“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms….received$509 million in government funds… that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.”
Also…Overuse of Antibiotics. Candida auris. Ebola.
“They prepared for the worst and hoped for the best, and that was exactly what they got. That’s what Maureen Tarrant said about Presbyterian St. Luke’s Medical Center and Rocky Mountain Hospital for Children’s preparations during the novel coronavirus outbreak. Tarrant has been the CEO of the hospitals since 2014.
“Our hospital was never overwhelmed with COVID patients,” she said.
Tarrant credits the state and city leaders for taking steps early to prepare area hospitals.
“We all saw the stories of some of the more densely populated areas, such as Queens, New York,” Tarrant explained. “Colorado and Denver have not been like that.”
In turn, Tarrant said something else happened.
“I think we had an unintended consequence: I think we made people afraid to come back to the hospital,” she said.
Revenues are down at the hospital, she said. The emergency department alone has seen between a third and a half of its normal volume…
The key to a hospital rebound, according to Tarrant, is to remind people that hospitals are still safe and not as chaotic as you would think.
“If we think about celebrating the heroes and the healthcare workers, the nurses and the doctors, the last thing we would ever want is for them to suffer personally with financial consequences,” Tarrant said.” (A)
“Most hospitals and outpatient clinics have made changes designed to keep patients and staff members safe. Many are testing patients and certain workers. In many hospitals, Covid-19 patients are kept in separate units. Masks are usually mandated for both patients and clinicians. Cleaning protocols have been turbocharged. As a result, experts say, the risk of acquiring Covid-19 when going into a hospital is very low.
But one of the common safety measures — banning visitors, even close family members — is a huge reason for patients’ fear and apprehension.
“The hospital was an ominous, nerve-racking and scary place for patients even before Covid,” said Dr. Lisa VanWagner, a transplant hepatologist at Northwestern Medicine in Chicago. “Now you take a stressful situation like a pandemic and you tell people that they cannot have their normal support system while they’re in the hospital, and that really magnifies those fears.”..
Health system administrators are redoubling their efforts to convince patients that it’s safe to come into hospitals and outpatient clinics, even as testing for hospital personnel and patients remains spotty.
“Our goal is to spend almost all our marketing dollars over the next year around the safety of our institution,” said Dr. Stephen Klasko, chief executive of Jefferson Health, a 14-hospital system based in Philadelphia.” (B)
“As the virus spread, visits to emergency rooms in the United States decreased 42 percent over four weeks in April, compared to the same period in 2019, according to a new analysis released Wednesday by the C.D.C. The declines were greatest among children 14 and younger, women and in geographic areas like the Northeast.
While there were high numbers of emergency room visits because of the virus, including an increase in visits related testing for infectious diseases and for pneumonia, these were outweighed by the steep declines in visits that typically make up trips to the emergency room.
The C.D.C. also noted that there had been a recent rebound in visits, but the volume of visits remained significantly lower. Visits to the emergency room were down 26 percent in the last week of May, compared with a year earlier.
The agency’s report highlights the months long decline in general hospital care as the virus took hold and overwhelmed some hospitals. Across the nation, hospitals stopped performing elective procedures, whether a routine mammogram or a knee replacement, even if they were not experiencing a surge in Covid-19 patients. While hospitals have slowly begun resuming care, many patients, concerned about potential infection, continue to avoid them….
While E.R. treatment for complaints of minor ailments were far fewer this year, agency officials pointed to a more disconcerting drop in the number of people seeking emergency care for chest pain, including those undergoing a heart attack. There were also declines in children requiring emergency help for conditions like asthma.
C.D.C. officials also said the drop in emergency room visits could affect people’s ability to get care when they have no other alternative sources.” (C)
“As the U.S. continues to battle the novel coronavirus outbreak, fears over a second wave of cases have been looming over the country.
While there is no doubt that more cases will continue to emerge in the months ahead, it’s not too late for America to prevent a second wave of COVID-19, according to Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID) and member of the White House COVID-19 task force.
Speaking to Newsweek, Fauci says: “It’s in our hands. We can prevent a second wave if we respond to the inevitable infections we’ll see in the fall and winter…
We have four months to prevent a second wave
While many states are beginning to report a plateau in daily cases, yet more are still dealing with daily increases in new COVID-19 patients.
Fauci says whether or not these ongoing new cases will become a wave will depend on whether “we prepare ourselves from now through June, July, August and September.”
