Last summer, then-President Donald Trump was privately concerned about the state of the presidential race, fearing that the severity of the COVID-19 pandemic and the proliferation of mail-in balloting would threaten his reelection bid, according to a newly-released book by the Washington Post reporters Carol D. Leonnig and Philip Rucker.
Kellyanne Conway, who at the time was a senior counselor to Trump, said that the president could win the election if he leaned into a message that then-Democratic presidential nominee Joe Biden was a career politician and a relic of the past.
At the same time, former Republican Gov. Chris Christie of New Jersey told Trump that he was behind in the race and suggested that the president conduct a national ‘thank you’ tour of hospitals, and manufacturers that produced medical PPE (personal protective equipment), which Leonnig and Rucker detailed in “I Alone Can Fix It: Donald J. Trump’s Catastrophic Final Year.”
“The public won’t know what to do with Donald Trump running around saying ‘thank you’ to everybody – and, more importantly, Joe Biden won’t know what to do,” the former governor said, according to the book.
Christie, who knocked off incumbent Democratic Gov. Jon Corzine in 2009 before winning reelection in the liberal-leaning Garden State four years later, was candid with Trump about the realities of running for reelection, when voters are looking for a fresh message from political candidates.
“Look, you’re running the 2016 campaign again and you can’t run the same campaign twice,” Christie said, according to the book. “It just never works. Times are different. You’re different. The way people view you is different. Your opponent is different. This doesn’t make any logical sense to run the same campaign.”
He added: “You have to run a forward-thinking campaign. Incumbents who win are the ones who are talking about tomorrow, not yesterday. All you’re doing is talking about yesterday and you’ve got to stop doing it.”
Two months prior to the 2020 election, the US had the worst coronavirus response in the world, logging more coronavirus infections or deaths than any other country – including China, where the outbreak began. As Insider’s Hilary Brueck reported at the time, most Americans, when asked, said their country’s response to the virus made them feel “embarrassed.”
Trump did not heed Christie’s advice to lead a forward-looking campaign, and continued to falter on his handling of COVID-19 in the eyes of voters, which became a liability as Biden presented himself as a better steward for combatting the virus.
Shawna Blackmun-Myers grasped her patient’s hand, called the woman’s family, and held up the phone. As everyone said their goodbyes on the other end, the patient couldn’t respond: A tube down her throat was feeding oxygen from a ventilator into her lungs.
Blackmun-Myers, an ICU nurse at the Jacobs Medical Center in San Diego, told Insider that the woman was in her 50s and had been bubbly when she came in weeks earlier. Normally in the ICU, Blackmun-Myers said, “people are so sick that that energy and that light is dimmed, but even her being in that situation, she was still just such a bright light.”
“We were dancing and listening to music, and we were watching some soap opera drama stuff on TV and, you know, talking tea about everybody,” she added.
But the woman’s condition worsened quickly. Hospital staff readied a ventilator.
“She’s crying and telling me, you know, ‘I just don’t want to be alone. And I just know that once this tube goes in, I don’t think it’s coming out. I think this is going to be it,'” Blackmun-Myers said.
“I did my best to let her know, you know, obviously she’s not alone. I was there with her. I had her back,” she added.
Then the virus brought heart and kidney problems. The woman went on dialysis. Eventually, there was nothing more the hospital could do to restore her quality of life, and her family knew she wouldn’t want to live this way.
In January, Blackmun-Myers oversaw the woman’s death as hospital staff disconnected the ventilator. The sound of crying family members echoed through the phone.
It was the middle of winter in Southern California. Coronavirus cases were at an all-time high, and ICUs were above 90% capacity. Blackmun-Myers’s unit was losing multiple patients every day.
“I ugly-cry, and then I get angry, and I accept the fact that I did everything I could,” she said. “And just move on so I can take care of the next person and their family.”
Blackmun-Myers didn’t know it at the time, but a new coronavirus variant had been overtaking the region.
The CAL.20C variant was first identified in Los Angeles in July, then disappeared from the record until October. But by January, it accounted for 44% of Southern California coronavirus samples in one study, and more than half of California samples in another.
Several other factors contributed to Southern California’s winter surge – holiday travel, crowded housing, pandemic fatigue – but many researchers think the variant played a role.
Two studies that aren’t yet peer-reviewed suggest that the variant is more infectious than the original virus strain. The research also found it to be associated with a higher incidence of severe illness and partially resistant to antibodies developed in response to the original virus or vaccines.
