While You Were Sleeping: Coronavirus updates for November 25

Coronavirus

INDIANAPOLIS — There were several developments in the coronavirus pandemic that you may have missed overnight.

Here’s a look:

Hamilton County restrictions. Hamilton County issued a public health order to complement Indiana’s existing orders, according to a release from the county health department.

“The Governor’s orders identify minimum levels for high exposure settings like social gatherings or events,” said Dr. Charles Harris, Health Officer for the Hamilton County Health Department. “This order establishes stricter limits for our county based on the state’s color-coding metrics for each county.” 

Harris said because of the ongoing COVID-19 pandemic and the recent surge of new cases and related hospitalizations in Hamilton County, officials issued the new health order to complement Governor Holcomb’s executive order issued on November 13.

Hamilton County currently falls under ORANGE on the state’s color-coding metrics. The county metrics map is updated every Wednesday and can be viewed at Coronavirus.In.Gov.

The Hamilton County Health Department said the following local restrictions are in effect. 

If Hamilton County is under ORANGE (moderate to high transmission level): 

  • The Hamilton County Health Department will not approve any safety plans for social gatherings of more than 250 people. 
  • Organizers of social gatherings and events at venues with multiple, clearly separate areas, such as banquet rooms, conference rooms, or multiple sports fields, must submit a safety plan for each separate area up to a maximum of 250 individuals per gathering or event. 
  • Attendance at community recreational sports leagues and tournaments will be restricted to 250 people (including participants, personnel, and spectators)  

If Hamilton County is under RED (very high transmission level): 

  • The Hamilton County Health Department will not approve any safety plans for social gatherings of more than 100 people.  
  • Organizers of social gatherings and events at venues with multiple, clearly separate areas, such as banquet rooms, conference rooms, or multiple sports fields, must submit a safety plan for each separate area up to a maximum of 100 individuals per gathering or event. (In addition, the venue shall ensure attendees at separate social gatherings do not commingle and that attendees at each gathering have separate designated restroom facilities. The venue must also ensure six feet of social distancing between tables as well as between individuals or household units sitting at the same table. The organizer or host of a social gathering must also maintain a list of event attendees and their phone numbers for up to 21 days following the social gathering for contact tracing purposes.)  
  • Attendance at community recreational sports leagues and tournaments will be restricted to 100 people (including participants, personnel, and spectators). (In addition, the use of electronic ticketing methods is strongly recommended to aid in managing capacity, identifying patron seating location, and contact tracing. The organizer or host of a community recreational sports league or tournament must also maintain a list of event attendees and their phone numbers for up to 21 days following the social gathering for contact tracing purposes.)  
  • Restaurants, bars, taverns, nightclubs and other establishments providing in-person food and drink service will only be allowed to seat customers at tables and bar seating will be closed, must limit capacity to 50% of indoor capacity, must be closed and cleared of customers between the hours of 12:00 a.m. and 5:00 a.m. to perform enhanced cleaning and disinfecting protocols. (In addition, table seating must be limited to six people per table and tables must be spaced at least six feet away from one another. Also, self-service food stations [buffets, salad bars, etc.] will be banned unless a staff member serves patrons. Finally, outdoor tent seating will only be permitted if the tent has at least two open-air sides for ventilation.) 
  • Gyms, exercise, and fitness centers (including yoga studios, dance studios, karate studios, martial arts studios, and other similar fitness centers) must limit capacity to 50%. 
  • Cultural, entertainment, and tourism sites (including museums, music venues, auction venues, flea market, and parks) must limit capacity to 50%. 
  • All other non-essential entertainment businesses (including movie theaters, bowling alleys, trampoline parks, boating and marina facilities, and rock wall climbing facilities) must limit capacity to 50%.  
  • Personal service businesses (including salons, barber shops, nail salons, spas, microblading and tattoo parlors) may remain by appointment. Face coverings may be removed for beard trimming or as required to complete the service. 
  • In addition, K-12 schools will be allowed to manage and implement their own plans for maintaining education services, so long as they utilize effective and appropriate measures to prevent the transmission of COVID-19. 

The health department said residents of Hamilton County are also strongly encouraged to quarantine for 14 days after traveling to or from another country, state, or county. 

Residents are asked to wear a mask outside of the home and to maintain at least six feet of social distance while out in public.

Eli Lilly’s treatment. IU Health and other hospitals around the state are beginning to administer Eli Lilly’s COVID-19 treatment, bamlanivimab.

The treatment is for COVID-19 patients with mild or moderate symptoms who are not hospitalized but are at high risk of developing severe symptoms.

IU Health received 500 doses of bamlanivimab. The hospital just converted a conference space into an infusion center.