“We have four months to make sure we have in place the system, the test, the capability, the manpower to do the kind of identification, isolation and contact tracing as cases begin to reappear in the fall, because they will reappear….
“I think it’s highly unlikely that we will eradicate COVID-19. The only disease in humans that we’ve ever eradicated is smallpox. We’ve eliminated polio from many areas of the world. For example, polio is eliminated in the U.S. and U.K. and the only cases that are around are vaccine-related cases.
“So it is conceivable that we will be able to eliminate it in the sense of getting enough herd immunity together with the vaccine that we have very few cases. And certainly we can control it, and we have been getting it under some control in some areas,” Fauci says…
The novel coronavirus is more likely to be with us for another season or two, depending when a vaccine is ready, with the second season expected to be much milder than the first, especially if there is a vaccine, Fauci explains.
“If we have a vaccine by next winter, that would be a game changer but there’s no guarantee we’ll have it. But if we don’t have a vaccine, we’ll have another season of it and hopefully by the following season, we will have a vaccine.”..
Looking at the trajectory of the outbreak, could America have done anything different to fight the virus?
“Of course. Nobody’s perfect. Anybody could have done better. Look at the U.K., they were going to go for herd immunity and that backfired on them,” Fauci told Newsweek.
“If you look at the death per capita in Sweden, compared to the death per capita in other Scandinavian countries, Sweden got hit worse. I think their decision to go for herd immunity speaks for itself.
“I declared that herd immunity [as a COVID-19 combat strategy] was absurd at the very beginning here in the U.S., saying ‘Are you kidding me? Do you know how many people are gonna die if you wait for herd immunity to come in?’ So that was not a good call [in Sweden],” Fauci says.” (E)
“Even after a vaccine is discovered and deployed, the coronavirus will likely remain for decades to come, circulating among the world’s population…
“This virus is here to stay,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago. “The question is, how do we live with it safely?”
Combating endemic diseases requires long-range thinking, sustained effort and international coordination. Stamping out the virus could take decades — if it happens at all. Such efforts take time, money and, most of all, political will…
The challenge in this pandemic is few such shortcuts remain to push U.S. leaders and the public into forward-thinking actions. The CDC has been sidelined by the White House and blocked from holding public briefings. Meanwhile, the Trump administration has made clear its priority is restarting the economy.
Increasingly, leading experts believe many Americans won’t make the shift toward long-range thinking until the virus spreads more widely and affects someone they know.
“It’s like people who drive too fast. They come upon the scene of an accident, and for a little while, they drive more carefully, but soon they’re back to speeding again,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
“Contrast that with people who have lost someone to drunk driving,” he said. “It mobilizes them and becomes a cause for them. Eventually, everyone is going to know someone who got infected or died from this virus.
“That’s what it may take.” (F)
Surge capacity is a hospital’s ability to adequately care for a significant influx of patients.7 Since 2011, the American College of Emergency Physicians has published guidelines calling for hospitals to have a surge capacity accounting for infectious disease outbreaks, and demands on supplies, personnel, and physical space.7 Even prior to the development of COVID-19, many hospitals faced emergency department crowding and strains on hospital capacity.8…
To prepare for the increased number of seriously and critically ill patients, individual hospitals and regions must perform a needs assessment. The fundamental disease process of COVID-19 is a contagious viral pneumonia; treatment hinges on four major categories of intervention: spatial isolation (including physical space, beds, partitions, droplet precautions, food, water, and sanitation), oxygenation (including wall and portable oxygen, nasal canulae, and masks), mechanical ventilation (including ventilator machines, tubing, anesthetics, and reliable electrical power) and personnel (including physicians, nurses, technicians, and adequate personal protective equipment).10 In special circumstances and where available, extra corporeal membrane oxygenation may be considered.10 The necessary interventions are summarized in Table 1.
Emergency, critical care, nursing, and medical leadership should consider what sort of space, personnel, and supplies will be needed to care for a large volume of patients with contagious viral pneumonia at the same time as other hospital patients. Attention should also be given to potential need for morgue expansion. Hospitals must be proactive in procuring supplies and preparing for demands on beds and physical space. Specifically, logistics coordinators should start stockpiling ventilators, oxygen, respiratory equipment, and personal protective equipment. Reallocating supplies from other regions of the hospital such as operating rooms and ambulatory surgery centers may be considered. These resources, particularly ventilators and ventilator supplies, are already in disturbingly limited supply, and they are likely to be single most important limiting factor for survival rates. To prevent regional shortages, stockpiling efforts should ideally be aided by state and federal governments. The production and acquisition of ventilators should be immediately and significantly increased.
