POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

POST 31. June 9, 2020. CORONAVIRUS. “I think we had an unintended consequence: I think we made people afraid to come back to the hospital,”

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And…

“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms….received$509 million in government funds… that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.”

Also…Overuse of Antibiotics. Candida auris. Ebola.

“They prepared for the worst and hoped for the best, and that was exactly what they got. That’s what Maureen Tarrant said about Presbyterian St. Luke’s Medical Center and Rocky Mountain Hospital for Children’s preparations during the novel coronavirus outbreak. Tarrant has been the CEO of the hospitals since 2014.

“Our hospital was never overwhelmed with COVID patients,” she said.

Tarrant credits the state and city leaders for taking steps early to prepare area hospitals.

“We all saw the stories of some of the more densely populated areas, such as Queens, New York,” Tarrant explained. “Colorado and Denver have not been like that.”

In turn, Tarrant said something else happened.

“I think we had an unintended consequence: I think we made people afraid to come back to the hospital,” she said.

Revenues are down at the hospital, she said. The emergency department alone has seen between a third and a half of its normal volume…

The key to a hospital rebound, according to Tarrant, is to remind people that hospitals are still safe and not as chaotic as you would think.

“If we think about celebrating the heroes and the healthcare workers, the nurses and the doctors, the last thing we would ever want is for them to suffer personally with financial consequences,” Tarrant said.” (A)

“Most hospitals and outpatient clinics have made changes designed to keep patients and staff members safe. Many are testing patients and certain workers. In many hospitals, Covid-19 patients are kept in separate units. Masks are usually mandated for both patients and clinicians. Cleaning protocols have been turbocharged. As a result, experts say, the risk of acquiring Covid-19 when going into a hospital is very low.

But one of the common safety measures — banning visitors, even close family members — is a huge reason for patients’ fear and apprehension.

“The hospital was an ominous, nerve-racking and scary place for patients even before Covid,” said Dr. Lisa VanWagner, a transplant hepatologist at Northwestern Medicine in Chicago. “Now you take a stressful situation like a pandemic and you tell people that they cannot have their normal support system while they’re in the hospital, and that really magnifies those fears.”..

Health system administrators are redoubling their efforts to convince patients that it’s safe to come into hospitals and outpatient clinics, even as testing for hospital personnel and patients remains spotty.

“Our goal is to spend almost all our marketing dollars over the next year around the safety of our institution,” said Dr. Stephen Klasko, chief executive of Jefferson Health, a 14-hospital system based in Philadelphia.” (B)

“As the virus spread, visits to emergency rooms in the United States decreased 42 percent over four weeks in April, compared to the same period in 2019, according to a new analysis released Wednesday by the C.D.C. The declines were greatest among children 14 and younger, women and in geographic areas like the Northeast.

While there were high numbers of emergency room visits because of the virus, including an increase in visits related testing for infectious diseases and for pneumonia, these were outweighed by the steep declines in visits that typically make up trips to the emergency room.

The C.D.C. also noted that there had been a recent rebound in visits, but the volume of visits remained significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with a year earlier.

The agency’s report highlights the months long decline in general hospital care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in Covid-19 patients. While hospitals have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid them….

While E.R. treatment for complaints of minor ailments were far fewer this year, agency officials pointed to a more disconcerting drop in the number of people seeking emergency care for chest pain, including those undergoing a heart attack. There were also declines in children requiring emergency help for conditions like asthma.

C.D.C. officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources.” (C)

“As the U.S. continues to battle the novel coronavirus outbreak, fears over a second wave of cases have been looming over the country.

While there is no doubt that more cases will continue to emerge in the months ahead, it’s not too late for America to prevent a second wave of COVID-19, according to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and member of the White House COVID-19 task force.

Speaking to Newsweek, Fauci says: “It’s in our hands. We can prevent a second wave if we respond to the inevitable infections we’ll see in the fall and winter…

We have four months to prevent a second wave

While many states are beginning to report a plateau in daily cases, yet more are still dealing with daily increases in new COVID-19 patients.

Fauci says whether or not these ongoing new cases will become a wave will depend on whether “we prepare ourselves from now through June, July, August and September.”