Although California cases have dropped from a peak of about 40,700 per day in late December to about 4,000 now, experts warn that CAL.20C or other variants could still change the course of the pandemic.
“Now is not the time to relax the critical safeguards that we know can stop the spread of COVID-19 in our communities,” Dr. Rochelle Walensky, the CDC director, said at a White House briefing last week.
“Please hear me clearly,” she added. “At this level of cases, with variants spreading, we stand to completely lose the hard-earned ground we have gained.”
Blackmun-Myers and three other Southern California healthcare workers say what they saw this winter should serve as a strong warning.
Struggling to be heard
The ICU was loud. Given the influx of coronavirus patients, the Sharp hospital network in San Diego had to jerry-rig negative-pressure systems to prevent virus particles from wafting out of patients’ rooms. The makeshift tubing roared overhead, so nurse Kristine Chieh had to yell over it – and through several layers of PPE – for patients to hear her.
Chieh isn’t normally an ICU nurse, but in January, the COVID floors needed all the help they could get. Two days before her first ICU shift, Chieh’s friend, a man in his late 40s, died from COVID-19 after more than two weeks in the hospital.
“I walked through the ICU, looking at the windows, and I swear I see my friend over and over and over again in those beds,” she said.
Chieh recalled stopping to help a man video chat with his family. A mask covered his face, pumping oxygen from a BiPap machine. Chieh lifted the mask for short intervals so he could speak to his family. After a few seconds, he would run out of breath, and Chieh would put the mask back down. Family members would speak up to fill the silence.
“There’s all kinds of people on that iPad, like he must have a large family,” Chieh said. “They thought it was so awesome to be able to hear his voice, and I think he was really excited to use his voice.”
She spent about half an hour like that, lifting and lowering the mask.
“The other ICU nurse was in the process of intubating somebody at the same time that this is happening, so there’s no way she would have been able to do that for him,” Chieh said. “I clocked out for the day and I don’t know what ever happened to him, long term. Hopefully he made it out okay.”
‘It almost overtook my vocabulary and my mind’
Chieh works as a float nurse across three locations in the Sharp hospital network, going wherever she’s needed. Typically, she works in progressive care units – the level before intensive care. But during the winter, even the COVID-19 patients there were severely ill. Chieh would dash from room to room, changing in and out of protective gear to help patients who suddenly found themselves struggling to breathe.
“Throughout my shift, I’ll get patients who are off and on just being like, ‘I can’t breathe, I can’t breathe.’ And then I go in and I do breathing exercises with them. I adjust their oxygen. I have the respiratory therapist come in, do breathing treatments, whatever is needed,” Chieh said.
They would calm down and be fine for about an hour, she said, before it happened again.
Robert Bang, a floor nurse in Los Angeles, spent his winter days the same way. Alarms were constantly sounding through the computer system, he said, to alert him that a patient’s oxygen levels had dropped too low. He would rush to the patient’s room, sometimes to find that they didn’t even realize they were losing oxygen.
“If you’ve been short of breath for so long, you just start developing fatigue from breathing so hard. So it might be like your new normal,” Bang told Insider.
Even when he went home, Bang said, he would still hear the alarms in his head. Work followed Chieh home, too.
“My husband gave me this feedback: I talked about COVID too much at home. Talked about math too much, talked about every news article,” she said. “It almost overtook my vocabulary and my mind.”
That hasn’t fully subsided – Chieh said those winter days still haunt her.
“I feel like I can remember every single COVID patient,” she said. “I imagine what it must be like to have this astronaut person come into their room to work with them. They must be terrified.”
‘I’ve never seen something infect people so easily’
Many of Dr. Kenny Pettersen’s patients in Los Angeles live in crowded homes with a combination of parents, kids, grandparents, or cousins under one roof. That made it difficult to make quarantine plans for the COVID-19 patients who weren’t sick enough to stay at the hospital.
In spring and summer, he told Insider, “when someone in the household would have COVID, usually like half or less of the rest of the household would get COVID.”
But this winter, Pettersen, said “it was almost universally 100%.”
Pettersen is a primary-care physician at Olive View-UCLA Medical Center. The change in LA’s outbreak was so noticeable to him during the winter that he assumed the virus itself must have changed.
“I’ve never seen something infect people so easily,” he said. “I felt like I was almost wasting my time talking to patients about the prevention of household transmission.”
