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The desperately lonely way that most people die from COVID-19 makes the disease and its mounting death toll difficult to grasp, oncologist Mark A. Lewis believes.
As Utah passed the grim milestone Thursday of 500 deaths from the pandemic, Lewis said the isolation may be disconnecting the general public from the tragedy at hand. U.S. deaths so far — now topping 211,000 — could fill the University of Utah’s Rice-Eccles Stadium nearly five times over, he noted, with the number of those lost now equivalent to 70 times the deaths on 9/11.
“So many of the deaths are happening behind closed doors: in hospital rooms and ICUs, in nursing homes and long-term care facilities,” said Lewis, an Intermountain Healthcare physician who has lost several cancer patients to the virus. “It makes it easier to think of the numbers as an abstraction as the death toll rises to a near-incomprehensible sum.”
With 1,501 new coronavirus cases reported on Thursday, Utah also set a new record for one-day diagnoses. For the past week, the Utah Department of Health has tallied 1,114 new positive test results a day, on average — continuing a streak of new record highs.
“We’re just disheartened in the fact that we have the most cases today, this rise is not going anywhere, our hospitals are full, and we don’t see things changing at the government level, or at the local level,” Dr. Eddie Stenehjem, an infectious diseases physician for Intermountain Healthcare, said in an online news briefing. “We need to do something differently if we want different results.”
Hospitalizations also reached a record high on Thursday, with 237 Utah patients concurrently admitted, UDOH reported. At a news conference with Gov. Gary Herbert, Dr. Emily Spivak summed up the stress the surge is causing for Utah’s health care system and its providers.
“Our health care workers are tired, they’re suffering, and they don’t want to see another person die alone of a preventable infection,” said Spivak, an infectious disease consultant at University of Utah Hospital. “Our hospital is getting full. Our ICU is getting full,” she said, noting that on Thursday morning, University Hospital’s intensive care unit was at 95% capacity.
But Herbert again balked at the suggestion of increasing restrictions to prevent further spread. “At the end of the day, I hope we don’t have to have the government tell us to do the right thing,” he said at the news conference.
Herbert has ordered “orange,” or moderate, restriction levels in Orem and Provo only, leaving the rest of the state at less restrictive yellow and green status — including Salt Lake City, where Herbert has so far declined Mayor Erin Mendenhall’s request to move to higher restrictions, FOX13 reported on Thursday.
In order to return to “yellow” status, Herbert has required Orem and Provo to record two-week averages of fewer than 35 new cases per day per 100,000 residents — about half the rate they are presently reporting, according to state data.
But many other communities have reported incidence rates above 35 for the past two weeks. In fact, 1.35 million Utahns live in communities and neighborhoods where new infections are exceeding Herbert’s threshold, including about half of the residents of Salt Lake City.
As of Thursday, Salt Lake, Davis, Tooele and Wasatch counties and health districts in Central and Southeast Utah all reported their highest-yet seven-day average for new cases, with Davis County and Southeast Utah reporting their biggest single-day increase.
There were 10,582 new test results reported on Thursday — the most ever reported in a single day in Utah, and about the state’s capacity for daily testing. The weeklong average is at 7,972 tests per day.
Officials at University of Utah Health said their testing sites remained at capacity even after switching to scheduled appointments last week, and Stenehjem said Intermountain’s test sites also were filling up.
For the past week, 13.7% of all tests statewide have come back positive.
“Our test volumes have been really high,” Stenehjem said. “What’s troubling is our percent positive is still remaining really high. There are likely plenty of [infected] people out there that are not getting tested.”
The share of new cases comprised by patients ages 15 to 24 continued to decline this week, as older age groups continued to rise, UDOH data showed.
“The 15- to 24-year-olds are taking those infections home with them and then spreading them to mom, dad, grandma grandpa and other community members,” Stenehjem said. “The huge concern about that is ... the 25 and up, particularly those that are above age 50, those are the people that are ... going to fill up our hospitals.”
In total, 4,167 patients have been hospitalized in Utah for COVID-19, up 54 from Wednesday. There have been 548 hospitalizations reported in the past two weeks — the most of any 14-day stretch since the pandemic began.