“We have four months to make sure we have in place the system, the test, the capability, the manpower to do the kind of identification, isolation and contact tracing as cases begin to reappear in the fall, because they will reappear….

“I think it’s highly unlikely that we will eradicate COVID-19. The only disease in humans that we’ve ever eradicated is smallpox. We’ve eliminated polio from many areas of the world. For example, polio is eliminated in the U.S. and U.K. and the only cases that are around are vaccine-related cases.

“So it is conceivable that we will be able to eliminate it in the sense of getting enough herd immunity together with the vaccine that we have very few cases. And certainly we can control it, and we have been getting it under some control in some areas,” Fauci says…

The novel coronavirus is more likely to be with us for another season or two, depending when a vaccine is ready, with the second season expected to be much milder than the first, especially if there is a vaccine, Fauci explains.

“If we have a vaccine by next winter, that would be a game changer but there’s no guarantee we’ll have it. But if we don’t have a vaccine, we’ll have another season of it and hopefully by the following season, we will have a vaccine.”..

Looking at the trajectory of the outbreak, could America have done anything different to fight the virus?

“Of course. Nobody’s perfect. Anybody could have done better. Look at the U.K., they were going to go for herd immunity and that backfired on them,” Fauci told Newsweek.

“If you look at the death per capita in Sweden, compared to the death per capita in other Scandinavian countries, Sweden got hit worse. I think their decision to go for herd immunity speaks for itself.

“I declared that herd immunity [as a COVID-19 combat strategy] was absurd at the very beginning here in the U.S., saying ‘Are you kidding me? Do you know how many people are gonna die if you wait for herd immunity to come in?’ So that was not a good call [in Sweden],” Fauci says.” (E)

“Even after a vaccine is discovered and deployed, the coronavirus will likely remain for decades to come, circulating among the world’s population…

“This virus is here to stay,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago. “The question is, how do we live with it safely?”

Combating endemic diseases requires long-range thinking, sustained effort and international coordination. Stamping out the virus could take decades — if it happens at all. Such efforts take time, money and, most of all, political will…

The challenge in this pandemic is few such shortcuts remain to push U.S. leaders and the public into forward-thinking actions. The CDC has been sidelined by the White House and blocked from holding public briefings. Meanwhile, the Trump administration has made clear its priority is restarting the economy.

Increasingly, leading experts believe many Americans won’t make the shift toward long-range thinking until the virus spreads more widely and affects someone they know.

“It’s like people who drive too fast. They come upon the scene of an accident, and for a little while, they drive more carefully, but soon they’re back to speeding again,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“Contrast that with people who have lost someone to drunk driving,” he said. “It mobilizes them and becomes a cause for them. Eventually, everyone is going to know someone who got infected or died from this virus.

“That’s what it may take.” (F)

Surge capacity is a hospital’s ability to adequately care for a significant influx of patients.7 Since 2011, the American College of Emergency Physicians has published guidelines calling for hospitals to have a surge capacity accounting for infectious disease outbreaks, and demands on supplies, personnel, and physical space.7 Even prior to the development of COVID-19, many hospitals faced emergency department crowding and strains on hospital capacity.8…

To prepare for the increased number of seriously and critically ill patients, individual hospitals and regions must perform a needs assessment. The fundamental disease process of COVID-19 is a contagious viral pneumonia; treatment hinges on four major categories of intervention: spatial isolation (including physical space, beds, partitions, droplet precautions, food, water, and sanitation), oxygenation (including wall and portable oxygen, nasal canulae, and masks), mechanical ventilation (including ventilator machines, tubing, anesthetics, and reliable electrical power) and personnel (including physicians, nurses, technicians, and adequate personal protective equipment).10 In special circumstances and where available, extra corporeal membrane oxygenation may be considered.10 The necessary interventions are summarized in Table 1.

