• We do not have much good news today. As bad as things have been over the last couple of weeks we continue to move in that same bad wrong direction. The data does not indicate that we are at or near the peak of this surge. Having said that...
• Congratulations to the Shot At A Million Winners.
  • Information on winners
  • Million dollar winner is a retired elementary school teacher who taught Special Ed Bossier and Caddo parishes. The winner, Janet, comes up he presents her with the check, they take a photo.
• The point of the campaign was to encourage people to get the COVID19 vaccine and get it as soon as possible without waiting. When the state announced the campaign the state was not in the current sure. It is now more important than ever that people get vaccinated.
• More news about incentives:
  • Shot for $100 - $100 dollars for the first 75,000 college students to get vaccinated on college/higher institution campuses.
    • Huge percentage of cases are driven by this age group and this age group is one of the least vaccinated.
• There have been more than 260k cases linked to college universities since the first of this year, and more than 700k cases over the course of the pandemic.
  • Over the summer spoke with Governors Fellows, student leaders on campuses, about how they wanted to do their part and put an end to the pandemic, and stop this surge by promoting the vaccine and taking advantage of incentives. Sharing trusted information with peers so everyone felt motivated to get vaccinated so campus activities could get back closer to normal sooner.
    • This program will help them reach this goal.
      • Delta is affecting younger populations and we are thankfully seeing more young people go sleeves up but we have a long way to go in that demographic.
      • Students want an in-person college experience and to safely experience that we need more shots in arms.
• It is in everyone's interest that this happens, so they protect themselves, their family, and their community. The nature of a public health emergency is such that what every individual does, what every group does, has implications not just on the individuals in groups but on all of us.
• The fall semester is a few days away for some institutions or maybe a few weeks for others and we think this will make a difference in student vaccine uptake across Louisiana.
• We are actively working with the Board of Regents and the higher education systems in Louisiana and this includes the independent colleges and universities in Louisiana as well. They are all eligible to participate and must opt-in if they choose to do this. The program will be easy for the colleges so it may not look the same on every single campus but we will make this as easy as possible for them.
  • At participating colleges and university students will be given a deactivated Visa card on their vaccination (mod note: wonder how much money Visa is making off this...) and then they will register online at ShotFor100.com and that card will be loaded with $100 or call 855-453-0774.
• As you all know, being vaccinated is very important to stop this current surge but also to reduce transmission and prepare us for any other surges that come down the road. And as we slow transmission we slow the rate of mutation and the variants that develop and so forth. There is nothing that prevents the next variant that happens from being worse than Delta if you can imagine that. So this is very important for all of those reasons and many many more.
• Vaccines are safe, effective, FREE, and convenient. Whether you live in a small town or a city it is very important you get vaccinated and that is true whether or not you are in higher education.
• Please get vaccinated today if you have not made the decision.
• This idea that I am being safe, I will do what I can do to protect myself from contracting the virus, or being exposed to the virus and contracting the disease is not enough. It is not enough when you have the Delta variant out there which is as transmissible as it is. From all accounts of the physicians, I'm talking to they believe it is more virulent as well.
• For people who continue to think maybe I should be more concerned about the vaccines than about the virus I want to share this tidbit.
  • 2.1 million first doses have been administered in Louisiana, meaning 2.1 Louisianans have received at least one shot.
  • 3.8 million doses have been administered to those 2.1 Louisianans.
  • There have been 8 severe reactions to the vaccine requiring hospitalizations.
  • Zero deaths.
    • Today alone we report 57 deaths from COVID19.
• COVID data
  • 7,548 new cases of COVID19 off of 56,108 new tests.
    • One of the highest single-day numbers reported during the pandemic.
  • 23% of our current cases are made up of individuals under 18.
  • Sadly we report 57 new deaths for a total of 11,519.
  • 2,907 individuals in the hospital with COVID19.
    • The highest we've ever had, and this is an increase of 6 from yesterday.
    • 399 of those individuals are on mechanical ventilators and that up 13 from yesterday.
  • Statewide case positivity is 16.1%
• You will see a chart when Dr. Kanter comes up that shows we have the highest growth rate of cases in the country right now by the 7-day cumulative case rate. It is not even close. We are in a bad place.
• We need to slow transmission and increase vaccinations.
• The number of hospitalizations is not just the highest they've ever been they are also almost a 1/3 higher than at any other point in the pandemic. The slope of the increase is almost vertical. Our hospitals are struggling. The staff remains the limiting factor on capacity. Our staff at the hospitals are maxed out, they have been doing this for 18 months.
  • Was on a call earlier this week with all of the Tier 1 hospital leaders. We've had these phonically on a regular basis since the start of the pandemic and I have never heard them express more alarm and anxiety than they did this week because we are rapidly approaching the breaking point. If you are an individual whose surgery has been postponed to remove a tumor and you are a cancer patient or if you have had an organ transplant delayed because there wasn't a recovery room. If surgical repair of your aneurysm... and these things are happening, but to you, those people experiencing these things we have reached a breaking point in our system.

