ICUs clogged on the way in, morgues on the way out in California's COVID crisis

MISSION VIEJO, California - Southern California is so overwhelmed with coronavirus cases that patients are backed up trying to get into hospitals, and corpses get stuck in another logjam once they leave.

At one hospital in Orange County, ambulances loaded with patients are lining up outside waiting for space in the intensive care unit, and COVID-19 patients fill the emergency room hallway.

In nearby Los Angeles County, where people are dying of the disease at the rate of one every eight minutes, and other hard-hit areas, refrigerated trailers will be brought in to provide extra corpse-storage capacity.

"When we get filled up with COVID patients, we can't take care of the community in general," said Dr. Jim Keany, 54, the managing partner for emergency physicians at Providence Mission Hospital in Mission Viejo. "Every bed is full, every nurse and doctor is occupied taking care of COVID patients."

One patient waited in the ambulance more than five hours before being admitted, Keany said.

Despite strict stay-at-home measures that were fortified across most of the state last month, California, the most populous state with nearly 40 million people, leads the United States with nearly 2.6 million COVID-19 cases, over a million more than the next state, according to a Reuters tally of official data.

Its death toll of more than 28,000 trails only those of New York and Texas.

With the bodies accumulating, the California Office of Emergency Services said it has arranged to send 88 trailers to needy areas around the state.

The Los Angeles County Coroner's Office headquarters will receive 10 morgue trailers, in addition to 12 set up there in April, said spokeswoman Sarah Ardalani.

Orange County officials had previously allowed hospitals to divert patients elsewhere when they were full, but now that virtually all the hospitals have reached capacity that policy has been rescinded, resulting in long waits for treatment, Keany said.

"We are pushing our carpenters and facility people to an extreme in trying to build out space where we can manage patients," Keany said.

Dr. Robert Goldberg, 44, a pulmonary and critical care physician at Providence Mission Hospital, called on the public to help reduce the threat by wearing masks, maintaining social distance and getting the vaccine once it becomes available.

"COVID is real. It's life-threatening," Goldberg said. "People of all ages are dying. We need to work together. We need to get through this together." 

-reuters-

Regeneron antibodies in demand after Trump treatment, doctors seek more data

Patients are asking to join clinical trials of antibody-based COVID-19 drugs after US President Donald Trump was treated last week with an experimental therapy from Regeneron Pharmaceuticals Inc, and on Wednesday he promised to make it free to Americans while touting its benefits.

Medical experts said more data is needed to assess the treatment's efficacy before wider use should be allowed.

Trump was discharged from the hospital late on Monday, just a few days after being diagnosed with COVID-19 that caused enough lung inflammation for blood oxygen levels to fall.

According to his doctor, blood tests on Monday detected infection-fighting antibodies, which a Regeneron spokesperson said were probably from the treatment.

The company said on Wednesday that it has submitted a request to the US Food and Drug Administration for an emergency use authorization (EUA) for its antibody combination.

In a video shot outside the White House, Trump credited the Regeneron therapy for his feeling much better than when he was first diagnosed and said he would push for EUAs of that treatment and others like it. He mistakenly said the drug was called Regeneron.

Regeneron's drug is a cocktail of 2 monoclonal antibodies - manufactured copies of antibodies that are one of the main weapons the immune system generates to fight infections.

The company so far has released some early data pointing to the promise of its therapy for COVID-19, and doctors were concerned Trump's treatment and subsequent promotion could put pressure on regulators.

Dr. Gary Kleiner, a pediatric immunologist at the University of Miami Miller School of Medicine and investigator in a trial designed to see if Regeneron's antibodies can prevent coronavirus infection, said he has been approached by patients seeking the drug since last week.

Dr. Dirk Sostman, head of the research network at Houston Methodist Hospital, a trial site for Regeneron and Eli Lilly & Co antibody programs, said more patients are asking to participate in an antibody trial.

He was cautious about broader use without more data.

"All we have seen are very brief press releases... so there is not much to go on," he said.

"The politics of the situation would suggest to me that the story could be Trump gets COVID... then American technology fostered by the Trump Administration cures COVID," Sostman added. "I would think there would be pressure on regulators."

Top US infectious disease expert Dr. Anthony Fauci, speaking on Monday on CNN, said he was "strongly suspicious" that Regeneron's drug has contributed to Trump's progress.

"Obviously you can't prove that until you do a number of studies to show that it actually works," he said.

Doctors emphasized that the timeline for Trump's illness was not entirely clear. 

"If he is responding at a pace where he is truly much better, it is going to be due to the antibodies," said Dr. Edward Jones-Lopez, infectious disease specialist at the University of Southern California Keck School of Medicine in Los Angeles.

Giving the treatment to the president seems "a tacit endorsement by the federal medical bureaucracy for Regeneron's medicine, and we expect an EUA for the treatment of COVID in a matter of days," Leerink analyst Geoffrey Porges said in a research note.

