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Health director: It's time to relax some restrictions in Omaha metro area

Even with coronavirus infections trending upward in Omaha and Nebraska, the time is right to relax some restrictions because local hospitals have enough capacity to treat patients and because people are becoming fatigued and are not following all the regulations anymore, Douglas County Health Director Adi Pour said Friday.

“We need to be realistic,” Pour said. “I think that’s what the governor is seeing, too.”

That said, she urged everyone to “be careful in these next two weeks.”

Pour allowed her directed health measures specific to Douglas County to expire, leaving Gov. Pete Ricketts’ statewide restrictions in place.

Some of those restrictions are being eased beginning Monday, allowing faith communities to have services and restaurants and many previously closed businesses to reopen with social distancing requirements still in place.

Omaha Mayor Jean Stothert said the initial tight restrictions had worked to flatten the curve in Nebraska. Pour likened those “very aggressive restrictions” to “the hammer.” The gradual easing of the restrictions, she said, is like “a dance.”

“We need to dance until we either have a vaccine or an anti- viral,” Pour said.

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Pour, speaking at a press conference with Stothert and U.S. Rep. Don Bacon, noted that Ricketts could tighten restrictions again if conditions warrant that. Pour said she is very concerned about churches resuming services.

“My advice would be if you are vulnerable, you are at high risk,” Pour said. “There are many other avenues where you can worship, and I would prefer individuals who are elderly, have underlying illnesses, immunocompromised systems, that those individuals stay at home.”

The easing of the restrictions comes as the number of cases is surging in Douglas County.

Douglas County reported 77 new cases of COVID-19 on Friday, bringing to 686 the total number of cases reported.

Stothert reiterated that sports practices and games, including youth club sports, are prohibited through May 31. She said she sent a letter to some coaches and clubs after getting reports from parents that they had received emails from coaches saying practices would start in May.

Stothert said the City of Omaha projects an $80 million shortfall in its general fund budget and $127 million to the city’s overall budget because of the coronavirus.

Bacon said he is introducing a bill in Congress that includes no new coronavirus emergency relief money for cities, counties and states, but that would allow some of the money already allotted to be used to make up for such lost tax revenue.

Bacon said he has bipartisan co-sponsors for the bill and hopes it will point the way to compromise in Congress.

Stothert said she is working closely with Nebraska’s congressional delegation “asking for clarification on what’s in the CARES Act but also asking them if they could work with us on some flexibility, at the minimum … that we could use that money that has already been allocated for some loss of revenue.”

Douglas County Board Chair Clare Duda said the county, which has been awarded $160 million in federal coronavirus expense aid, is waiting for specific guidance on how the money can be used.

He said he hopes it can help Omaha and the other towns and cities in the county, but added that there are seven opinions on the seven-member county board.

Albert Varas, executive director of the Latino Center of the Midlands, noted that Omaha’s Cinco de Mayo parade and festival have been at least postponed. He urged people who might want to celebrate the holiday to follow social distancing restrictions in order to prevent the spread of the coronavirus and protect vulnerable people.

Photos: Nebraska's coronavirus helpers

Money
Mask-wearing shoppers head to stores at Nebraska Crossing Outlets

Tina and Ollie Jones arrived at Nebraska Crossing 30 minutes before stores opened Friday in hopes of grabbing much-needed shoes — and returning safely to their home.

As Tina basked in the breezy day, she said it was nice to feel the sun on her face.

“I was getting tired of being cooped up,” she said.

But the couple’s plans were foiled when they realized that the Nike store wasn’t among the shops opening Friday as the outlet mall near Gretna reopened to the public.

The Joneses, one wearing a Minnie Mouse mask and the other in a Kansas City Royals mask, sat on a bench and then decided to head home.

“Even with masks, you can’t promise you’re gonna be OK,” Tina said. “We’ll be safe and just leave.”

Eleven stores at Nebraska Crossing were open to the public Friday, and an additional four were offering curbside pickup, according to the mall’s website.

The stores that were open included Uniform Destination, the sole business in the mall that has stayed open throughout the coronavirus pandemic.

Owner and developer Rod Yates said Friday that the number of stores open will change daily.

CHRIS MACHIAN/THE WORLD-HERALD 

A man walks into Nebraska Crossing on Friday. The mall said it was up to stores whether to turn people away for not wearing masks.

Stores at Nebraska Crossing weren’t the only ones that reopened Friday. Von Maur announced that its Westroads Mall store was opening, and Lincoln’s Gateway Mall also reopened.

Yates had said that he hoped Nebraska Crossing would be the first mall to reopen in North America — to demonstrate best practices and be a test case for safe shopping. Store operators could decide for themselves whether to open.

Yates also had said that the mall purchased infrared no-touch thermometers for stores to use for employees or shoppers if they wanted. The mall’s website displayed photos of how customers’ temperatures could be taken upon entry to the mall and said the mall had 10,000 masks to hand out to employees and customers.

