…The information provides nationwide data on hospital capacity and bed use at a hospital-by-hospital level…
The dataset — which includes capacity reporting from hospitals in 2,200 counties in the U.S. — spotlights areas where hospitals are getting dangerously full. In 126 counties, the average hospital is at least 90% occupied, according to an analysis of the data by the COVID-19 Hospitalization Tracking Project. The states with the most counties above this threshold are Kentucky, Georgia, Minnesota, Oklahoma and Texas.
Hospitals both large and small are feeling the strain, the data show. In Texas, for example, both the Memorial Hermann Hospital System, with its 250 beds, and the Hereford Regional Medical Center, with its 31 beds, were above 90% capacity in the past week.
Previously, with only state-level data available, it was hard for health leaders and researchers to identify regional hot spots. The new data show where individual hospitals are being overwhelmed, even when a state overall isn’t at crisis levels…
The dataset, uploaded to Healthdata.gov, provides a weekly snapshot of how COVID-19 is impacting individual hospitals across the country, including the number of COVID-19 patients admitted to the hospital and the number of severely ill patients requiring intensive care. The information dates back to July 31. Going forward, the data is expected to be updated each week.” (A)
“It focuses on one important metric — how many beds are filled with COVID-19 patients — and shows this for each hospital and on average for each county.
The ratio of COVID-19 hospitalizations to total beds gives a picture of how much strain a hospital is under. Though there’s not a clear threshold, it’s concerning when that rate rises above 10%, hospital capacity experts told NPR.
Anything above 20% represents “extreme stress” for the hospital, according to a framework developed by the Institute for Health Metrics and Evaluation at the University of Washington.
If that figure gets to near 50% or above, the stress on staff is immense. “It means the hospital is overloaded. It means other services in that hospital are being delayed. The hospital becomes a nightmare,”….
The University of Minnesota’s analysis shows that there are 55 counties where the hospital average has reached that rate.” (B)
To find data on a hospital highlight and click on this link, then on the map roll the cursor over the state of interest until you locate the county – hospital specific data will appear below the map.
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!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
POST 87. December 10, 2020. CORONAVIRUS. “…Rudolph W. Giuliani, the latest member of President Trump’s inner circle to contract Covid-19, has acknowledged that he received at least two of the same drugs the president received. He even conceded that his “celebrity” status had given him access to care that others did not have.”
“Ben Carson, Chris Christie and Donald J. Trump are not the sturdiest candidates to conquer the coronavirus: older, in some cases overweight, male and not particularly fit. Yet all seem to have gotten through Covid-19, and all have gotten an antibody treatment in such short supply that some hospitals and states are doling it out by lottery….
Mr. Giuliani’s candid admission once again exposes that Covid-19 has become a disease of the haves and the have-nots. The treatment given to Mr. Trump’s allies is raising alarms among medical ethicists as state officials and health system administrators grapple with gut-wrenching decisions about which patients get antibodies in a system that can only be described as rationing.
“We should not have Chris Christie and Ben Carson — and in the case of Carson with intervention by the president — get access,” said Arthur Caplan, a medical ethicist who works with drug companies on how to ration scarce medicines, referring to the secretary of housing and urban development’s admission that the president “cleared” him for the therapy. “That is not the way to secure public support for difficult rationing systems.”..
In an interview on Wednesday, one prominent businessman, who spoke on condition of anonymity to avoid harming his reputation, described his aggressive efforts to track down the Regeneron treatment — including calling friends who were hospital executives and hospital donors — after he tested positive last week.
Eventually he was directed to an emergency room in his city, which was expecting him. He was given an infusion of the drug on Monday. He is feeling much better, he said….
Once state and local health agencies determine which hospitals or medical facilities should get the drugs, they are shipped out by a third-party distributor. Then it is up to health care providers to figure out what to do with them. Dr. Peter L. Slavin, the president of Massachusetts General Hospital, said in an interview Tuesday that access there would be by lottery.
“The notion that we are going to be able to treat a significant percentage of the people who qualify for the drug with the drug — it’s not going to happen,” he said.” (A)
(October, 2020)
“As the symptoms of Covid-19 took hold, President Trump got an infusion of an experimental antibody cocktail and was whisked by helicopter to Walter Reed National Military Medical Center. When his oxygen levels dipped, he was quickly put on a steroid normally given to patients with severe cases of the disease. At every step of the way, the president has had a team of expert physicians carefully monitoring his care.
That experience is a world away from the stressful waiting game most patients wade through after a positive test.
They are told to stay home and monitor their symptoms. If they do become severely ill, there is only a remote chance they will get access to the antibody cocktail, which was developed by Regeneron Pharmaceuticals and is being tested in clinical trials. The company said Monday that the president was among fewer than 10 people who have gotten access to the drug through a compassionate use program.
“Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Lakshman Swamy, an ICU physician at Cambridge Health Alliance in Massachusetts.
If the president’s privileged treatment is understandable given his prominence, the contrast is no less stark for millions of Americans who have faced down Covid-19 in their homes or local hospitals, where barriers to cutting-edge care do not simply melt at the mere mention of their names or job titles.
“That’s the most heartbreaking thing about this virus,” Josh Barocas, an infectious disease physician at Boston Medical Center, a safety-net hospital that treats a largely underserved population. “A portion of the people who are severely symptomatic don’t have access to health care … and they are the population that is just being decimated by this.”
In many ways, it’s not a disparity that’s exclusive to Trump. High-profile individuals — in particular, professional athletes — have had frequent access to testing with fast-turnaround results. For much of the rest of the population, however, confirming a case of Covid-19 has meant waiting in line for a test, and waiting even longer for results.
Many patients are worried about losing their jobs because of a positive test, or afraid to go into the hospital because no one else will be available to care for their children if they’re admitted. So they stay home and try to ride it out.
For ordinary patients, there is no such thing as a precautionary hospitalization. Unlike the president, they would not be admitted based on concerns about what could happen if they are not in close proximity to doctors and state-of-the art equipment. They are only hospitalized if signs of severe infection emerge…
But ordinary patients don’t necessarily get the everything-but the-kitchen sink care received by the president. In addition to remdesivir and the antibody cocktail, the president’s physicians have also said he was given the steroid dexamethasone after a temporary drop in his oxygen levels. It is unclear whether the president was actually sicker than his doctors had portrayed at that point. But for most patients, the steroid is only given if they are severely ill and already on a ventilator or otherwise receiving supplemental oxygen.” (B)
“The medical team in charge of Trump’s care have prescribed the President an experimental antibody cocktail, an antiviral drug, and a steroid usually administered to patients with severe cases of COVID-19. The comprehensive nature of Trump’s treatments and the conflicting reports about his health have led medical experts to raise concerns about a new risk: “VIP syndrome.”
“VIP syndrome,” coined in 1964 by Walter Weintraub, a doctor at the University of Maryland School of Medicine, describes a phenomenon in which the medical treatment of a famous, powerful, or influential patient—a very important person, or VIP—faces challenges caused by the person’s fame, power, or influence.
Doctors might make decisions they wouldn’t normally make because they are more willing to accede to the famous person’s demands or are more concerned than usual that the VIP avoids feeling pain or recovers quickly.
“[VIP syndrome] often pressures the health care team to bend the rules by which they usually practice medicine,” according to a 2011 paper in the Cleveland Clinic Journal of Medicine.
Complications can arise when doctors embark on medical treatments that diverge from the standard course of care that may turn out to be detrimental to the patient’s health.
“A VIP draws special attention based on his or her status in society and level of importance as perceived by the health care professional providing treatment,” according to a 2007 article in the peer-reviewed medical journal Intensive Care Medicine. “The special handling of the VIP patient…induces the potential for inappropriate and ineffective care.”
To be clear, there is no firm evidence that VIP syndrome is a factor in the President’s care, but experts have offered it as a possible explanation for the mixed messages from Trump’s medical team.” (C)
“So overall I think the care of President Trump raises many questions. One, it’s possible he’s a whole lot sicker than what we’re led to believe, or he’s had this virus for longer than we think he has. But the other possibility is that he is receiving VIP Medicine, which means more drugs sooner and new combinations. And it sounds like that ought to be better for patients, but so often it isn’t, and it can be detrimental.
So I’m concerned for the president, I’m concerned for his medical care. And I guess I’m concerned about the message that it sends to the broader public. That just because there are therapies that might work doesn’t mean that we know that they do work. And potentially there’s a reason why we’re not offering a bunch of therapies to someone who still has the odds in his favor. Because even though he’s 74, and even though he’s overweight, most people who fit those criteria with SARS-COV-2 do fully recover. And that’s not a situation where you want to try kitchen sink medicine, that’s a situation where you want to stick to well accepted evidence based practices.