Hospitals must additionally prepare for demands for physical space and beds. Techniques to maximize space and bed availability (see Table 2) include discharging patients who do not require hospitalization, and canceling elective procedures and admissions. Additional methods would be to utilize unconventional preexisting spaces such as hallways, operating rooms, recovery rooms, hallways, closed hospital wards, basements, lobbies, cafeterias, and parking lots. Administrators should also consider establishing field hospitals or field wards, such as tents in open spaces and nearby roads. Medical care performed in unconventional environments will need to account for electricity, temperature control, oxygen delivery, and sanitation.” (G)
“COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic. A user of COVID-19Surge can produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support. The user can then compare those estimates with hospital capacity, using either existing capacity or estimates of expanded capacity.” (H)
Dr. Tom Frieden, the former director of the US Centers for Disease Control and Prevention, laid out “10 plain truths” about Covid-19 on Wednesday as he spoke at a House Appropriations Committee hearing on the pandemic response.
“In my 30 years in global public health, I’ve never seen anything like this,” Frieden, who now serves as president and CEO of Resolve to Save Lives, said. “It’s scary. It’s unprecedented.”
Here are the 10 truths, according to Frieden:
1. “It’s really bad” in New York City
“Even now with deaths decreasing substantially, there are twice as many deaths from Covid-19 in New York City as there are on a usual day from all other causes combined,” Frieden said…
2. It’s “just the beginning”
Frieden said as bad as things seem now, he thinks we’re still in the beginning phases of the pandemic…
3. Data is a “very powerful weapon against this virus”
Frieden explained that data being used to monitor trends can help stop clusters before they turn into outbreaks. Data, he said, can help stop outbreaks from turning into epidemics…
4. We need to “box the virus in”
While stay-at-home orders slowed the spread of the virus and flattened the curve in states such as New York and California, the virus continues to spread throughout the country with approximately 30,000 new cases a day for nearly a month….
5. We must find the balance…
The economy doesn’t have to come at the expense of public health. Dr. Frieden said it is necessary to find the balance between restarting our economy and letting the virus run rampant.
6. Protect the “frontline heroes”
“We must protect the health care workers and other essential staff, or the frontline heroes of this war,” Frieden said…
7. Protect our most vulnerable people, too
Eight out of 10 deaths reported in the US have been from adults that are 65 years old and older, according to the CDC. And people with weak immune systems and underlying conditions such as asthma, heart disease, high blood pressure or diabetes are at more risk.
8. Governments and private companies need to work together
Both government and industry must collaborate to make “massive continued investments in testing and distributing a vaccine as soon as possible,” Frieden said…
9. We must not neglect non-Covid health issues
While the coronavirus pandemic has flooded and overwhelmed many hospitals with patients across the world, people are no longer suddenly immune to other diseases and sicknesses. Many elective procedures have been canceled or postponed, and patients with other illnesses wait in fear as they put treatment on hold. Many are too scared to venture out and visit hospitals out of fear of contracting the virus.
10. Preparedness is paramount
“Never again,” Frieden said. “It is inevitable that there will be future outbreaks. It’s not inevitable that we will continue to be so underprepared.” (I)
“The good news is that we have the technology and know-how to confront and substantially mitigate these epidemics. What we have lacked is the willpower to implement this knowledge. We will have won when the following takes place:
1. When we no longer neglect stockpiling needed equipment and supplies.
2. When we have a national public reporting laboratory infrastructure for all dangerous pathogens.
3. When we have enough trained and supported infection preventionists (IPs).
4. When we have developed more respect for infectious disease.
5. When we have improved and larger physical plants to service patients.
6. When we have redundancy in our healthcare facilities.
7. When our leaders stop politicizing public health and rely on scientists to make public policy.
8. When we have healthcare, that is centered on patients and not on profits.” (J)
“Much of the rationale for the flattening of the curve, to make space for patients with the novel coronavirus. But multiple health experts say this has an unexpected second order effect — leading to Americans neglecting their health concerns, which have done anything but subside.
