In COVID-hit India, a 26-year-old doctor decides who lives and who dies

By Alasdair Pal

NEW DELHI (Reuters) -Rohan Aggarwal is 26 years old. He doesn’t even complete his medical training until next year. And yet, at one of the best hospitals in India, he is the doctor who must decide who will live and who will die when patients come to him gasping for breath, their family members begging for mercy.

As India’s healthcare system teeters on the verge of collapse during a brutal second wave of the novel coronavirus, Aggarwal makes those decisions during a 27-hour workday that includes a grim overnight shift in charge of the emergency room at his New Delhi hospital.

Everyone at Holy Family Hospital – patients, relatives and staff – knows there aren’t enough beds, not enough oxygen or ventilators to keep everyone who arrives at the hospital’s front gates alive.

“Who to be saved, who not to be saved should be decided by God,” Aggarwal says.

“We are not made for that – we are just humans. But at this point in time, we are being made to do this.”

India has reported a global record of more than 300,000 daily cases for the last two weeks – figures experts say are almost certainly conservative. In the capital, fewer than 20 of more than 5,000 COVID-19 ICU beds are free at any one time. Patients rush from hospital to hospital, dying on the street or at home, while oxygen trucks move under armed guard to facilities with perilously low stocks. Crematoriums work round the clock, throwing up plumes of smoke as the bodies of victims arrive every few minutes.

During his marathon shift, which Reuters documented to provide one of the most comprehensive accounts of overwhelmed hospitals during India’s harrowing surge, Aggarwal says he fears what will happen if he gets infected too, knowing that his own hospital will be unlikely to find him a bed.

He is unvaccinated: He was sick in January when shots for medical professionals were being rolled out, and then by February, he began to relax.

“We were all under the misconception the virus had gone,” he says.

MORNING ROUNDS

When Aggarwal begins his shift around 9 a.m., four bodies lie in one of the areas where staff are supposed to remove their protective equipment.

In the emergency room, conditions are even more cramped. Patients and relatives crowd every available space, many wearing no protection except for a simple cloth mask. Doctors and nurses have stopped wearing full protective equipment too – it is simply too difficult to work in.

Trolleys are close enough for patients to touch each other. One man even lies in a storage area surrounded by bins of medical waste, a relative dragging in a new oxygen cylinder as one runs out.

In normal circumstances, Holy Family is one of the best hospitals in the country, attracting patients from across the world – and it still is, considering the conditions in government hospitals, where patients lie two to a bed, or die outside on trolleys in the baking sun.

But the facility is still in a desperate position.

The hospital, which normally has capacity for 275 adults, is currently caring for 385. A sign posted outside shows the number of available general and intensive-care COVID beds remains the same as it has for weeks: zero.

Heading the ER, with its broken bones and coughs and colds, is usually a relatively simple task, left to a more junior doctor while senior consultants and specialists work in the ICU, where serious cases are quickly escalated. That system has long broken down, and the on-duty doctor in the ER is now one of the most critical in the hospital.

Before he begins his turn in the ER, Aggarwal first makes his rounds of the general COVID wards. Along with a senior colleague, he is responsible for 65 patients. That gives him a maximum of three to four minutes to see each one before any emergencies, which frequently occur.

He is minutes into his rounds when he receives an urgent call – one of his patients is sick. He sprints down the stairs and along a dimly lit corridor to Room 323, where an elderly man is barely conscious.

“He is on the way down,” Aggarwal explains to the man’s son.

The son sits with his head in his hands while space is made in the ICU. The patient is one of the lucky ones: He’s already been admitted to a COVID ward, unlike those pleading to get in, and thus has access to intensive care.

“They don’t have beds, but they will have to manage,” Aggarwal says.

A security guard, Mahendar Baisoyar, is posted outside the emergency room door to ensure relatives don’t try to secure a bed “by force,” he says.

Last month, relatives at another hospital in the capital attacked staff with knives after a patient died. The city state’s top court has warned that more law-and-order problems at hospitals are likely if shortages continue.

Like many others in Delhi, Holy Family has taken to Twitter to beg state and federal politicians for help securing oxygen.

Its medical staff look at everyone, give first aid as best they can, but there just isn’t space for everyone.

Slumped in the back of a car, 62-year-old Vijay Gupta is one patient turned away, his family and friends debating what to do next.

“We have been roaming around since 6 a.m. looking for a bed,” says Gupta’s friend Rajkumar Khandelwal.