More research on CAL.20C is still needed to confirm his suspicions, though, since the initial studies of the variant haven’t been peer reviewed, and the spike-protein mutation that characterizes it has not been thoroughly investigated.
Relief and grief after the surge
Pettersen’s grandmother died of coronavirus in August. Many of his patients died, too, and some left behind young children. One family is losing their home after the coronavirus-related deaths of two family members.
“Practically every one of my patients, either they’ve been infected, or many of their family members have been infected, they know somebody very well who has died or gotten severely sick,” Pettersen said. “I think the cumulative toll that takes on my patients is just really profound.”
Still, he said, the mood among his coworkers is more upbeat now. There are even days at the hospital when nobody dies of COVID-19.
“I think that we can start to breathe with a little bit more confidence,” Pettersen said. He and his wife have both been vaccinated.
Bang and Chieh say they feel safer these days, too. The volume of COVID-19 patients is much lower. They’ve been vaccinated, and more people are getting shots each day. But the winter memories persist. Some healthcare workers are now nervous about other variants. And there’s a strong possibility they or their colleagues will develop PTSD.
But Pettersen, at least, said he was finally able to go to an outdoor restaurant for sushi with his wife recently.
“We can, you know, be optimistic for the first time in about a year,” he said.
By late Wednesday, the US hit a milestone: 1 million doses of the COVID-19 vaccine had been administered in 10 days.
This week brought further scrutiny of Alibaba and Ant Group leader Jack Ma, both inside and outside China.
After being closed for days, the border between the UK and EU reopened. Of 2,637 drivers who had been tested by midday Thursday, only three tests came back positive, the UK secretary of transportation said on Twitter.
The COVID-19 pandemic didn’t slow down for the holiday week. Instead, it accelerated around the US, and the world. By midweek, almost 79 million cases were reported worldwide, with about 18.5 million in the US, according to data from Johns Hopkins University.
Los Angeles Country remained the US epicenter, although daily new cases in the state slipped to about 40,000, down from a record of 63,817 new cases on December 16.
Only 1.1% of beds were available at California’s intensive care units, Gov. Gavin Newsom said Wednesday on Twitter. Frontline workers in the state begged people to stay home for the Christmas holiday.
Pfizer and Moderna vaccines continued to roll out
Doses of both the Pfizer and Moderna COVID-19 vaccines were delivered to hospitals and clinics around the US last week. People getting doses won’t be able to choose which they receive, although there are some ways to tell which shot you’ll get.
On Monday, a few frontline workers shared their experience getting the vaccine with Business Insider. As lawmakers in Washington also began receiving their shots, Rep. Alexandria Ocasio-Cortez and Sen. Rand Paul disagreed on on Monday about whether Washington should be prioritized.
By late Wednesday, the US hit a milestone: 1 million doses of the vaccine had been administered in 10 days.
In a statement announcing the milestone, Robert Redfield, director of the Centers for Disease Control and Prevention, said the vaccine was a “critical tool,” but more work needed to be done.
He said: “But until every person in the US is able to get a COVID-19 vaccine, we continue to ask Americans to embrace proven public health strategies including social distancing, good hand hygiene, and wearing a mask in public to reduce the risk of transmission and protect our communities.”
China broadened its investigation into Jack Ma’s empire
The Chinese government continued its investigation into the business empire built by Jack Ma, the country’s richest man.
Alibaba founder Ma had planned to bring Ant Group to the public markets this year, with plans to raise about $34.5 billion. In November, those plans were put on hold, and later reports said the IPO might not happen in 2021 either.
On Monday, reports said Ma had tried to schmooze China’s rulers by breaking up Ant Group, and handing parts over to the government.
This week brought further scrutiny of Ma, both inside and outside China. On Wednesday, a report said that China had demanded that Alibaba process stolen US data.
Last Sunday, the French president, Emmanuel Macron, closed the UK-EU border, citing concerns about a new strain of coronavirus in the UK.
Early in the week, thousands of trucks waiting to cross the border lined up outside checkpoints. Salvation Army volunteers fed drivers, and Tesco warned of a fruit and vegetable shortage. By Wednesday, a small group of drivers had scuffled with police offers at the port.
The port reopened late Wednesday, with officials on the ground doing COVID-19 tests on the thousands of drivers waiting to cross.