It’s one thing to go with the expanded access route when someone’s on death’s door. It’s another thing entirely to do it early when somebody has the odds on his side of doing well. So VIP Medicine, it isn’t always what’s best for people. And I think the president’s case may be an example of that.” (D)
“You are a bioethics fellow at a major hospital. How are VIPs treated differently than the rest of us? Lecturer Joseph Dunne
Medical centers try and do the same things they always do when anyone comes in—which is to provide the best medically indicated care possible for the patient at hand.
I can assure you that hospitals don’t have super-secret machines hidden in the back or technology saved for just such people! The only difference in treatment, if there is any, comes instead with more practical measures like locking or restricting the patient’s chart access—to protect against snoopers and gossipers—and providing additional security personnel to protect the vulnerable patient.
What are the ethical pressures physicians face when treating VIPs?
It’s this scenario: “Doctors save lives. So when we bring you our VIP, you should save their life, right? Don’t you know how important they are!?”
I am not a physician, but there seems to be an intense pressure facing the physician treating the VIP to “do everything possible” and simply make them well again because of how necessary or integral they are to the function of whatever important institution(s) they are connected with.
Do these pressures change the medically indicated care plan?
Pressures typically apply to not-purely-medical things like requests for the most experienced medical personnel, access to window rooms (or requests against them so no one can see in) and heightened 24/7 monitoring. Pressures to treat VIPs don’t typically affect what is medically indicated—if at all.
If a prominent person comes in for a myocardial infarction (heart attack), then they will be treated, medically speaking, in the same way as other patients suffering from that issue. That’s because there’s not much that can be done outside of routine medically indicated care for the issue….
The only deviation from this general trend is when the medical care may involve novel treatments, meaning not yet approved by the FDA, for novel conditions—for example, new treatments for COVID-19. Where there is no clear routine or medically indicated care yet, physicians will typically exercise their best judgment under the developing umbrella of justifiable treatment options — some of which can be more or less risky, more or less efficacious, and more or less scarce. Physicians would most likely begin by utilizing the less risky, more efficacious and less scarce options and see if those work first.
In philosophy, people are considered morally equal. So why does a VIP get scarce COVID treatment when my grandma doesn’t?
The worry is that social inequality, in some sense, trumps—pun not intended—medical equality. Is this justified or is it a moral calamity?
Here’s one reason to think that it’s not unjustified: Suppose a hospital system gets a limited supply of COVID vaccines and has to figure out how to distribute them. Who should get them first? You might think that we should give them to people based purely on who is the most vulnerable (older, obese, etc.). But most hospitals won’t distribute the vaccine like this — in fact, they have been recommended not to by the NIH and CDC via the National Academies of Sciences, Engineering and Medicine.
Instead, hospitals will likely give those scarce vaccines to their own staff who work primarily with COVID patients, with their most vulnerable employees getting the vaccine first…” (E)
“In a video shot moments after his return, Trump addressed the American people as if he had already beat the disease. “Don’t let it dominate you,” he said, not wearing a mask, despite almost certainly still being infectious. “Don’t be afraid of it, you’re going to beat it, we have the best medical equipment, we have the best medicine.”
Trump has certainly had the most advanced medicine. He was treated with at least three drugs – an experimental monoclonal antibody from Regeneron, antiviral remdesivir and steroid dexamethasone – which are usually reserved for patients with “severe” Covid-19 or a “life-threatening” condition.
Average Americans will not have access to Regeneron’s antibody cocktail, and certainly not at the dose Trump took, which was three times greater than what is being studied. Regeneron’s chief scientific officer, George Yancopoulos, acknowledged this special treatment.
“If I had to treat one patient, I’d give the high dose,” Yancopoulos said, according to Science magazine. “From a societal point of view and the need to treat as many people as possible, I’d give the lower dose.”
Remdesivir has been in short supply for months. It only became available for hospitals to buy from the distributor, rather than the US government, the same day Trump is believed to have received his first positive Covid-19 test. Dexamethasone is normally reserved only for severely ill patients.
All of this special treatment underlines the inequality in America’s medical system – regular people have to jump through bureaucratic hoops and pay exorbitant prices for healthcare. But special treatment is not necessarily healthy for the patient it is bestowed on either.
Doctors at the Cleveland Clinic, where the institution’s academic esteem attracts royalty and political luminaries from around the world, set out principles to care for VIP’s. The first one is “don’t bend the rules” of clinical practice.
“In other words, suspending usual practice when caring for a VIP patient can imperil the patient,” wrote the group of physicians. Cleveland Clinic doctors continued: “Usually, the VIP is relieved if the physician states explicitly, ‘I am going to treat you as I would any other patient.’”” (F)
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!
POST 30. June 3,202. CORONAVIRUS. “The wave of mass protests across the United States will almost certainly set off new chains of infection for the novel coronavirus, experts say….
Post 32. June 16, 2020. CORONAVIRUS. Could the Trump administration be pursuing herd immunity by “inaction”? “ If Fauci didn’t exist, we’d have to invent him.”
POST 34. June 26, 2020. CORONAVIRUS. CDC Director Redfield… “the number of coronavirus infections…could be 10 times higher than the confirmed case count — a total of more than 20 million.” As Florida, Texas and Arizona become eipicenters!
POST 35. June 29, 2020. CORONAVIRUS. Pence: “We slowed the spread. We flattened the curve. We saved lives..” While Dr. Fauci “warned that outbreaks in the South and West could engulf the country…”
POST 36. July 2, 2020. CORONAVIRUS. “There’s just a handful of interventions proven to curb the spread of the coronavirus. One of them is contact tracing, and “it’s not going well,” (Dr. Anthony Fauci)..
POST 37. June 8, 2020. CORONAVIRUS. When “crews arrive at a hospital with a patient suspected of having COVID-19, the hospital may have a physical bed open for them, but not enough nurses or doctors to staff it.”
POST 38. July 15, 2020. CORONAVIRUS. Some Lessons Learned, or not. AdventHealth CEO Terry Shaw: I wouldn’t hesitate to go to Disney as a healthcare CEO — based on the fact that they’re working extremely hard to keep people safe,” (M)
POST 39. July, 23,2020. CORONAVIRUS. A Tale of Two Cities. Seattle becomes New York (rolls back reopening) while New York becomes Seattle (moves to partial phase 4 reopening)
POST 40. July 27, 2020. CORONAVIRUS.” One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
POST 41. August 2, 2020. CORONAVIRUS. “Whenever a vaccine for the coronavirus becomes available, one thing is virtually certain: There won’t be enough to go around. That means there will be rationing.”
POST 44. September 1, 2020. CORONAVIRUS. “The CDC…modified its coronavirus testing guidelines…to exclude people who do not have symptoms of Covid-19.” (While Dr. Fauci was undergoing surgery.) A White House official said: “Everybody is going to catch this thing eventually..”
POST 45. September 9, 2020. CORONAVIRUS. Trump on Fauci. ‘You inherit a lot of people, and you have some you love, some you don’t. I like him. I don’t agree with him that often but I like him.’
POST 46. September 17, 2020. CORONAVIRUS. “Bill Gates used to think of the US Food and Drug Administration as the world’s premier public-health authority. Not anymore. And he doesn’t trust the Centers for Disease Control and Protection either….”
POST 47. September 24, 2020. CORONAVIRUS. “Perry N. Halkitis, dean of the School of Public Health at Rutgers University…called New York City’s 35 percent rate for eliciting contacts “very bad.” “For each person, you should be in touch with 75 percent of their contacts within a day,” he said”
POST 48. October 1, 2020. “…you can actually control the outbreak if you do the nonpharmaceutical interventions (social distancing and masks). In the United States we haven’t done them. We haven’t adhered to them; we’ve played with them.” (A)
POST 49. October 4, 2020. CORONAVIRUS. RAPID RESPONSE. “The possibility that the president and his White House entourage were traveling superspreaders is a nightmare scenario for officials in Minnesota, Ohio, New Jersey and Pennsylvania…”
POST 50. October 6, 2020. CORONAVIRUS. Monday October 5th will go down as one of the most fraught chapters in the history of American public Health (and national security).
POST 51. October 12, 2020. Rather than a hodge-podge of Emergency Use Authorizations, off-label “experimentation”, right-to-try arguments, and “politicized” compassionate use approvals maybe we need to designate REGIONAL EMERGING VIRUSES REFERRAL CENTERS (REVRCs).
POST 52. October 18, 2020. ZIKA/ EBOLA/ CANDIDA AURIS/ SEVERE FLU/ Tracking. “… if there was a severe flu pandemic, more than 33 million people could be killed across the world in 250 days… Boy, do we not have our act together.” —”- Bill Gates. July 1, 2018
POST 54. October 22, 2020. CORONAVIRUS. POST 54A. New Jersey’s Coronavirus response, led by Governor Murphy and Commissioner of Health Persichilli started with accelerated A+ traditional, evidence-based Public Health practices, developed over years of experience with seasonal flu, swine flu, Zika, and Ebola.
POST 55. October 26, 2020. CORONAVIRUS. The Testing Conundrum: “ It’s thus very possible to be antigen negative but P.C.R. positive, while still harboring the virus in the body..”