There is a moment of indecision as he and Gupta’s son, Kushal, debate what to do next.

“Where shall we go?” Khandelwal asks the son helplessly, before they leave to try another hospital.

Others in the ER are so sick they are in urgent need of a ventilator, and Aggarwal pleads with families to look elsewhere. But they already have.

By the time his morning rounds end after about three hours, Aggarwal’s eyes are already burning from tiredness.

A BRIEF RESPITE

Aggarwal, who was brought up in Delhi, wanted to be a doctor since he was 6 years old – a job that carries huge prestige in India.

He passed his first set of exams when he was 19, and began training at a medical college attached to a government hospital in the east of the capital.

But this wasn’t what he expected when he moved to the missionary-founded Holy Family, where depictions of Christ are everywhere: looming over the main staircase, watching over patients in the ICU, in cheap plaster idols wrapped in plastic in the shuttered gift shop.

“I am vaccinated by the precious blood of Jesus,” one poster says. “No virus can touch me.”

Sumit Ray, the hospital’s medical superintendent and head of the ICU, says the hospital staff are doing everything they can. “The doctors and nurses are demoralized,” he says. “They know they can do better, but they just don’t have the time.”

No matter where Aggarwal is, he hears the sound of heart-rate monitors as he tries to sleep. He hears their gentle chimes and staccato bursts as he naps fitfully at the hospital. But he also hears them at home in his own bed, making it impossible to forget about the deaths under his care not from lack of trying, but lack of resources.

Aggarwal normally takes lunch in the hospital, but on this day, the sound – “the ICU noise,” as he calls it – is too much for him to bear.

He finds respite in a nearby 24-hour convenience store, with its powerful air conditioning, imported cereal and Selena Gomez playing softly on the in-store stereo.

“It’s really a depressing atmosphere,” he says of the hospital as he eats from a takeaway carton of biryani. “I just want to have a break of an hour or so outside the hospital so that I can just recollect myself. Because I have to be there for another 24 hours.”

Like many young Indians, he still lives with his parents, and worries constantly about their safety.

Aggarwal used to barricade himself in his first-floor apartment, but his mother has other ideas.

“I used to go and see them every 10 days or two weeks. But my mom wants to have food with me; she can’t be away from me,” he says.

ER SHIFT

A little before 3 p.m., Aggarwal returns for his shift in the emergency room. He sits behind a desk as relatives crowd around him, pleading for admission.

He makes the decision-making process sound simple.

“If a patient has a fever, and I know he’s sick but he’s not requiring oxygen, I can’t admit him,” he says.

“That’s the criteria. People are dying on the streets without oxygen. So people who don’t require oxygen, even if they are sick, so we don’t admit them usually.”

That’s one choice.

“Another choice is I have an old male and I have a young guy. Both are requiring high-flow oxygen; I have only one bed in the ICU. And I can’t be emotional at that time, that he is a father to someone. The young have to be saved.”

He begins touring the ER, his manner brisk. He barely looks at patients who are sitting up and conscious.

“Will he recover?” one relative asks as Aggarwal looks at the patient’s X-ray.

“I will try my best, but I can’t promise anything,” he replies, already turning to the next patient.

One woman, Pratibha Rohilla, is moaning and clutching at her oxygen mask.

Her son, Aditya, looks angrily as another patient is moved onto a ward. He tries to argue with a nurse.

“I understand, but not a single bed is there,” she replies.

“There are no beds,” the son says of hospitals in the capital, a refrain that almost everyone in the emergency room says minutes after meeting anyone. “We have tried 15, 20 hospitals.”

He starts reeling off their names, but begins to forget where he has tried.

One woman, 74-year-old Karuna Vadhera, is in critical condition.

Aggarwal punches the woman’s shoulder and puts his thumb gently into her eye socket to test for resistance.

There is none; her head lolls forward, oxygen levels perilously low.

“She might die at any time,” he tells her nephew Pulkit, imploring him to move her to a hospital with an ICU bed free.

“We have five family members in different parts of Delhi each trying,” Pulkit replies, his phone barely leaving his ear. “No one has found a bed.”

THE NIGHT SHIFT

Aggarwal spends the night fighting constant emergencies in the wards. Three of his patients die, including a young woman.

While helping out in the ICU, Aggarwal sees a senior colleague. Both of their fathers have been sick, and have recently recovered. They share a private joke, and Aggarwal realizes it is the first time he has laughed in weeks.