California was the first state to implement a mandatory stay-at-home order, opted early on to adopt a proactive approach, rather than face the risk of being overwhelmed. Los Angeles has become the epicenter of the virus, logging the highest number of cases of the state’s 58 counties,
University of California Los Angeles’ Health System, which operates four hospitals and 180 clinics in Southern California, was fully prepared to handle the surge in novel coronavirus cases, but never saw unmanageable demand, according to president Johnese Spisso, who also serves as CEO of the UCLA Hospital System….
“What we learned is the public was very frightened of hospitals and clinics. We had to do a lot of outreach education. We worked together as a hospital community in Los Angeles to educate the public and to tell them it’s time to come back for the health care they have put on pause. We were especially concerned as a tertiary medical center, reduction we saw even in our emergency departments in heart attacks and strokes. We know COVID did nothing to cure those, so we were very concerned people weren’t presenting for the care that’s needed. We very quickly began to see that as we opened back up, who really should have been coming in a lot sooner,” she said.
‘Life may be on pause. Your health isn’t.’
Earlier this month, UCLA Health teamed up with five of the largest nonprofit health care networks across Los Angeles to launch BetterTogether.Health, a campaign to encourage community members to put health first and access care when needed.
UCLA Health, Providence, Keck Medicine of USC, Kaiser Permanente, Dignity Health and Cedars-Sinai, which collectively serve 8.4 million Angelenos, launched public service announcements with themes that include, “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part” and “Get care when you need it.”
Beyond the impact on individuals who neglected their non-coronavirus related health concerns, this fear has inevitably impacted the bottom line of hospital systems.
UCLA Hospital System was forced to tap financial reserves to close a gap of more than $85 million as of mid-May. The system, which employs 30,000 people, reported a $140 million revenue loss, which was partially offset by $55 million in federal aid, which covered about one-third of losses from March and April.
“In the month of April, we had a revenue drop that isn’t sustainable, which is why we’ve been anxious to return to our normal business of health care so that we can really meet our mission for the community. So our health system — like so many [others] in the country — has really had to weather some extreme economic losses,” she said.” (K)
“Patients’ hesitation about seeking care in the midst of a pandemic means that healthcare facilities need to work extra hard to assure them that they are taking the necessary precautions to ensure their safety…
Rush University System for Health has instituted several changes, including removing reading material from waiting rooms and providing visual cues and markings to indicate how far apart people must stand while waiting in lines and in elevators to maintain social distancing, said Dr. Ranga Krishnan, CEO of the Chicago-based system.
Tacoma, Wash.-based CHI Franciscan has increased testing and screening and requires everyone in their facility to wear masks.
“We understand that many patients are concerned and are heeding stay-at-home orders carefully. That said, it’s especially important for patients experiencing an emergency to seek care as soon as possible,” said Michael H. Anderson, MD, CHI Franciscan’s CMO. “There can be serious, long-term impacts for delaying care, and it’s essential that they come to the emergency room as soon as they can.”
Nemours Children’s Health System in Jacksonville, Fla., is directly involving patients in the conversation about returning for care. At Nemours, leaders have asked for suggestions from the families of their pediatric patients.
“It is important to directly elicit patient and family perspectives about their fears as they seek healthcare and to ask for suggestions that would increase their comfort level in doing so,” said Peggy Greco, PhD, medical director of patient experience at Nemours.
Parents have asked that specific information about screening practices, cleaning routines and patient volume restrictions be shared with them, Tina Arcidiacono, Nemours’ administrative director of patient experience said. They also wanted details about managing their safety during clinic and hospital visits.
Nemours has now made sure that all those who make contact with families are providing the information the families need, including specific processes in place to ensure their safety.” (Q)
“The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.” (S)
“A multibillion-dollar institution in the Seattle area invests in hedge funds, runs a pair of venture capital funds and works with elite private equity firms like the Carlyle Group.
But it is not just another deep-pocketed investor hunting for high returns. It is the Providence Health System, one of the country’s largest and richest hospital chains. It is sitting on nearly $12 billion in cash, which it invests, Wall Street-style, in a good year generating more than $1 billion in profits.
And this spring, Providence received at least $509 million in government funds, one of many wealthy beneficiaries of a federal program that is supposed to prevent health care providers from capsizing during the coronavirus pandemic.
With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled. The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.
So far, the riches are flowing in large part to hospitals that had already built up deep financial reserves to help them withstand an economic storm. Smaller, poorer hospitals are receiving tiny amounts of federal aid by comparison.
