The number of new COVID-19 cases and hospitalizations in Nebraska continued to rise at a record-setting pace this week.
Nebraska on Tuesday ranked No. 7, ahead of Iowa at No. 8, in terms of new cases per capita, according to data from the federal Centers for Disease Control and Prevention.
On Wednesday, the state was averaging 684 new cases a day over the preceding seven days, up from 545 cases a day for the seven days that ended Oct. 3, according to state data.
Both figures topped the average of 427 new daily cases on May 8, the earlier peak of COVID-19 cases in Nebraska.
Indeed, the state on Wednesday was adding COVID-19 cases at an average rate of 35.3 per 100,000 residents, according to HealthyNebraska.org. That’s up from 23.2 on May 8.
In addition, Nebraska’s positivity rate of 12.95% on Tuesday ranked eighth in the nation, according to the COVID Tracking Project. Iowa was No. 5 at 19.4%.
Hospitalizations also have continued to tick up over the past week. On Tuesday, 315 Nebraskans were hospitalized with COVID-19, up from 288 a week ago. The spring peak was May 27, when 232 were hospitalized.
Nebraska Gov. Pete Ricketts acknowledged the increase in cases and hospitalizations during a press briefing Wednesday. He said state officials are monitoring both the counts and hospital capacity.
Ricketts said Dr. Deborah Birx, coordinator of the White House coronavirus task force, told governors and others Tuesday that data from contact tracing indicates a lot of spread is occurring inside people’s homes.
Federal officials have been warning in recent weeks that states in the Upper Midwest are trending in the wrong direction.
Ricketts cautioned that people who have family get-togethers or invite friends over should wear masks, even inside their homes.
“Just because you know someone, they can still give you the virus,” he said.
Health officials recommend that people wear masks whenever they’re around those from outside their household and they can’t maintain at least 6 feet of distance.
Ricketts said officials would continue to look at the data and make any changes they feel are necessary.
The governor said it is possible, however, to have events such as trick-or-treating and tailgating if people keep their distance and wear masks.
“We can do this, but we have to manage it,” he said. “It can’t be like it was in the past.”
One planned event, a Nebraska-Ohio State football watch party at Pinnacle Bank Arena, prompted concerns from some local health officials and health care providers. On Wednesday, the arena’s general manager notified city and local health officials that the Oct. 24 event had been canceled.
“As we’ve learned, the COVID-19 pandemic is unpredictable, and with the current high number of cases and hospitalizations, we reconsidered this event,” Tom Lorenz said.
Adi Pour, director of the Douglas County Health Department, said Wednesday that informal gatherings are generating local cases.
A homecoming party for 200 people sparked one outbreak, Pour said. And a workplace conference in which participants gathered indoors for several hours resulted in six cases, she said.
“This is all about personal responsibility,” Pour said. “We have put everything in place that we can. … Now it’s up to the individuals to do it correctly.”
Physicians and scientists from the University of Nebraska Medical Center last week warned that the state was entering a dangerous period in the pandemic.
They noted that the increases in cases and hospitalizations have come as the state continues to relax social distancing measures and fully open schools. At the same time, cooler weather is beginning to drive activities indoors. And influenza season looms.
In addition, they said, Nebraska is relying on hospitals that are more than 85% full to absorb the increasing load of patients.
One concern cited by the researchers and other health care providers: While hospitals may be able to add physical capacity, the pool of skilled health care providers available to care for patients, particularly those who are critically ill, is limited. And many of them are worn out from treating so many people with the virus for so long.
Ricketts said Wednesday that the state is looking at how it can provide additional staffing resources.
Dr. Bob Rauner, president of Partnership for a Healthy Lincoln, said health officials must project into the future when looking at numbers of patients hospitalized with COVID-19, given the lag between new cases being diagnosed and some of those patients later being hospitalized.
If the state had 315 hospitalized on Tuesday, he said, that number could top 500 three weeks from now. If the state decides to hire nurses through staffing agencies, it could find itself competing with other states. Finding staff trained to handle critically ill patients, he said, could be particularly challenging.
“That’s a special skill set,” Rauner said. “You don’t just find that on eBay.”
The increase in cases, which also is occurring in rural areas of Nebraska, has prompted concerns from community physicians, some of whom have called for additional leadership.
Dr. Rebecca Steinke, a family physician at Family Practice of Grand Island, said cases in the east-central Nebraska city have increased in the last couple of days.
Health officials there held a press conference last week to alert residents of the need to take precautions. Steinke also serves as medical director of the Central District Health Department, which covers Hall, Merrick and Hamilton Counties.
“I know people are tired of being told to wear a mask, and they don’t want a (mask) mandate,” she said. “But they also want their kids in school and their businesses open.”
“I’m not looking for zero cases,” Steinke said. “I’m looking for a low, controlled, containable level where we can keep our kids in school and keep a little normalcy.”
Steinke said she foresees that health officials will have to reign in some larger gatherings and perhaps step back from the directed health measures that have reopened most venues.
Dr. Libby Crockett, an OB-GYN at the Grand Island Clinic, said the community benefited from Ricketts’ work with health officials to slow the spread in the pandemic’s early days.
When she has had patients call for a test or to be admitted to a hospital, they often have told of attending a wedding or a funeral or a backyard barbecue.
Lowering cases in the community, she said, allows for all of those things, including school.
“I would love to save the holidays,” she said.
Dr. Jenn Harney, a family medicine physician with Memorial Community Health in Aurora, said case counts in Hamilton County are averaging 53.6 per 100,000, well above the state average.
Some people have been taking precautions all along, she said. But a number of people who don’t think COVID-19 is a problem in rural America have not being doing so.
The rise in cases means clinic and hospital staff sometimes must take time off to cover child care help lost due to exposures, Harney said.
The hospital, meanwhile, has found it increasingly difficult to find a larger hospital that will accept critically ill patients that it has to transfer because of capacity and staffing problems.
Harney said health care providers are hoping the state will allow local health departments to implement tailored local measures that can help slow the virus’s spread.
She said she also hopes to see rural residents step up as they always do in a crisis. When there’s a child with cancer, they raise money. When a farmer is injured, they harvest the crops.
“That’s what I am asking of rural Nebraska,” she said. “Help us slow the spread and move the curve back down so we can get ahead of coronavirus and protect our people.”
World-Herald staff writer Henry J. Cordes contributed to this report.
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