In August, Stacey Singer DeLoye was finally allowed to visit her mother, Marilyn, at her Minnesota nursing home – as long as they were outdoors, masked, and distant.
“She was totally cheerful,” Stacey told Business Insider. “I was astonished at how happy she was in that place, and I was impressed with how well they did at keeping the pandemic out.”
But a few weeks ago, everything changed.
The Monday after Thanksgiving, a social worker at the nursing home called Singer DeLoye in tears. The worker told her that Marilyn, at age 80, had tested positive for COVID-19.
“They thought Mom was going to rally, but she wasn’t rallying,” Singer DeLoye said. “She seemed to be very, very tired and she was declining.”
On December 6, the nursing home called again: It was time to say goodbye. Marilyn was unconscious. Stacey’s brother Scott grabbed an iPad, donned a mask, and went into their mom’s room in the COVID-19 ward. He video-called Stacey and all of Marilyn’s grandchildren.
“When she’d breathe in and breathe out, it sounded just like crackling cellophane,” Stacey said. “We all told her we loved her. We all remembered a story about something she did that was really special to us.”
An hour later, Marilyn died.
She’s one of more than 47,000 people in the US who have died from COVID-19 since Thanksgiving.
On Wednesday, the US reported a record of 3,448 deaths. In total, more than 312,000 have died in the country since the beginning of the pandemic (though that’s almost certainly an undercount).
This unprecedented and tragic surge in fatalities is, in part, a product of pandemic fatigue, cold weather that has led people indoors, and the patchwork nature state policies on masks and closures – many of which are quite lax. But these recent record-breaking days of death, in particular, are the result of infections contracted around Thanksgiving.
Despite CDC warnings to the contrary, an NPR analysis of mobile phone data found that 13% of Americans ventured more than 31 miles from home on Thanksgiving Day. That’s not a huge drop from last year, when it was 17%.
But it’s common knowledge that the most Thanksgiving travel comes in the days before and after the holiday. The Transportation Security Administration screened 9.5 million airline passengers during the 10-day Thanksgiving travel period. That’s less than half of what the TSA reported in 2019, but it still included some of the busiest days since the pandemic began.
Cases generally take about two weeks to appear in official tallies, since the virus incubates in the body for an average of five days, then people usually wait a few days to get tested after symptoms appear. Then there’s the multiday wait for results, and the subsequent process of reporting them to health agencies.
Deaths, in turn, generally follow one to three weeks after a rise in cases.
Like clockwork, that is what we’re seeing now.
“Every floor I walked in today, everybody’s completely full,” Amy Carlozo, the chaplain at Swedish Covenant Hospital in Chicago, told Business Insider.
“This is so horrifically awful,” she added.
Nursing homes and hospitals are overwhelmed
Singer DeLoye suspects that staffing issues over Thanksgiving week created an opening for the virus to get into her mom’s facility. That week, Minnesota Public Radio reported that the state’s nursing homes were experiencing severe staffing shortages. This forced officials to call in the National Guard and email thousands of state employees in search of temporary staff.
With new people coming into a facility and understaffed workers spread thin, it can be difficult to spot new cases before patients infect others.
Scott Singer told his sister that there were 16 other patients on their mom’s COVID-19 floor – one of two such wards in the nursing home.
Marilyn Singer’s end-of-life isolation did not match the way she’d lived. She’d moved from place to place for most of her years – California, Portugal, Belgium, Illinois, Wisconsin, Florida. She went to business school (the first woman in her program, she always said), appeared as an extra in a few movies, and worked as an accountant. She’d given Stacey and Scott many of her own original oil paintings, which decorate the walls of their homes. She had four grandchildren.
Zoom goodbyes like the one those grandchildren had with Marilyn have become a daily occurrence for Carlozo. Cook County, where Chicago is located, has the third-highest death toll in the US at more than 7,500, according to Johns Hopkins.
Due to a shortage of N95 masks, Carlozo doesn’t go into COVID-19 patients’ rooms unless absolutely necessary.
“It’s almost like doing your job with your hands tied behind your back,” she said.
Instead, she stands outside and calls into the video meetings with family members.
“I just want to do one more thing, and I wish I could do that one more thing for every patient I’ve dealt with,” Carlozo said. “The volume is just so large at times I feel like I can’t do enough.”
She also frequently calls relatives after a patient has died, to listen to their grief and walk them through the process of finding a funeral home. Sometimes it’s the first time Carlozo is meeting them.
