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As COVID numbers decline, health officials brace for holidays
But health authorities warn residents not to stop precautions

Hansen

Szot

Encouraging statistics from the Wisconsin Hospital Association show a sharp decline in the number of people being hospitalized for COVID-19 in northwestern Wisconsin.

The numbers from the Northwestern Healthcare Emergency Readiness Coalition suggest that hospital admissions spiked in the 15-county region on Nov. 17, when 240 people were admitted to the region's 26 hospitals. By Dec. 1, that total had fallen to 169 total new COVID-19 patients hospitalized per day. At the same time, the number of positive COVID-19 cases identified per day in the region fell from a high point of 1,159 on Nov. 15 to 499 cases on Dec. 1.

That jibes with what doctors at Memorial Medical Center in Ashland have seen. The Hospital was treating three COVID patients midweek and had 14 patients overall in its 33 beds.

"Last week we were having 17 or 18 patients and a few weeks before that we had as high as 20 patients," Chief Operating Officer Karen Hansen said. "I would say it is still going up and down."

Though the trend is heading generally in the right direction across the region, Hansen and Ashland County Health Officer Elizabeth Szot cautioned against reading too much into the figures.

"There are a couple of ways of looking at it," Szot said. "One would be the hope that, yes, things are finally leveling off, but at the same time there is also concern that with deer hunting and the holidays, that people may have just opted to not be tested."

That was Hansen's concern, too. She said MMC did less testing over Thanksgiving week than the week before, as did the National Guard in Ashland.

"I heard they did less testing than they anticipated also, so I can't say we have a trend yet," she said.

Most concerning: 17% of MMC's tests come back positive.

That leaves Szot still "very guarded" about viewing the hospitaladmissions data as good news, particularly in the Bay Area where the state has deemed transmissions rates "critically high."

"I don't mean to sound jaded when I say that it's a good sign, but anyone who was at hunting camp or were at Thanksgiving dinner and there was someone there who happened to be mildly ill and hadn't found out they were COVID positive, any of the people who were potentially exposed, we are going to see those case numbers start to come in by the end of the week. It could be a rough weekend, and we still have Christmas to get through."

Still, Eric Borgerding, president and chief executive officer of the Wisconsin Hospital Association, said the latest statistics are good news in a time when almost all other virus-related news has been bad.

"After we have been basically going up in a straight vertical line for the last several weeks, to see some relief from that that is very, very welcome," he said.

But he too advised caution against reading too much into the data.

"I can tell you one of the many things we have learned about COVID is just when you think you are out of the woods, it comes raging back. That is lesson number one, two, three, four and five," Borgerding said. "Very cautiously, we are viewing this as a pause. We would much rather be over-prepared in the health care setting than underprepared. It's a lot easier to ramp down than it is to ramp up."

He noted that the statewide numbers for hospital admissions bumped upwards on Dec. 1, and that the data will be closely watched with Christmas and the New Year's holidays less than a month away.

"I think the biggest takeaway for us is to remain extremely diligent and prepared for all this. It remains as important as ever for our communities, for Ashland and all parts of the state to continue really observing diligently the emergency precautions everyone has been talking about for so long," Borgerding said. "It is human nature; we are all human and we are all sick of COVID. As human beings we love our families, and Thanksgiving and Christmas are the most important times to spend and to reconnect with family. It is human nature to look at these numbers and breathe a sigh of relief and think we are finally through this challenge and start relaxing."

He said it was important to continue masking, maintaining social distancing and avoiding large gatherings.

"All those things I believe are what are contributing to the downward trends we are seeing. Now is not the time to let up," he continued. "It's not permanent, but we have to keep it up for a bit longer."

Bayfield County Public Health Director Sara Wartman likewise said she was "cautiously optimistic" about the data.

"I am not sure if I should be elated because our numbers are decreasing for two weeks in a row, or if I should be concerned that there are sick people who are are just not getting a test because they didn't want to be told to stay home before Thanksgiving," she said.

