Thirteen days later, on March 9, Louisiana reported its first case of covid-19. Then came another, and another. Clusters broke out in several nursing homes. The cases popping up across the state were not easily linked to each other, meaning that a galloping community spread was already underway.
A terrible realization began to dawn on residents and political leaders: The famous bonhomie of the world’s biggest free party may have helped supercharge one of the most rapid spreads of the coronavirus, which is now threatening to overwhelm Louisiana’s health-care system and potentially make the state one of the next epicenters.
“We had people from all over the world. We also had the spread of this virus, and people did not realize it was spreading,” said Rebekah Gee, a former state health secretary now on the faculty of Louisiana State University’s medical school. “So people not only caught beads, but they caught covid-19.”
As of Thursday, Louisiana had reported 2,305 cases and 83 deaths related to coronavirus — with about two-thirds of the cases and deaths in the New Orleans metro area.
New Orleans Mayor LaToya Cantrell said canceling or curtailing Mardi Gras was never considered. Federal agencies that are part of planning Mardi Gras every year — including the FBI and Homeland Security — did not raise concerns about the coronavirus, she said. Federal officials who walked the parade route with members of her administration were focused on terrorist attacks.
“We were not given a warning or even told, ‘Look, you know what? Don’t have Mardi Gras,’ ” she said.
At that point in late February, American life had not been seriously altered. People were still packing airports. The NBA hadn’t suspended games, and Disney World was still open for business.
“Leadership matters,” Cantrell said. “And if the federal government is not responding to or saying that we’re potentially on the verge of having a crisis for the pandemic coming to the U.S. — that would change everything. But that wasn’t happening.”
Cantrell noted that a couple weeks later, she did cancel the St. Patrick’s Day Parade — and was harshly criticized by some in New Orleans. As it happened, partiers didn’t heed the ban, and bars in the French Quarter were packed.
During the first two weeks of known infections, the virus was coursing through Louisiana at an extraordinarily rapid pace, according to an analysis by Gary Wagner, a professor at the University of Louisiana at Lafayette. He found that the rate of growth in that period was the highest in the world.
“It seems the virus was there when crowds were around for Mardi Gras and it may have turned into a super-spreader event,” he said. “You can see what’s happening in Italy and Spain, and there is every reason to think the same events are going to happen here.”
Given the coronavirus’s nimble and exponential transmissibility, it wouldn’t have taken many cases mingling among the Mardi Gras partyers to push the state to where it is today. As few as two or three people with the coronavirus in New Orleans in late February could have engendered the current number of confirmed cases, according to a model by Susanne Straif-Bourgeois, a specialist in infectious diseases at the LSU School of Public Health. She added that there probably are many more people infected in the city than are known, because they’re not showing serious symptoms.
“It seemed like during our Mardi Gras week, we had at least two [infected] people coming into our population,” she said. “And from there, it really spread very, very fast.”
There might have been other factors, too, said Joe Kanter, the state’s medical director for the region that includes New Orleans. The city’s robust cruise industry and many conventions and gatherings were filling New Orleans with visitors just as the coronavirus arrived.
A slow-moving disaster
State and local officials have taken steps this week to try to stay ahead of the spread of the virus — including a statewide stay-at-home order and the closing of all but essential businesses in New Orleans. But they have been blunt that the health-care system, particularly in New Orleans, could begin to run out of beds and vital supplies by the first week in April. Gov. John Bel Edwards (D) said at a news conference Wednesday that although 300 ventilators — essential equipment when covid-19 patients have trouble breathing — were set to be delivered to the state, that will be insufficient.
“Even if we allocate all 300 of those, we know just in [the New Orleans region] we’re still 600 ventilators short and we haven’t even begun to get to the Baton Rouge area and the Shreveport area,” he said.
Executives at Ochsner Health, which operates the largest health system in Louisiana, told reporters on Wednesday that they have seen a drastic uptick in the use of ventilators among intensive-care patients at their hospitals because of covid-19.
Typically, they said, about 30 percent are on ventilators. Now, that figure is about 80 percent.
Projections released this week by the Institute for Health Metrics and Evaluation at the University of Washington show Louisiana could be short 1,436 ICU beds at peak need, which the analysis predicts will occur around April 8. That marks one of the largest projected gaps of any state between available resources and need, according to the analysis.
President Trump declared a major disaster in Louisiana on Tuesday, freeing up more federal funds, and the state has requested and received supplies of medical equipment from the national stockpile and private vendors, including some 100,000 N95 masks. N95 masks, which are safer than surgical masks, can filter out the virus when it is vaporized.
“What we have received is not enough,” Edwards said, adding that Apple is donating another 100,000 masks.
There are also plans being developed to use the Morial Convention Center to hold covid-19 patients who no longer must be in a hospital bed but are not well enough to go home. The first 120 beds at the convention center will be ready by end of the weekend, with another 1,000 to be added the following week, Edwards said Thursday.
Meanwhile, two federal drive-through coronavirus test centers operated by the National Guard have opened in the city, drawing long lines of cars. Only 250 test kits per day are allotted to each site, and they are usually gone by midday. Tests are also available at more than two dozen city hospitals and clinics, where 1,900 people were tested yesterday, Cantrell said.
With supplies getting scarce across the city, doctors on the front lines are improvising ways to reuse or extend the life of protective gear such as the N95 masks and face shields. Karin Halvorson, medical director of the intensive care unit at the Tulane University Medical Center, said a doctor in the emergency department bought a box of 100 carpenters’ goggles to replace disposable plastic shields needed to protect the eyes against coronavirus. The goggles can be washed and reused.