It isn’t until 5 a.m. that he manages some sleep in the break room of the ER.

By the time he emerges, bleary-eyed, a few hours later, Vadhera, the older woman who didn’t get a bed in the ICU, has died. Her nephew Pulkit stands by as her body, wrapped in a white shroud, is loaded into an ambulance for cremation.

Rohilla, the woman whose son had tried 15 to 20 hospitals before Holy Family, will take her place in what is a slightly less cramped corner of the emergency room, though she should be in the ICU, too.

Finally, after 27 hours, his shift is over, and an exhaustion has taken hold that makes him want to sleep for the rest of the day, and the next one too.

But he has one final job: A friend’s father is sick, and he’s asked Aggarwal for help – one of many such calls he receives each day. Nine times out of 10, there is nothing he can do, no matter how loved or insistent the caller, but he tries all the same.

And so he puts his mask back on and heads back inside.

(Reporting by Alasdair Pal; editing by Kari Howard)

India infections top 18 million as gravediggers work round the clock

By Alasdair Pal and Francis Mascarenhas

NEW DELHI/MUMBAI (Reuters) -India’s total COVID-19 cases passed 18 million on Thursday after another world record number of daily infections, as gravediggers worked around the clock to bury victims and hundreds more were cremated in makeshift pyres in parks and parking lots.

India reported 379,257 new infections and 3,645 new deaths on Thursday, health ministry data showed, the highest number of fatalities in a single day since the start of the pandemic.

The world’s second most populous nation is in deep crisis, with hospitals and morgues overwhelmed.

Mumbai gravedigger Sayyed Munir Kamruddin, 52, said he and his colleagues were working non-stop to bury victims.

“I’m not scared of COVID, I’ve worked with courage. It’s all about courage, not about fear,” he said. “This is our only job. Getting the body, removing it from the ambulance, and then burying it.”

Each day, thousands of Indians search frantically for hospital beds and life-saving oxygen for sick relatives, using social media apps and personal contacts. Hospital beds that become available, especially in intensive care units (ICUs), are snapped up in minutes.

“The ferocity of the second wave took everyone by surprise,” K. Vijay Raghavan, principal scientific adviser to the government, was quoted as saying in the Indian Express newspaper.

“While we were all aware of second waves in other countries, we had vaccines at hand, and no indications from modelling exercises suggested the scale of the surge.”

India’s military has begun moving key supplies, such as oxygen, across the nation and will open its healthcare facilities to civilians.

Hotels and railway coaches have been converted into critical care facilities to make up for the shortage of hospital beds.

India’s best hope is to vaccinate its vast population, experts say, and on Wednesday it opened registration for all above the age of 18 to receive shots from Saturday.

But although it is the world’s biggest producer of vaccines, India does not have the stocks for the estimated 800 million now eligible.

Many who tried to sign up for vaccination said they failed, complaining on social media of being unable to get a slot or even to simply get on the website, as it repeatedly crashed.

“Statistics indicate that far from crashing or performing slowly, the system is performing without any glitches,” the government said on Wednesday.

More than 8 million people had registered, it said, but it was not immediately clear how many had got slots.

A local official in Mumbai said the city had paused its vaccination drive for three days as supplies were running short, while officials said the worst-hit state of Maharashtra was likely to extend strict coronavirus curbs by another two weeks.

DEATHS LIKELY UNDER-REPORTED

Only about 9% of India’s population of about 1.4 billion has received a dose since the vaccination campaign began in January.

However, while the second wave overwhelms the health system, the official death rate is below that of Brazil and the United States.

India has reported 147.2 deaths per million, the Reuters global COVID-19 tracker shows, while Brazil and the United States reported figures of 1,800 and 1,700 respectively.

However, medical experts believe India’s true COVID-19 numbers may be five to 10 times greater than the official tally.

At Delhi’s Holy Family Hospital, patients arrived in ambulances and private vehicles, some gasping for air as their oxygen cylinders ran out. In the ICU, patients lay on trolleys between beds.

“Someone that should be in the ICU is being treated in the wards,” Dr. Sumit Ray, head of the unit, told Reuters.

“We are completely full. The doctors and nurses are demoralized, they know they can do better, but they just don’t have the time. No one takes a break.”

The U.S. State Department issued a travel advisory on Wednesday against travel to India because of the pandemic and advised its citizens to leave the country.