Wartman said that over the summer, health officials saw many people who were made only slightly ill by the virus.

"It's difficult to tell someone who has seasonal allergy-like symptoms that they need to stay at home for at least 10 days," she said. "Perhaps it's flipped a bit, where people who aren't feeling well are staying at home and therefore we are not having as much exposure," she said.

Wartman also said many workplaces have become more diligent about enforcing COVID precautions, ensuring that sick workers stay home and get tested.

"I don't have a very good explanation about why we have had a decrease; but I am grateful. For a while there it felt like we were drowning in new cases," she said.

Wartman too warned that the decrease was not an invitation to abandon COVID safety measures.

"I have concerns that people will hear that we have had decreases and stop taking precautions," she said. "The one thing that is ever present is while we are seeing fewer new cases, our deaths continue to go up. It has been heartbreaking."

That's why MMC is keeping an eye on other hospitals in the region and preparing for a holiday surge by readying even more rooms for specialized COVID treatment — and hoping it doesn't have to take the dire measures that other hospitals have.

"(We) don't have army cots set up," Hansen said. "Around the state last week, some of the hospitals talked about having converted ambulance garages and parking ramps, so there are places that have done it, but it's not us."


As vaccine nears, who gets it first?

Getting a COVID-19 vaccine to the right people could change the course of the pandemic in the United States. But who are the right people?

As the decision looms for President-elect Joe Biden's incoming administration, a new analysis argues for targeting the first vaccines to the same low-income Black, Hispanic and Native American households that have disproportionately suffered from the coronavirus. But no one at the federal level has committed to the idea, which would be a significant shift from the current population-based method adopted by Operation Warp Speed.

"It's not just a math problem. It's a question of implementing a major social justice commitment," said Harald Schmidt, a medical ethicist at the University of Pennsylvania, who conducted the analysis of the strategies with colleagues from the Massachusetts Institute of Technology and Boston College.

If the shots get to the right people, Schmidt argues, the benefits could extend to the entire nation: Fewer people would get sick, hospital capacity would improve and more of the economy could reopen. Lives would be saved.

In October, a panel advising the federal government suggested setting aside 10% of the vaccine supply to distribute as an extra boost to the states with greater shares of disadvantaged groups. But the idea from the National Academies of Sciences, Engineering and Medicine has been largely ignored.

Schmidt's analysis finds the strategy could get vaccines to 12.3 million more vulnerable people in the early phases of distribution compared with the population-based method.

Any distribution system will reverberate across the nation, with consequences for everyone. It will be shaped

by the early steps of federal officials and by state leaders who will allocate vaccines in the months when there is not enough supply to go around. California and several other states have stated that they intend to direct some of their supply to disadvantaged neighborhoods, but there's no national strategy to do so.

No vaccine has been authorized for use yet in the U.S., but the preliminary results of ongoing clinical trials have been encouraging for Moderna's and Pfizer's candidates. If the Food and Drug Administration allows emergency use of one or both of those vaccines, there will be limited, rationed supplies before the end of the year.

Operation Warp Speed officials announced last week that states would receive vaccine in proportion to their adult populations, at least for the first 6.4 million doses and possibly beyond.

"We thought it best to keep it simple," Health and Human Services Secretary Alex Azar said. "We thought that would be the fairest approach, the most consistent."

Fairness isn't that simple, Schmidt said.

"Allocating vaccines to states according to population does not help reduce inequity," Schmidt said. Vulnerable people will face more rationing in states such as New Mexico that have higher shares of vulnerable people. "That's not fair."

Schmidt worked with Parag Pathak, Tayfun Sonmez and M. Utku Unver, pioneers in devising how to distribute resources in high-stakes systems such as school choice and organ donation. The researchers shared their underlying data with The Associated Press. Their paper was posted online ahead of publication and has not been reviewed by other researchers.