Twenty large recipients, including Providence, have received a total of more than $5 billion in recent weeks, according to an analysis of federal data by Good Jobs First, a research group. Those hospital chains were already sitting on more than $108 billion in cash, according to regulatory filings and the bond-rating firms S&P Global and Fitch. A Providence spokeswoman said the grants helped make up for losses from the coronavirus.
Those cash piles come from a mix of sources: no-strings-attached private donations, income from investments with hedge funds and private equity firms, and any profits from treating patients. Some chains, like Providence, also run their own venture-capital firms to invest their cash in cutting-edge start-ups. The investment portfolios often generate billions of dollars in annual profits, dwarfing what the hospitals earn from serving patients.
Many of these hospital groups, including Providence, are set up as nonprofits, which generally don’t have to pay federal taxes on their billions of dollars of income.
By contrast, hospitals that serve low-income patients often have only enough cash on hand to finance a few weeks of their operations.” (D)
Providence Health & Services, the $5.2 billion-a-year behemoth of Oregon health care, plans sweeping pay cuts and other cost-cutting moves that will hit doctors and other health care employees.
At least 1,800 Providence employees will be impacted by the reductions. Compensation reductions will range from 5% to 50%.
About 1,200 employees got the word late Monday that they were among those caught up in the expense reduction plans, Providence confirmed Monday evening. That’s on top of 600 other employees who got hit with mandatory furloughs or other pay reductions in May.
The more than 600 employees of the Providence Medical Group, most of them physicians, will have their compensation reduced by 10% to 17%. Physician assistants, occupational and physical therapists and others also will be subject to the cuts.
Providence officials said the pay cuts will last only through a single quarter of this year. Earlier memos suggested that the reductions could extend longer if Providence’s financial results didn’t improve. But the nonprofit confirmed Monday that salaries will be restored after three months…
The Providence doctors say privately that given their employer’s enormous financial resources, it shouldn’t need to lean on employees to stay afloat. Providence’s Oregon operation alone listed $4.7 billion in total assets at the end of 2019. More than $806 million of it was in cash and cash equivalents.” (O)
“The New York Times analyzed tax and securities filings by 60 of the country’s largest hospital chains, which have received a total of more than $15 billion in emergency funds through the economic stimulus package in the federal CARES Act.
The hospitals — including publicly traded juggernauts like HCA and Tenet Healthcare, elite nonprofits like the Mayo Clinic, and regional chains with thousands of beds and billions in cash — are collectively sitting on tens of billions of dollars of cash reserves that are supposed to help them weather an unanticipated storm. And together, they awarded the five highest-paid officials at each chain about $874 million in the most recent year for which they have disclosed their finances…
Dr. Rod Hochman, the chief executive of the Providence Health System, for instance, was paid more than $10 million in 2018, the most recent year for which records are available. Providence received at least $509 million in federal bailout funds.
A spokeswoman, Melissa Tizon, said Dr. Hochman would take a voluntary pay cut of 50 percent for the rest of 2020. But that applies only to his base salary, which in 2018 was less than 20 percent of his total compensation.” (Q)
“HHS announced June 9 that it is making additional distributions from the provider relief fund created under the Coronavirus Aid, Relief and Economic Security Act.
3. HHS is distributing an additional $10 billion to safety-net hospitals. To qualify, hospitals must have average uncompensated care per bed of at least $25,000, profitability of 3 percent or less and a Medicare Disproportionate Payment Percentage of 20.2 percent or greater.
4. The payments to safety-net hospitals will occur this week, and each hospital will receive between $5 million and $50 million, HHS said.” (R)
__________________________
“With few treatment options, doctors turned to a familiar intervention: broad-spectrum antibiotics, the shot-in-the dark medications often used against bacterial infections that cannot be immediately identified. They knew antibiotics were not effective against viruses, but they feared the patients could be vulnerable to life-threatening secondary bacterial infections.
“During the peak surge, our antibiotic use was off the charts,” said Dr. Teena Chopra, the hospital’s director of epidemiology and antibiotic stewardship. She and other doctors across the United States who liberally dispensed antibiotics in the early weeks of the pandemic said they soon realized their mistake.
Now, doctors nationwide are seeking to draw lessons from their overuse of antibiotics, a practice that can spur resistance to lifesaving drugs as bacteria mutate and outsmart the drugs. Antimicrobial resistance is a mounting threat that claims 700,000 lives annually — a global health crisis that has been playing out in slow motion behind the scenes while the coronavirus took center stage.