Utah’s intensive care units were 73% occupied as of Thursday, still meeting the state’s goal of less than 85% occupancy.
‘It is a fact,’ masks work
After earlier threatening that it might have to close because of an explosion of COVID-19 cases on its Provo campus, officials at Brigham Young University said this week that it appears the spike there is leveling out. As of Thursday, there were 1,645 cases reported at the school with 43,000 students and staff.
BYU’s decline in cases is real, the Utah County school said in a statement, and “not a result of a decrease in testing or a decrease in receiving reported test results.”
While state epidemiologist Angela Dunn also praised Utah County for lowering rates of new cases in recent days, the county still had a higher rate of new infections than any other area of the state during the past week: 51 new daily cases, compared to a statewide average of about 35.
The drop in Utah County cases occurred only after a countywide mask mandate was implemented. But Herbert said Utahns should be trusted to comply with prevention measures voluntarily, citing the state’s history of community service.
“We’re being tested today, like we’ve never been tested before, to see if that same enthusiasm for helping our neighbor applies to the pandemic,” he said.
With Herbert, Spivak again repeated the call for Utahns to wear a face mask whenever they leave home, to prevent the spread of droplets and aerosol particles that can carry the coronavirus.
“As a physician, I honestly don’t know how this became a debate,” Spivak said. “Wearing a mask makes a huge difference. It is a fact: They work, and they are safe.”
A survivor of pancreatic cancer, Lewis has won thousands of social media followers with regular posts emphasizing empathy and the importance of wearing of masks in the ongoing crisis. “You don’t have to feel sick to transmit it to others!” he reiterated this week.
“Since we never know what other people are going through, either physically or emotionally, I try to remember that I could be potentially transmitting the virus to people who are especially vulnerable,” the physician said via email, “and I act accordingly, whether in my clinical role or on the rare opportunities I venture out in public.”
‘The sheer inhumanity’
The five fatalities reported Thursday pushed Utah’s death toll to 501. They were a Davis County man and a Salt Lake County woman both older than 85; two men from Salt Lake County and Washington County who were between 65 and 84; and a Salt Lake County man who was 45 to 64.
The stories from Utah frontline workers who are caring for dying patients are “heartbreaking,” Spivak told The Salt Lake Tribune in an interview. They describe patients telling them, as “the last thing they say — ‘I think I’m going to die.’ And then they do, and they never got to talk to their family again.”
Spivak lamented "the sheer inhumanity of the way people have to die, or be sick for many, many weeks, and be away [from their families]. …
“There are people who don’t even speak English, lots of them. They’re in a setting where they’re surrounded by people in hazmat suits,” Spivak said. " ... It must be terrifying, absolutely terrifying, for everyone involved."
For patients also fighting cancer, Lewis said, the strict quarantine for the coronavirus cuts them off from family members and friends who would otherwise be “therapeutic allies” in their care.
“Dealing with cancer is never easy at the best of times, but to do it without the presence of loved ones is particularly brutal and difficult,” he said.
That, Lewis said, has led him to step up his own support. “So much of it is just presence. If I can I try to spend a little more time with each patient, whether in the clinic or in the hospital,” he said. “Even though I remain behind a scrim of PPE [personal protective equipment],” he said, “I find that just ‘being there’ can overcome a lot of their sense of isolation.”
Lewis said he’s seen “an entirely new level of fear among his patients” and that people underestimate the acute and chronic effects of COVID-19.
“I have never seen a virus cause this degree of respiratory distress,” said Lewis, also director of gastrointestinal oncology for Intermountain. Lasting effects, he said, include severe limitations in capacity to exercise, breathing and even thinking, depending on a patient’s immune response.
Though he noted that it might seem “self-pitying” for health care workers to complain about their own mental health in a pandemic, Lewis said it was well-documented that anxiety, depression and burnout are all on the rise among doctors, nurses and other medical providers.
“We are experiencing both an individual and collective grief in processing the losses of COVID-19,” he said.
Health care professionals go through regular training on how to compartmentalize their personal and professional lives, Lewis said, “but this year has, for many, seen the complete erasure of that always-permeable membrane.”