Friday morning, almost all the entrances were taped off, including the main entrance, which was closed because of paving work. The north entrance, where a tent had been set up, was open, but no one was seated at the tablecloth-covered table. No one was taking anyone’s temperature or handing out masks.

When asked later about the checkpoint, Yates said the reporter had arrived before the opening and that security staff was still getting set up for the day.

“They are providing complimentary masks and using non-contact infrared thermometers,” he wrote in an email. “... All the stores are taking on the daunting task of being the first to reopen in their portfolio. They will be testing, learning and scaling new best practices.”

Two mall entrances have checkpoints, Yates said.

A sign asked shoppers to be considerate and practice social distancing, cover their nose and mouth and wash their hands, among other guidelines recommended by federal health officials.

About a dozen shoppers arrived right before 11 a.m., when shops were scheduled to open. Most shoppers had brought their own masks.

One man came without a mask and asked a reporter if the mall was handing out face covers. He proceeded to walk into the mall without a mask.

Nebraska Crossing officials said in a Facebook comment that they’re letting store managers decide whether to check shoppers’ temperatures and whether to turn them away if they’re not wearing a mask.

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Just before 11 a.m., Johanna Boston, Nebraska Crossing’s chief strategy officer, ordered a World-Herald reporter and photographer and another member of the press to leave the mall, noting that it is private property.

In a phone call an hour later, Boston declined to comment. Yates emailed his comments afterward.

In the Nebraska Crossing app, stores are posting their own guidelines for shopping at their locations. Polo Ralph Lauren, for example, asks that all employees and guests wear face masks and said any clothing that has been tried on that isn’t purchased will be “held in a designated area for 24 hours.”

American Eagle said that customers must wear masks to shop there and that workers would “clean and sanitize after every guest.”

Maddie Buettner of Omaha arrived at Nebraska Crossing with her two daughters, ages 3 and 5, and her mother, Melody Wiggs of Papillion. Buettner placed small masks on her daughters when the group arrived.

Buettner said she felt fine shopping at the outlet mall because it’s an open-air mall that allows lots of space away from others. They planned to get summer clothes and shoes but were bummed that kids’ stores such as Carter’s weren’t open yet.

Jasmine Ramos arrived early with a few family members to buy items for a newborn baby and to send clothes to Mexico. Ramos, who works at Nebraska Medicine, also planned to stop at Uniform Destination to grab some pairs of scrubs. She and her family were wearing masks, and Ramos told her family not to touch any merchandise unless they planned to buy it.

The family said they decided to arrive early to beat the crowds in an effort to be safer.

“I’m not too comfortable with it,” Ramos said. “I think it’s a little too soon to be open.”

Jonathan Myers and his son Cole also went to the mall early to look for walking shoes. Like the Jones couple, they were dismayed to see that Nike was closed but decided to check out Skechers, one of the stores that planned to be open.

“This is pretty dead,” Myers said, adding that such stores as Walmart are usually busier. “Obviously, it’s not polluted (with people), so we shouldn’t have a problem with a safe distance.”

April photos: Nebraska faces coronavirus

Health
Elective surgeries to resume at Omaha hospitals — with coronavirus screening

Hospitals and surgical centers in Omaha and Lincoln will proceed slowly — and cautiously — when it comes to restarting elective surgeries and other procedures Monday.

And, like so many things these days, the process won’t look like it did before.

Hospital officials say they will be selecting their patients carefully.

For starters, they will be screening them for COVID-19, the disease caused by the novel coronavirus, either through questionnaires or testing. And, at least initially, most will avoid those who would be particularly vulnerable if they contracted the virus — namely those patients older than 65 and ones with significant underlying health conditions.

Some hospitals will also limit procedures to those that can be done with a short stay. And procedures will likely be spaced out so staff can maintain social distancing.

The no-visitors policies will continue except under certain circumstances, meaning no anxious relatives lingering in waiting rooms.

“As folks come back to our hospitals, we’re laser-focused on making safety the No. 1 priority,” said Dr. Cliff Robertson, chief executive of CHI Health. “That’s something we always do, but now we have this new variable.”

Dr. William Lydiatt, vice president of medical affairs and chief medical officer at Methodist and Methodist Women’s Hospitals, said the measures are intended to keep both patients and health care workers safe.

Both groups have been particularly hard-hit in areas such as New York City, where the virus has been more prevalent.

“Our focus has always been on patient safety,” Lydiatt said. “This time, you have to include staff safety as being paramount.”

Most nonessential surgeries and medical procedures have been on hold in the Omaha area since mid-March, when hospital officials agreed to postpone them in an effort to conserve critical medical supplies, prevent staff burnout and free up beds as coronavirus cases mounted.