• There is no good news we can pick out from the data right now. We are anxiously awaiting any sign we have turned the corner in this unprecedented corner in this fourth surge and we have not seen any concrete signs in the data. It has been another week of increased cases and hospitalizations.
• We have never had a time during the pandemic where there is this much COVID circulating, where we have this number of individuals requiring care in the hospital, and where the situation in our acute care hospitals have never been as drastic as it is now. It was true last week when we spoke, and unfortunately, it is more true now.
• Gating criteria:
  • Individuals coming to the ER with COVID-like illness: We see a tiny bit down to 14.4% which is still a record looking back at the three prior surges. Difficult to know how to interpret this small dip. There is a line of thought that as hospitals get busy and as we've asked people to try to avoid hospitals for minor symptoms, that they have done so that that might account for the small dip. Regardless it remains a historic number for us and a reflection of the terrible burden hospitals are facing right now.
  • Case incidence: Has gone up by 96% over the last two weeks and over the last month by 876%. It is higher now than it has ever been at any point in time during the pandemic.
    • There are more people being diagnosed daily with COVID than there have been at any other point in time during this pandemic
    • The state's two-week incidence is at 1,389 per 100k residents.
    • Over the past two weeks, 1.4% of the state's population was infected with COVID19. These are just the infections we know about, the ones that got diagnosed and had positive test results reported to the Department of Health.
    • Average day we are seeing 106 new cases per 100k residents. I mention this because when we look at what the CDC considers to be "high" having over 100 cases per 100k residents and puts you at the highest rank for CDC categories of risk and we are doing that on a daily basis. We have the highest of the four possible categories of community risk across all regions of the state. So fair to say, the risk of contracting COVID no matter where you are in the state of Louisiana has never been higher
  • Percent positivity and testing volume: Testing volume is going up quite significantly as more people get exposed more people get tested. Percent positivity has also increased it is 16.1% this week. We have not been that high since April 15th of 2020. When we were that high, over a year ago, we had 7x less testing volume being conducted. That is back when it was very hard to get a test and it was restricted through the CDC and that artificially inflated the percent positivity. So in the context of 7x more tests occurring across the state right now our percent positivity of 16.1% is remarkable.
  • Deaths: have increased over 135% across all age groups. In individuals below the age of 40, it has increased 766%. A 766% increase of people who died from COVID over the past month under the age of 40.
  • Hospitalization: We are at the highest point right now than we have ever been in the pandemic. Almost a 1/3 higher, close to a thousand people higher than at the prior max of our DecembeJanuary surge. There aren't 2,907 patients hospitalized with COVID19 right now across the state. In our prior peak, we had 2,069. In the past month, we have added over 2,600 hospitalized covid patients. WE've added more patients hospitalized than we had at our highest peak to date prior to the fourth surge. This is simply remarkable and not sustainable.
• Epidemiologists have tracked 39 new outbreaks attacked to 251 associated cases. The largest settings have been daycares, restaurants, worksites, and religious venues.
• New cases by age bracket, you'll see tremendous increases across all ages.
  • Individuals ages 18-29 represent the largest cases of new cases diagnosed day in and day out.
  • Followed shortly thereafter by individuals below 18 and those between 30-39.
    • Of all cases reported to the LDH today people below the age of 18 accounts for 23%. That is substantial.
• When we think about what will keep us safe moving forward and avert this surge we need to reduce transmission wherever and whenever that transmission occurs. It is very clear this transmission occurs regardless of age. We've had outbreaks at daycares and we had outbreaks at summer camps when they were still in operation. When you look at the data and get into contact tracing data there is significant transmission amongst younger age groups including children. This is why masking is so important in those age groups. We will not be successful at averting this tragedy if we do not avert transmission wherever it occurs.
• Yet again, we, unfortunately, report Louisiana leads the country in the number of new cases of covid diagnosed every day. Florida is second place to us and not by a small amount. Yet again for another week, we are the COVID hotspot for the country.
  • We continue to be an emanating hotpot with a large amount of COVID reaching out across our region.
• What does this mean for you? Clearly, if your family or you are sick with COVID it means a great deal, but what if you are not? What does this mean for you?
  • When our hospitals get this busy they cannot provide the level of care nor the quality of care for any patient that we have become accustomed to. That is a serious thing to discuss. People need to be aware that hospitals are stretched to the point that they are not able to provide the quality of care to any patient they normally would under the regular circumstances. We've had 58 hospitals to date reach out to the Department of Health formally asking for help -- indicating they cannot meet the current demands with their current staff available. That is unprecedented and we have enter had anything like this before.