POST 57. November 3, 2020. CORONAVIRUS. Dr. Deborah Birx: the US is entering its “most deadly phase” yet, one that requires “much more aggressive action,”
POST 58. November 4, 2020. CORONAVIRUS. “…the president has largely shuttered the White House Coronavirus Task Force and doubled down on anti-science language…”
POST 59. November 5, 2020. Coronavirus. “The United States on Wednesday recorded over 100,000 new coronavirus cases in a single day for the first time since the pandemic began..
POST 61. November 7, 2020. CORONAVIRUS. “Joe Biden’s top priority entering the White House is fighting both the immediate coronavirus crisis and its complex long-term aftermath…” “Here are the key ways he plans to get US coronavirus cases under control.”
POST 62. November 8, 2020. CORONAVIRUS. “The United States reported its 10 millionth coronavirus case on Sunday, with the latest million added in just 10 days,…”
POST 63. November 9, 2020. CORONAVIRUS. “New York City-based Mount Sinai Health System has opened a center to help patients recovering from COVID-19 and to study the long-term impact of the disease….”
POST 64. November 10, 2020. CORONAVIRUS. “It works! Scientists have greeted with cautious optimism a press release declaring positive interim results from a coronavirus vaccine phase III trial — the first to report on the final round of human testing.”
POST 65. November 11, 2020. CORONAVIRUS, “The Centers for Disease Control and Prevention took a stronger stance in favor of masks on Tuesday, emphasizing that they protect the people wearing them, rather than just those around them…
POST 66. November.12, 2020. CORONAVIRUS.”… as the country enters what may be the most intense stage of the pandemic yet, the Trump administration remains largely disengaged.”… “President-elect Biden has formed a special transition team dedicated to coordinating the coronavirus response across the government…”
POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”
POST 68. November 14, 2020. CORONAVIRUS. The CDC “now is hewing more closely to scientific evidence, often contradicting the positions of the Trump administration.”..” “A passenger aboard the first cruise ship to set sail in the Caribbean since the start of the pandemic has tested positive for coronavirus..”
POST 69. November 15, 2020. CORONAVIRUS. “Colorado Gov. Jared Polis will issue a new executive order outlining steps hospitals will need to take to ready themselves for a surge in COVID-19 hospitalizations and directing the hospitals to finalize plans for converting beds into ICU beds, adding staffing and scaling back on or eliminating elective procedures….
POST 70. November 16, 2020. CORONAVIRUS. “White House coronavirus task force member Dr. Atlas criticized Michigan’s new Covid-19 restrictions..urging people to “rise up” against the new public health measures.
POST 71. November 17, 2020. CORONAVIRUS. ”Hospitals overrun as U.S. reports 1 million new coronavirus cases in a week.” “But in Florida, where the number of coronavirus infections remains the third-highest in the nation, bars and schools remain open and restaurants continue to operate at full capacity.”
POST 72. November 18, 2020. CORONAVIRUS. “The Health and Human Services Department will not work with President-elect Joe Biden’s (PANDEMIC) team until the General Services Administration makes a determination that he won the election,….”
POST 73. November 19, 2020. CORONAVIRUS. “…officials at the CDC…urged Americans to avoid travel for Thanksgiving and to celebrate only with members of their immediate households…” When will I trust a vaccine? to the last question I always answer: When I see Tony Fauci take one….”
POST 74. November 20, 2020. CORONAVIRUS. Pfizer…submitted to the FDA for emergency use authorization for their coronavirus vaccine candidate. —FDA issued an EUA for the drug baricitinib, in combination with remdesivir, as WHO says remdesivir doesn’t do much of anything.
POST 75. November 21, 2020. CORONAVIRUS. “The president and CEO of one of the nation’s largest non-profit health systems says he won’t be wearing a mask at work because he’s recovered from COVID-19, and doing so would only be a “symbolic gesture” because he considers himself immune from the virus….
POST 76. November 23, 2020. CORONAVIRUS. “No battle plan survives contact with the enemy.” Ventilators..”just keep people alive while the people caring for them can figure out what’s wrong and fix the problem. And at the moment, we just don’t have enough of those people.”
POST 77. November 26, 2020. CORONAVIRUS. Pope Francis: “When I got really sick at the age of 21, I had my first experience of limit, of pain and loneliness.”.. “….Aug. 13, 1957. I got taken to a hospital…”….” I remember especially two nurses from this time.”…” They fought for me to the end, until my eventual recovery.”
POST 78. November 27, 2020. CORONAVIRUS. “Kelby Krabbenhoft is no longer president and CEO of Sioux Falls, S.D.-based Sanford Health.” “…for not wearing a face covering… “ because “He considered himself immune from the virus.”
POST 79. November 28, 2020. CORONAVIRUS. Mayo Clinic. “”Our surge plan expands into the garage…”..””Not where I’d want to put my grandfather or my grandmother,” … though it “may have to happen.”
POST 81. December 1, 2020. CORONAVIRUS. “Dr. Atlas, … who espoused controversial theories and rankled government scientists while advising President Trump on the coronavirus pandemic, resigned…”
POST 82. December 3, 2020. CORONAVIRIUS. The NBA jumped to the front of the line for Coronavirus testing….while front line nurses often are still waiting. Who will similarly “hijack” the vaccine?
POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
POST 85. December 7, 2020. CORONAVIRUS. “…Florida, Gov. DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced..”.. “NY Gov. Cuomo said…the state will implement a barrage of new emergency actions..”… Rhode Island and Massachusetts open field hospitals… “Biden Names Health Team to Fight Pandemic”
POST 86. December 9, 2020. If this analysis seems a bit incomprehensible it is because “free Coronavirus test” is often an oxymoron! with charges ranging from as little as $23 to as much as $2,315… Laws (like for free Coronavirus tests) are Like Sausages. Better Not to See Them Being Made. (Please allow about 20 seconds for the text to download. Thanx!)
Federal law requires health insurers to cover the costs of enrollees’ coronavirus tests, but some insurers are reporting that those costs vary among states, labs, and providers—with charges ranging from as little as $23 to as much as $2,315…
FDA has approved more than 90 manufacturers’ tests for the new coronavirus, and health insurers are reporting that the amount they are charged for those tests can vary widely.
According to the New York Times’ “The Upshot,” most providers charge insurers between $50 and $200 for the tests, and an analysis of Castlight Health data on almost 30,000 bills for coronavirus tests found that 87% of the tests’ costs were listed as $100 or less….
LabCorp, one of the largest diagnostic testing companies in the United States, has said it bills insurers $100 for coronavirus tests, which is the reimbursement amount that CMS has set for coronavirus tests covered by Medicare…
For instance, Blue Cross and Blue Shield of Texas has gotten more than 600 bills listing out-of-network charges for coronavirus tests as more than $500, with the average costs of those charges at $1,114, “The Upshot” reports. In addition, insurers have flagged that a chain of EDs in Oklahoma and Texas have charged them $500 to $990 for coronavirus tests, according to “The Upshot.”..
“If you are an out-of-network lab, you can name your price,” said Loren Adler, an associate director at the U.S.C.-Brookings Schaeffer Initiative for Health Policy. “I could say it’s $50,000, and you are required to pay me that amount.”
Although the federal government has largely protected patients from being charged for coronavirus tests directly, Americans may wind up paying for the tests in the form of higher insurance premiums, “The Upshot” reports.
Further, labs and providers could perform additional tests intended to diagnose respiratory illnesses, such as the flu, while also testing for the new coronavirus, and charges for those tests could be passed along to patients via their co-payment requirements or deductibles.
In addition, Americans enrolled in private individual health plans or employer-sponsored coverage may be required to cover some costs for the coronavirus tests via their copay or deductible requirements, though many insurers have announced that they will not pass costs for coronavirus testing and care along to their members—at least temporarily, USA Today reports.” (A)
“Some cities, such as Washington, D.C. are offering free coronavirus testing for people who’ve attended protests. Where free tests aren’t available, some people may find insurance refuses to cover precautionary testing.
In the wake of the massive turnout at anti-racism demonstrations around the country, public health officials are encouraging protesters to get tested for the coronavirus. As purely precautionary testing has become more common, some insurance companies are arguing they can’t just pay for everyone who’s concerned about their risk to get tested…
The Families First Coronavirus Response Act passed by Congress requires health plans to fully pay for testing deemed “medically necessary.” But as testing expands enough to allow people without symptoms to be tested, a gray area is beginning to appear.
The coverage mandate can be up to interpretation.
“This is a very live and active debate right now,” says health policy research professor Sabrina Corlette of Georgetown University.
“That requirement may only apply if you’ve been referred for a test by a health care professional after presenting with symptoms of the disease,” she says.