Emergency, critical care, nursing, and medical leadership should consider what sort of space, personnel, and supplies will be needed to care for a large volume of patients with contagious viral pneumonia at the same time as other hospital patients. Attention should also be given to potential need for morgue expansion. Hospitals must be proactive in procuring supplies and preparing for demands on beds and physical space. Specifically, logistics coordinators should start stockpiling ventilators, oxygen, respiratory equipment, and personal protective equipment. Reallocating supplies from other regions of the hospital such as operating rooms and ambulatory surgery centers may be considered. These resources, particularly ventilators and ventilator supplies, are already in disturbingly limited supply, and they are likely to be single most important limiting factor for survival rates. To prevent regional shortages, stockpiling efforts should ideally be aided by state and federal governments. The production and acquisition of ventilators should be immediately and significantly increased.

Hospitals must additionally prepare for demands for physical space and beds. Techniques to maximize space and bed availability (see Table 2) include discharging patients who do not require hospitalization, and canceling elective procedures and admissions. Additional methods would be to utilize unconventional preexisting spaces such as hallways, operating rooms, recovery rooms, hallways, closed hospital wards, basements, lobbies, cafeterias, and parking lots. Administrators should also consider establishing field hospitals or field wards, such as tents in open spaces and nearby roads. Medical care performed in unconventional environments will need to account for electricity, temperature control, oxygen delivery, and sanitation.”  (G)

“COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic. A user of COVID-19Surge can produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support. The user can then compare those estimates with hospital capacity, using either existing capacity or estimates of expanded capacity.” (H)

Dr. Tom Frieden, the former director of the US Centers for Disease Control and Prevention, laid out “10 plain truths” about Covid-19 on Wednesday as he spoke at a House Appropriations Committee hearing on the pandemic response.

“In my 30 years in global public health, I’ve never seen anything like this,” Frieden, who now serves as president and CEO of Resolve to Save Lives, said. “It’s scary. It’s unprecedented.”

Here are the 10 truths, according to Frieden:

1. “It’s really bad” in New York City

“Even now with deaths decreasing substantially, there are twice as many deaths from Covid-19 in New York City as there are on a usual day from all other causes combined,” Frieden said…

2. It’s “just the beginning”

Frieden said as bad as things seem now, he thinks we’re still in the beginning phases of the pandemic…

3. Data is a “very powerful weapon against this virus”

Frieden explained that data being used to monitor trends can help stop clusters before they turn into outbreaks. Data, he said, can help stop outbreaks from turning into epidemics…

4. We need to “box the virus in”

While stay-at-home orders slowed the spread of the virus and flattened the curve in states such as New York and California, the virus continues to spread throughout the country with approximately 30,000 new cases a day for nearly a month….

5. We must find the balance…

The economy doesn’t have to come at the expense of public health. Dr. Frieden said it is necessary to find the balance between restarting our economy and letting the virus run rampant.

6. Protect the “frontline heroes”

“We must protect the health care workers and other essential staff, or the frontline heroes of this war,” Frieden said…

7. Protect our most vulnerable people, too

Eight out of 10 deaths reported in the US have been from adults that are 65 years old and older, according to the CDC. And people with weak immune systems and underlying conditions such as asthma, heart disease, high blood pressure or diabetes are at more risk.

8. Governments and private companies need to work together

Both government and industry must collaborate to make “massive continued investments in testing and distributing a vaccine as soon as possible,” Frieden said…

9. We must not neglect non-Covid health issues

While the coronavirus pandemic has flooded and overwhelmed many hospitals with patients across the world, people are no longer suddenly immune to other diseases and sicknesses. Many elective procedures have been canceled or postponed, and patients with other illnesses wait in fear as they put treatment on hold. Many are too scared to venture out and visit hospitals out of fear of contracting the virus.

10. Preparedness is paramount

“Never again,” Frieden said. “It is inevitable that there will be future outbreaks. It’s not inevitable that we will continue to be so underprepared.” (I)

“The good news is that we have the technology and know-how to confront and substantially mitigate these epidemics. What we have lacked is the willpower to implement this knowledge. We will have won when the following takes place:

1. When we no longer neglect stockpiling needed equipment and supplies.

2. When we have a national public reporting laboratory infrastructure for all dangerous pathogens.

3. When we have enough trained and supported infection preventionists (IPs).

4. When we have developed more respect for infectious disease.

5. When we have improved and larger physical plants to service patients.

6. When we have redundancy in our healthcare facilities.

7. When our leaders stop politicizing public health and rely on scientists to make public policy.

8. When we have healthcare, that is centered on patients and not on profits.” (J)

“Much of the rationale for the flattening of the curve, to make space for patients with the novel coronavirus. But multiple health experts say this has an unexpected second order effect — leading to Americans neglecting their health concerns, which have done anything but subside.