  • Dr. Kanter occasionally continues to work as ER physical and this past weekend, one example, the hospital I was practicing in still had a couple of beds available and was still able to receive the occasional transfer from outside facilities. Not every hospital in the state is able to do this. We accepted a transfer of a patient with what is called a STEMI (the most severe type of acute heart attack). We accepted a patient with an acute heart attack who had to bypass 6 Cath lab capable hospitals to get to us. A two-hour ambulance ride to get to us for a condition that is amongst the most time-sensitive conditions we have in medicine and we know every minute we delay with this type of acute heart attack up to the Cath lab is literal heart muscle that dies. That is heart muscle they will not have should the patient recover from the condition with real functional impairment. We track these types of patients with the number of minutes. We track how long does it take to get the patient from the door of your hospital up to the Cath lab to getting the balloon cathedral open. That is the measure of detail we track down to the minute and this patient had to bypass 6 hospitals to get to us because none of the other Cath labs capable hospitals had a bed available to the patient. These are the type of scenarios happening all across the state right now so if you think this doesn't impact you because you are not sick with COVID you are absolutely wrong. These types of medical emergencies happen to every and they happen when you least expect them. To not have the resources of a normal hospital at your disposal is not something we are used to in this country and it is quite scary. It was scary for this patient and it is scary for other families too and people need to understand that.
• We need to connect the dots this not happening by itself. This situation in the hospital is not some event that we do not have agency or control of. We have all the agency in the world to avert this situation and it goes back to how we reduce transmission.
  • If people chose not to mask, and chose not to distance, if people choose not to get vaccinated cases of COVID will go up. This surge will continue. This situation in the hospital will get worse. Meaning if Louisiana need care for whatever reason they will have a greater likelihood not to receive that care when they need it. It comes back to ur personal decision to mask, distance, and get ourselves vaccinated.
• "Breakthrough data"
  • 90% of all cases reported last week were not fully vaccinated people.
  • 91% of people currently hospitalized with COVID-19 today in Louisiana are not fully vaccinated.
  • 83% of COVID-19 deaths reported last week were among not fully vaccinated people.
• It remains as true as ever that these vaccines provide excellent but not perfect protection.
  • When it is pouring outside you have to put on an umbrella and rain jacket or else you will get wet.
  • When we are in the middle fo this type of surge getting vaccinated is essential but you need to take additional measures like distancing and masking because there is so much COVID out there.
• Nursing homes
  • New COVID-19 cases amongst residents: 150 cases this week up from 136 the week prior.
  • New resident COVID19 deaths: 5 deaths that are down from 8 the week prior.
  • New COVID cases amongst nursing home staff: 259 cases that are up from 246 the week prior.
  • Takeaway point number 1: when you rein a high risk congregate setting (and it doesn't get more high risk than nursing homes) and you do not have 100% vaccine coverage (52% of staff have initiated their vaccine series and 87% of residents) you will have transmission. Often it comes from nursing home staff and when COVID19 is presented into an environment like that it will spread particularly when we are in the middle of the giant surge.
  • Takeaway point number 2: vaccines are working and are doing what they are supposed to do because while we see increases in new cases amongst staff and residents we do not see a similar increase in deaths.
  • Vaccines designed to prevent hospitalizations and death and even in the most high-risk situation we have for COVID19 --congregate setting where it can be spread very easily and individuals it infects are at the highest risk-- we still despite, a moderate increase in cases, have not seen commiserate increases in deaths. That is evidence the vaccines are working. I cannot imagine what would be happening in nursing homes right now if we did not have 87% of residents who have initiated or completed their vaccine series.
  • Per Federal guidelines, when a nursing home has an outbreak, or even 1 case, that triggers a number of actions - widespread testing, quarantine, temporary visitation restrictions while they mitigate through it. This is done to keep loved ones safe in the nursing home.
• One good news, we continue to see good increases in vacation and we have increased over 400% in the past month. A month ago we were doing 2,000 new administrations a day and we went up to around 12,000 and we maybe plateauing or coming down a little bit, but that is still a substantial increase.
  • These are all individuals who changed their mind for one reason or another and that is encouraging.
  • Its unfortunate it takes a large surge to make this real for people but it is encouraging and will protect us from future surges going forward.
• Symptoms of COVID.
  • if you have any of these symptoms, even mild symptoms, take them seriously and assume you are positive until you can confirm via testing otherwise and limit contact with other people until you do so.
• When you are out you can do three things to increase your safety:
  • Outdoors as opposed to indoors.
  • Distance yourself from others.
  • Wear a mask.
  • Ideally you will do two of those things.