The guidance from the Centers for Medicare and Medicaid Services says full coverage is required “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”…
The Equal Employment Opportunity Commission has issued guidance saying employers can legally require testing. Still, most businesses aren’t taking their coronavirus precautions that far. Employment attorneys say they’re settling for temperature checks and questionnaires about symptoms and exposures.
But at least one industry is already staring down this dilemma of who pays — long-term care. Nursing home staffers in many states are required to be tested every week. In New York, it’s twice a week, and health plans are beginning to balk.
One-time testing wouldn’t be that big of an expense, though even that would add up across hundreds of employees at roughly $100 per test…
Public health researchers emphasize the importance of regularly testing nursing home residents and employees, as well as other asymptomatic, but high-risk people, and making testing available to people who may have been exposed at events like protests. This can help catch undetected disease and stop it from spreading in a community.
Many cities are offering to fund the precautionary tests for people who’ve attended protests. Still these free tests aren’t available everywhere and since most states are not yet paying for testing (though Tennessee is) many people are left relying on their private insurance.” (B)
“As she waited for the results of her rapid COVID-19 test, Rachel de Cordova sat in her car and read through a stack of documents given to her by SignatureCare Emergency Center.
Without de Cordova leaving her car, the staff at the freestanding emergency room near her home in Houston had checked her blood pressure, pulse and temperature during the July 21 appointment. She had been suffering sinus stuffiness and a headache, so she handed them her insurance card to pay for the $175 rapid-response drive-thru test. Then they stuck a swab deep into her nasal cavity to obtain a specimen.
De Cordova is an attorney who specializes in civil litigation defense and maritime law. She cringes when she’s asked to sign away her rights and scrutinizes the fine print. The documents she had been given included disclosures required by recent laws in Texas that try to rein in the billing practices of stand-alone emergency centers like SignatureCare. One said that while the facility would submit its bill to insurance plans, it doesn’t have contractual relationships with them, meaning the care would be considered out-of-network. Patients are responsible for any charges not covered by their plan, it said, as well as any copayment, deductible or coinsurance.
The more she read, the more annoyed de Cordova became. SignatureCare charges a “facility fee” for treatment, the document said, ranging “between five hundred dollars and one hundred thousand dollars.” Another charge, the “observation fee,” could range from $1,000 to $100,000….
As she waited, de Cordova realized she didn’t want to play insurance roulette. She changed her mind and decided she’d pay the $175 out-of-pocket for her test. But when the SignatureCare nurse came to collect the paperwork, de Cordova said the nurse told her, “You can’t do that. It’s insurance fraud for you to pay for our services once we know you have insurance.”Unable to pay cash and unwilling to take a chance on the unknown cost, de Cordova decided to leave without getting the results of her COVID-19 test…
“I Would Have Signed Anything”
Later that day, de Cordova couldn’t get past what happened. She wondered what happened to patients who didn’t read the fine print before signing the packet.
Then she realized she and her husband, Hayan Charara, could investigate it themselves. In June, the couple’s 8-year-old son had attended a baseball tryout. They thought the kids would be socially distanced and that precautions would be taken. But then the coaches had crowded the players in a dugout, with no masks or social distancing, and a couple days later the boy said he wasn’t feeling well.
Charara, de Cordova and their children are covered by the Employees Retirement System of Texas, a taxpayer-funded benefit plan that covers about half a million people. They hadn’t received any notices about the charges for their son. So they contacted the SignatureCare billing department and asked for an itemized statement. The test charge was indeed $175. But the total balance, including the physician and facility fees associated with an emergency room visit, came to $2,479.
The facility fee was $1,784 and the physician fee $486.
The couple were dumbfounded. Their son’s vital signs had been checked but there had been no physical examination, they said. The interactions took less than five minutes total, and the child stayed in the car. “You’re getting a drive-thru test, and they’re pretending like they’re giving you emergency services,” de Cordova said…” (C)
“Covid-19 tests are supposed to be free for anyone who has insurance, but unexpected bills from doctors’ offices and hospitals remain a big concern, researchers say. Employers who want to prevent outbreaks among their employees are increasingly paying for tests, and some say those expenses are only growing.
How much the test costs depends on who offers it, as hospitals, laboratories, and doctors’ offices all set their own prices. The same test one clinic charges $50 to perform could cost $5,000 at a hospital, researchers who study billing practices say.
“It seems to us to be totally and completely random what they charge,” said Gerard Anderson, a professor of health policy at Johns Hopkins University who is studying hundreds of hospital charges for Covid-19 tests.
Increasing the number of Covid-19 tests is key to containing the spread of the coronavirus and keeping businesses open until a vaccine for virus is developed and distributed widely, public health officials have said. Almost 1.2 Americans applied for unemployment benefits last week as a large portion of the U.S. economy still struggles with the virus.
For one of the most common Covid-19-related tests, the swab-in-the-nose that can take days to see results, health-care providers charge on average $63 and facilities collect on average $372, insurance claims data from the nonprofit FAIR Health show. Hospitals and health systems are generally charging more than doctors’ offices, Anderson said.
Large hospitals charge between $20 to $850 for a single test, an analysis by the Kaiser Family Foundation found. Anderson said he saw a single charge from a Texas hospital for $5,000 for a Covid-19 test.
There’s been as many as 900,000 new Covid-19 tests performed in a single day in the U.S., although in recent weeks that figure has dipped below 800,000 new tests per day, according to Bloomberg News data. Some public health experts have suggested the U.S. needs to perform as many as 3 million tests per day in order to contain the virus.
Some industries say they’re covering their employees’ tests but worry about how the costs are adding up as the virus spreads through the summer.
In California, builders and contractors were deemed essential businesses and allowed to continue operating even as Covid-19 cases were growing rapidly earlier in the year. Some companies tested their employees whenever one of them was potentially exposed to the virus and occasionally wound up paying add-on fees for on-site testing or high prices for the tests, Michele Daugherty , president and CEO, Associated Builders and Contractors Northern California, said.
An outbreak among workers can cripple a contracting company, which employs skilled workers who aren’t easily replaced, and the industry is worried that if they can’t keep the virus at bay the state will stop allowing them to work, Daugherty said. The cost of the tests so far is easier to take on than losing weeks or months of work, she said.
“We look at it as our responsibility,” she said. “That right to work as an essential business could be taken away if there’s an abundance of outbreaks in our industry.”
Daugherty said her organization started setting up testing for construction companies in northern California to help them navigate this uncertain landscape. The group works with PMH Laboratory Inc. to set up tests that cost $125 each, she said.” (D)
Sarah Goldstone got a coronavirus test in Massachusetts after her health insurer said it was “waiving cost sharing for Covid-19 testing-related visits.”
Amanda Bowes, a health policy analyst in Maryland, got hers because she knew a new federal law should make coronavirus testing free for insured patients like her.
Kelly Daisley had one after seeing New York City’s ads offering free tests. “Do it for them,” says one bus shelter ad near her home, showing a happy family.
All three were surprised when their health insurers said that they were responsible for a significant chunk of their bills — in Ms. Daisley’s case, as much as $2,718.
“I had seen so many commercials saying there is testing everywhere, it’s free, you don’t need insurance,” said Ms. Daisley, 47, who was tested at an urgent care center three blocks from her Brooklyn apartment. “If I had to pay it off, it would clear out my savings.”
For months, Americans have been told not to worry about the costs of coronavirus tests, which are crucial to stopping the pandemic’s spread. “It is critical that Americans have peace of mind knowing that cost won’t be a barrier to testing during this national public health emergency,” Medicare’s administrator, Seema Verma, said in April.
Congress passed laws requiring insurers to pay for tests, and the Trump administration created a program to cover the bills of the uninsured. Cities and states set up no-cost testing sites.
Patients, whether with or without insurance, are beginning to find holes in those new coverage programs. Nationwide, people have been hit with unexpected fees and denied claims related to coronavirus tests, according to dozens of bills that The New York Times has reviewed. Insurers have told these patients they could owe from a few dollars to thousands…
Federal law requires insurers to pay for any doctor visit associated with a coronavirus test, specifically noting that visits to urgent care centers are included. It is silent, however, on how much an insurer must pay to an out-of-network facility — although most experts agree a health plan would need to pay something rather than deny the fee…
Experts say federal law requires the insurer to cover the antibody test in full, even out of network. But the rules around the other tests are less clear: The law states that insurers must cover services related to obtaining a coronavirus test but doesn’t identify what type of care makes the cut. Some providers seem to tack on unrelated lab tests. Patients at a drive-through coronavirus testing site in Texas, for example, were unknowingly tested for sexually transmitted diseases. Without clear federal guidance, insurers are left to sift through charges to decide what is related to coronavirus and what isn’t.
Initially, Ms. Daisley was left with more than $2,000 to pay to out-of-network labs: $210 for the antibody test and $2,508 for the other lab services. Her health plan, Anthem, denied the larger charge because her health benefits do not cover out-of-network care.