Meanwhile, an official at the LSU Healthcare Network purchased 75 protective suits from eBay, Gee said.
Fighting the virus takes its toll on health-care workers. Three nurses at a New Orleans area hospital, who spoke on the condition of anonymity because they were not authorized to speak publicly, painted a grim picture of their daily work lives. One said of her coronavirus patients, “When they scream for mama, that means they are about to die.”
A family came in with symptoms of covid-19 — a mother with two sons and a daughter ranging in age from the late 30s to 50s. After a few days, one son was dead, the daughter was on a ventilator and the mother was in hospice. The other son left the hospital before receiving the results of his test. It was positive.
“I haven’t felt so mortal in a very long time,” a second nurse said. “The last couple weeks feel like they’ve been years.”
The speed at which the patients deteriorate is the scariest thing, they said.
“People are going from, ‘Yeah, I don’t really feel well. I think I’m sick,’ ” the second nurse said. “And a matter of hours later, they are intubated and in renal failure. It’s terrifying.”
A nurse at University Medical Center, the city’s Level 1 trauma center, said the hospital always deals with a high volume of patients. But now, instead of handling a wide variety of problems such as gunshot wounds and car accidents, 90 percent of cases are related to the coronavirus.
“There is going to come a point where we do run out of space, and there is going to come a point where possibly 10 to 20 of your co-workers can’t come in because they are showing symptoms,” she said. “And there is going to come a point where I wake up and have a fever. This is like a slow, steady mass casualty. It is not stopping.”
Gatorade, Tylenol and a pat on the back
Hospital leaders are on the phone with each other daily to keep up to date on where beds and equipment and staff are lacking, said Jeff Elder, an emergency-room doctor in the incident command center of LCMC Health, which has five hospitals in New Orleans. Forty percent of LCMC’s hospitalized patients have covid-19-related symptoms, he said.
The situation is especially hard on patients. Meghan Garvey, 44, a public defender, happened to be treated at one of LCMC’s hospitals. She woke up the morning of March 19 with a terrible headache and nausea. A few hours later, she started vomiting and was running a fever of 104.8 degrees. Her doctor told her to go to the emergency room immediately, so she drove to Touro Infirmary in uptown New Orleans.
A tent was set up in the parking garage with metal folding chairs, spaced at least six feet apart, for incoming patients. Medical workers checked Garvey’s temperature, blood pressure and heart rate, then put her in a wheelchair and took her to the emergency department across the street. She received intravenous fluids and anti-nausea medications. Nurses then told her to drink Gatorade, take Tylenol, and sent her on her way. She hobbled across the street, got in her car and drove home.
Garvey’s fever continued to spike, and she started to cough in “this especially, scary, disgusting way.” She called the hospital and said she was told the only reason to come to the emergency room is if she has trouble breathing. She said she doesn’t blame the hospital.
“There is nothing anyone can do,” Garvey said as she awaits the results of a coronavirus test. “You can’t treat this disease.”
She has been sick now for eight days and continues to run a fever.
A representative for LCMC said the provider could not comment on Garvey’s account because of patient privacy rules.
Aside from the rapid spread of the virus, New Orleans and Louisiana are vulnerable in another way. They face higher rates of hospitalization — and therefore a relatively greater need for hospital beds and supplies — because of the comparatively poorer health of the population.
“We have a sicker populace in Louisiana with more co-morbidities” — underlying illnesses such as diabetes, hypertension and obesity — “than a lot of other cities do in the country,” said Kanter from the state health department. “Yes, we think that the people of Louisiana have a high degree of vulnerability, and we’re worried that that might translate into a higher percentage of hospitalization.”
Simon Johnson, a professor at MIT, has developed a model that pinpoints Louisiana as the next place “where covid-19 will wreak havoc.” The co-director of MIT’s coronavirus alliance and his team assigned risk scores to every county in the United States based on the medical factors that make a person vulnerable to severe illness from coronavirus: age, obesity, diabetes and hypertension. The areas that he says were “flashing red” as having high rates of all of those are Louisiana and its neighbors Alabama and Mississippi.
“This is what we believe happened in Bergamo,” he said, referring to a region of Italy that has been hit hard by the virus. “It was a lot of vulnerable people living together in close quarters that caused the devastation.”
Clark Brennan, captain of the Krewe of Bacchus, one of the most popular and historic Mardi Gras parades in New Orleans, said he respects those experts who contend the spread of coronavirus in New Orleans started during the annual celebration. But he fears the damage it could do to a city that is reeling economically. Mardi Gras brings in $400 million of economic activity.
“It could have happened anywhere,” he said. “It could have happened at a bar or a wedding with 200 people. Just to point to Mardi Gras is an injustice.”
After being tested for the coronavirus at a drive-through test center in the parking lot of the Mahalia Jackson Theater for the Performing Arts, Monica Cochennic, 22, said she didn’t think Mardi Gras should have been called off — but she wished city officials had put out an advisory so people could have partied prepared.
“If we had been more aware and sanitizing and doing the right precautions beforehand and maybe wear a mask, it would have been okay,” said Cochennic, whose two jobs — working in a pizzeria and cleaning houses — have been cut because of the pandemic. One of the friends with whom she attended Mardi Gras has tested positive. She will learn her own results in a few days.
“I probably would’ve been wearing a bandanna the whole time, or wearing something around my face, just in case,” she said. “At Mardi Gras, you’re so carefree. You’re touching everybody, talking to everybody, hugging everybody. . . . I wish I would have paid more attention.”
Amy Brittain and Brittney Martin contributed to this report.