PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
“ The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.
This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.” (A)
“Virginia, Texas, Georgia, and Vermont have said they’ve been adding two numbers to their totals: viral test results and antibody test results.
Viral tests are taken by nose swab or saliva sample, and look for direct evidence someone currently has Covid-19. By contrast, antibody tests use blood samples to look for biological signals that a person has been exposed to the virus in the past.
Combining the two tests’ results into one total could provide an inaccurate picture of where and when the virus spread. It could also overstate a state’s ability to test and track active infections — a key consideration as states ease coronavirus restrictions. Experts have consistently emphasized that for states to reopen safely, adequate testing and tracing is needed.
“You only know how many cases you have if you do a lot of testing,” said Elizabeth Cohen, CNN’s senior medical correspondent. “If you put the two tests together, you fool yourself into thinking you’ve done more testing than you have.”’…
Texas, Virginia and Vermont have said they’ve recognized the data issue and moved to fix it in the past few days. In Georgia, health officials said they’ve been adding antibody tests to their “total tests” number in line with methodology from the Centers for Disease Control and Prevention.” (B)
Viral tests — commonly referred to as PCR tests as most of them use a process known as polymerase chain reaction — are used by health professionals to determine whether or not a person is currently infected with the disease. During the pandemic, viral tests have been the most effective way of being able to diagnose a positive case of COVID-19. They are what state governments have been counting to track the number of confirmed cases of the virus they have.
Antibody, or serology, tests serve a different purpose. Unlike viral tests that are taken by nose swab or saliva sample, antibody tests examine a person’s blood to see if their immune system has created antibodies to combat COVID-19. These tests allow doctors to see if someone has previously been exposed to the virus. As the push for widespread testing in the U.S. has strengthened, antibody tests have been widely produced, many experts have balked at saying that antibodies equate to immunity from COVID-19. Serology tests are also less accurate than PCR tests, increasing the chances for a false negative.
Moreover, a negative test means different things for either test. A negative PCR test indicates to physicians that the patient isn’t currently ill with the disease. But, a negative serology test means that the patient has most likely not been exposed to or infected with COVID-19.
“The viral testing is to understand how many people are getting infected, while antibody testing is like looking in the rearview mirror. The two tests are totally different signals,” Jha told The Atlantic.” (C)
“The Atlanta-based Centers for Disease Control and Prevention and Georgia’s state health department will alter their website data to separate testing data combining antibody and diagnostic test totals.
Wednesday evening, Channel 2 Action News learned Georgia included 57,000 antibody tests in their tally of the number of Georgians who had been tested for COVID-19. That accounted for roughly 15% of the Georgians who were reportedly tested for the virus. When removed from the positive case data, it increased the rate of infected Georgians by 2%.
Simply put, the data inflated the number of Georgians who have been tested for COVID-19. That figure stands around 3%.
The inclusion of the data also offered an “apples-to-oranges” look at the testing. Antibody tests give you a window into the past. COVID-19 test results are used to determine current trends and infections…
Thursday, a CDC spokeswoman told Channel 2 investigative reporter Nicole Carr that the agency would also change its online reporting data in the coming weeks.
“Initially, when CDC launched its website and its laboratory test reporting, viral testing (tests for current infection) were far more commonly used nationwide than serology testing (tests for past infection),” the statement read. “Now that serology testing is more widely available, CDC is working to differentiate those tests from the viral tests and will report this information, differentiated by test type, publicly on our COVID Data Tracker website in the coming weeks.”..
…experts here in Georgia explained the problems that arise from the conclusions drawn when that data is mixed. This comes days after Georgia began removing antibody positives out of case counts.
“When you only count the positives from the viral test, it’s going to look like the number of people who are testing positive as a percentage of all tests is going down, when it, in fact, that may not be the case, or at least it’s exaggerating that effect,” …
“It gets more complicated than that because these tests have different accuracy levels,”… “The percentage of false positives and false negatives is going to be different with each test, so why do you would mix them together? It just clouds what you know about the situation.”…
“In the realization yesterday that that total testing number was almost impossible to interpret called, really, those numbers into question and all the policies that have been based on those numbers into question,”…“And I think rightfully raises concerns in the minds of many Georgians.”
“We really need one coordinated public health response,” he added.” (D)
“In addition, combining antibody testing with diagnostic testing could reduce the number of tests that appear to be producing positive results, lowering the overall “positivity rate.” That’s another important benchmark. The World Health Organization has recommended a positivity rate of 10% or less as a signal of whether enough testing is taking place.” (E)
“How CDC explained its actions: The inflated totals resulted from states reporting their data to the agency in that format, a CDC spokesperson told POLITICO’s Brianna Ehley. Some states are still using a simplified submission form CDC created early on that combines both types of tests, meaning they get bunched together in the federal numbers too.
The agency is now shifting states to a more detailed form that should eliminate that issue, and it plans to break out figures for the two types of tests in the next week or so.
Some questions are still unanswered. CDC wouldn’t say how long it’s been combining the two tests, and it wasn’t until Wednesday — amid questions about its practices — that CDC deleted an assertion on its website that the totals “represent only viral tests.” It’s also unclear how significantly the practice has inflated the testing totals.” (F)
““This is not an intentional misuse of information — it’s part of the fog of the infectious disease war,” said Michael T. Osterholm, a University of Minnesota professor and former state epidemiologist who was sharply critical of the disease control centers early in the pandemic. “We’ve done surveillance for cases, and now we’re all trying to do testing, and it presents unique challenges.”
Whatever the reason, the numbers are fueling Mr. Trump’s frequent — and inaccurate — boasts that the United States is doing more testing “than all other countries combined,” a claim that the fact-checking website PolitiFact has declared “pants on fire wrong.” Governors rely on testing in deciding how far to go in reopening their economies. With all 50 states moving to reopen, accurate tracking is essential.
“We’re like the blind epidemiologists trying to understand the elephant,” said Michael Levy, a professor of epidemiology at the University of Pennsylvania. Health officials, he said, need good reporting to “understand the relationship between the epidemic that we can’t see, and the data that we can see.”
Scott J. Becker, the executive director of the Association of Public Health Laboratories, said there was another reason states were tracking testing: Mr. Trump wants the numbers.