The insurer covered the charges after The Times inquired. “Seeing as Ms. Daisley was unaware the treating provider would send her samples to multiple out-of-network labs for what she understood was related to Covid testing, Anthem is covering the costs of the outstanding claims,” a spokeswoman for Anthem, Leslie Porras, said.” (E)
“Federal law does not require out-of-network providers to bill insurance directly for COVID-19 tests. Typically, providers that participate in a patient’s health plan network are contracted to bill that patient’s insurance directly. While the law requires coverage of out-of-network testing without cost sharing, patients who seek COVID-19 testing out-of-network may be required to pay up front for services, then submit claims to their health plan for reimbursement. Patients who don’t know how to manually submit out-of-network claims or who are too sick to do so may not succeed.
Federal coverage requirements apply only to individualized diagnostic testing, but not when conducted as part of employee “return to work” programs. Guidance issued by federal agencies states that health plans are not required to cover testing that is “conducted to screen for general workplace health and safety (such as employee “return to work” programs), for public health surveillance… or for any other purpose not primarily intended for individualized diagnosis or treatment of COVID-19…” To the extent employers may expect or require their workers to be tested periodically for COVID-19, private health plans would not be required to cover such testing costs. However, employers that do require periodic testing for workers could choose to cover the cost of testing for their employees.
Federal requirements to cover COVID-19 tests do not apply to all private plans. The FFCRA and CARES Act coverage requirements do not apply to non-ACA compliant plans, such as short-term health insurance policies. Some health insurers and short-term policy issuers have said they will voluntarily waive cost-sharing for COVID-19 tests under all of their policies.” (F)
“I’ve spent much of the past four months collecting patients’ bills related to coronavirus. As part of that project, I’ve read through more than 100 patient stories about coronavirus tests. Many patients are happy to report no charge at all, while others have been billed large unexpected fees or denied claims related to coronavirus tests.
The surprise bills have hit uninsured Americans as well as those with robust coverage. The health data firm Castlight estimates that 2.4 percent of coronavirus test bills leave some share of the charge to consumers, which means there could be millions of patients facing fees they did not expect.
These are some simple steps you can take to lower your chances of becoming one of them.
If you can, get tested at a public site
Many states, counties and cities/towns now have public testing facilities. Very few patients have reported surprise medical bills from those testing sites (although it’s not impossible). You can typically use your state health department website to find public testing options.
If a public test site isn’t an option where you live, you might consider your primary care doctor or a federally qualified health clinic. The largest surprise coronavirus test bills I’ve reviewed tend to come from patients who are tested in hospitals and free-standing emergency rooms. Those places often bill patients for something called a facility fee, which is the charge for stepping into the room and seeking service.
Patients are finding that these fees can pop up even when they don’t actually set foot in the facility. Multiple patients at one Texas emergency room had $1,684 facility fees tacked onto their drive-through coronavirus tests. A patient in New York faced a $1,394 charge for her test at a tent outside a hospital. The majority of the bill was the facility fee. The investigative news site ProPublica has reported on how facility fees can sometimes cost as much as 10 times the coronavirus test itself.
If you get your test at a primary care provider, or at a public test site, you shouldn’t have to worry about that type of billing. They typically do not charge facility fees for coronavirus tests or any other types of care.
Ask your provider what they’ll bill you for
When patients receive a surprise medical bill related to a coronavirus test, the charges they face often are not for the test itself. Instead, they are for other services that the patient may not have known about.
Some of those services make sense. Many bills for coronavirus tests have fees for the doctor visit that went along with it. Others make less sense, like the ones that include screenings for sexually transmitted diseases that have nothing to do with coronavirus. Those extra fees appear to be a bit more common in emergency rooms, or when health providers send their samples to outside laboratories. But they can happen at public testing sites, too: One Connecticut doctor regularly tested patients for dozens of illnesses at a town drive-through. The patients thought they were simply getting coronavirus tests.
To avoid those extra charges, ask your provider what diseases they will screen for. It can be as simple as saying: “I understand I’m having a coronavirus test. Are there any other services you’ll bill me for?” Having a better understanding of that up front can save you a headache later, and you can make an informed decision about what care is actually needed. If your providers can’t tell you what they’ll bill for, that may be a signal you want to seek care elsewhere.
Uninsured? Ask your doctor to bill the government, not you
Uninsured patients have faced coronavirus bills upward of $1,000, according to billing documents reviewed by The New York Times.
That type of billing is legal: Health care providers are not required to provide free coronavirus tests to Americans who lack health insurance. But they do not necessarily have to bill patients directly. The federal government has set up a provider relief fund: Health providers can seek reimbursement for coronavirus testing and treatment provided to those without coverage. Once again, it pays to ask ahead of time how providers handle uninsured patients and whether they submit to the fund. Unfortunately, they are not required to do so — and could continue to pursue the debt.
You should also be aware that 17 states have authorized their state Medicaid plans to cover coronavirus test costs for uninsured Americans. This means your state government can pay the bill instead of you. You can find out if you live in one of these states here.” (G)
“When Dr. Zachary Sussman went to Physicians Premier ER in Austin for a COVID-19 antibody test, he assumed he would get a freebie because he was a doctor for the chain. Instead, the free-standing emergency room charged his insurance company an astonishing $10,984 for the visit — and got paid every penny, with no pushback.
The bill left him so dismayed he quit his job. And now, after ProPublica’s questions, the parent company of his insurer said the case is being investigated and could lead to repayment or a referral to law enforcement…
During the brief visit, Sussman said he chatted with the emergency room doctor, whom he didn’t know. He said there was no physical examination. “Never laid a hand on me,” he said. His vitals were checked and his blood was drawn. He tested negative. He said the whole encounter took about 30 minutes.
About a month later, Golden Rule sent Sussman his explanation of benefits for the physician portion of the bill. The charges came to $2,100. Sussman was surprised by the expense but he said he was familiar with the Physicians Premier high-dollar business model, in which the convenience of a free-standing ER with no wait comes at a cost…
Sussman felt more puzzled to see the insurance document say, “Payable at: 100%.” So apparently Golden Rule hadn’t fought for a better deal and had paid more than two grand for a quick, walk-in visit for a test. He was happy not to get hit with a bill, but it also didn’t feel right.
He said he let the issue slide until a few weeks later when a second explanation of benefits arrived from Golden Rule, for the Physicians Premier facility charges. This time, an entity listed as USA Emergency sought $8,884.16. Again, the insurer said, “Payable at: 100%.”
USA Emergency Centers says on its website that it licenses the Physicians Premier ER name for some of its locations.
Sussman’s insurer, Golden Rule, agreed to pay 100% of Physicians Premier’s $8,884.16 facility charges for a COVID-19 antibody test. According to Sussman, the materials to make each test cost about $8. (Redactions and highlights by ProPublica)
Now Sussman said he felt spooked. He knew Physicians Premier provided top-notch care and testing on the medical side of things. But somehow his employer had charged his health plan $10,984.16 for a quick visit for a COVID-19 test. And even more troubling to Sussman: Golden Rule paid the whole thing.
Sussman was so shaken he resigned. “I have decided I can no longer ethically provide Medical directorship services to the company,” he wrote in his July 13 resignation email. “If not outright fraudulent, these charges are at least exorbitant and seek to take advantage of payers in the midst of the COVID19 pandemic.”…
The claims also included codes for a nasal swab coronavirus test. But that test was not performed, Sussman said. The physician’s orders documented in the facility’s medical record also do not mention the nasal swab test. Those charges came to $4,989.
The claims show two charges totaling $1,600 for the antibody test Sussman received. In a spreadsheet available on its website on Friday, Physicians Premier lists a price of $75 for the antibody test.
For comparison, Medicare lists its payment at $42.13 for COVID-19 antibody tests. That’s because Medicare, the government’s insurance plan for the disabled and people over 65, sets prices.
Complicating matters, Texas is the nation’s epicenter for free-standing emergency rooms that are not connected to hospitals. Vivian Ho, an economist at Rice University who studies the facilities, said their business model is based on “trying to mislead the consumer.” They set up in locations where a high proportion of people have health insurance, but they don’t have contracted rates with the insurers, Ho said. They are designed to look like lower-priced urgent care centers or walk-in clinics, Ho said, but charge much higher emergency room rates. (The centers have defended their practices, saying that they clearly identify as emergency rooms and are equipped to handle serious emergencies, and that patients value the convenience.)
The day after he resigned, Sussman texted an acquaintance who works as a doctor at Physicians Premier. The acquaintance said the facility typically only collects a small percentage of what gets billed. “I just don’t want to be part of the game,” Sussman texted to him…
The charges for Sussman’s COVID-19 test visit are “ridiculous,” said Niall Brennan, president and CEO of the Health Care Cost Institute, a nonprofit organization that studies health care prices. Brennan wondered whether the CARES Act has made insurers feel legally obligated to cover COVID-19 costs. He called it “well intentioned” public policy that allows for “unscrupulous behavior” by some providers. “Insurance companies and patients are reliant on the good will and honesty of providers,” Brennan said. “But this whole pandemic, combined with the CARES Act provision, seems designed for unscrupulous medical providers to exploit.” (H)
“Throughout the COVID-19 crisis in Florida, Gov. Ron DeSantis’ administration engaged in a pattern of spin and concealment that misled the public on the gravest health threat the state has ever faced, a South Florida Sun Sentinel investigation has found.