Gov. Pete Ricketts followed about a week later with a directed health measure prohibiting elective surgeries and procedures throughout the state.

But two weeks ago, Ricketts announced that he would lift the ban effective Monday for hospitals that had sufficient beds and ventilators to care for patients with COVID-19.

Specifically, hospitals must have 30% of overall beds available, as well as 30% of intensive care beds and 30% of ventilators.

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The governor’s announcement also freed dental and veterinary offices to resume nonelective procedures, as well as eye care facilities and ambulatory surgery centers.

Robertson said CHI Health will phase in surgeries at its Omaha and Lincoln hospitals next week. But hospitals in Grand Island and Kearney, which remain in the middle of coronavirus hot spots, will not yet be in a position to start elective surgeries.

Lydiatt said the health systems are being cautious, knowing that the projected peak of the pandemic in Nebraska still lies several weeks in the future.

At the same time, local hospitals have a lot of capacity.

While hospitals have continued with necessary care, such as some cancer surgeries and other can’t-wait procedures, some of the procedures left to wait include those needed to relieve patients’ symptoms and even to remove some low-grade or benign tumors.

“We also have a lot of people who need medical care who have postponed,” Lydiatt said.

Sometime after the initial relaunch, hospitals and surgical centers will gradually ramp up the number and complexity of cases.

But Lydiatt and Robertson stressed that health system officials will be watching to make sure that they are prepared to handle any surge in coronavirus cases. Such a surge could mean turning off elective procedures again.

“This is something we’re going to deal with for months and years to come,” Robertson said. “There is concern that having COVID-19 at the same time we have the flu could strain health care providers and hospitals. We’ll be planning for that so we’re always able to care for patients that need us.”

Different health systems will take slightly different approaches to testing and screening. Testing capacity, while continuing to grow, is still limited by supply shortages in some places.

Lydiatt said Methodist won’t require testing for every patient.

But health care providers will screen every patient multiple times for symptoms and for exposure to people with COVID-19. Patients will also be asked to quarantine for 10 days before the procedure.

Given Omaha’s relatively low prevalence of the virus combined with known false negatives for tests, Lydiatt said, testing every patient wouldn’t add a lot to the equation. But screening will take into account where patients live and the prevalence of the virus in those communities.

And all patients undergoing high-risk procedures will be tested.

Bryan Health in Lincoln will follow a similar course, officials said.

But CHI Health and Nebraska Medicine will test all patients before their procedures.

Dental offices, too, have gotten the green light to reopen Monday.

David O’Doherty, executive director of the Nebraska Dental Association, estimated that about half of the state’s dental practices would be ready to open Monday.

After the governor’s announcement that they could reopen, some dental professionals raised concerns that they lacked the protective gear needed to restart.

Some practices had donated their gear to hospitals. But O’Doherty said those supplies are being restocked.

Practices are not required to reopen.

O’Doherty said clinics in Hall County, which has the state’s highest case count, could reopen but have been asked not to by the local health department.

And practices that do reopen will be operating under new guidance from the association. Patients will be screened, and procedures that produce a lot of aerosol particles will be limited. The pace of appointments will also be slower. Staff will disinfect dental chairs and other equipment between patients.

Staff at Premier Dental in west Omaha were training in the new protocols Friday.

Pam Beninato, who owns the practice with her husband, said staff will be screened daily and all patients will be screened before they enter. Staff will wear additional protective gear, and everyone will do their best to maintain a 6-foot distance from one another.

Patients will also rinse with hydrogen peroxide before their procedures, a step that has been shown to reduce pathogens.

“We’re excited to open,” Beninato said, “and we’ve got patients excited to come in. Oral health is related to overall health, and we all want to be healthy.”

April photos: Nebraska faces coronavirus

Local
Iowa couple in their 80s survive coronavirus in time for their 70th wedding anniversary

An Iowa couple almost 90 years old have survived life-threatening coronavirus infections, just in time for their 70th wedding anniversary.

Ardis McCandless, 89, and the younger man she married in 1950, Bert McCandless, contracted COVID-19 in March and were hospitalized at Creighton University Medical Center-Bergan Mercy. Ardis didn’t have it as bad as Bert, who’s 88.

She spent three days in the hospital in late March. He went into the hospital on April 1 in shock and barely alive. A doctor estimated that he had a 10% to 20% chance of surviving. Bert was on a ventilator for more than two weeks. But on April 24, Bert returned to the couple’s home in Whiting, Iowa, where Ardis was so happy to see him, she sat on his lap.

“She hasn’t done that in 30 years,” Bert said. “So I must be a hot commodity.”

“I hugged him and kissed him and cried, and I have a picture of me lying across his lap,” Ardis said, laughing. Just to be clear, she added, “We had our clothes on.”