Prime Minister Narendra Modi has been criticized for allowing massive political rallies and religious festivals which have been super-spreader events in recent weeks.

“The people of this country are entitled to a full and honest account of what led more than a billion people into a catastrophe,” Vikram Patel, a global health expert at Harvard Medical School, said in the Hindu newspaper.

AID STARTS ARRIVING

India expects close to 550 oxygen generating facilities from around the world as medical aid starts pouring in, Foreign Secretary Harsh Vardhan Shringla said on Thursday.

Two planes from Russia, carrying 20 oxygen concentrators, 75 ventilators, 150 bedside monitors, and 22 tonnes of medicine, have arrived in Delhi.

The United States is sending supplies worth more than $100 million, including 1,000 oxygen cylinders, 15 million N95 masks and 1 million rapid diagnostic tests, the White House said on Wednesday.

The supplies will begin arriving on Thursday, it added.

The United States also has redirected its own order of AstraZeneca manufacturing supplies to India, to allow it to make more than 20 million doses, the White House said.

India will receive a first batch of Russia’s Sputnik V vaccine on May 1. Russia’s RDIF sovereign wealth fund, which markets Sputnik V globally, has signed deals with five Indian manufacturers for more than 850 million vaccine doses a year.

Bangladesh said it would send about 10,000 vials of anti-viral medicines, 30,000 PPE kits, and several thousand mineral and vitamin tablets.

Germany will send 120 ventilators on Saturday, and a mobile oxygen production facility next week, its defense ministry said.

(Additional reporting by Shilpa Jamkhandikar in Mumbai, Anuron Kumar Mitra in Bengaluru, Neha Arora and Tanvi Mehta in Delhi, Ruma Paul in Dhaka, Subrata Nag Choudhury in Kolkata; Writing by Michael Perry and Giles Elgood; Editing by Raju Gopalakrishnan and Gareth Jones)

‘Unnecessary sadness’: Inside Ontario’s strained intensive care units

By Anna Mehler Paperny

TORONTO (Reuters) – Over the course of a single shift last week, critical care physician Laveena Munshi saw her intensive care unit (ICU) at Toronto’s Mount Sinai Hospital fill with pregnant and post-partum COVID-19 patients.

During that week, the ICU doubled the total number of pregnant COVID-19 patients it had previously seen throughout the entire pandemic. Swamped with patients with complex medical needs, one day Munshi ended up pulling a 36-hour shift.

“You do what you have to do,” she said.

Ontario’s hospitals and ICUs have been crushed by a punishing third coronavirus wave, as depleted resources and overworked staff push Canada’s healthcare system – often held up as a model for the rest of the world – to the brink.

Last week, Munshi and her colleagues spent agonizing hours discussing what to do if a pregnant woman needed an artificial lung to help her get enough oxygen.

“Having delivery equipment outside an ICU room is never a thing you want to be walking into at the beginning of your shift,” she said. “It just adds an added layer of unnecessary sadness to this whole pandemic.”

By Thursday, ICUs in Ontario, Canada’s most populous province, had 800 COVID-19 patients, with such admissions at the highest point since the pandemic began.

Patients are coming in younger and sicker, driven by more highly transmissible virus variants. Hospital staff say they are seeing whole families infected due to transmission at front-line workplaces that have remained open through lockdowns and stay-at-home orders.

Mount Sinai Hospital just added a third ICU. It has seconded non-ICU nurses to help deliver critical care to the most seriously ill patients as it braces for the worst.

“The next couple of weeks are going to be extremely busy, there’s no question,” Munshi said, adding that people most affected by the current wave do not come from privileged backgrounds that would allow them to protect themselves, for example by working from home.

The provincial government has promised more ICU beds and requested medical staff from other provinces.

‘HOW MUCH MORE CAN WE STRETCH?’

Ramping up vaccinations targeting high-risk communities will help bring the third wave under control, experts said. But that will not relieve the immediate pressure on hospitals.

Exhausted staff are pulling overtime shifts and doctors are bracing for the tipping point no one wants to talk about: The activation of a “triage protocol” that will dictate who gets critical care when there isn’t enough for everyone who needs it.

Ontario’s Ministry of Health did not respond when Reuters asked what criteria would activate that protocol.

The protocol provides a standardized way to predict who is more likely to survive the subsequent 12 months, “trying to prioritize so that the most lives could be saved,” explained Dr. James Downar, one of its authors.