“We’ve never needed to capture test volume. That is what the White House wanted to know, how many tests were being done,” Mr. Becker said, adding, “Ordinarily this all works through the public health system, but in this response, there’s been a drive to have data numbers, at multiple levels.”” (G)
“According to The Atlantic’s COVID Tracking Project, COVID-19 testing capacity in the U.S. has more than doubled over the past month, increasing from about 147,000 tests a day in mid-April to more than 413,000 tests a day as of May 20. Simultaneously, the proportion of positive tests recorded each week fell from 10% to 6% of total tests conducted. Both trends appear encouraging at face value, but given that diagnostic and antibody tests are sometimes being lumped together, it’s impossible to know whether the data reflects reality, The Atlantic reported.
When asked about the mess-up, CDC spokesperson Kristen Nordlund said that the agency “hopes” to separate the data on their COVID Data Tracker within the next few weeks.” (H)
Prequel
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
“Top executives at Denver Health Medical Center received significant bonuses this month for their performance in 2019, ranging from $50,000 up to $230,000, one week after frontline hospital workers were asked to voluntarily take leave without pay or reduce their hours as the hospital dealt with the financial downturn resulting from the coronavirus pandemic.
to read Posts 1-27 in chronological order, highlight and click on
On April 3, Denver Health CEO Robin Wittenstein emailed hospital workers noting “the current situation will stress us financially.”
She announced a hiring freeze and asked employees to voluntarily take leave without pay, use personal time off or reduce their normal work week.
“The goal is to reduce our total salary expense without the need to lay off employees or implement mandatory PTO/furloughs,” wrote Wittenstein.
She said the hospital was also considering mandating workers to use their paid time off, mandatory leave without pay and other steps.
“The goal is to avoid these extreme measures if at all possible,” she wrote.
One week later, on April 10, Wittenstein and her executive staff saw their 2019 Management Incentive Plan bonuses deposited into their bank accounts. They had been notified in late March that this would occur.,,
Wittenstein’s base salary for 2019 was $967,155, her bonus was $230,275 — which equates to 23.8% of her salary. She said her performance bonus is set by the Denver Health Authority board of directors and that the executive bonuses end up putting Denver Health administrators squarely in the middle of compensation for health and hospital executives.
“We want to try to pay people fairly,” said Wittenstein. ”Those incentives are what keeps people at the midpoint of the compensation range,” she said, as compared to colleagues around the country.
She said without the bonus payments, Denver Health executives would be paid less than the average for their counterparts nationwide…” (A)
“Denver City Councilman Chris Hinds said Friday that handing out millions of dollars in performance bonuses to Denver Health Medical Center administrators and executives in the midst of the coronavirus pandemic was “disgraceful,” and that the money should be returned to benefit front-line health care workers at the hospital.
“That there are certain executives that are receiving large bonuses of tens or sometimes even hundreds of thousands of dollars, that is not okay,” said Hinds, during a Facebook live statement.
“I’m really frustrated that we have public health administrators… that are taking tens of hundreds of thousands of dollars of bonuses… while working families are sacrificing themselves.”
Hinds said he learned of the performance bonuses from a CBS4 Investigation that aired Thursday night…
Hinds said the right thing to do would be for those executives to give the money back. He said he cut his office staff from three people to two this week which will help save the city money.
But in an email from Wittenstein to hospital staff sent Friday morning, it appeared unlikely bonuses would be returned…
Wittenstein, who received a $230,000 performance bonus on top of her $967,000 salary, said she was sacrificing by using her paid time off in lieu of regular salary, and she was waiving the accrual of paid time off for the next three months.
But Hinds said all that falls short, “PTO days are not enough. We need actual dollars; we need bonuses to be returned to the community.” (B)
“After weeks of defending executive performance bonuses, the board overseeing Denver Health Medical Center said Wednesday it planned to “revisit the compensation philosophy and approach for Denver Health, including but not limited to the leadership group. As part of the work,” said the board statement, “the Board will review the Management Incentive Plan.”…
Wittenstein and the hospital board continually defended the bonuses saying the timing of handing them out was poor, but the strategy itself was sound.
“It gives executives an opportunity to put a portion of their salary at risk,” said Wittenstein, “and earn it based on work that goes on.”..
Wittenstein again apologized for the timing of the bonuses but “not the compensation program the board of directors has approved.”
But in a statement Wednesday, the hospital board backed down, saying it understood “the anger, frustration and pain created by the Management Incentive Payments received by the leadership of Denver Health. The compensation system, was created and is overseen by this board and not by the leadership of Denver Health, or the employees who are covered by the plan.”
The statement went on to say, “Based on the voices we have heard from staff and from leadership, the board will revisit the compensation philosophy and approach for Denver Health, including but not limited to the leadership group. As part of this work, the Board will review the Management Incentive Plan.”
The release also said the leadership group of Denver health, comprised of executives and physician Directors of Service, told the board they are voluntarily reducing their salaries by 20% immediately “to help mitigate the economic impact of this pandemic on Denver Health.”” (C)
“Following public outcry, Denver Health and Hospital Authority Board pledged to “revisit the compensation philosophy and approach for Denver Health.”
Denver Health, which runs hospitals, emergency rooms, a public health department and other medical services, acknowledged the “anger, frustration and pain” caused.
“We know everyone on the front line is working hard, in an incredibly stressful time, taking care of patients while taking risks,” a statement said.
“We regret the division this situation has created but appreciate the willingness of our staff to speak up and share their concerns.”
Dr. Bob Phillips, executive director of The Center for Professionalism & Value in Health Care, told 9NEWS Denver the “choice to give bonuses to leadership at this time, even if it’s based on past behavior or past outcomes” was “frankly unconscionable.”
“Health care leaders and hospital CEOs are in a tough, tough spot, of having to make choices about staff and having to survive in this environment,” Phillips said.” (D)
“Angry about executive bonuses, long hours and a lack of personal protective equipment, Denver Health Medical Center workers announced Tuesday they are forming a union to “fight for workers’ rights, institutional change, and meaningful public investment to improve patient health outcome,” according to a news release from the Communications Workers of America, which would be affiliated with the new union.
Thomas Walker, with the CWA, said there were 20 Denver Health employees on a steering committee, and said the union idea had been “in the works for a little while.” He said it would be open to all employees, ranging from doctors to nurses and beyond.
“The announcement follows troubling revelations about soaring executive compensation and bonuses as nurses and other staff are asked to bear cuts in the midst of the COVID-19 crisis,” said the announcement.