Questions for Dr. Kanter.

• This is completely stretching our resources and this is worse than what we have seen before and is close to a breaking point.
• Taking care of our community like we want to is a challenge than it has ever been over the last 18 months and I never thought we would be in this position to say that given what we went through before.
• One month ago we had 30 COVID19 patients in our hospital today we have 162. At our main campus we have 98. The average age is 54. Consequently the average of mortality is 54. That is 15-20 years younger than what we saw with prior surges.
• The virus is taking up a full 1/3 of our hospital beds but has consumed all of the energy that remains in our healthcare workers. Exhaustion is not even a word that describes it.
• Last year, the unknown was the scary part now they are more anxious because they know what is coming and they are on the edge of the seat trying to figure out what we are facing. With numbers going straight up we do not know what limit or the peak will be. But they are remarkable and come to hospital to take care of their patients and come back to their shifts over rand over again. Our community cannot thank them enough for this and I have personally thanked each and every one of them.
• I want the community to understand that it is affecting more than those that are just suffering from the virus which is why we should all be concerned regardless of personal covid status. For several weeks we've delayed surges for more than 100 every single week. We've called them elective procedure but that does not mean they are just minor procedures these are procedure that are slow growing tumors or aneurysms these are bypass surgeries, hysterectomies, they are not minor, they are serious. But they have to be put off because they are surgeries that need a bed to stay in afterwards, sometimes multiple days or need of an ICU. We do not have a bed to give them which is why we have to put them off. We need the right care to take care of them afterwards post surgical care is just as important as the surgery itself. So they are suffering physically and we are monitoring them and they are suffering emotionally because they do not know when they can expect to get back in to get their surgeries done.
• We are expanding our units everywhere we can. We are surging into different parts of the hospital but in order to do that we need the capacity and the people to do that. We are quickly running out of space and we really have no more staff to pull from. I mention the one facility with 98 patients with COVID and that is one city but other facilities are facing similar.
• The ripple effect should be resonating with our community members. When rural campuses have no where to send to the major hospitals, they don't have the resources to take care of the patients, so the patients sit in the ER until they can find a room to go to. So the ambulance rolls up and there is no place to put them. So the EMTs are setting in the hallways waiting to place the patient somewhere. Then someone calls 911 in the community and there's isn't an ambulance to go to them. That is the fear we all have for anyone of us who may get sick and pick up 911 but there aren't enough people to come and get you.
• COVID has added more volume onto our regular business which is already busy.
• Some waiting rooms have 7-10 hours of waiting and if they need o be admitted to the hospital they may wait 48 hours in the ER waiting for a bed upstairs so it is essentially gridlock when we go through surges like this.
• We are a level II trauma center and tertiary center so we receive dozens of calls daily to take patients who cannot be served at other locations, but today we can hardly accept any of those. We may get 1 bed open per 12 hours and we cannot take any calls. We've declines 70% of transfer requests since the surge began. Theses calls are coming from all around the state and surrounding states as well. Unfortunately we have to say no.
• That being said if you think you are having heart attack or stroke do not sit at home out of fear. Come to us we will triage you and stabilize you to the best of our abilities. We cannot promise you will stay in the local area we may need to find a bed for you quite far away.
• A lot of people say they do not believe the case counts, they are growing at an alarming rate, regardless of what you think about case counts the hospitalizations are very real and 90% of those in the hospital with COVID19 right now are unvaccinated.
• What can you do?
  • Its not too late to get vaccinated and build up your immune response.
  • If you have questions left to be answered about the vaccine go to a trusted resource, talk to you physician, do what you can to move and get vaccinated and protect those around you.
  • Hunker down and avoid unnecessary gatherings and stick to those who are the most protected around you, your safe pod --- those you trust who you know are healthy and are doing the right thing.
  • Do not wait to get tested I've heard time and time again I thought I had a sinus infection. Testing is widely available. Get tested early and do not expose others. This will help us slow transmission down.
  • Wear a mask. Wear a mask you can infect others before you even realize you are sick.

