Amid a new daily record of COVID-19 cases in Wisconsin and increasing hospitalizations, a state committee that has worked on ventilator triage guidelines took up other thorny topics expected to become more contentious in coming months: reopening of schools and distribution of anticipated coronavirus vaccines.
“School opening is an engine for all the other respiratory viruses,” said Dr. Jonathan Temte, a UW-Madison family medicine professor and member of the State Disaster Medical Advisory Committee, which met online July 9. “This is going to be a nightmare for our school districts.”
Hospitalizations for COVID-19 in Wisconsin went up last week, following a recent surge in cases, including a record 754 new cases reported July 9 amid a high level of testing. Statewide, 284 patients were hospitalized with the condition as of July 9, up from 235 July 4. In Dane County, 33 coronavirus patients were in the hospital July 9, up from 22 July 4. The totals July 9 were well below peaks in early April.
An online registration system for COVID-19 testing, which has been available this week at the Alliant Energy Center in Madison, is being rolled out at other community testing sites, officials said July 9. It is at register.covidconnect.wi.gov.
The state committee, created this spring by the Department of Health Services to help the state respond to the COVID-19 pandemic, didn’t discuss formal action regarding schools. The group talked about recommendations from the American Academy of Pediatrics last month that students should be “physically present in school” as much as possible.
The Centers for Disease Control and Prevention has advised that remote learning is safest and social distancing should be enforced for in-person classes. President Donald Trump on July 8 threatened to cut federal funding for districts that don’t resume classes in person, and Vice President Mike Pence said the CDC would soften its recommendations. CDC director Robert Redfield told ABC Thursday the agency won’t revise its guidelines but will provide additional information.
Detailed guidance for schools, such as the pediatrics association recommendations, can reduce problems but the situation will still be difficult, said Dr. Silvia Munoz-Price, a committee member and infectious diseases specialist at Froedtert and the Medical College of Wisconsin.
“It’s very optimistic and potentially dangerous,” Munoz-Price said. “I am not very hopeful that guidance is going to work as we think it’s going to work.”
The state committee plans to develop guidelines for allocation of COVID-19 treatments and vaccines. The state already has a distribution plan for remdesivir, a drug recently approved for emergency use in patients with severe disease. But the state needs an overall plan for that drug and other medications that might be used, said Dr. Jon Meiman, a medical officer with the state health department.
Distribution of coronavirus vaccines — if and when any of more than 150 experimental candidates are approved, perhaps as early as winter — could become complicated, committee members said.
The CDC and an advisory group are looking at offering vaccines first to vital medical and security workers and then to other essential workers and people at high risk, including the elderly and people with medical conditions, according to The New York Times. Some advisers suggest Black and Latino people, who have been disproportionately affected by COVID-19, should also get priority.
Temte, who is on the COVID-19 vaccine work group of the CDC’s Advisory Committee on Immunization Practices and is a previous chair of the committee, said he’s heard other federal agencies may also weigh in.
“I worry that there’s going to be conflicting parties out there making their own recommendations,” he said.
Dr. Ryan Westergaard, a state health department medical officer on the state committee, said the state will need to disperse whatever quantities of vaccine it gets in a fair manner.
“The likely scenario is that we’re going to receive insufficient vaccine to give all tier 1 patients vaccine at the same time — and then how do we allocate to regions or communities or facilities that serve patients?” he said.
The committee also discussed guidelines for emergency medical services during COVID-19, such as deciding that certain patients might not be transported to hospitals if emergency rooms become overwhelmed with patients.
Who gets ventilators?
In April, the committee drafted guidelines for who should get ventilators if supply becomes scarce, saying patients likely to survive at least a year and who are younger should have priority. After public comment, the group dropped the effort and instead offered advice to hospitals on drafting or revising their own guidelines.
“Despite the benefit of uniform statewide ventilator allocation guidelines, it has proven infeasible to develop and implement a broadly accepted guideline at the present time,” the committee said in issuing its document for hospitals in late May.
Ventilator demand grew in early April to a peak of 375 patients on the breathing machines at hospitals statewide April 11, out of a total of about 1,200 ventilators, according to the Wisconsin Hospital Association. Since then the number of ventilated patients at hospitals has ranged from about 275 to 350, with 294 using them as of Thursday.
The committee has also made recommendations on transfers of patients with or without COVID-19 from hospitals to nursing homes.