A CBS4 investigation last month reported that nurses and front line workers were asked April 3 to take pay cuts and reduce hours to help the hospital through a financial downturn brought about by the pandemic. But a week later, on April 10, about 140 executives and managers received Management Incentive Plan (MIP) bonuses for their work at the hospital in 2019.
Some of the bonuses to six-figure workers amounted to nearly 20% of their salaries. The hospital CEO, Robin Wittenstein, received a $230,000 MIP bonus.
Wittenstein has defended the bonuses as simply a component of salary and not actual bonuses, but conceded, “The timing of the payments was terrible.”
But in an employee meeting this week, she and other executives who defended the payments were peppered with questions from staff members about salaries for front line workers, a lack of Personal Protective Equipment and short staffing.
“I’m on my sixth day, and I’m exhausted,” said one nurse. Another nurse asked, “What is the bonus compensation for everyone, not just executive staff?” Others asked about hazard pay for front line workers.” (Q)
“When the top-ranked Mayo Clinic stopped all nonemergency medical care in late March, it began to lose millions of dollars a day.
The clinic, a Minnesota-based hospital system accustomed to treating American presidents and foreign dignitaries, saw revenue plummet as it postponed lucrative surgeries to make way for coronavirus victims. The hospital network produced $1 billion in net operating revenue last year, but now expects to lose $900 million in 2020 even after furloughing workers, cutting doctors’ pay and halting new construction projects…
The American health care system for years has provided many hospitals with a clear playbook for turning a profit: Provide surgeries, scans and other well-reimbursed services to privately insured patients, whose plans pay higher prices than public programs like Medicare and Medicaid.
The Covid-19 outbreak has shown the vulnerabilities of this business model, with procedures canceled, tests postponed and millions of newly unemployed Americans expected to lose the health coverage they received at work.
“Health care has always been viewed as recession-proof, but it’s not pandemic-proof,” said Dr. David Blumenthal, president of the Commonwealth Fund, a health research organization. “The level of economic impact, plus the fear of coronavirus, will have a more dramatic impact than any event we’ve seen in the health care system weather in my lifetime.”..
Hospitals are losing an estimated $50 billion a month now, according to the American Hospital Association. And 134,000 hospital employees were among the estimated 1.4 million health care workers who lost their jobs last month, data from the Bureau of Labor Statistics shows. Across the country, hospitals reported seeing between 40 and 70 percent fewer patients from late March through early May, many of them scheduled for profitable services like orthopedic surgery and radiological scans…
Hospitals that treated high numbers of coronavirus patients say they have been hit especially hard, as they had to spend heavily on protective equipment and increased staffing just as their most profitable services were halted. These patients often had long stays in intensive care units, requiring expensive equipment like ventilators and treatment from multiple specialists.
“We began ordering everything at a feverish pace,” said Kenneth Raske, president of the Greater New York Hospital Association. “The costs were sometimes 10 or 20 times normal. We were scrounging all over the world for supplies.”
His organization estimates that, across New York City, large academic medical centers lost between $350 million and $450 million each last month. Unlike hospitals fighting smaller coronavirus outbreaks, they could not furlough workers to offset the decline.
“In terms of taking care of patients, our hospitals did the right thing,” Mr. Raske said. “But the right thing has challenged their ability to continue sustaining themselves.” “ (E)
“Probably few hospital systems need the emergency federal grants announced this week to handle the coronavirus crisis as badly as Florida’s Jackson Health does.
Miami, its base of operations, is the worst COVID-19 hot spot in one of the most severely hit states. Even in normal years, the system sometimes barely makes money. At least two of its staff members have died of the virus…
Migoya and executives at other beleaguered systems are blasting the government’s decision to take a one-size-fits-all approach to distributing the first $30 billion in emergency grants. HHS confirmed Friday it would give hospitals and doctors money according to their historical share of revenue from the Medicare program for seniors — not according to their coronavirus burden.
That method is “woefully insufficient to address the financial challenges facing hospitals at this time, especially those located in ‘hot spot’ areas such as the New York City region,” Kenneth Raske, CEO of the Greater New York Hospital Association, said in a memo to association members.
States such as Minnesota, Nebraska and Montana, which the pandemic has touched relatively lightly, are getting more than $300,000 per reported COVID-19 case in the $30 billion, according to a Kaiser Health News analysis.
On the other hand, New York, the worst-hit state, would receive only $12,000 per case. Florida is getting $132,000 per case. KHN relied on a state breakdown provided to the House Ways and Means Committee by HHS along with COVID-19 cases tabulated by The New York Times.
The CARES Act, the emergency law passed last month to address the pandemic, gives HHS wide latitude to administer $100 billion in grants to hospitals and doctors.
But the decision to allocate the first $30 billion according to past Medicare business surprised many observers.
The law says the $100 billion is intended “to prevent, prepare for and respond to coronavirus,” including paying for protective equipment, testing supplies, extra employees and temporary shelters and other measures ahead of an expected surge of cases. It says hospitals must apply for the money…
HHS’ method “could tilt the playing field” against hospitals whose patients are largely uninsured or covered by the Medicaid program for low-income patients, said Bruce Siegel, CEO of America’s Essential Hospitals, a group of systems serving the poor and vulnerable.
HHS said the next slice of the $100 billion to go out “will focus on providers in areas particularly impacted by the COVID-19 outbreak” as well as rural hospitals and those with lower shares of Medicare revenue.
Jackson Health’s budget depends heavily on reimbursement for the kind of elective procedures that it has canceled to ensure it has the capacity to handle COVID-19 patients, Migoya said. Lost revenue is $25 million per month, it estimates.
“We cut off our own funding sources in order to sustain our mission,” he wrote in the letter to Azar.” (F)
“After it faced blowback for how it distributed the first tranche of emergency funding to hospitals, the Department of Health and Human Services plans to set aside funding for hospitals in Covid-19 hotspots and rural hospitals. The agency provided guidance on Tuesday for how the remainder of the $100 billion set aside for healthcare providers under the CARES Act will be spent.
“Our goal in all of the decisions we’re making is to get the money from the Provider Relief Fund out the door as quickly as possible while targeting it to those suffering the most from the pandemic,” HHS Secretary Alex Azar said in a news release. “We will continue using every regulatory and payment flexibility we have to help providers continue doing their vital work until we’ve defeated this virus.”