Questions

• Due to the nature of our service, being a women's hospital, we've been more insulated from the COVID19 crisis as opposed to the general hospitals.
• We are now suffering from the effects of the pandemic.
• I am here to speak specifically about the new CDC guidelines which thankfully encourage all pregnant and lactating women to get the vaccine.
• First of all, we can all remember when those two planes crashed into the Twin Towers, I was medical student at Charity hospital in New Orleans and watched in horror in disbelief as thosudnas of innocent people lost their lives that day. We are now facing another watershed moment in our nation but now we have a weapon to fight it. We've taken oaths to preserve life and do no harm and we are coming to you today to plead wit you to get vaccinated.
• This pandemic has not only taken lives but has extraordinarily altered the lives of many of us. I am not making a political statement I am physician. I am simply doing what I was trained to do and that is giving good sound medical advice. I am so happy to have the support of the CDC in recommending the COVID19 vaccine to pregnant and breastfeeding women. They are in the higher risk category of suffering serious or deadly consequences from COVID infection.
• I want everyone to focus on 3 very important research based facts. This is what we know.
  • It is completely safe for pregnant women to receive the vaccine at any point during pregnancy.
  • The covid19 vaccine does not cause miscarriages.
  • Moms that get the COVID19 vaccine while pregnant actually help to pass protective immune chemicals to their unborn children that will actually help protect them after they are born.
• I trust this research based information settles the hearts and minds of all of you Mamabears our there that are only looking to protect your children.
• I hope I speak for all healthcare providers when I say we did not go into medicine to watch people die. We are tired, we are exhausted both mentally and physically. Our children are mentally stressed from the pandemic. Please get the vaccine so your doctors and nurses do not have to fight to save your life, and your family members do not have to mourn your death, and you do not need to protest so your kids do not wear masks in school, please get the vaccine so we can all move forward with our lives with some semblance of normalcy and reclaim the freedoms we hold so dear.

• I don't care who you are if you go tot he hospital and you have COVID and you have a serious case you will trust the physicians to do everything they can in order to save your life. Put that trust in your physicians now and let them give you the recommendation that is necessary to keep you out of the hospital in the first place. Put that same trust in them ahead of time.
• We've got to slow Delta down. We've got the slow the transmission, the hospitalizations, and lord knows we have to reduce the number of deaths we are reporting. WE do that by being vaccinated, wearing our masks, and doing all of the common mitigation measures that have been discussed here today and over the last 18 months.
• Today is a new day, lets get with the program, let's do what is required for ourselves, our families, our communities, our state, let's avoid the worse case scenarios that these doctors tell you about that are not so far away in time. Output of care and quality care is already being adversely impacted.

Questions

Closing notes

• There is no better day than today to get vaccinated.
• Wear your mask. We have to curb transmission.
• For people who continue to question the necessity, I just ask what data are you looking at? Where are you getting your information? Do you not care what Dr. Kanter, Dr. Logue, or Dr. Thomas just shared with you?
• Let's pull together and get through this. I welcome and ask for your prayer for our state, each other, and especially our healthcare workers.

• Grab the remote and switch the stream to Netflix.
• Grab the remote and switch the stream to Sling.
• Snuggle up all cute like grab the remote and then laugh like a maniac as I chase her for said remote.