“That’s kind of how fast some of this is going. We haven’t developed a relationship with them before their loved one has passed,” she said.
Horror in the hospital
Experts are not surprised that exactly three weeks after Thanksgiving, the number of COVID-19 deaths each day has hit a new record. The virus became the leading cause of death in the US this month, according to an analysis published Thursday in the Journal of the American Medical Association.
“I don’t think we’ve seen the full brunt of what happened during Thanksgiving yet. I think we’re beginning to, but it’s probably going to continue for some time,” Amesh Adalja, an infectious-disease expert at the Johns Hopkins University Center for Health Security, told Business Insider.
That’s because the chain of cases from the holiday are still spreading. Yet hospitalizations were already at all-time high of more than 114,000 as of Thursday. Nearly 22,000 of those people were in the ICU, and more than 7,800 were on ventilators, according to the COVID Tracking Project. In Southern California, intensive-care units have no beds left.
“There’s been times when we’ve had multiple patients having cardiac arrest at the same time, and we’ve had to really triage to figure out which patient to resuscitate first,” Dr. Hari Reddy, the intensivist medical director at St. Bernardine Medical Center in San Bernardino, told The Los Angeles Times. “If there’s multiple emergencies, I try to gauge which patient I can make the most difference in.”
More than 180 hospitals in California have applied for waivers to bypass mandatory staff-patient ratios, the LA Times reported.
“If you have a heart attack, if you get into a car accident, if you fall off a ladder or have a stroke, we may not have a bed for you,” Dr. Brad Spellberg, chief medical officer at Los Angeles County-USC Medical Center, said in a briefing on Friday.
It could get much worse
The upcoming December holidays could spread the virus even more than Thanksgiving, according to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases.
“This cannot be business as usual this Christmas because we’re already in a very difficult situation, and we’re going to make it worse, if we don’t do something about it,” he told The Washington Post.
The Institute for Health Metrics and Evaluation projects that COVID-19 could kill about 148,000 more people in the US by February 1.
“It’s gotten to the point where it’s just sort of numbers whizzing by and charts showing, you know, this horrible curve,” Singer DeLoye said. “The human toll is missing.”
Adalja said he doesn’t expect this surge to let up before the holidays accelerate it.
“There’s a lot of transmission going on, and there are just so many vulnerable people getting hit with infections, that I think it’s just going to be a continual surge that we face until we get to a point where enough people are vaccinated,” he said. The earliest that could be, he added, is January.
Carlozo said she had planned to take time off around Christmas but has now decided against it.
“I don’t want to not be there for my nurses and my patients and my staff,” she said.
She’s trying not to think about the further death her hospital might see in the weeks ahead.
“I can’t live in the would’ve, could’ve, should’ve,” she said. “I just can’t watch the news anymore. I can’t hear it. I can’t hear the deniers. I went through my period of anger back in, you know, October and November, and I’m done. I’m done. I just need to take care of what’s in front of me.”
Much of California will enter a new restrictive lockdown on Sunday, closing businesses and asking people to stay in their homes, as hospitals reached their limits from a surge of new COVID-19 patients.
As of Sunday night, tens of million of Californias will be ordered to stay at home, and will be required to wear masks whenever they’re outside their homes for essentials. Most businesses will close.
The mandate covers the Bay Area, Southern California, including San Diego and Los Angeles, and much of the Central Valley. It comes into effect as hospitals in Southern California and the Central Valley fell below a threshold of 15% available beds, set by Gov. Gavin Newsom on Thursday. In the Central Valley, just 8.6% of beds were empty as of Saturday, with 12.5% empty in Southern California, said the California Department of Public Health.
“The bottom line is if we don’t act now our hospital system will be overwhelmed. This is the most challenging moment since the beginning of this pandemic,” Newsom said when announcing the stay-at-home restrictions.
Midday Saturday, the Southern California region, which includes San Diego and Los Angeles, announced that less than 15% of its hospital beds were free, which would require it to enter the lockdown.
“Lives are at stake, so this action is necessary,” said Dr. Eric McDonald, medical director of San Diego County’s Health and Human Services Agency, in a statement. “We must restrict our activities and avoid contact with others to reduce transmissions of COVID-19.”
Melissa Melendez, a Republican state senator from Riverside County in Southern California, urged residents to “get the capacity back” up on Saturday to avoid the shutdown.