In recent weeks, public health experts have been warning that the same government inaction that helped foster the rapid spread of the coronavirus could spur an even deadlier epidemic of drug-resistant infections. The United Nations warns such an epidemic could kill 10 million by 2050 if serious action is not taken.
The pipeline for new antimicrobial drugs has become perilously dry. Over the past year, three American antibiotic developers with promising drugs have gone out of business, and most of the world’s pharmaceutical giants have abandoned the field.
Legislation in Congress to address the broken antibiotics marketplace has failed to gain traction in recent years, but public health experts are hoping the coronavirus pandemic can help break the political logjam in Washington.” (L)
“A fresh outbreak of the deadly Ebola virus has flared up in the Democratic Republic of Congo, a country that was already contending with the world’s largest measles epidemic, as well as the coronavirus.
Congo’s health ministry said that the new Ebola outbreak has killed four people, and infected at least two more, in Mbandaka, a city of 1.2 million people on the country’s western side. A fifth person died on Monday, according to UNICEF, the United Nations agency for children.
Less than two months ago, Congo was about to declare an official end to an Ebola epidemic on the eastern side of the country that had lasted nearly two years and killed more than 2,275 people. Then, with just two days to go, a new case was found, and the outbreak could not be declared over. But officials say it is in its final stages.
It is unclear how Ebola emerged in Mbandaka, which is about 750 miles west of the nearly-vanquished outbreak on the country’s eastern edge. Congo (formerly known as Zaire) is the largest country in sub-Saharan Africa, and has been under travel restrictions to prevent the spread of the coronavirus.” (M)
“Candida auris is an emerging multidrug-resistant fungus that is rapidly spreading worldwide. Currently, C. auris cases have been reported globally from >30 countries. Most reported infections involve critically ill patients in hospitals, mainly in intensive care unit settings. Infection with C. auris is associated with high mortality rates, and it is often resistant to multiple classes of antifungal drugs. Despite the rapid global spread, it is difficult to predict the actual burden of the infection as the standard laboratory methods fail to correctly identify the fungi. Longer stays in healthcare facilities, use of tracheostomies and percutaneous endoscopic gastrostomy tubes, ventilators in clinical care units and mobile equipment in healthcare settings are shown as major risk factors of C. auris infection. Due to its propensity to cause outbreaks and its antifungal resistance, C. auris poses a risk for patients in healthcare facilities. The emergence of pan-resistant C. auris strains in some areas is an alarming signal for the disease with limited treatment options, high mortality rates, and the ability of the pathogen to spread easily in healthcare settings. In this regard, susceptibility testing on clinical isolates, mainly for patients treated with echinocandins, is needed. Increasing awareness about C. auris infection and advancing the diagnostic methods are also essential for early detection and control of the deadly fungal infection.” (N)
PART 2. May 13, 2019. CANDIDA AURIS. “In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?…
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….
The virus seems to spread the most when people yell (such as to chant a slogan), sneeze (to expel pepper spray), or cough (after inhaling tear gas). It is transmitted most efficiently in crowds and large gatherings, and research has found that just a few contagious people can infect hundreds of susceptible people around them. The virus can spread especially easily in small, cramped places, such as police vans and jails.
As such, for the past several days, the virus has found new environments in which to spread across the United States. At least 75 cities have seen widespread demonstrations and social unrest as Americans have gathered to protest systemic racism and the killing of George Floyd, the black man who died last week under the knee of a Minneapolis police officer…
The pandemic and unrest together have trapped the country in a bind. The demonstrations oppose police brutality. But peaceful, masked protesters—and the journalists covering them—have sometimes been met with an overly aggressive police response.
“I don’t think there’s a question of whether there will be spikes in cases in 10 to 14 days,” Mark Shrime, a public-health researcher at Harvard, told me. “With so many protests happening, that are getting so much bigger, I don’t think it’s a question of if, but when and where.”
Maimuna Majumder, a computational epidemiologist at Boston Children’s Hospital and Harvard Medical School, agrees. “All things considered, there’s little doubt that these protests will translate into increased risk of transmission for COVID-19,” she told me by email.” (A)
“As nationwide protests sparked by the death of a black man in police custody stretched into their sixth day, current and former government officials warned Sunday that the mass demonstrations could lead to new waves of coronavirus infections.