“It’s a one-hour infusion during which they’re monitored,” said Dr. Michelle Saysana, chief quality and safety officer. “After the infusion is over, we stop the IV. They have to hang out with us for an hour to make sure there aren’t any reactions.”

Saysana explained the separate facility will have a positive impact on the further spread of the virus, at least in the hospital.

“That’s actually why we chose to repurpose space so that we weren’t mixing patients with COVID with other patients,” Saysana said.

Bamlanivimab is a part of Operation Warp Speed. The main idea of this treatment is to prevent people from winding up in the hospital due to serious symptoms.

“We’ve heard that from folks across the state, other health systems, that it gives people some light,” Saysana said. “I think it’s the bridge till we get the vaccine.”

Long-term effects. Researchers are racing to learn more about COVID-19 to better understand how to treat those who test positive for the virus.

An Indianapolis doctor explained that shortness of breath, fever and a cough are the most common symptoms among patients in the hospital, but there are other symptoms causing him concern.

“Some patients, especially older adults, get symptoms which are different than these symptoms. Some would feel tired, not feeling motivated and most important of them is feeling confused or feeling like the brain is not working properly,” said Dr. Babar Khan, associate professor of medicine.

“Those are the symptoms that make us worried about patients who are not having typical features.”

Khan works in the intensive care unit at Eskenazi and IU Health hospitals in Indianapolis. He said they are seeing a number of patients are coming to the emergency department after experiencing confusion.

“The rates of delirium among patients admitted to the ICU are up to 80% in the ICU,” he said. “The historical rates were 40% in the intensive care unit, so COVID-19 patients have doubled the rate of delirium compared to historical controls.”

Khan is a researcher with a focus on developing a biomarker profile among delirious patients in the ICU to predict their long-term cognitive, physical and psychological morbidity. He’s concerned COVID-19 patients who struggle with delirium could develop cognition problems for years, based on previous research on delirium.

A fraction of people who test positive for COVID-19 end up in the hospital. But even in cases that are not severe enough for the hospital, researchers worry about how the virus will impact a person’s health in the long term.

“Once you see the data, there is no turning back from being concerned,” said Dr. Natalie Lambert, associate research professor at the IU School of Medicine.

Lambert recently collected surveys from more than 5,600 people around the world to learn what symptoms they experienced after contracting COVID-19.

She is collaborating with other researchers to analyze the data. Lambert said they are finding many of these symptoms can start just a couple days or a couple weeks after people get the virus, but they can last for many weeks and months.

So far, Lambert’s survey shows fatigue, headache and shortness of breath were the top three symptoms. 52% of respondents said they had difficulty concentrating or focusing. 38% had memory problems. Participants reported more than 100 symptoms.

“There were definitely a lot of heart problems that people reported,” she said.

A few months ago, Lambert published a survey done in collaboration with Survivor Corps. Survivor Corps posted an open Facebook poll asking members to indicate all of their long-term COVID-19 symptoms.

Participants identified 98 unique long-term COVID-19 symptoms, 26.5% of which are typically painful symptoms, with a large portion of symptoms affecting the brain, nervous system and whole body.

Lambert thinks they will do another wave of surveys in a month or two to see if any symptoms have changed.

EU vaccine distribution. A top European Union official said Wednesday that the first citizens in the 27 nation bloc could be vaccinated against the coronavirus by Christmas, but she warned that member countries must urgently prepare their logistical chains for the rollout of hundreds of millions of doses of the vaccines.

Claiming that “there’s finally light at the end of the tunnel,” European Commission President Ursula von der Leyen told EU lawmakers that “the first European citizens might already be vaccinated before the end of December.”

The commission, the EU’s executive arm, has agreements with six potential vaccine suppliers and is working on a seventh contract. The deals allow it to purchase over 800 million doses, more than the population of the bloc, which stands at around 460 million people.

On Tuesday, Brussels said it would sign a contract for up to 160 million doses of the experimental coronavirus vaccine developed by Moderna, which the company says appears to be 94.5% effective, according to its preliminary data.

But von der Leyen said that while vaccines are important, “what counts are vaccinations. ”

“Member states must get ready now. We’re talking about millions of syringes, we’re talking about cold chains, we’re talking about organizing vaccination centers, we’re talking about trained personnel that is there. You name it. All this has to be prepared,” she warned.

Still, Von der Leyen urged European citizens to continue respecting restrictions, even as the measures harm businesses, further damage coronavirus-ravaged economies and put people through social and mental hardship.

“With nearly 3,000 deaths a day, COVID-19 was the number one cause of death in the EU last week. Hospitals remain under stress, and in some regions some intensive care units are overwhelmed,” she said.

“We must learn from the summer and not repeat the same mistakes. Relaxing too much is a risk for a third wave after Christmas,” von der Leyen said, adding that “this Christmas will be different, and yes, it will be quieter.”

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