California was the first state to implement a mandatory stay-at-home order, opted early on to adopt a proactive approach, rather than face the risk of being overwhelmed. Los Angeles has become the epicenter of the virus, logging the highest number of cases of the state’s 58 counties,

University of California Los Angeles’ Health System, which operates four hospitals and 180 clinics in Southern California, was fully prepared to handle the surge in novel coronavirus cases, but never saw unmanageable demand, according to president Johnese Spisso, who also serves as CEO of the UCLA Hospital System….

“What we learned is the public was very frightened of hospitals and clinics. We had to do a lot of outreach education. We worked together as a hospital community in Los Angeles to educate the public and to tell them it’s time to come back for the health care they have put on pause. We were especially concerned as a tertiary medical center, reduction we saw even in our emergency departments in heart attacks and strokes. We know COVID did nothing to cure those, so we were very concerned people weren’t presenting for the care that’s needed. We very quickly began to see that as we opened back up, who really should have been coming in a lot sooner,” she said.

‘Life may be on pause. Your health isn’t.’

Earlier this month, UCLA Health teamed up with five of the largest nonprofit health care networks across Los Angeles to launch BetterTogether.Health, a campaign to encourage community members to put health first and access care when needed. 

UCLA Health, Providence, Keck Medicine of USC, Kaiser Permanente, Dignity Health and Cedars-Sinai, which collectively serve 8.4 million Angelenos, launched public service announcements with themes that include, “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part” and “Get care when you need it.”

Beyond the impact on individuals who neglected their non-coronavirus related health concerns, this fear has inevitably impacted the bottom line of hospital systems.

UCLA Hospital System was forced to tap financial reserves to close a gap of more than $85 million as of mid-May. The system, which employs 30,000 people, reported a $140 million revenue loss, which was partially offset by $55 million in federal aid, which covered about one-third of losses from March and April.

“In the month of April, we had a revenue drop that isn’t sustainable, which is why we’ve been anxious to return to our normal business of health care so that we can really meet our mission for the community. So our health system — like so many [others] in the country — has really had to weather some extreme economic losses,” she said.” (K)

“Patients’ hesitation about seeking care in the midst of a pandemic means that healthcare facilities need to work extra hard to assure them that they are taking the necessary precautions to ensure their safety…

Rush University System for Health has instituted several changes, including removing reading material from waiting rooms and providing visual cues and markings to indicate how far apart people must stand while waiting in lines and in elevators to maintain social distancing, said Dr. Ranga Krishnan, CEO of the Chicago-based system.

Tacoma, Wash.-based CHI Franciscan has increased testing and screening and requires everyone in their facility to wear masks.

“We understand that many patients are concerned and are heeding stay-at-home orders carefully. That said, it’s especially important for patients experiencing an emergency to seek care as soon as possible,” said Michael H. Anderson, MD, CHI Franciscan’s CMO. “There can be serious, long-term impacts for delaying care, and it’s essential that they come to the emergency room as soon as they can.”

Nemours Children’s Health System in Jacksonville, Fla., is directly involving patients in the conversation about returning for care. At Nemours, leaders have asked for suggestions from the families of their pediatric patients.

“It is important to directly elicit patient and family perspectives about their fears as they seek healthcare and to ask for suggestions that would increase their comfort level in doing so,” said Peggy Greco, PhD, medical director of patient experience at Nemours.

Parents have asked that specific information about screening practices, cleaning routines and patient volume restrictions be shared with them, Tina Arcidiacono, Nemours’ administrative director of patient experience said. They also wanted details about managing their safety during clinic and hospital visits.

Nemours has now made sure that all those who make contact with families are providing the information the families need, including specific processes in place to ensure their safety.” (Q)

“The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.” (S)

“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms like the Carlyle Group.