By Friday, the lively couple were back in their little ranch house in the small northwestern Iowa town of Whiting, watching the birds through the dining room window and looking forward to getting back to gardening, quilting and visits from their grandchildren and great-grandchildren. They’re still recovering, especially Bert. But it looks like by summer, he will be able to make his daily rounds of senior centers, coffee shops and bars to give away the vegetables he grows for fun.

That’s a lot better than the outlook for most of the spring.

The novel coronavirus has hit older people a lot harder than younger people. It has been particularly dangerous for people over 85. A study released in mid-April, as reported in the Washington Post, found a death rate of 40% among people 85 and older who had been hospitalized with COVID-19 in the U.S. Even among relatively healthy people without co-morbidities like the McCandlesses, the death rate in the study was still 22% to 27%.

Ardis McCandless contracted it first. The couple’s daughter, Terri Schaaf, is pretty sure that they got it from her and that she picked it up on a trip to the Ozarks in mid-March, just before cases started to be reported in the Midwest. Ardis went to the clinic in Onawa, Iowa. She was turning blue, so on March 25, she was sent by ambulance to Bergan Mercy. The family has an affinity for the Omaha hospital because of Bert’s successful heart bypass surgery there a couple decades ago.

Ardis was able to go home on March 28. But Bert’s cough and other symptoms worsened. He, too, went to the hospital in Onawa. He was in dire condition by the time the ambulance took him to Omaha on April 1. He has no recollection of more than two weeks, going back to before the trip to Omaha.

Dr. Bryan Krajicek, a CHI physician who was involved in Bert’s care, can fill in some of the blanks. He said Bert was in shock and “already intubated, requiring a ventilator,” when he arrived at Bergan Mercy.

“He was in our ICU for over two weeks, requiring really every bit of critical care support that we could provide to him in the ICU,” Krajicek said. “Mechanical ventilation, He required neuromuscular paralysis ..., which is something we do to kind of limit the body’s oxygen needs and to improve his interactions with the ventilator.”

MCCANDLESS FAMILY 

Ardis and Bert McCandless relax at their home after surviving the coronavirus. They look forward to getting back to gardening, quilting and seeing their grandchildren and great-grandchildren. Their 70th anniversary is on Oct. 6.

They used medicine to keep Bert’s tanking blood pressure up. They periodically “proned” him, or turned him over on his stomach, to optimize his lungs’ oxygen uptake and protect his lungs, a practice that is shown to reduce mortality in such patients, Krajicek said.

“In an 88-year-old guy who was that sick, his predicted mortality would be 80 to 90% or beyond, quite honestly,” he said.

The team of doctors and nurses provided what Krajicek called an “evidence-based standard of care” to keep Bert alive until his body could fight off the virus. He did not receive convalescent plasma or remdesivir, as some coronavirus patients do. Krajicek attributed Bert’s survival to such care as the team’s careful management of ventilator pressure and fluid intake, as well as to Bert’s physical condition coming in.

According to Bert, the first doctor he talked to after waking up put it this way: “You’re one tough son of a bitch.”

Bert said he was grateful to the Bergan Mercy doctors, and especially the nurses, who took care of him.

His daughter thinks that hard work in the garden has something to do with his survival.

“Last summer, he would have been 87, he’d be out working in the garden sweating his butt off all day, and come in and change his clothes and go back out later,” Terri said.

The couple live within a couple miles of the farm where they raised Terri and their son, Dennis, along with corn, beans and livestock. Ardis worked as a postmaster for 30 years. The couple traveled a lot, once taking their grandchildren on a road trip to Alaska.

Bert has been around the world three times with his buddy Gene Simpson of Omaha, who owned an aircraft sales company. Bert and another friend built an outboard motorboat from a kit and piloted it from Onawa down the Missouri and Mississippi Rivers all the way to New Orleans in 1958.

Now Bert makes daily rounds of senior centers, coffee shops and bars (to play pool and have a pop; he doesn’t drink.) They have more than a dozen grandchildren and great-grandchildren and catch a lot of their ballgames.

Ardis works in the flower garden and sews quilts, including with a group of friends at the library in Whiting. She had 27 quilts in a show last fall, including her favorite, a “whack and stack” with Southwestern colors.

“We’ll never freeze to death,” she quipped.

The couple were high school sweethearts in Whiting. Ardis dumped Bert after they graduated. But she let him know that she would like to see him again, and they were married in a small ceremony in Whiting on Oct. 6, 1950.

They don’t have big plans for their 70th anniversary. Ardis doesn’t like a lot of fuss.

“I’ll look at her,” Bert said. “And she’ll look at me.”

Krajicek Said: “We’ve had a few really good outcomes that we’re really proud of. To have a 70th wedding anniversary to celebrate at the end of this recovery is just remarkable. It’s stories like these that certainly make for a good day.”

April photos: Nebraska faces coronavirus