The analysis shows 15 states and Washington, D.C., have the largest shares of vulnerable, lowincome minorities. These worse-off populations make up more than 25% of the states' total populations. Those states stand to gain the most from a distribution method that sets aside a 10% national reserve.

A federal set-aside is not the only way to get vaccine to vulnerable neighborhoods. In their vaccination plans, 18 states have said they will consider race and income as they map out vaccine distribution.

Tennessee plans to reserve 10% of its vaccines for use in targeted areas with high scores on a measurement known as the social vulnerability index, which is based on census data that incorporates race, poverty, crowded housing and other factors. The index was developed by the Centers for Disease Control and Prevention to help identify communities that may need support in emergencies such as hurricanes.

Vaccines will remain in limited supply for a time after Biden is sworn in, so rationing will continue into the spring.

"I think it's early to say what the Biden and Harris administration will ultimately do on that front," said Dr. Marcella Nunez-Smith, associate dean for health equity research at Yale University's medical school. She co-chairs Biden's advisory board on the pandemic and has been a leading voice on reducing health disparities for the transition.

Nunez-Smith said there are several data-based models to consider for distributing vaccines to communities hardest hit by the virus.

"Thinking about equity has to be a top priority and cannot be an afterthought in the work," she said.


City hopes to name top cop by year's end

Boulley

The search for a new Ashland chief of police has moved into high gear, as members of the police and fire commission met Monday with representatives of the McGrath Consulting Group, the firm that is helping to assess candidates for the position.

The representatives of the Illinois firm, Malayna Maes and Ron Moser, tentatively slated Dec. 7 and Dec. 10 as dates to interview candidates.

Ashland Human Resources Director Jennifer Boulley said the McGrath team would deliver its recommendations shortly thereafter. That would put the commission, which is responsible for all hiring and disciplinary matters within the police and fire departments, on track for selecting a new chief before the end of the year.

"I am hoping that they will have a recommendation when they finish their interviews on the 10th, but that is a tentative estimate. The Police and Fire Commission is committed to doing this process thoroughly. It has taken quite a while, but I think that is just a testament to their dedication," she said.

The commission retained McGrath to help select among five finalists: Jeffery Engel of Highlands Ranch, Colorado; Kenneth R. Grams of Oak Creek; acting chief Willis L. Hagstrom of Ashland; Joel R. Sanders of St. Joseph, Illinois; and David Case of Chicago.

That number expanded by one after a final application for the post came in after the commission selected four finalists in October, said Commission President Gordon Gilbertson. He said the commission agreed to include the fifth applicant in the competition to replace Chief Jim Gregoire, who retired after 23 years earlier this year from the position that pays $81,650 a year, not including benefits.

Boulley said McGrath Consulting has contracted with the city in the past, working with the Fire Department and reviewing position descriptions for other city employees.

During Monday's meeting, Mosier and Maes discussed what the commission saw as the most important attributes they were looking for

in a new chief. One of those was the ability to deal with issues of community relations and social justice.

Ashland Mayor Debra Lewis told the two that many Ashland residents share some of the concerns voiced elsewhere in the country in recent months over fair policing of communities of color.

"Our issue is not a black-white issue as much as it is a (Native American) issue," she said. "There is a concern among our Native community of some disparities in the legal system, and obviously in the law enforcement system. That is a topic that is of interest not only to the Native community, but to those who are supportive of the Native community."

Commission members also said community policing and diversity in the workforce, budgeting skills, and ability to handle relationships with the police collective bargaining unit would be important for the department's next leader.

Lewis said that the perception of crime and the level of crime as a result of the community's drug issues is a top concern among residents and leaders, especially this year the city's methamphetamine and opioid crisis expanded to include a spike in alcohol-related crime.

Commission member Ed Monroe said he wants the next chief to demonstrate that he can bring the community and department together.

"Change for the sake of change doesn't buy us much," he said.


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