It does not include a provision for withdrawing life-sustaining measures, he said.

Raman Rai, manager of the ICU at Toronto’s Humber River Hospital, said she has never seen such a volume of critical care patients.

The hospital has redeployed staff, is treating people in “unconventional spaces,” and is stretching resources so a nurse who might have been responsible for one or two patients now has three, Rai said.

“We have already gone over capacity,” she said. “How much more can we stretch?”

Hospitals have been conducting drills and exercises in preparation for the triage scenario, said Ontario Hospital Association Chief Executive Anthony Dale.

“If it is used, it means we’ve failed as a province,” he said. “This did not have to happen. But are we preparing with everything we’ve got? Yes.”

In Toronto’s Sunnybrook Hospital on Wednesday morning, the ICU was buzzing with health workers having bedside discussions, punctuated by alarms from pumps and various equipment monitoring patients’ vital signs.

“It’s particularly distressing when we see someone who is 30 years old and healthy who comes in unable to breathe,” said intensivist doctor Hannah Wunsch. She is also seeing younger patients, pregnant patients and whole families with COVID-19.

From a medical perspective much of the work is the same, Wunsch said – save for ubiquitous masks.

“I haven’t seen anyone smile in a long time.”

(Reporting by Anna Mehler Paperny; Editing by Denny Thomas and Bill Berkrot)

After 114 days in ICU, Catalan COVID-19 patient soaks up seaside sunshine

By Luis Felipe Castilleja and Nacho Doce

MADRID (Reuters) – Medical staff rolled Joan Soler Sendra, 63, across the street in his hospital bed to bask on the sunlit seashore, in his first outing after almost four months in intensive care in Barcelona’s Hospital del Mar.

Sendra and his two brothers were infected with the coronavirus last November in Catalunya – but only Sendra had to go to hospital.

After finally managing to breathe without a respirator this week, Sendra, the ward’s longest-staying patient, was due for some sea-and-sun therapy.

“To us it’s a shot of morale, a boost,” said Sendra’s brother, Jaume Soler, lowering his mask so that Sendra, who lost his hearing as a baby due to meningitis, could read his lips.

Dr. Andrea Castellvi, deputy head of the hospital’s intensive care service, said being able to go out and see their families, the sun and the sea gave long-haul COVID-19 patients “a boost of vitality and a desire to continue fighting.”

Castellvi said Sendra’s initial symptoms were flu-like, but worsened within days to a high fever and body weakness, meaning he could neither walk nor breathe by himself. “But now we are progressing, little by little.”

(Reporting by Luis Felipe Castilleja and Nacho Doce; writing by Clara-Laeila Laudette; editing by Giles Elgood)

French coronavirus patients in intensive care highest since end November

PARIS (Reuters) – The number of people in intensive care in France who have COVID-19 is at the highest level since the end of November, health officials said on Tuesday as new infections rose slightly to 23,302 from 22,857 a week ago.

The new cases pushed the cumulative total since the start of the pandemic a year ago to 3.93 million, the health ministry reported, and the seven-day moving average of new cases was virtually steady at 21,333.

While France has been registering over 20,000 new cases per day since late January, week-on-week increases have slowed from nearly five percent in mid-January, when a tighter curfew at 6 p.m. was imposed, to less than four percent over the past five days.

But despite a vaccination campaign focused on the oldest and most vulnerable people, those in intensive care with COVID-19 has risen steadily from less than 3,000 people at the end of January to nearly 4,000 on Tuesday.

The number of COVID-19 patients in intensive care units was up by 69 to 3,918 people, the most since the of November, in the last days of the second month-long lockdown. That month, ICU numbers peaked at just under 5,000.

In the Paris region alone, almost 1,000 people are in ICU with COVID-19, but the government is not planning to put the Ile-de-France region around the capital into lockdown, France’s public health chief said.

He said lockdown would be a last-resort measure imposed only if the hospital system could no longer cope.

The health ministry also reported on Tuesday that 4.15 million people, or 7.9 % of the adult population, had received a first coronavirus vaccine and 2.04 million had also received a second shot, for a total of nearly 6.2 million injections.

The government aims to vaccinate 10 million people by mid-April, 20 million by mid-May and 30 million by summer.