DeSantis, a Republican who owes his job to early support from President Donald Trump, imposed an approach in line with the views of the president and his powerful base of supporters. The administration suppressed unfavorable facts, dispensed dangerous misinformation, dismissed public health professionals, and promoted the views of scientific dissenters who supported the governor’s approach to the disease.
The DeSantis administration’s approach to managing COVID-19 information carries costs. It supports a climate in which people proudly disdain masks, engage in dangerous group activities that could spread the disease, and brush aside information that conflicts with their political views. With partygoers packing Florida bars and holiday travelers filling hotels and guest rooms, the state faces a few difficult months before the possible relief of vaccines.
These findings are based on interviews with more than 50 people, including scientists, doctors, political leaders, employees of the state health department, and other state officials, as well as more than 4,000 pages of documents.
— The Florida Department of Health’s county-level spokespeople were ordered in September to stop issuing public statements about COVID-19 until after the Nov. 3 election.
— The DeSantis administration refused to reveal details about the first suspected cases in Florida, then denied the virus was spreading from person to person — despite mounting evidence that it was.
— State officials withheld information about infections in schools, prisons, hospitals and nursing homes, relenting only under pressure or legal action from family members, advocacy groups and journalists.
— The DeSantis administration brushed aside scientists and doctors who advocated conventional approaches to fighting the virus, preferring scientists on the fringes who backed the governor’s positions.
— The governor’s spokesman regularly takes to Twitter to spread misinformation about the disease, including the false claim that COVID was less deadly than the flu.
— The governor highlighted statistics that would paint the rosiest picture possible and attempted to cast doubt on the validity of Florida’s rising death toll….
The attempt to deflect attention from negative news is called “blue sky” messaging, and that’s how it was described to local health representatives, according to three health department spokespeople.
“Nothing gets approved without it passing through the governor’s office,” said one county health department spokesperson. “If it’s not blue sky, then it’s held up or we’re told to hold off and it never gets approved.”…
Florida’s wealth of university-affiliated experts on infectious diseases have largely watched from the sidelines as the governor consulted coronavirus advisers who would back his policies.
“We have over 200 affiliated faculty within this institute,” said Dr. Glenn Morris, director of the University of Florida’s Emerging Pathogens Institute. “This is what we do for a living. Yet the state has not taken full advantage of that expertise.”
The DeSantis administration’s failure to rely on the institute — established by the state Legislature in 2006 to address disease threats to Florida — is emblematic of its decision to shut out mainstream scientists in favor of a select group who would confirm the less-restrictive COVID-19 policies favored by many Republicans.
“Unfortunately, they’re not drawing on the best science, they’re drawing on political needs,” Morris said. “In many ways, it’s a tragedy.”…
In place of Florida scientists, the governor called on a group of experts and quasi-experts who would tell him what he wanted to hear.
Among them was Dr. Scott Atlas, a radiologist and senior fellow at Stanford University’s conservative Hoover Institution, who served as Trump’s coronavirus adviser despite having a medical specialty that did not involve infectious disease. Atlas won Trump’s favor with optimistic statements on the pandemic, skepticism of masks, advice to limit testing and promotion of an approach that involved reopening the economy.
“Calling people in from out of state to be experts who are of your same mindset, you are controlling the narrative, and it’s politics not science,” said Dr. Jay Wolfson, senior associate dean of the University of South Florida’s Morsani College of Medicine. “Florida is one of the top states in the nation for expertise to draw on. Unfortunately, at the state level, I’m afraid we are not being heard, and evidence-based data is not being used as far decisions being made.”…
At a news conference Monday, the governor said the hard evidence on tactics such as lockdowns and mask mandates shows they simply don’t work.
“At some point you have to look at the observed experience about what’s happening,” he said. “And I think there’s narratives like ‘lockdowns work.’ And they don’t, if you look at the evidence, business closures, all this stuff, look at what just happened in Europe, France locked down Switzerland didn’t — same viral curve, literally, no difference. So you focus on protecting vulnerable people. You provide the resources to our medical and hospitals as they need it.”” (A)
“Last week, Florida became the third state to report more than 1 million cases, following California and Texas. A total of 1,058,074 people in Florida have tested positive since the pandemic began.
In November alone, Florida reported 200,753 cases of COVID-19 — nearly 20 percent of the total number of cases in the state since March…
As for testing, the health department reported 7.86 percent of 118,590 test results returned from labs were positive for COVID-19 through Dec. 5. The median age of Floridians testing positive is 40.
As for hospitalizations, 4,400 people in Florida were hospitalized with coronavirus as their primary diagnosis as of Sunday afternoon. Of those, 1,104 patients were in the Tampa Bay area.
Statewide, a total of 56,457 people in Florida have been hospitalized with the virus at some point during the pandemic.” (B)
“Warning that New York had entered a “new phase in the war against Covid,” Gov. Andrew M. Cuomo said on Monday that the state will implement a barrage of new emergency actions, some of which echo the strict measures taken this spring, to stem a rising tide of infections and deaths.
Mr. Cuomo said that the strength of the virus’s second wave has forced the state to rely less on test positivity rates as the determinant for restrictions, and focus more on hospital capacity. On Monday, the governor announced that hospitalizations topped 3,500 over the weekend, a level not seen since May.
The governor said if hospitals become overwhelmed, he could impose a regionally based shutdown, or “pause” order, as he did statewide in the spring. He also asked hospitals to begin identifying retired doctors and nurses to help staff medical facilities, where he said burnout was an increasingly common problem.
The governor said he wanted to prevent the conditions that led to Elmhurst Hospital in Queens being inundated by coronavirus patients this spring, with beds filled, doctors overworked and refrigerated trucks posted outside to hold the dead.
“We are not going to live through the nightmare of overwhelmed hospitals again,” Mr. Cuomo said during a briefing in Manhattan.
Mr. Cuomo said that he would ask hospitals to increase the number of beds by 50 percent, and hospital chains to evaluate where there was capacity inside of those systems, to help redistribute patients where there was availability.
Plans for field hospitals were being dusted off, the governor said, adding that capacity would also be evaluated between hospitals in different parts of the state, an idea known as “surge-and-flex,” another measure the governor implemented in the spring.
Similarly, Mr. Cuomo also announced that he was ordering hospitals to stop elective surgery in Erie County, in Western New York, which is currently enduring the highest weekly positive test rates in the state. The county led the state in number of deaths reported on Monday.
Despite rising rates of infection, Mr. Cuomo has resisted implementing the kind of widespread shutdowns seen in March, when hundreds of New Yorkers began to die every week, and much of New York’s economic activity ground to a complete halt.
Rather, Mr. Cuomo’s strategy has been to utilize targeted restrictions on individual areas — known as his “micro-cluster initiative” — which has now expanded to nearly 30 locations around the state, including in all five boroughs of New York City, its suburban counties, and major upstate population centers.
The announcement on Monday came after weeks of steadily more worrying news in New York. The state’s daily rate of positive tests on Sunday topped 4 percent for the first time since May, and the number of more serious cases continued to grow. The positivity rate was reported to be 4.57 percent on Monday…
On Monday, the governor said new metrics — including hospitalization rates, death and case rates, and available hospital beds — would be used to determine lockdown levels under the “micro-cluster” strategy, the state’s color-coded restriction system. Mr. Cuomo said those new numbers will be set this week, after the state evaluates the effects of people congregating during last week’s Thanksgiving holiday.
“I don’t believe we’ve seen the hit from Thanksgiving,” he said, adding that he believed the increase in cases “will be dramatic.”
It’s still unclear how the governor will reconcile positivity rates and hospital metrics to determine new restrictions, but state officials said homing in on hospitalizations was a useful way to determine the severity of the disease in any given location. There are areas in the state where the number of people testing positive has increased, for example, but hospitalizations have not, lessening the urgency for new restrictions there, officials said.
State officials fear that testing sites will reveal a new surge in virus numbers caused by Thanksgiving gatherings.
With Mr. Cuomo ordering the redistribution of patients across hospitals, the state plans to track hospitalizations by a patient’s home address, not only where the person is hospitalized, to better ascertain which parts of the state are driving hospital admissions….
State officials believe a majority of new cases in the state stem from small gatherings in homes, with people increasingly congregating indoors as temperatures drop, rather than in public settings like bars and restaurants. Changing that behavior, the governor said, would require a robust public messaging campaign similar to the one employed around mask wearing.
“It is all in our control,” Mr. Cuomo said.” (C)
“Massachusetts Gov. Charlie Baker toured the field hospital that’s been rebuilt at Worcester’s DCU Center and announced that a second field hospital will be built in the state soon.