HHS said it would send $20 billion to hospitals based on their 2018 net patient revenue. This funding is meant to offset the initial $30 billion that the agency sent out last week based on Medicare revenue, which missed some facilities that had been affected, such as children’s hospitals. Healthcare providers in New York and other hard-hit states had also balked at initial $30 billion round of funding given that it didn’t take into account the number of Covid-19 cases hospitals had treated.
In an emailed statement on Wednesday, American Hospital Association CEO Rick Pollack said the newly allocated funds would help hospitals that see high numbers of patients covered by Medicare Advantage and Medicaid.
Addressing concerns about funding for Covid-19 hotspots, HHS is carving out $10 billion for hospitals most affected by the virus. Hospitals in New York are expected to receive a large portion of this funding; New York City alone has seen 138,000 cases and 9,944 deaths attributed to Covid-19 as of Wednesday.
The funding will factor in the number of admissions with a positive Covid-19 diagnosis since January. HHS also said it would take Disproportionate Share Hospital payments into account, which means hospitals that see patients who are uninsured or covered by Medicaid would get a portion of the funds…
“Hospitals have seen a 12% increase in costs related to Covid, but a 40% to 50 % reduction in revenue. Even the hospitals that are doing well, this has really rocked them back on their heels,” said David Mosley, a partner with Guidehouse. “Do I think (the funding) will make them whole financially? Probably not. … We’ve cancelled all these elective surgeries, but we still have all of the costs associated with those practitioners.”..
A portion of the $100 billion fund will also go to covering uninsured patients who had received treatment for Covid-19, but it’s not yet clear how much will be needed. HHS said healthcare providers who provided treatment for uninsured Covid-19 patients can begin submitting claims in early May.” (G)
“The Trump administration has said a portion of the $100 billion pie will be diverted to cover COVID-19 testing and treatment for the roughly 30 million uninsured Americans. It’s a significant promise: A Kaiser Family Foundation analysis released Tuesday estimated that hospital costs for the uninsured could reach as high as $42 billion.
And though the emergency funding legislation included a 20% bump in Medicare rates for common treatments of the disease, hospitals could still lose roughly $1,200 per COVID-19 case, according to one analysis.” (H)
“The American Medical Association, along with other physicians groups, wrote to congressional leaders Wednesday in regard to the funding. While calling the CARES Act as “a meaningful step in preserving the health care infrastructure during today’s crisis and beyond,” the letter urges leaders to “take additional steps to protect patient access to care by preserving the viability of physician practices as part of the nation’s essential health care system.”
The group asked lawmakers to consider supplemental measures addressing financial burdens healthcare providers are facing, such as adjusting Medicare and Medicaid payment provisions for providers unable to repay the accelerated payments.
Expanding small business loans and eligibility for the Paycheck Protection Program is another way to keep financially battered practices afloat. According to the letter, larger physician practices with more than one location but with 500 employees or fewer per location are currently ineligible for the PPP…
“There are providers across the country that aren’t able to work, very much like our restaurants and entertainment industry, large segments of the healthcare industry aren’t able to provide services they normally would,” Verma said. “It’s having a financial impact on both sides. In this next tranche, we’re trying to address that.”” (I)
“In response, hospitals and health care companies have announced a wave of layoffs and cutbacks:
Mayo Clinic said it will cut $1.6 billion in employee pay after suffering a $3 billion revenue loss, including furloughs or shorter hours for about 30,000 staff members…
The federal stimulus packages that have passed will provide about $175 billion, or about 35% of the revenue lost to the health care industry in the first quarter of 2020, Shulkin said.
“The rest will need to come from hard decisions that hospitals are going to need to make,” Shulkin said.
Phased reopening of state economies could help health care’s bottom line, by bringing back elective procedures and other clinical activities that were halted or scaled back during lockdowns, Shulkin said.
“We’re beginning to see this opening up in parts of the country that appear to be safe,” Shulkin said.
But that might be too late for some hospitals, particularly those located in the rural parts of America, Ku noted.
“Rural hospitals were in trouble already, even before all this happened,” Ku said. “It could be that the losses right now are that extra little thing that would push them off the edge. I wouldn’t be surprised to hear that some more rural hospitals or very small hospitals, this was the thing that pushed them into bankruptcy.”
Health care will definitely take a severe financial hit as a result of COVID-19, Shulkin said. “But how bad it is, the script is still being written. What happens with the infection is really going to determine that,” he added.
“If we see a second wave or resurgence of infections, we’re going to have to go right back to stopping some of those elective activities, and that’s going to hurt hospitals and health providers further,” Shulkin concluded.” (J)
“This week, California hospitals are planning to ask the state for $1 billion before June 30 to help with revenue losses, said Carmela Coyle, the CEO of the California Hospital Association. An injection of cash from the state could help hospitals avoid or reduce pay cuts and layoffs, she said. California hospitals so far have received $3 billion in aid from the federal government, she added.
Hospitals have also asked that health insurance plans accelerate payments for claims within 30 days during the pandemic. Currently, claims can take up to 90 days to process, but “we need to move those dollars more quickly,” Coyle said during an Assembly budget hearing last week.
Coyle said hospitals have done their best to keep their staff, but furloughs and layoffs have begun. “And that is because 60 percent of hospital spending is for labor,” she told lawmakers.
At the outset of the pandemic, the state asked hospitals to prepare for a surge and make room for about 40,000 more patients at once. “And we did that, we answered that call. We emptied California’s hospitals to make way. That means canceling surgeries and procedures and more,” she said. “But as we begin to assess the damage, the toll is enormous.”
In late April, Gov. Gavin Newsom allowed hospitals to resume some elective surgeries, which is the bread and butter for many facilities. But some hospitals, especially smaller ones or those in rural areas, are already in a deep hole…
“It is a weird dichotomy,” said Joanne Spetz, associate director of research at the Healthforce Center at the University of California, San Francisco. The labor challenge for health systems, she said, is that not all positions transfer smoothly into surge preparedness. A nurse in a primary care office or one who specializes in orthopedic care, for example, perhaps wouldn’t be the best fit to care for a coronavirus patient on a ventilator, she explained.