(Reporting by Geert De Clercq; editing by Grant McCool)

As pandemic worsens, Portugal reports nearly half of all its COVID-19 deaths in January

By Catarina Demony and Victoria Waldersee

LISBON (Reuters) – Portugal reported close to half of all its COVID-19 deaths in January, highlighting the severe worsening of the pandemic in a country whose plight has caused several European nations to offer help.

Hospitals across the nation of just over 10 million appear on the verge of collapse, with ambulances queuing sometimes for hours for lack of beds and some health units struggling to find enough refrigerated space to preserve the bodies of the deceased.

Austria is willing to take in intensive-care patients and is waiting for Portuguese authorities to propose how many patients they want to transfer, the Austrian embassy in Lisbon said.

Germany will send medical staff and equipment.

Hard-hit neighbor Spain has offered help too, but Portugal is yet to accept, a Spanish foreign ministry source told Reuters, while Foreign Minister Arancha Gonzalez Laya told LaSexta TV both countries were in “direct contact every day, at all levels”.

In January, 5,576 people died from COVID-19, representing 44.7% of all 12,482 fatalities since the start of the pandemic in Portugal, health authority DGS said.

Portuguese officials have blamed the huge increase in the infection and death rates on the more contagious variant of the disease first detected in Britain, while acknowledging that a relaxation of restrictions on social movement over the Christmas holidays played a role.

The association representing funeral homes warned that public hospitals were running out of refrigerated space to preserve the bodies of COVID-19 victims, and some, including Portugal’s largest hospital Santa Maria, have installed extra cold containers to ease pressure on their morgues.

Over 711,000 infections have been reported since March 2020, with 43% of those infections in January, according to DGS, whose tally increased by 275 deaths and 5,805 cases on Monday.

Portugal has the world’s highest seven-day rolling average of new daily cases per million inhabitants, according to data tracker ourworldindata.org.

With 865 coronavirus patients in intensive care and 6,869 in hospital wards, hospitals are running out of beds and there is a shortage of doctors and nurses.

Portugal has 850 ICU beds allocated to COVID-19 cases in its mainland public health system and another 420 for those with other ailments, according to the latest data.

For most, vaccination against the virus is the light at the end of the tunnel. But only roughly 70,000 people have been fully vaccinated with the two required doses so far. Those over 80 start getting their shots on Monday.

(Reporting by Sergio Goncalves, Catarina Demony and Victoria Waldersee; Additional reporting by Belen Carreno and Emma Pinedo Gonzalez in Madrid and Seythal, Thomas Seythal in Berlin; Editing by Ingrid Melander, Mark Heinrich and Bernadette Baum)

France’s new COVID-19 hospitalizations and ICU treatments rise sharply

PARIS (Reuters) – The number of people hospitalized in France for COVID-19 rose by more than a 1,000 over the last two days, a trend unseen since Nov 16, and the number of patients in intensive care units for the disease exceeded 3,000 for the first time since Dec 9.

A growing number of medical experts have called for a third lockdown in France but French media report that President Emmanuel Macron is trying to avoid such a measure.

Macron hopes a 6 p.m. curfew put in place 10 days ago will be enough to rein in the surge in new infections prompted by the emergence of more contagious variants of the virus.

Getting the number of patients treated in ICUs for COVID-19 below the 3,000 limit was the main justification for replacing the second lockdown with the national curfew on Dec 15.

At 3,041, the ICU total is less than half its all time high of 7,148 on April 4, but has grown almost every day since Jan 7.

French Finance Minister Bruno Le Maire said on Bloomberg Television that a new lockdown would make it very difficult for the country to reach its 2021 target of 6% economic growth.

The government had also aimed to bring the average new daily cases below 5,000 before lifting the second lockdown. After a 54,440 high on Nov 7, the seven-day moving average of daily new infections, which averages out reporting irregularities, fell to 10,348 on Dec 4 but is now at a two-month high of 20,447.

The daily tally of new COVID infections was 4,240 on Monday, down from Sunday’s 18,346 but higher than last Monday’s 3,736. France’s cumulative total of cases now stands at 3,057,857, the sixth-highest in the world.

The country’s COVID-19 death toll was up by 445, at 73,494, the world’s seventh highest, versus a rise of 172 on Sunday. The seven-day moving average of new fatalities increased to 401, the highest since Dec. 9.

(Reporting by Benoit Van Overstraeten; Editing by Hugh Lawson and Philippa Fletcher)

California to lift stay-at-home orders on Monday: report

(Reuters) – California is expected to lift its regional stay-at-home orders across the state on Monday, moving counties back into the tier-based reopening framework, local media reported.

