongoing sign that COVID-19 has once again infiltrated into nursing homes and other long-term care facilities and is once again wreaking havoc on those older residents.

In the last month, the number of daily cases of COVID-19, the total number of patients in hospitals for COVID-19 treatment and average number of daily deaths have all about doubled from where they were a month ago in September.

That sharp increase in cases has led to a resurgence of infections in nursing homes, a place where the state had put major focus in the spring and had been successful in getting the virus mostly out of those facilities throughout the summer and early fall.

On Wednesday, Oct. 28, Gov. Eric Holcomb and Indiana State Health Commissioner Dr. Kris Box updated the state’s ongoing second effort to serve nursing homes and addressed the continuing worsening situation on the statewide level.

“We’re seeing COVID-19 spread in virtually every community, every county at different levels, and this will help explain why we’re taking this targeted approach into our long-term care centers,” Holcomb said. “Our hospitals are under a tremendous amount of pressure. We know we’re going to save lives … as we target our resources to drive down those hospitalizations and protect our most vulnerable.”

Health officials have long warned that unchecked spread of COVID-19 among less vulnerable populations would eventually snake back to more vulnerable populations. That warning has appeared to have come to fruition in October as hospitalizations and deaths have surged to numbers not seen since April and May when COVID-19 was reaving through nursing homes.

While older Hoosiers have always been the most susceptible to serious complications from COVID-19, Box reported Wednesday that the percentage of 60-plus Hoosiers being admitted to hospitals is at its highest proportion ever at about 70% of new admissions.

Older Hoosiers have always been the majority of hospital admits. The lowest percentage was at 57% of patients aged 60-plus in both May and June, but that proportion has been climbing every month since.

“This is the highest percentage since the start of the pandemic. This is the population that also resides in our long-term care facilities,” Box said.

Total hospital capacity has been decreasing over the last month. In late September, about 13% of intensive care unit beds were in use by COVID-19 patients, a ratio that has nearly doubled to about 22% recently.

In total, about 40% of ICU beds were available a month ago, compared to 29% as of this week.

Hospitals are now better equipped, trained and knowledgeable about how to treat COVID-19 patients now compared to back in the spring, so treatments and outcomes have generally improved.

That being said, average daily deaths across Indiana have increased to about 21 per day, after being 10 per day in July and August and 11 per day in September.

While some hospital systems are currently being stressed by the recent boom in new patients, Box said facilities still do have ability to boost their capacity by transitioning available space to serve COVID-19 patients. The downside, however, is that the state doesn’t necessarily want to be tapping that capacity reserve now before influenza and other winter illnesses drive up hospitalizations as they typically do in the winter.

“We continue to see more than 100 people per day being admitted with symptoms of COVID,” Box said. “(Hospitals) can get creative and build ICU capacity. The hospitals still have the ability to adjust for a surge by working internally.”

The state is in the midst of a renewed surge of resources to nursing homes, including activating the Indiana National Guard to assist long-term care facilities and sending out additional supplies.

On Wednesday, Brigadier Gen. R. Dale Lyles, adjutant general of the Indiana National Guard spoke briefly about how his troops will be assisting around the state.

Starting next week, the first 399 soldiers will head out to 133 of the hardest-hit facilities in the state to assist staffs with testing, data entry and other infection control procedures, Lyles said. More National Guardsmen will follow in the subsequent two weeks until the state is serving ideally all facilities.

Dr. Dan Rusyniak, who heads up Indiana’s response to nursing homes, said priority was given to facilities with highest numbers of cases among residents and especially staff, with the second and third waves heading out to less-impacted sites.

“Within three weeks we really hope to have Guard in all the facilities around the state,” he said.

Box has warned that COVID-19 may continue surging this winter as more people move indoors and as gatherings become more commonplace during the upcoming holiday season.

The U.S. is growing closer to having a COVID-19 vaccine available, with Box updating that the first doses of a viable vaccine may be out in small supply as soon as late November.

That vaccine would likely be a two-dose shot that needs to be stored at incredibly low temperatures of -70 degrees and is not expected to be widely available.

So it’s extremely unlikely that everyday people would have an opportunity to get vaccinated before the holidays.

“We do not know how much Indiana will receive yet but we believe the supply will be limited,” Box said.

Indiana is continuing to develop its vaccination plans, but the first round of doses will be directed primarily toward health care workers on the front lines and then to the most vulnerable populations.

More widespread availability of a vaccine is “months away,” Box said, telling Hoosiers to not expect major vaccine campaigns until early 2021 at the earliest.

In the meantime, Hoosiers need to keep up the same best practices that have been touted for months.

“Keep wearing your mask, washing your hands and practicing social distancing,” Box said. They’re the best tools we have.”

Holcomb acknowledged many Hoosiers are experiencing pandemic fatigue, but the widespread and still-increasing activity of the virus in October shows that Hoosiers can’t let up just yet.

Even in communities that are seeing low spread, that can change very quickly. A month ago, more than half of the counties in the state were showing low spread of the virus. Now, more than half are showing moderate to high spread.

“Don’t wait until it’s too late. It’s coming. It’s there,” Holcomb said. “If it’s not in your neighborhood yet and folks are careless, it will be.”

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