The Worcester field hospital being readied amid a second surge of COVID-19 will have “a lot more capacity” than it did when it was active in the spring, Massachusetts Gov. Charlie Baker said Thursday morning, and it will be ready to take patients Sunday.
“Field hospitals play a critical role in our preparedness strategy that helps us alleviate pressure on the health care system generally and enables hospitals to focus on non-COVID patients,” Baker said after touring the field hospital that the National Guard is establishing at the DCU Center in Worcester. At full capacity, it is expected to be able to accommodate 220 patients.”” (D)
“Rhode Island has opened two field hospitals that combined have more than 900 beds as the number of people hospitalized with COVID-19 in the state reached a new high….
Care New England opened a field hospital with more than 300 beds in Cranston on Monday, the same day the state sent an emergency alert saying conventional hospitals had reached their coronavirus capacity.
A facility with nearly 600 beds opened Tuesday at the Rhode Island Convention Center in Providence. It is run by Lifespan, the state’s largest hospital group.
The Lifespan facility expects to admit 24 to 48 patients on Tuesday, but may need more staff, Chief Nursing Executive Cathy Duquette said.
“We are prepared to take up to 100 patients with the staff we have been able to get. If we see demand increasing, we will certainly reach out to get more from our agency partners,” she said.
Both field hospitals will take patients who are not critically ill.” (E)
“COVID-19 deaths and hospitalizations are at record levels, and the rising case toll from Americans’ holiday travel has created an unprecedented surge with no relief in sight.
The problem is especially ominous in the nation’s intensive care units – specialized units crowded with a record number of critically ill Americans as the nation struggles through the most dangerous phase of the pandemic….
Hospitals already are employing strategies to stretch resources. Utah hospitals have canceled surgeries and shifted staff to makeshift ICU units to care for the growing number of COVID-19 patients. North Dakota’s rural hospitals, short on available beds and expertise, in recent weeks transferred patients to surrounding states. And in Colorado, Gov. Jared Polis signed an executive order authorizing the state health department to order at-capacity hospitals to halt admissions and transfer patients…
New Mexico’s ICU beds were at 103% capacity as of Thursday, the highest rate in the nation, according to U.S. Department of Health and Human Services figures.
Space also is tight at the state’s medical-surgical units in Albuquerque, Las Cruces and Farmington, and rural hospitals are quickly filling, too, according to Troy Clark, president and CEO of New Mexico Hospital Association.
Hospitals used extra space in emergency departments and operating rooms not licensed for beds to accommodate patients, but Clark said the major bottleneck is finding enough doctors, nurses and respiratory therapists to care for them.
COVID-19’s effect on health care workers is far greater now than during the spring or summer. Hospital workers can be infected at home or in their communities. Even if they are not sick, workers exposed to the virus often wait up to four days for test results, Clark said.
“That’s where we’re stressed across the state of New Mexico right now,” he said. “While there may be physical beds, there is not a nurse, a nurse tech or respiratory therapist to care for those patients.”
In North Dakota, Gov. Doug Burgum issued an order last month allowing staff who test positive for the virus but show no symptoms to keep caring for COVID-19 patients….
But hospitals will continue to seek ways to stretch resources under crisis-care scenarios, experts say.
Nursing home residents who need to be hospitalized might find such stays are shortened, Orlowski said.
And when things get really tight, hospitals need to choose who gets life-sustaining therapies. A person with minor ailments might get treatment while a person with several preexisting conditions and low oxygen might not.
If doctors determine a person’s chances of death are significantly high, “they may say, you know what, we are going to use our resources not to do this miraculous save, but we’re going to concentrate our resources on people we know who will be improved by our care,” Orlowski said.
New York hospitals struggled with similar decisions when allocating ventilators and kidney dialysis for lifesaving care during the worst days this spring.
According to the Johns Hopkins report, some hospitals did not have clear written guidelines on ventilators when “capacity became limited.” Doctors had to decide whether to intubate, or insert breathing tubes into people, and which type of ventilator to use. In some cases, hospitals had the equipment but not enough staff.
The same was true for COVID-19 patients suffering kidney failure. Therapy was in short supply for these patients, so doctors had to triage, or choose whether kidney failure patients would get two or three days of dialysis, according to the Johns Hopkins report.
During the summer surge, Banner Health in Arizona faced a shortage of ECMO machines. Extracorporeal membrane oxygenation machines are a last-ditch therapy for those whose lungs are damaged and they can no longer effectively breathe with a ventilator. The machine pumps blood to an artificial lung, adds oxygen and returns the blood to the patient…
Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, said hospital administrators face tough choices.
“You have to think about capacity on a day by day basis, because we don’t see this surge ebbing any time soon.”” (G)
“New Mexico hospitals may soon move to “crisis standards of care,” allowing providers to ration care depending on a patient’s likelihood of survival, Gov. Michelle Lujan Grisham (D) said in a Washington Post interview.
The state of play: “New Mexico has consistently won praise among public health experts for its aggressive approach to combating the virus,” the Post writes. But hospitals across the state have been operating at or near capacity recently, with many close to running out of ICU and regular beds, the Santa Fe New Mexican reports.
By the numbers: On Friday, the state saw 2,073 new COVID-19 cases, and had a 14.2% case count increase over the past week, according to the COVID Tracking Project. Currently 934 people are being hospitalized.
The big picture: Lujan Grisham imposed a two-week shutdown ahead of Thanksgiving to mitigate the risk of a rise in cases. The latest restrictions were the strictest in the state since the stay-at-home order issued in March, according to the Santa Fe New Mexican.
Although the governor told WaPo that positivity and infection rates dropped, she said she would likely allow hospitals to move to “crisis standards of care” this Monday.
Of note: Each hospital will decide on its own whether that step is necessary.” (H)
“President-elect Joe Biden picked California Attorney General Xavier Becerra for secretary of health and human services on Monday as one of his administration’s top officials to fight the raging coronavirus pandemic.
Biden, who takes office on Jan. 20, also chose Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital in Boston, to run the U.S. Centers for Disease Control and Prevention (CDC). Biden formally tapped Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, as his chief medical adviser on the virus.
Biden named Jeff Zients, an economic adviser known for his managerial skills, as a coronavirus “czar” to oversee the response that will soon include an unprecedented operation to distribute hundreds of millions of doses of a new vaccine, coordinating efforts across multiple federal agencies.
“This team of world-class medical experts and public servants will be ready on Day One to mobilize every resource of the federal government to expand testing and masking,” Biden said in a statement, adding that they would “oversee the safe, equitable, and free distribution of treatments and vaccines.”…
Biden also picked Vivek Murthy, a physician and former surgeon general, to return for a second term as surgeon general. He chose Dr. Marcella Nunez-Smith, a professor at the Yale School of Medicine, to lead a group to deal with addressing the disproportionate impact of COVID-19 on Black and Latino Americans.” (F)
POST 84. December 6, 2020. CPRONAVIRUS. “ More than 100,000 Americans are in the hospital with COVID-19…” “We’re seeing C.D.C. …awaken from (its) politics-induced coma…”…Dr. Fauci “to be a chief medical adviser in Biden’s incoming administration..”.. “Trump administration leaves states to grapple with how to distribute scarce vaccines..”
“DOCTOR” is looking for an organizational partner – e.g., hospital system, MPH/ MPA/ MBA health care administration program, School of Public Health. Please contact [email protected]
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POST 83. December 4, 2020. CORONAVIRUS. “California Gov. Gavin Newsom says he will impose a new, regional stay-at-home order for areas where capacity at intensive care units falls below 15%.”… East Tennessee –“This is the first time the health care capability benchmark has been in the red..”
“The number of hospital beds occupied by COVID-19 patients far outpaces peaks in mid-April and July of about 59,000. Early last month, the number of hospitalizations again reached that mark and has been on an upward progression ever since…
Even with a vaccine in sight, the U.S. continues to grapple with a major surge in new coronavirus infections. Health officials are imploring Americans to stay home for the holidays.
The Centers for Disease Control and Prevention Director Robert R. Redfield warned Wednesday that things are likely to get worse over the winter months. He predicted deaths could reach “close to 450,000” by February if Americans fail to take more health precautions, such as wearing a mask.” (A)
“With coronavirus infections soaring across the nation, federal health officials on Friday urged Americans in the most forceful language yet to take steps to protect themselves — starting with consistent, proper use of masks — and pressed local governments to adopt 10 public health measures deemed necessary to contain the pandemic.
The guidance reflected deep concern at the agency that the pandemic is spiraling further out of control and that many hospitals are reaching a breaking point, potentially disrupting health care across the country.
Agency officials have issued increasingly stark warnings in the waning weeks of the Trump administration, and President-elect Joseph R. Biden Jr. has promised a new national strategy to turn back the virus. On Thursday, Mr. Biden said he would call on Americans to wear facial coverings for 100 days.