But it is not just another deep-pocketed investor hunting for high returns. It is the Providence Health System, one of the country’s largest and richest hospital chains. It is sitting on nearly $12 billion in cash, which it invests, Wall Street-style, in a good year generating more than $1 billion in profits.

And this spring, Providence received at least $509 million in government funds, one of many wealthy beneficiaries of a federal program that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.

With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled. The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.

So far, the riches are flowing in large part to hospitals that had already built up deep financial reserves to help them withstand an economic storm. Smaller, poorer hospitals are receiving tiny amounts of federal aid by comparison.

Twenty large recipients, including Providence, have received a total of more than $5 billion in recent weeks, according to an analysis of federal data by Good Jobs First, a research group. Those hospital chains were already sitting on more than $108 billion in cash, according to regulatory filings and the bond-rating firms S&P Global and Fitch. A Providence spokeswoman said the grants helped make up for losses from the coronavirus.

Those cash piles come from a mix of sources: no-strings-attached private donations, income from investments with hedge funds and private equity firms, and any profits from treating patients. Some chains, like Providence, also run their own venture-capital firms to invest their cash in cutting-edge start-ups. The investment portfolios often generate billions of dollars in annual profits, dwarfing what the hospitals earn from serving patients.

Many of these hospital groups, including Providence, are set up as nonprofits, which generally don’t have to pay federal taxes on their billions of dollars of income.

By contrast, hospitals that serve low-income patients often have only enough cash on hand to finance a few weeks of their operations.” (D)

Providence Health & Services, the $5.2 billion-a-year behemoth of Oregon health care, plans sweeping pay cuts and other cost-cutting moves that will hit doctors and other health care employees.

At least 1,800 Providence employees will be impacted by the reductions. Compensation reductions will range from 5% to 50%.

About 1,200 employees got the word late Monday that they were among those caught up in the expense reduction plans, Providence confirmed Monday evening. That’s on top of 600 other employees who got hit with mandatory furloughs or other pay reductions in May.

The more than 600 employees of the Providence Medical Group, most of them physicians, will have their compensation reduced by 10% to 17%. Physician assistants, occupational and physical therapists and others also will be subject to the cuts.

Providence officials said the pay cuts will last only through a single quarter of this year. Earlier memos suggested that the reductions could extend longer if Providence’s financial results didn’t improve. But the nonprofit confirmed Monday that salaries will be restored after three months…

The Providence doctors say privately that given their employer’s enormous financial resources, it shouldn’t need to lean on employees to stay afloat. Providence’s Oregon operation alone listed $4.7 billion in total assets at the end of 2019. More than $806 million of it was in cash and cash equivalents.” (O)

“The New York Times analyzed tax and securities filings by 60 of the country’s largest hospital chains, which have received a total of more than $15 billion in emergency funds through the economic stimulus package in the federal CARES Act.

The hospitals — including publicly traded juggernauts like HCA and Tenet Healthcare, elite nonprofits like the Mayo Clinic, and regional chains with thousands of beds and billions in cash — are collectively sitting on tens of billions of dollars of cash reserves that are supposed to help them weather an unanticipated storm. And together, they awarded the five highest-paid officials at each chain about $874 million in the most recent year for which they have disclosed their finances…

Dr. Rod Hochman, the chief executive of the Providence Health System, for instance, was paid more than $10 million in 2018, the most recent year for which records are available. Providence received at least $509 million in federal bailout funds.

A spokeswoman, Melissa Tizon, said Dr. Hochman would take a voluntary pay cut of 50 percent for the rest of 2020. But that applies only to his base salary, which in 2018 was less than 20 percent of his total compensation.” (Q)

“HHS announced June 9 that it is making additional distributions from the provider relief fund created under the Coronavirus Aid, Relief and Economic Security Act.

3. HHS is distributing an additional $10 billion to safety-net hospitals. To qualify, hospitals must have average uncompensated care per bed of at least $25,000, profitability of 3 percent or less and a Medicare Disproportionate Payment Percentage of 20.2 percent or greater.