"Patients most likely to benefit from this treatment have a similar profile to President Trump, in that they had undetectable antibodies at baseline and were early in the course of disease," Regeneron spokeswoman Alexandra Bowie said in an emailed statement.

Regeneron has received $450 million from the US government for up to 300,000 doses of the dual-antibody cocktail, and the company has said those supplies would be distributed free of charge.

Eli Lilly on Wednesday said a mid-stage trial testing its combination antibody therapy showed that it helped cut hospitalization and emergency room visits for COVID-19 patients and that it also planned to seek an EUA.

Shares of Regeneron, up nearly 6 percent so far this month, closed at $591.69 on Wednesday. Lilly's shares rose 3.4% on Wednesday to close at $148.96.

-reuters-

Trump criticized for leaving hospital to greet supporters

WASHINGTON - US President Donald Trump sparked an angry backlash from the medical community Sunday with a protocol-breaking visit to his supporters outside the hospital where he is being treated for the highly-infectious, potentially deadly new coronavirus.

He was masked as he waved from inside his bulletproof vehicle during the short trip outside Walter Reed military medical center near Washington, which appeared designed to take back the narrative on his improving health after a weekend of muddled messaging from his doctors.

The last-minute limousine outing came with Trump's doctors satisfied enough about his progress to suggest the possibility of his being discharged on Monday.

But experts complained that the outing broke his own government's public health guidelines requiring patients to isolate while they are in treatment and still shedding virus -- and endangered his Secret Service protection. 

Trump, who has been repeatedly rebuked for flouting public health guidelines and spreading misinformation on the pandemic, said in a video that dropped on Twitter just before the appearance that he had "learned a lot about COVID" by "really going to school" as he has battled the virus.

But health experts took to the airwaves and social media to criticize the "stunt," which they said demonstrated that he had learned nothing at all. 

"Every single person in the vehicle during that completely unnecessary Presidential 'drive-by' just now has to be quarantined for 14 days," said James Phillips, chief of disaster medicine at George Washington University.

"They might get sick. They may die. For political theater. Commanded by Trump to put their lives at risk for theater. This is insanity."

White House spokesman Judd Deere said "appropriate" precautions had been taken to protect Trump and his support staff, including protective gear. 

"The movement was cleared by the medical team as safe to do," he added.

But Zeke Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania and regular TV pundit, described the appearance as "shameful."

"Making his Secret Service agents drive with a COVID-19 patient, with windows up no less, put them needlessly at risk for infection. And for what? A PR stunt," he tweeted.

CONFUSED MESSAGING

The episode came hours after a briefing by Trump's medical team, who said he had "continued to improve" and could be returned to the White House, which has the facilities to treat and isolate the president, as early as Monday.

The president was flown to Walter Reed with a high fever on Friday after a "rapid progression" of his illness, with his oxygen levels dropping worryingly low, Trump's physician Sean Conley said in a Sunday briefing.

Health experts have complained that the messaging from the administration -- and particularly Trump's medical team -- has caused widespread confusion.

Conley admitted Sunday that he had kept from the public the fact that the president had been given extra oxygen, in a bid to reflect an "upbeat attitude."

And he gave a rosy account of Trump's progress Saturday, only for White House chief of staff Mark Meadows to tell reporters immediately after that Trump's condition had been "very concerning" and that he was "still not on a clear path to a full recovery."

'WHITE HOUSE CLUSTER'

With his tough reelection campaign in its final month against Democratic rival Joe Biden, Trump's diagnosis and hospitalization have left him sidelined from what he does best -- campaigning.

Meanwhile, Biden -- who announced Sunday his latest negative test for the virus -- will start the week with a trip Monday to key swing state Florida.

But Trump and his advisors have done their best to project a sense of continuity.

His deputy campaign manager Jason Miller told ABC Sunday he had spoken to Trump for a half-hour Saturday and that the president was "cracking jokes." 

But controversy has been mounting over the possibility that Trump might have exposed numerous others to COVID-19 even after a close aide tested positive. 

A timeline provided by his advisors and doctors suggested he met more than 30 donors on Thursday in Bedminster, New Jersey, even after learning that Hope Hicks had the virus -- and just hours before he announced his own positive test.

There were more than 200 people at the fundraiser, and a contact-tracing operation underway in New Jersey was looking at potentially thousands of people who may have been exposed.

All this came in a week when a Wall Street Journal/NBC poll -- taken in the 2 days after a bruising presidential debate with Biden but before news emerged of Trump's illness -- gave Biden a significant 53-39 percent lead among registered voters.

As well as Trump and Hicks, numerous White House insiders and at least 3 Republican senators have contracted COVID-19, along with First Lady Melania Trump, who has not experienced severe symptoms.

Public health experts have expressed alarm at the "White House cluster" that has been linked to the Sept. 26 Rose Garden celebration of conservative judge Amy Coney Barrett's nomination to the Supreme Court.

Agence France-Presse