“So you have furloughs happening in community health centers and in certain departments of hospitals, while at the same time there is concern about a surge and we’re hearing these calls for things like a health corps,” she said.” (K)
“Connecticut hospitals, stung by the widespread cancellation of elective procedures, a steep drop in emergency room visits and the need for additional staffing and protective gear to navigate the COVID-19 crisis, stand to lose $1.5 billion this fiscal year…
The state’s hospital industry so far has received about $260 million in federal stimulus money to help offset some of the losses, which vary widely by facility. Another $290 million is expected in the coming days. But for many hospitals, the funding isn’t nearly enough to make up for revenue that has vanished since the pandemic began.
Some have resorted to furloughing employees, cutting pay for executives or requiring staff to work reduced hours. Others have looked into options for deferring employee pension contributions and payroll taxes, or getting advanced Medicare payments – maneuvers that help them stay afloat during the immediate financial squeeze.
“There’s still a big gulf between what hospitals have received and the amount that’s remaining,” Schaefer said. “That is potentially going to be a loss that weakens Connecticut’s hospitals tremendously if we don’t figure out a way to address it.”..
With the exceptions of New York and San Francisco, almost every other U.S. hospital has experienced unforeseen declines in patient volume. From March 1 to April 15, health systems in the U S. saw an average drop in emergency visits and in-hospital stays of about 30% to 50%.
Concerns about the financial health of hospitals go beyond patient care. The health systems are a main driver of the economy, and in Connecticut, the state’s hospital association puts their total economic impact – including jobs, health care spending and capital improvements – at $28.9 billion. Hospitals are some of the largest employers in their communities and spend hundreds of millions on buildings and equipment.
With fewer patients, the community hospitals lose bargaining leverage with insurers when negotiating payment rates. And with fewer patients and lower payment rates, the hospitals struggle to invest in programs, staff, marketing or the infrastructure needed to adapt to the changing health care system…
“Larger systems, say Hartford Healthcare or the Yale New Haven Health system, they are seeing the same kind of revenue decline and probably the same kind of expense increase. But if you look at the financial strength of those organizations and their capacity to weather a storm like this, it’s greater,” Charmel said. “It takes a smaller number to do damage here than it does there.”
“Everybody is going to be hurt by this,” he said. “But I think the viability of those independent hospitals is going to be more challenged, without a doubt.” (L)
“As hospitals around Maryland grappled with a flood of coronavirus patients, treatment for other patients dropped so much that the executives are now turning to salary cuts, furloughs and other measures to cope with the loss in revenue.
About four dozen acute care hospitals expect to lose about $1 billion in revenue from April through June, or about a quarter of their normal revenue, according to the Maryland Hospital Association…
Hospitals including Johns Hopkins have told staff, including doctors treating COVID-19 patients, about pay and benefit reductions that could cost them a significant portion of their annual income.
A recent letter to workers at Johns Hopkins Medicine, which includes the system hospitals and school of medicine, officials recognized staff contributions during the pandemic but announced elimination of merit raises, limited hiring, furloughs and suspension of retirement contributions. Executive pay will be cut up to 20%…
Hospital rates in Maryland are tightly regulated by a state agency called the Health Resources Cost Review Commission under a unique agreement with federal regulators. The agency said in early April that it would allow “reasonable” temporary rate increases to all patients, from those having babies to emergency heart surgery, or now getting COVID-19 care.
Rate increases, charged to all public and private insurers, are often controversial and have led to questions about stewardship of the hospitals, pay to executives and spending on community health.
Tequila Terry, a commission spokeswoman, said Thursday that in this case the agency’s projections show losses could be higher than the hospital’s estimate at more than $2 billion, or 44%. Based on that, it expected to allow for a rate increase that could bring in about $200 million, but the final tabulation of the increase as well as the losses at the hospitals will not be known until the end of the year.” (M)
“The Illinois Health & Hospital Association last month estimated that the state’s more than 200 hospitals were losing a total of $1.4 billion a month amid COVID-19, with outpatient revenues down 50 to 70 percent…
Starting May 1, executives and senior managers at NorthShore University HealthSystem are taking 20 to 35 percent pay cuts “as we work through many future uncertainties,” the five-hospital chain said in a statement.
In 2018, CEO J.P. Gallagher’s total compensation was $2 million, $742,000 of which was his base pay, filings show.
“NorthShore is implementing proactive measures to remain financially sustainable so that we may continue serving our communities into the future with the same level of innovation, service and quality they deserve,” the statement says. In addition to pay reductions for leaders, the hospital chain has suspended contributions to employee retirement accounts and required workers to use vacation time as it modifies work hours.
The University of Chicago Medical Center recently announced that it’s furloughing workers and postponing planned capital projects, among other cost-cutting measures, having seen a $70 million decline in operating revenue and a $35 million loss in cash flow in both March and April.” (N)
“Citing hefty investment losses, Oakland, Calif.-based Kaiser Permanente saw its net loss reach $1.1 billion in the first quarter of 2020, according to recently released financial results. In the same period one year earlier, Kaiser reported net income of $3.2 billion.
The health system reported operating revenue of $22.6 billion in the first quarter of this year, compared to $21.3 billion one year prior.
The health system also saw its expenses rise to $21.4 billion, an increase of $1.6 billion from the first quarter of 2019.
The system’s operating income reached $1.3 billion, compared to $1.5 billion in the first quarter of 2019.
The health system said its first-quarter loss was primarily driven by an investment loss of $2.4 billion in the first quarter of 2020. This compares to a $1.6 billion gain in the first quarter of 2019.
Kaiser said its first-quarter results also reflect costs to prepare for the COVID-19 pandemic, but noted that only a “small portion” of the financial effect of COVID-19 was felt this quarter.
“During the first quarter we began establishing mobile hospitals and triage units, recommissioning retired units, increasing our available inpatient capacity, and acquiring additional equipment to prepare for the potential surge of COVID-19 patients,” said Kathy Lancaster, Kaiser’s executive vice president and CFO. “Even with all this rapidly escalating preparation and direct care delivery, only a small portion of the financial effects of the pandemic, in terms of lost revenue and increased costs, was experienced in the first quarter.” “(O)
“The Economic Policy Institute estimates that nearly 13 million Americans have likely lost their employer-sponsored health insurance so far.
“Even if [patients] do go back to the hospital, they’ll be paying a lot lower rate than they did when they had insurance through their employer,” says Christopher Whaley, a policy researcher with the Rand Corporation.” (P)
“The International Brotherhood of Teamsters has sent a letter to other Tenet Healthcare shareholders urging them to reject a $24 million pay package for Tenet Chairman and CEO Ronald Rittenmeyer.