California Governor Gavin Newsom’s office has decided to lift the orders as ICU availability in the regions that remained under the stay-at-home order, including the Bay area and Southern California are projected to rise above the 15% threshold that triggered the lockdown measures, according to the San Francisco Chronicle.

According to the report, counties will move back to the tiered system, with most regions across the state expected to move into the purple tier, meaning personal care services like hair salons can re-open with modifications and restaurants can open for outdoor service.

California, the United States’ most populous state, emerged as a leading U.S. epicenter of the pandemic despite re-imposing some of the most stringent restrictions on social gatherings and business activity.

Total cases in the United States crossed 25 million on Sunday, even as states accelerate their vaccine distribution. California has reported over 3.1 million cases and 36,745 deaths so far, a Reuters tally showed.

But the number of new infections appear to be slowing after a surge following the Holiday season.

The state’ top health official said earlier this month that the number of hospitalized coronavirus patients statewide had steadily declined, showing signs of the virus leveling off.

Strict stay-at-home orders were renewed for much of California in December to avert a crisis in hospitals.

(Reporting by Bhargav Acharya with additional reporting by Anurag Maan in Bengaluru; Editing by Toby Chopra)

For Los Angeles-area ambulance crews, the COVID-19 calls never stop

By Norma Galeana and Alan Devall

SANTA FE SPRINGS, Calif. (Reuters) – For Southern California ambulance crews, the shifts feel never-ending and the calls to pick up COVID-19 patients seem endless.

“In 30 years, I’ve never seen a call volume like this,” said Eileen Cegarra, 56, an ambulance dispatch center supervisor for Care Ambulance Service, one of the largest ambulance companies in the Los Angeles area, which has become the epicenter of the U.S. coronavirus pandemic.

California hospitals have grown so full of COVID-19 patients that state officials ordered hospitals to delay non-life-threatening surgeries, preserving space for serious cancer removal and necessary heart operations.

Outside many Southern California hospitals, ambulances loaded with COVID-19 patients wait for hours until space becomes available in the intensive care unit (ICU) or emergency room (ER).

Beside affecting the patients, the backlog has taken its toll on the ambulance crews who respond to calls for the sick.

“The calls don’t stop just because the crews are in the ER,” Cegarra said.

Jennifer Mueller, 30, works 24-hour shifts as a Care emergency medical technician, saying the pandemic has taken a physical and emotional toll on those in her profession.

“Everyone’s exhausted. Everyone’s tired. We run the calls; we want to help people. But there’s only so much that we can do,” Mueller told Reuters during a spare moment.

Patients are left sitting on hard gurneys in the cold. About all Mueller said she can do is offer a blanket.

“They’re in pain,” she said. “It’s just, it’s heartbreaking.”

California, the most populous state with nearly 40 million people, has accounted for much of the U.S. surge since November.

State officials reported 33,751 newly recorded confirmed cases Tuesday, pushing the total to 2.8 million since the pandemic began a year ago.

In Los Angeles County, with a population of about 10 million, COVID-19 kills someone every eight minutes, health officials say.

Every minute, 10 people test positive in L.A. County, and more than 1 percent of those who test positive end up dead, according to the Los Angeles County Department of Public Health.

Dispatcher Jaime Hopper, 29, has seen the tragedy first hand.

“The other day I had I think at one time nine calls sitting. So, that’s nine people that are in distress,” Hopper said. “So, it’s a little bit, it’s unnerving, but you kind of just got to do what you can.”

(Reporting by Norma Galeana and Alan Devall; Writing by Daniel Trotta; Editing by Aurora Ellis)

COVID-19 surge pushes U.S. hospitals to brink as 2nd vaccine nears approval

By Susan Heavey and Sharon Bernstein

WASHINGTON (Reuters) – An unrelenting U.S. coronavirus surge pushed besieged hospitals further to the brink as the United States pressed on with its immunization rollout on Thursday and prepared to ship nearly 6 million doses of a new vaccine on the cusp of winning regulatory approval.

COVID-19 hospitalizations rose to record heights for a 19th straight day, with nearly 113,000 coronavirus patients counted in U.S. medical facilities nationwide on Wednesday, while 3,580 more perished, the most yet in a single day.

