About 75 million residents of Connecticut, Illinois, New York and California have been directed to sequester, with only essential workers allowed away from home. The extreme measure is necessary to “avoid the loss of potentially tens of thousands of lives,” Illinois Gov. J.B. Pritzker said.
While California Gov. Gavin Newsom said police will not be regulating the statewide order, Connecticut Gov. Ned Lamont said residents of his state could be fined for choosing to ignore the directions.
The sweeping steps follow similar directives throughout the week issued by city and state leaders urging residents to stay put. Those came on top of a slew of orders across the country demanding many bars and restaurants convert to only take-out and delivery services.
All with the aim of keeping people apart.
“Every state will head this way,” CNN national security analyst Juliette Kayyem said Friday. “People need to prepare themselves that this gets harder before this gets easier.”
President Donald Trump did not anticipate issuing any nationwide stay-at-home orders, he said Friday. Days earlier, the federal government issued “15-day pause” guidelines asking Americans to avoid public gatherings with more than 10 people, among other suggestions.
The “pause” may last longer than 15 days, the US Centers for Disease Control and Prevention, or CDC, said in its own guidelines.
One federal plan obtained by CNN includes preparations for a pandemic that could last 18 months or longer and include “multiple waves of illnesses.”
Cases climb as more are tested
There were at least 21,240 confirmed cases as of Saturday morning in the United States — a number that has soared as testing became more available. At least 267 people have died.
About half of those cases are in New York state, where there are 10,356 confirmed cases, Gov. Andrew Cuomo said Saturday. A majority of those cases, 54%, were people between the ages of 18 and 49, the governor said.
More than 195,000 Americans have been tested, Vice President Mike Pence told reporters in a White House briefing Saturday. That total does not include county hospitals or health care labs, the vice president said.
Pence himself will be tested Saturday afternoon, along with his wife, after a staff member in his office tested positive. The staffer is doing well, Pence said Saturday, and neither the vice president nor the President had direct contact with the staffer.
The White House doctor determined there was no reason to believe Pence was exposed, but Pence will be tested “given the unique position that I have as the vice president and as leader of the White House coronavirus task force,” the vice president said.
In a strategic shift, New York City and Los Angeles County health authorities recommended this week that health care providers avoid testing patients except in cases in which a test result would significantly change the course of treatment.
Guidance from the Los Angeles County Department of Health, dated Thursday, said testing at public health labs would prioritize patients with symptoms, health care workers, residents of long-term care facilities, paramedics and other high-risk patients. Others were encouraged to simply stay at home.
The recommendation reflects a “shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” the guidance said.
Guidance from the New York Department of Health, dated Friday, directed health care facilities to stop testing non-hospitalized patients in an effort to preserve dwindling medical supplies.
“At this point in the pandemic, demand for unnecessary testing is contributing to the rapidly diminishing supply of PPE and leading to a decreasing supply of swabs and viral transport media used to collect diagnostic specimens for COVID-19 testing,” the guidance read. “Testing may play a more significant role after the pandemic has peaked.”
Makeshift masks and hospitals
But as numbers climb, health care workers and state leaders have sounded the alarm on medical supplies beginning to run short.
In New York City, now the epicenter of the outbreak in the US, Mayor Bill de Blasio called on Trump for help and said supplies may only last for the next few weeks.
“I said very clearly that for the month of March, we have the supplies that we need, the city has very strong reserves of the kind of supplies that I talked about,” he said. “It is going into April that I’m worried about. I don’t have the perfect day for you. We’re assessing all the time, but it is a day — two weeks from now or three weeks from now — where we must, by then, have had a very substantial resupply.”
The CDC in new guidance this week said facilities facing a “crisis” should consider options to combat shortages that “are not commensurate with US standards of care.”
That includes reusing masks, as well as using “homemade ones” from materials like bandanas and scarves.
Hospitals across the country have already reported they’ve had to get creative with how to make more masks and make them last longer.
Some have moved to makeshift hospital facilities, too, with one Washington state community getting ready to open a 200-bed hospital on a soccer field.And deBlasio said his city will use “every building we can … to become essentially annexes to hospitals.”
“Supplies are a major issue — (personal protective equipment), gloves, gowns, mask suppliers,” Cuomo said Friday. “I am now asking all product providers, all companies who are in this business, we will pay a premium for these products.”
Some facilities, including in New York, also have drastically upped their orders for ventilators. Michael Dowling, president and CEO of the Northwell Health, was picked by New York’s governor to lead a hospital surge team. He said he wants to purchase as many as 500 ventilators, which can cost $20,000 to $40,000 a machine.
US is unprepared, experts say
The coronavirus outbreak in Italy — where there are more hospital beds per 1,000 people than the United States — could signal a lack of preparedness in the US, according to commentary published this week in the New England Journal of Medicine.
“Though Italy’s health system is highly regarded and has 3.2 hospital beds per 1,000 people (as compared with 2.8 in the United States), it has been impossible to meet the needs of so many critically ill patients simultaneously,” Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, wrote in the piece.
The US is “two months too late” in preparing, one expert told CNN earlier this week.
“I really think this is a fundamental responsibility of government to have acted on this a long time ago,” said Dr. Eric Toner, who studies hospital preparedness at the Johns Hopkins Center for Health Security.
Staffing shortages will likely come even before equipment starts to run out, said Dr. David Hill, a pulmonary critical care physician and a spokesman for the American Lung Association.
“Part of it is just exhausting our personnel. Health care is complicated and people make mistakes when they’re overworked,” Hill said.
If health care workers get sick, “everything can fall apart very quickly,” says Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine.
Hotez is “especially worried now about our health care providers because we’re starting to see those individuals become sick as well and be taken out of the workforce, or in some cases become seriously ill. So here’s where everything can fall apart very quickly,” he said.
To combat a possible shortage, Georgia officials are moving to expedite licensing for nursing professionals who come in from other states to help stem the spread of the virus, Secretary of State Brad Raffensperger said.
“Fighting, defeating, and overcoming coronavirus in Georgia and across the country will require enlisting the help of the best and brightest medical professionals available,” Raffensperger said in a news release.
And in New York and Connecticut, state leaders reached out to retired doctors and nurses to request help during the pandemic.