The Teamsters, whose pension and benefit funds invest in Dallas-based Tenet, said time-vesting awards for Mr. Rittenmeyer and Tenet President and COO Saum Sutaria, MD, have made the two executives “the least exposed to corporate performance.”
The union, which represents more than 300 Tenet workers, criticized the company’s decision to furlough 10 percent of its workforce during the COVID-19 pandemic without reining in executive compensation.” (Q)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
“When the coronavirus hit, both UPMC Pinnacle…took their hospital cleaning protocols up a number of notches.
These days, the housekeeping staff make constant rounds wiping down “high-touch” hospital areas, even as visitors have been sharply curtailed.
There’s not a doorknob, elevator button, telephone, handrail, light switch, ATM, table, chair, nurse station, work station or mobile computer in the entire hospital that goes unsprayed or un-wiped for long…
When a COVID-19 patient leaves, it requires an even higher level of cleaning – along with a protection-first mindset – among those tasked with eradicating every last, lingering coronavirus molecule…
…his environmental services staff teams up in pairs when entering coronavirus patient rooms to perform what he called a “thorough cleaning and inspection.”…
The staff doubles up to sanitize these rooms doubly well. They do so totally protected with PPE and fully armed with hospital-strength cleaning agents and top-to-bottom wipe-down protocols…
Virtually everything in a coronavirus room is disinfected, with the housekeeping staff waiting a full 90 minutes after the patient leaves before entering and beginning their deep clean.” (A)
“With subway service set to halt for overnight cleaning beginning at 1 a.m. Wednesday, the MTA elaborated Monday on the plan they hope will help stop the spread of the coronavirus among riders and workers.
All 472 subway stations will be closed until 5 a.m., with 500 cleaners surging through the system.
The cleaning program will have three phases over 24 hours:
–Daytime Terminal Car Cleaning: After each train reaches its final destination, crews will remove trash, clean spills and bio hazards, and spot clean seats, floors, and other surfaces. Trains will also be disinfected at terminals during particular hours over the course of the day.
–Overnight Yard Cleaning: Trains in service during daytime hours but out of service at night will receive a more comprehensive cleaning every night in yards. Crews will remove garbage and graffiti, clean spills and bio hazards, mop floors, clean seats cleaning, and disinfect surfaces.
–Overnight Terminal Car Cleaning: Trains that remain in service at night will receive cleaning that is identical to the yard cleaning above, except at terminal stations.
Cleaning will include antimicrobial biostatistics and ultraviolet light, testing “multiple products from multiple companies.”
“Products that claim to eradicate COVID-19 for 30, 60 or 90 days, MTA Chairman and CEO Pat Foye said. “That would be great news. We are testing and piloting these things on an aggressive timeframe.” (B)
“The MTA would likely need to have its entire workforce cleaning and disinfecting trains, buses and stations around the clock to stop the deadly coronavirus from spreading, according to a public health expert.
But the transit agency’s plan to clean frequently used surfaces in stations once per day and trains and buses every 72 hours is likely the “best they can do” under the circumstances, said Anthony Santella, an associate professor of Public Health at Hofstra University.
“The transportation agency is not going to all of a sudden call every single one of its workers to work around the clock, 24/7. You probably need that to really clean things as much as they should be,” Santella told the Post, noting that multiple hands touch MTA surfaces every few seconds and that the virus often goes days undetected.
“Those resources simply do not exist. You would have to basically stop doing several other public health initiatives that are equally important to this,” he added. “What can they do without a lockdown or curfew or scaring people? Take precautions on things that could cause harm to New Yorkers.”” (C)
“While cleaning will help kill the virus if it’s on any of the surfaces, Dr. Stephen Morse, a professor of epidemiology at Columbia University’s Mailman School of Public Health, told Gothamist/WNYC, “There’s only so much cleaning that can be done and you never know when something is going to become contaminated. They can’t guarantee that there won’t be someone who comes there and accidentally contaminates the environment because they may be infected.” (D)
“The effectiveness of the antimicrobial solutions and surface protectants are unknown, and MTA officials said they are working with the U.S. Environmental Protection Agency to determine if they can eradicate viruses for extended periods, as manufacturers say. LIRR spokeswoman Meredith Daniels said the railroad is “anxiously awaiting” the results of the tests.
The MTA has not disclosed the names of the products, but several manufacturers from around the globe claim to have developed antimicrobial solutions that can protect surfaces against contamination for several months with just one application. The manufacturers said their products have been in use in hospitals, nursing homes and other settings for months, and have shown encouraging results, according to the MTA. Some products coat surfaces with millions of tiny capsules containing disinfectants that are activated and released upon human contact.
The MTA also has been testing since March the use of ultraviolet lamps to kill the coronavirus on buses, although officials noted UV light does not protect from future contamination.” (E)
“A school or an office is ultimately only as germ-free as the people in it. A complete disinfection can buy temporary peace of mind, but it’s no substitute for routine, ongoing cleaning. “As soon as we get done with our work, you open the door and somebody walks in,” Storrer says, “and boom, it might be all over.”” (F)
“While cleaning for the coronavirus is not that different from disinfecting for other viruses, like the flu or a common cold, industries are tailoring the cleaning in keeping with what makes sense for them. Public health officials suggest a few common steps can be used by both businesses and individual households: increasing the frequency of cleanings, using disinfectant products that federal officials say are effective, cleaning “high-touch” spots and making hand sanitizer readily available.
But there is no universal protocol for a “deep clean” to eradicate the coronavirus. Ridding it from smooth surfaces is easier than getting it out of upholstery or carpeting, for instance. And the key to eliminating the spread of the virus hinges on good hygiene practices.
“No cleaning protocol is perfect,” said Benjamin Lopman, an associate professor of epidemiology at Emory University in Atlanta. But combining cleaning with other public health initiatives, such as social distancing, “will act in concert hopefully in reducing the transmission of the coronavirus,” he added.
Deep cleaning is not a scientific concept and likely means something different to individual businesses or consumers. The Centers for Disease Control and Prevention has issued guidelines for community facilities that have had people with suspected or confirmed coronavirus disease, called COVID-19. It recommends that “high-touch” surfaces be disinfected daily.