To some experts, the C.D.C.’s appeal appeared to augur a more comprehensive and coordinated national approach to controlling the pandemic — one consistent with messages from Mr. Biden and his advisers.
“We’re seeing C.D.C. and other public health institutions awaken from their politics-induced coma,” said Dr. Thomas R. Frieden, who served as the agency’s director under President Barack Obama.
“This is them aligning themselves more with science, which also aligns them more with the Biden administration,” he added.
While none of the directives are new, experts said the rising case numbers demonstrated a need for a more uniform approach, rather than the patchwork of restrictions adopted by states.
“The role of the C.D.C. is to lead with the science,” said Dr. Celine Gounder, an infectious-disease physician and member of Mr. Biden’s Covid advisory group. “In the absence of strong national guidance from the C.D.C., we’ve had a variety of responses across the country, some more scientifically grounded than others.”
The scientific evidence supporting the effectiveness of certain health measures, such as wearing masks, has been accumulating, and those measures are urgently needed now to stop the spread, C.D.C. officials said.
Though the agency has issued all of the recommendations in earlier guidance, the new summary represented the first time the C.D.C. had published a multipronged list of strategies for states, a sort of battle plan.
“This idea of a 50-state solution is completely impractical when we live in one nation,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University’s Bloomberg School of Public Health. “We are not going to get past this pandemic unless we have a concerted national approach.”
The new recommendations place high priority on keeping schools open, from kindergarten through 12th grade, saying schools should be both “the last settings to close” and “the first to reopen” because of the critical role they play in providing meals and support services to children. Closures take a disproportionate toll on low-income families, the agency noted…
In a shift, the C.D.C. also urged states and local jurisdictions to encourage and enforce these behaviors, including mandating the wearing of masks in public spaces and on public transportation…
Having all 10 measures in one document is helpful and underscores the message that no one strategy can hinder the spread of the virus, experts said. But the document was thin on some details, said Dr. Nahid Bhadelia, medical director of the special pathogens unit at Boston Medical Center.” (B)
“These combined strategies will protect health care, essential businesses, and schools, bridging to a future with high community coverage of effective vaccines and safe return to more activities in a range of settings…
These strategies include
1) universal face mask use,
2) maintaining physical distance from other persons and limiting in-person contacts,
3) avoiding nonessential indoor spaces and crowded outdoor spaces,
4) increasing testing to rapidly identify and isolate infected persons,
5) promptly identifying, quarantining, and testing close contacts of persons with known COVID-19,
6) safeguarding persons most at risk for severe illness or death from infection with SARS-CoV-2, the virus that causes COVID-19,
7) protecting essential workers with provision of adequate personal protective equipment and safe work practices,
8) postponing travel,
9) increasing room air ventilation and enhancing hand hygiene and environmental disinfection, and
10) achieving widespread availability and high community coverage with effective COVID-19 vaccines.
In combination, these strategies can reduce SARS-CoV-2 transmission, long-term sequelae or disability, and death, and mitigate the pandemic’s economic impact. Consistent implementation of these strategies improves health equity, preserves health care capacity, maintains the function of essential businesses, and supports the availability of in-person instruction for kindergarten through grade 12 schools and preschool.
Individual persons, households, and communities should take these actions now to reduce SARS-CoV-2 transmission from its current high level. These actions will provide a bridge to a future with wide availability and high community coverage of effective vaccines, when safe return to more everyday activities in a range of settings will be possible…
No single strategy can control the pandemic; rather, a multipronged approach using all available evidence-based strategies at the individual and community levels can break transmission chains and address high levels of community transmission; reduce related illnesses, long-term sequelae, and deaths; and mitigate the pandemic’s economic impact….” (C)
“Local public health authorities determine and establish the quarantine options for their jurisdictions. CDC currently recommends a quarantine period of 14 days. However, based on local circumstances and resources, the following options to shorten quarantine are acceptable alternatives.
Quarantine can end after Day 10 without testing and if no symptoms have been reported during daily monitoring.
With this strategy, residual post-quarantine transmission risk is estimated to be about 1% with an upper limit of about 10%.
When diagnostic testing resources are sufficient and available (see bullet 3, below), then quarantine can end after Day 7 if a diagnostic specimen tests negative and if no symptoms were reported during daily monitoring. The specimen may be collected and tested within 48 hours before the time of planned quarantine discontinuation (e.g., in anticipation of testing delays), but quarantine cannot be discontinued earlier than after Day 7.
With this strategy, the residual post-quarantine transmission risk is estimated to be about 5% with an upper limit of about 12%.” (D)
THE BIDEN PLAN TO COMBAT CORONAVIRUS (COVID-19) AND PREPARE FOR FUTURE GLOBAL HEALTH THREATS (E)
President-elect Joe Biden said Thursday that he had asked Dr. Anthony Fauci earlier in the day to stay on in his role and to be a chief medical adviser in Biden’s incoming administration.,
“I asked him to stay on in the exact same role he’s had for the past several presidents, and I asked him to be a chief medical adviser for me as well, and be part of the Covid team,” Biden told CNN’s Jake Tapper in the first joint interview of Biden and Vice President-elect Kamala Harris since being elected.
Biden added that Ron Klain, the incoming White House chief of staff, knew Fauci well and had been talking to him “all the time.” Speaking on NBC’s “Today” show Friday morning, Fauci said he accepted the offer “right on the spot.”
Fauci previously told CNN that he had worked “very closely” with Klain during the Ebola outbreak when Klain was tasked with coordinating the Obama administration’s response to the crisis. He praised Klain as an “excellent choice” for White House chief of staff and said he was “absolutely terrific at the Ebola situation, where we had a very successful ultimate endgame with Ebola.”
Fauci told CNN later Thursday that he had an hour-long meeting at the White House that day with Biden’s agency review team. Team members who met with Fauci with included Jeffrey Zients, Biden’s choice for coronavirus czar, as well as two co-chairs of Biden’s 12-member coronavirus advisory board: Dr. David Kessler, the former commissioner of the US Food and Drug Administration, and former US Surgeon General Dr. Vivek Murthy.
Among the topics they discussed were vaccine distribution and the state of the pandemic, according to Fauci, who said it was a good meeting and that it is “the way transition should work.” (F)
“Joe Biden said Thursday that he will ask Americans to commit to 100 days of wearing masks as one of his first acts as president, stopping just short of the nationwide mandate he’s pushed before to stop the spread of the coronavirus.
The move marks a notable shift from President Trump, whose own skepticism of mask wearing has contributed to a politicization of the issue. That’s made many people reticent to embrace a practice that public health experts say is one of the easiest ways to manage the pandemic, which has killed more than 276,000 Americans.
The president-elect has frequently emphasized mask wearing as a “patriotic duty” and during the campaign floated the idea of instituting a nationwide mask mandate, which he later acknowledged would be beyond the ability of the president to enforce.
Speaking with CNN’s Jake Tapper, Biden said he would make the request of Americans on Inauguration Day, Jan. 20.” (G)
‘The Trump administration is shunting to the states hard decisions about which Americans will get the limited early supplies of coronavirus vaccines — setting up a confusing patchwork of distribution plans that could create unequal access to the life-saving shots.
Federal and state officials agree that the nation’s 21 million health care workers should be first in line. But there is no consensus about how to balance the needs of other high-risk groups, including the 53 million adults aged 65 or older, 87 million essential workers and more than 100 million people with medical conditions that increase their vulnerability to the virus.
The Trump administration has told states that they have ultimate authority for determining who gets vaccinated first. It has also decided to allocate scarce early doses based on states’ total populations, forcing hard choices in states with a greater proportion of residents at high risk — including Black, Indigenous and Latino communities that have suffered disproportionate rates of hospitalization and death from Covid-19.
Public health experts say that could undermine already shaky public confidence in the vaccine effort, whose success depends on convincing large numbers of Americans to get immunized.
“States are going to have to pick and choose who gets the first doses,” said Josh Michaud, an associate director for global health policy at Kaiser Family Foundation who has reviewed nearly every state’s distribution plan. “It’s very obvious that states are in different places when it comes to planning and identifying who those people are.”…
The Centers for Disease Control and Prevention normally lays out the guidelines for who should get priority for each vaccine, based on recommendations from a group of experts known as the Advisory Committee on Immunization Practices. The panel had not been scheduled to finalize its recommendations until after the first vaccine was authorized by the FDA. But that changed abruptly over the weekend, with the panel now set to meet Tuesday to hammer out advice for the highest priority groups — health care workers and residents of nursing homes and long-term care facilities.
“Typically there is a window of time after ACIP recommendations and before the vaccine hits the shelf,” said Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, during the panel’s meeting last week. “This time we’re talking about an almost instantaneous rollout.”…
“This is all going to be very messy,” Michaud said. “There’s no question that plans on paper are one thing, but putting it into practice and getting vaccines into the arms of people is a whole different ballgame. It’s going to be a Herculean task.” (H)