4. The payments to safety-net hospitals will occur this week, and each hospital will receive between $5 million and $50 million, HHS said.” (R)

__________________________

“With few treatment options, doctors turned to a familiar intervention: broad-spectrum antibiotics, the shot-in-the dark medications often used against bacterial infections that cannot be immediately identified. They knew antibiotics were not effective against viruses, but they feared the patients could be vulnerable to life-threatening secondary bacterial infections.

“During the peak surge, our antibiotic use was off the charts,” said Dr. Teena Chopra, the hospital’s director of epidemiology and antibiotic stewardship. She and other doctors across the United States who liberally dispensed antibiotics in the early weeks of the pandemic said they soon realized their mistake.

Now, doctors nationwide are seeking to draw lessons from their overuse of antibiotics, a practice that can spur resistance to lifesaving drugs as bacteria mutate and outsmart the drugs. Antimicrobial resistance is a mounting threat that claims 700,000 lives annually — a global health crisis that has been playing out in slow motion behind the scenes while the coronavirus took center stage.

In recent weeks, public health experts have been warning that the same government inaction that helped foster the rapid spread of the coronavirus could spur an even deadlier epidemic of drug-resistant infections. The United Nations warns such an epidemic could kill 10 million by 2050 if serious action is not taken.

The pipeline for new antimicrobial drugs has become perilously dry. Over the past year, three American antibiotic developers with promising drugs have gone out of business, and most of the world’s pharmaceutical giants have abandoned the field.

Legislation in Congress to address the broken antibiotics marketplace has failed to gain traction in recent years, but public health experts are hoping the coronavirus pandemic can help break the political logjam in Washington.” (L)

“A fresh outbreak of the deadly Ebola virus has flared up in the Democratic Republic of Congo, a country that was already contending with the world’s largest measles epidemic, as well as the coronavirus.

Congo’s health ministry said that the new Ebola outbreak has killed four people, and infected at least two more, in Mbandaka, a city of 1.2 million people on the country’s western side. A fifth person died on Monday, according to UNICEF, the United Nations agency for children.

Less than two months ago, Congo was about to declare an official end to an Ebola epidemic on the eastern side of the country that had lasted nearly two years and killed more than 2,275 people. Then, with just two days to go, a new case was found, and the outbreak could not be declared over. But officials say it is in its final stages.

It is unclear how Ebola emerged in Mbandaka, which is about 750 miles west of the nearly-vanquished outbreak on the country’s eastern edge. Congo (formerly known as Zaire) is the largest country in sub-Saharan Africa, and has been under travel restrictions to prevent the spread of the coronavirus.” (M)

“Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. Currently, C. auris cases have been reported globally from >30 countries. Most reported infections involve critically ill patients in hospitals, mainly in intensive care unit settings. Infection with C. auris is associated with high mortality rates, and it is often resistant to multiple classes of antifungal drugs. Despite the rapid global spread, it is difficult to predict the actual burden of the infection as the standard laboratory methods fail to correctly identify the fungi. Longer stays in healthcare facilities, use of tracheostomies and percutaneous endoscopic gastrostomy tubes, ventilators in clinical care units and mobile equipment in healthcare settings are shown as major risk factors of C. auris infection. Due to its propensity to cause outbreaks and its antifungal resistance, C. auris poses a risk for patients in healthcare facilities. The emergence of pan-resistant C. auris strains in some areas is an alarming signal for the disease with limited treatment options, high mortality rates, and the ability of the pathogen to spread easily in healthcare settings. In this regard, susceptibility testing on clinical isolates, mainly for patients treated with echinocandins, is needed. Increasing awareness about C. auris infection and advancing the diagnostic methods are also essential for early detection and control of the deadly fungal infection.” (N)