But not all forms of infection control are the same. Disinfectants kill germs on a surface. Cleaning can remove ― but not necessarily kill — viruses. Sanitizing refers to lowering the number of infectious agents to a safe level through cleaning or disinfecting an area.
The Environmental Protection Agency has released a list of registered cleaning products that work against hardier germs and are presumed to be good options to fight the novel virus, said Karen Hoffmann, the immediate past president of the Association for Professionals in Infection Control and Epidemiology.
“This virus is actually very sensitive to all the common cleaning and disinfecting agents out there, so that’s the good news,” said Hoffmann…
A spokesperson for the American Hospital Association said that while frequent cleaning is standard, hospitals are giving special attention to “high-touch surfaces such as in-room phones, TV/nurse calls, light switches and cords, handles, drawer pulls, bed rails, tray tables and bathroom fixtures.” “ (G)
“A study published in the New England Journal of Medicine last week found that SARS-CoV-2 can persist on some surfaces for up to three days in amounts sufficient to get someone sick. The Centers for Disease Control and Prevention suggests that people concerned about spreading the virus regularly wipe down frequently touched surfaces, like doorknobs and light switches, with a strong disinfectant.
Whether full-room disinfections are necessary is not always clear. Certainly, it’s not sufficient to keep a space safe: The virus can also be transmitted from droplets floating in the air, not just surfaces. As Noyman points out, the moment cleaners leave, passers-by begin to undo all their work.
And some cleaning methods have only mixed support. The Environmental Protection Agency has put out a list of approved disinfectants for use against SARS-CoV-2, but the list currently only includes chemicals. Olinger said that, based on current evidence, while steam can kill the virus, it needs a lengthier application time than some users may realize. “At this point during the pandemic I would not use steam at all,” Wilcox wrote, citing a lack of strong evidence. Some industry representatives, including Wayne Delfino, whose family owns Advanced Vapor Technologies of Everett, Washington, however, insist that dry steam vapor works. The company’s non-chemical, “Thermo Accelerated Nano Crystal Sanitation” technology, he wrote in an email, “has been tested and proven effective on harder-to-kill viruses and on a similar human coronavirus in seven seconds or less.”
While opinions vary, thorough cleaning of any kind can offer some peace of mind – and many techniques do kill pathogens. “Any time you can minimize your exposure, you’re helping yourself out,” said Jonathan Sexton, an environmental microbiologist at the University of Arizona who studies disinfection.” (H)
“Firstly, deep cleaning isn’t a scientific concept and likely means different things to different people and businesses…
General cleaning refers to that done on a daily basis, focusing on washrooms and carpets, and other easy to access areas, and is often done around people using that space. Deep cleaning, however, is much more intense.
“[Deep cleaning] causes more disruption so it’s done at the weekend or overnight when the users aren’t present. Chemicals could be used, and we need time for carpets to dry,” Liang says.
The company’s disinfection service is even more intense and requires a specialised team with the correct gear, PPE (personal protective equipment) masks and hazmat suits. If a ULV (ultra-low volume) fogger is used then time must be allowed for the chemical agents to settle. (I)
“The New York Stock Exchange was not built for social distancing. But it is not ready to close and send the traders home because of the coronavirus.
And so, starting late Friday night, the stock exchange got fully sanitized for the first time since the iconic neoclassical building opened in 1903. More precisely, it got a “deep clean.”
The process took eight hours and a crew of 10 specialists. These deep cleanings are planned to be repeated weekly, at a cost of hundreds of thousands of dollars per month. But those in charge of the building and many of the traders themselves believe the New York Stock Exchange — a symbol of American economic might and stability — is too important to shut down.
The disinfection crew wore matching hazardous material suits, reflective yellow vests, doubled-up blue gloves, goggles and purple respirators.
The hazmat suit-clad cleaning team wandered and sprayed every surface — computers, chair legs, tables, floor, everything — with Z BioScience Multi-Task Probiotic Cleaner. They threw out every paper they encountered, making piles of notes and printer paper. They wiped the surfaces down.
Next, they rolled out a big yellow tank and a couple of crew members put on tank backpacks. Using a specialized sprayer that looked like a paint gun, they coated everything with Anasphere, a biohazard disinfectant. This was the most toxic step.
They left the disinfectant there for about ten minutes to allow it to cure. They worked quietly at the beginning. As the night wore on, they talked and joked a little more.
The last step was preventive. They applied a probiotic layer — Z BioScience Enviro-Mist Microflora spray — that would stay on all the surfaces and buy them a couple more days until the process needed to start again…
The disinfection crew sprayed just about everything but the opening bell.
They finished early Saturday morning, funneling out in civilian clothes before the sun rose over Wall Street, quiet on a weekend.” (J)
“How can you decontaminate COVID-19 when an outbreak occurs in a commercial building? How can you decontaminate for a new virus we know so little about? Until further information is produced, the CDC has directed cruise ships, hospitals, schools, and businesses to rely on interim guidance for disinfection based on the past successful decontamination techniques used for previous strains of coronavirus. It would be best to consider worst case scenarios and use the best-known decontamination practices, equipment, and personal protective equipment. Cutting corners could be risking infection.
Some of the questions to ask with any virus decontamination project are:
What areas where infected people in?
Who have they come in contact with, and what areas do those people occupy?
What type of HVAC system is in the building?
What is the design of the ductwork?
What are the high traffic areas in the building?
What are the main areas of ingress and egress?
How quickly does the building need to be operational?
Bringing in the proper industry experts would be advised. These experts should include an engineer who is familiar with the construction of the building including the HVAC system, an HVAC company that follows the National Air Duct Association Standards (NADCA) and is familiar with decontaminating ductwork, an industrial Hygienist who is specialized in virus and bacteria decontamination to write the overall protocol and provide testing services, and a decontamination company that has experience with proper personal protective equipment (PPE) use and proper training including OSHA Disaster Site Worker and HAZWOPER 40 certificates. HAZWOPER training is a requirement for all workers completing the decontamination.2 These companies should also be familiar working with multiple materially interested parties on commercial projects to facilitate efficient communication.” (K)
“When Vanessa is asked to clean up after patients who have the seasonal flu or measles or MRSA in the Pennsylvania hospital where she works in environmental services, she knows what to do. She knows how to disinfect surfaces, what needs to be thrown away and what she should wear to protect herself. But when she’s asked to clean rooms occupied by COVID-19 patients, she’s flying blind.