The virus has claimed over 311,000 lives in the United States to date, and health experts have warned of a deepening crisis this winter as intensive care units (ICUs) fill up and hospital beds spill over into hallways.

“We expect to have more dead bodies than we have spaces for them,” Los Angeles Mayor Eric Garcetti said at a briefing on Thursday, adding that the country’s second-largest city had fully exhausted its ICU capacity.

The number of U.S. cases rose by at least 239,018 on Thursday, according to a Reuters tally, the highest one-day increase since the pandemic began, driving the number of known infections nationally to more than 17 million.

The tolls mounted as U.S. regulators weighed whether to grant emergency use authorization for a vaccine developed by Moderna Inc, just a week after an earlier vaccine from Pfizer Inc and German partner BioNTech SE won consent for mass distribution.

A panel of outside advisers to the U.S. Food and Drug Administration overwhelmingly endorsed Moderna’s vaccine candidate for emergency use after a daylong meeting on Thursday. FDA authorization could come as soon as Friday.

Both vaccines require two doses, given three or four weeks apart, for each person inoculated.

The initial 2.9 million doses of the Pfizer/BioNTech vaccine began shipping on Sunday and were still making their way to hospitals across the country and into the arms of doctors, nurses, and other frontline medical professionals.

Some of the first shots were also going to residents and staff of long-term care facilities. Other essential workers, senior citizens and people with chronic health conditions will be next on the list.

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It will take several months before vaccines are widely available to the public on demand, and opinion polls have found many Americans are hesitant about getting inoculated.

Some are distrustful of immunizations in general, and some are wary of the unprecedented speed with which the first vaccines were developed and rolled out – 11 months from the first documented U.S. cases of COVID-19.

Health authorities have sought to reassure Americans that large-scale clinical trials and rigorous scientific review found the vaccines to be safe as well as highly effective at preventing illness.

Those messages have been combined with urgent pleas for Americans to remain diligent about social distancing and mask-wearing until immunizations become widely available.

Data shows infections continuing to spread virtually unabated across much of the country, apparently fueled by increased transmissions of the virus as many Americans disregarded warnings to avoid social gatherings and unnecessary travel over the Thanksgiving holiday last month.

California has been hit particularly hard in recent weeks, with many of its hospitals reporting ICUs at or near capacity, a dire situation that triggered a renewal of sweeping stay-at-home orders across much of the state.

“Hospitals and healthcare workers continue to be stretched to the limit, as we continue to surge beyond even what we anticipated. And we’re not even through the holidays yet,” said Adam Blackstone, a spokesman for the Hospital Association of Southern California.

In San Bernardino County, where available ICU space was down to zero, newly admitted patients at Arrowhead Regional Medical Center were lined up in beds in corridors waiting for care, spokeswoman Justine Rodriguez told Reuters.

With the strain taking a growing toll on medical staff, the race to expand vaccinations is seen as critical to preventing a collapse of healthcare systems.

Health and Human Services Secretary Alex Azar told CNBC on Thursday that 5.9 million Moderna vaccine doses had been allotted for state governments to receive and were ready to distribute nationwide starting at the weekend.

The Moderna vaccine has less onerous cold storage requirements than the Pfizer/BioNTech shot, making it a better option for remote and rural areas.

Nevertheless, ambivalence over the vaccine has emerged even among pockets of healthcare workers designated as first in line for inoculation.

“Some are on the fence. Some feel that we need to get it done. It’s split down the middle,” Diego Montes Lopez, 28, a phlebotomist at Martin Luther King Jr. Community Hospital in South Los Angeles, said of co-workers after getting injected himself.

But Dr. Simon Mates, an ICU co-medical director at Dignity Health California Hospital Medical Center in downtown Los Angeles, said the physicians and nurses he knows view the vaccine as having arrived at a crucial moment.

“Our biggest concern was: ‘What if one of us gets sick?’ But now with the vaccine, that concern seems to be ebbing,” said Mates, who learned Wednesday that he had already received the vaccine, rather than a placebo, as a participant in the Pfizer trials. “It’s one less thing to worry about.”

(Reporting by Susan Heavey, Sharon Bernstein, Dan Whitcomb, Manas Mishra, Peter Szekely, Richard Cowan, Susan Cornwell, Lucy Nicholson and Anurag Maan; Writing by Daniel Trotta and Steve Gorman; Editing by Steve Orlofsky, Bill Berkrot, Grant McCool and Richard Pullin)