• A.’Revenues are way down’: Colorado hospital CEO talks about the hidden financial effects of COVID-19, By: Eric Lupher, https://www.thedenverchannel.com/news/local-news/revenues-are-way-down-colorado-hospital-ceo-talks-about-the-hidden-financial-effects-of-covid-19
• B.Fear of Covid-19 Leads Other Patients to Decline Critical Treatment, By Katie Hafner, https://www.nytimes.com/2020/05/25/health/coronavirus-cancer-heart-treatment.html?referringSource=articleShare
• C.U.S. emergency room visits plunged, raising concerns about the care for people with serious conditions., https://www.nytimes.com/2020/06/03/world/coronavirus-live.html?referringSource=articleShare#link-7a483401
• D.Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers, By Jesse Drucker, Jessica Silver-Greenberg and Sarah Kliff, https://www.nytimes.com/2020/05/25/business/coronavirus-hospitals-bailout.html?referringSource=articleShare
• E.Dr. Anthony Fauci on How America Can Avoid a Second Wave of the Coronavirus, by Soo Kim, https://www.msn.com/en-us/health/medical/dr-anthony-fauci-on-how-america-can-avoid-a-second-wave-of-the-coronavirus/ar-BB14FQpn?ocid=msnews
• F.Coronavirus may never go away, even with a vaccine, by  William Wan, Carolyn Y. Johnson, https://www.msn.com/en-us/news/us/coronavirus-may-never-go-away-even-with-a-vaccine/ar-BB14GlDs?ocid=msnews
• G.COVID-19 and surge capacity in U.S. hospitals, by Adam Blumenberg, Matt Noble, And Robert G. Hendrickson, https://www.the-hospitalist.org/hospitalist/article/220527/coronavirus-updates/covid-19-and-surge-capacity-us-hospitals
• H.COVID-19 Surge, https://www.cdc.gov/coronavirus/2019-ncov/hcp/COVIDSurge.html
• I.These are the ’10 plain truths’ about the coronavirus pandemic, according to former CDC Director Dr. Tom Frieden, By Allen Kim and Amanda Watts, https://www.cnn.com/2020/05/06/health/cdc-coronavirus-truths-trnd/index.html
• J.We’ll Know We’ve Won the War Against COVID-19 When…, by Kevin Kavanagh, https://www.infectioncontroltoday.com/covid-19/well-know-weve-won-war-against-covid-19-when
• K.People have been ‘frightened to go back to hospitals and clinics’: UCLA Hospital System CEO, by Melody Hahm, https://finance.yahoo.com/news/ucla-hospital-system-ceo-people-have-been-frightened-to-go-back-to-hospitals-and-clinics-120315388.html
• L.Overusing antibiotics early in the pandemic could spur resistance to lifesaving drugs., https://www.nytimes.com/2020/06/04/world/coronavirus-us-update.html?referringSource=articleShare
• M.New Ebola Outbreak in Congo, Already Hit by Measles and Coronavirus, By Ruth Maclean, https://www.nytimes.com/2020/06/01/world/africa/ebola-outbreak-congo.html
• N.Candida auris: From Multidrug Resistance to Pan-Resistant Strains, by Muluneh Ademe and Friehiwot Girma, https://pubmed.ncbi.nlm.nih.gov/32440165/
• O.Impact of COVID-19 leads to more pay cuts at Providence, restructuring at Salem Health, By Jeff Manning, https://www.oregonlive.com/coronavirus/2020/06/health-care-workers-at-providence-salem-health-face-pay-cuts-furloughs-reorganization.html
• P.Moving toward a ‘new normal’: How hospitals are convincing patients it’s safe to come back, by Anuja Vaidya, https://www.beckershospitalreview.com/patient-experience/moving-toward-a-new-normal-how-hospitals-are-convincing-patients-it-s-safe-to-come-back.html
• Q.HCA Healthcare, based in Nashville, received about $1 billion in federal bailout funds, part of an effort to stabilize hospitals during the pandemic., by By Jessica Silver-Greenberg, Jesse Drucker and David Enrich, https://www.nytimes.com/2020/06/08/business/hospitals-bailouts-ceo-pay.html?referringSource=articleShare
• R.HHS to dole out $35B in CARES Act funds: 6 things to know, by Ayla Ellison, https://www.beckershospitalreview.com/finance/hhs-to-dole-out-35b-in-cares-act-funds-6-things-to-know.html
• S.How Many More Will Die From Fear of the Coronavirus?, By Tomislav Mihaljevic and Gianrico Farrugia, https://www.nytimes.com/2020/06/09/opinion/coronavirus-hospitals-deaths.html
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Prequels

PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…

EBOLA. PART 13. Ebola Treatment Centers are having difficulty maintaining their ability to respond to Ebola cases that may come again to the U.S.