“It’s kind of terrifying,” says Vanessa, who TIME is identifying by first name only for professional protection. Her supervisors told her to clean the rooms just as she would for a flu patient, but she says she’s treating them like she would for more serious illnesses—throwing out nearly everything disposable, mopping the walls and scrubbing every inch—to be safe. “No one knows exactly how to clean it. We don’t know how contagious this is.”
At a time when cleaning supplies are invaluable and hand-washing is a national activity, people who clean professionally, like Vanessa, have watched their jobs take on new meaning—and considerable new risks. But what has remained the same, they say, is a lack of respect and, often, inadequate compensation.
Vanessa, for example, makes only about $11 an hour for the unenviable job of disinfecting hospital rooms, often without proper protective gear for herself. The fresh N-95 masks still available in her hospital, she says, are mostly going to doctors and nurses; she and her housekeeping colleagues often have to reuse the ones they have. She says she might have stopped showing up at work if she didn’t need the money, especially since she has underlying health conditions that put her at extra risk of getting COVID-19.
“Because I’m working there,” Vanessa says, “I’m too afraid to go see my family right now.” She lives with her best friend, and is staying away from her parents’ home for now….
“There are people who really do appreciate [us] and know the janitors are in a big risk,” K.T. says. “But there are a lot of people who…don’t even look at the bottom, and they see us at the bottom.”
The risks cleaning professionals assume might be easier to stomach, Vanessa says, if they were recognized publicly.
“Us housekeepers, we have families, we have health issues, we have people and animals we go home to that we could be giving this to,” Vanessa says. “The doctors and nurses have that too, but they get recognized. No one ever mentions the people who clean it up after they’re gone.”” (L)
“Nearly 70 Environmental Services workers fan out through Presbyterian Medical Center every morning to clean the hospital.
While most of America is on its first cup of coffee, the first shift of nearly 70 team members line a fluorescent hallway at 7 a.m. deep inside Presbyterian Medical Center…
Once a patient has been discharged, the workers don extra protective gear for a vigorous “terminal clean.” The room is first misted with a deep cleaning chemical to kill any virus before the crew goes in. From there, the walls and floor are disinfected and everything is stripped, with the team sweeping through on a clockwise rotation to stay organized and make sure nothing is missed. Other layers of protection concerning ventilation and air flow also come into play…
Meanwhile, little on-the-job routines keep environmental services workers going through their days as they constantly slather hand sanitizer and strip off one pair of lavender latex gloves and replace them with another while moving from room to room.” (M)
“Some large West Coast employers, including Microsoft, Google, and Facebook, have promised to pay their entire workforce, from janitor to engineers, for the duration of the Covid-19 crisis, regardless of whether or not they’re working. But not all are so lucky. The policy at Alliance Building Services, a contractor that supplies more than 750 janitors to properties around Seattle, is for employees to use regular vacation or sick days in case they fall ill with the novel coronavirus. The company has also forgone extra training or protective equipment for employees.
“It’s just a flu — a very contagious, fast-spreading flu — but it’s just a flu, so it’s easy to kill,” said Scott Smith, the principal of the company.
In a sense, he’s right, epidemiologists say: Like the coronaviruses that cause the common cold and seasonal influenza, the novel coronavirus that brings on Covid-19 is vulnerable to such standard interventions as soap, water, bleach, UV light, and alcohol-based cleaners. But once the virus gets transmitted, Covid-19 appears to have a far higher mortality rate than the seasonal flu, especially for older people or those with compromised immune systems.
Should they contract the virus, lower-income immigrant workers may also be among the most vulnerable populations, because they often struggle to access medical care and public health information in their own language, and may lack the financial resources to stock up on food and medicines. Immigration enforcement agencies have stopped making most arrests during the Covid-19 crisis, in an effort to encourage undocumented people to seek treatment if they need it.” (N)
“In response to the COVID-19 pandemic, House Education and Labor Committee Chair Rep. Bobby Scott (D-VA) and 20 other representatives are sponsoring a partisan bill that would require OSHA to issue an emergency temporary standard for health care facilities to implement comprehensive infectious disease exposure control plans.
The COVID-19 Health Care Worker Protection Act of 2020 (H.R. 6139) would direct OSHA to publish the temporary standard within 30 days.
“Although the Centers for Disease Control and Prevention issues guidance to protect health care workers, the guidance is not binding and OSHA currently has no enforceable standard to protect workers from airborne infectious diseases,” a March 10 press release from Scott’s office states, “leaving the nation’s health care workers at an elevated risk of exposure to the coronavirus at a time when they are needed most.”..
On March 5, Scott and Rep. Alma Adams (D-NC), chair of the House Workforce Protections Subcommittee, sent a letter to Secretary of Labor Eugene Scalia and acting OSHA administrator Loren Sweatt. “If health care workers are quarantined in large numbers, or get ill or die, or fear coming to work due to the risks, it’s not just a personal or workplace problem, it’s a national public health disaster,” the letter states. “OSHA is the only agency in the federal government authorized to enforce safe working conditions for the nation’s workers – including those in health care facilities.
“As we enter into what is likely to be the greatest infectious disease crisis this country has faced in over a century, it is in the national interest that OSHA be on the forefront of protecting workers essential to the country’s health care system.”
National Nurses United – the nation’s largest union and professional association of direct care registered nurses – petitioned OSHA to issue an emergency temporary standard, in a March 4 letter sent to Scalia and Sweatt.
OSHA published employer guidance on the coronavirus March 9 in collaboration with the Department of Health and Human Services. The agency also published its COVID-19 webpage in January, not long after the first documented case in the United States.” (O)
Seventy-six-year-old Paul Willis checked his mail at noon, like he does every day, and was surprised to see a piece of mail from over three decades ago. CNN reports it was a postcard from Havasu Falls, Arizona that had a photo of his younger sister Lovell — now 65 and living in California — on the other side.
It has a San Francisco postage stamp marked for December 18, 1987 and a newer stamp from Des Moines dated April 29, 2020, CNN says.
Willis reached out to his sister to thank her for the mail, according to CNN, and both were curious as to how it ended up in his mailbox this late. He then made another call to the post office.
“I asked if they had any insight and she just told me that many of the post offices were doing deep cleanings because of COVID-19 and that’s what we think had just happened,” he said. “And somebody thought enough to stick it back in the mail.”
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