“There’s going to be a lot of issues coming out of what’s happened in the last week, but one of them is going to be that chains of transmission will have become lit from these gatherings,” former Food and Drug Administration commissioner Scott Gottlieb said in an interview on CBS News’s “Face the Nation.”” (B)
“While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus…
In Los Angeles, where demonstrations led to the closing of virus testing sites on Saturday, Mayor Eric Garcetti warned that the protests could become “super-spreader events,” referring to the types of gatherings, usually held in indoor settings, that can lead to an explosion of secondary infections.
Gov. Larry Hogan of Maryland, a Republican, expressed concern that his state would see a spike in cases in about two weeks, which is about how long it takes for symptoms to emerge after someone is infected, while Atlanta’s mayor, Keisha Lance Bottoms, advised people who were out protesting “to go get a Covid test this week.”…
…Dr. Howard Markel, a medical historian who studies pandemics, likened the protest crowds to the bond parades held in American cities like Philadelphia and Detroit in the midst of the 1918 influenza pandemic, which were often followed by spikes in influenza cases.
“Yes, the protests are outside, but they are all really close to each other, and in those cases, being outside doesn’t protect you nearly as much,” Dr. Markel said. “Public gatherings are public gatherings — it doesn’t matter what you’re protesting or cheering. That’s one reason we’re not having large baseball games and may not have college football this fall.”
Though many protesters were wearing masks, others were not. SARS-CoV-2, the virus that causes the Covid-19 disease, is mainly transmitted through respiratory droplets spread when people talk, cough or sneeze; screaming and shouting slogans during a protest can accelerate the spread, Dr. Markel said.
Tear gas and pepper spray, which police have used to disperse crowds, cause people to tear up and cough, and increase respiratory secretions from the eyes, nose and mouth, further enhancing the possibility of transmission. Police efforts to move crowds through tight urban areas can result in corralling people closer together, or end up penning people into tight spaces.
And emotions have been running high, Dr. Markel said. “People get lost in the moment, and they lose awareness of who is close to them, who’s not, who’s wearing a mask, who’s not,” he said.
The biggest concern is the one that has bedeviled infectious disease experts since the pandemic began, and it’s the coronavirus’s secret weapon: that it can be transmitted by people who don’t display any symptoms and feel healthy enough to participate in protests.” (C)
“Because of delays between exposure to the virus and symptoms, the effects of the protests on the spread of the virus will not be known for several weeks. But epidemiologists said the protests would almost certainly lead to more cases.
Health experts know that the virus is far less likely to be spread outdoors than indoors. And masks reduce the chance of transmitting respiratory droplets that contain the virus. But yelling, shouting and singing can increase how far those droplets are projected. Crowds also increase the risk of transmission. Police tactics such as spraying tear gas — which causes people to cough — herding protesters into smaller areas for crowd control and placing arrested individuals in buses, vans and holding cells also increase the risk of infection.
Tay Anderson, a protest leader and city school board member in Denver, said he had been worried about the disparate effects of the virus on black Colorado residents as thousands marched through the city and rested shoulder to shoulder on the lawn of the State Capitol in silent demonstrations to decry Mr. Floyd’s death.
He put out a call on social media for all protesters to join him in getting tested for the virus on Saturday morning at the Pepsi Center, a concert arena where Denver has been running free, large-scale testing.
“WE ARE STILL IN A PANDEMIC,” he wrote on Twitter.” (D)
““We are still in the middle of a pandemic,” Minnesota Gov. Tim Walz (D) reminded demonstrators in a news conference where he announced the full mobilization of the state National Guard to control the violent unrest.
Warning that hospitals were “on the verge of being overrun,” Walz said “demonstrators should wear masks and try to practice social distancing.”..Two to four weeks after many states began lifting restrictions on restaurants, bars and larger gatherings, cases are rising in areas that had previously dodged the worst of the virus’s impact. Arizona, Mississippi, South Carolina, Utah and Wisconsin all set record highs for new cases reported Friday. Restaurants, gyms, and other businesses have been allowed open for at least two weeks in all of the states.
The five are among 18 states that continue to see increases in their rolling seven-day case averages as of Friday, according to Washington Post data, as has Puerto Rico. Some of the places, such as Washington state, California and parts of Virginia, had imposed stringent stay-at-home measures and had been cautious in their reopening procedures. Other states experiencing case increases, such as Alabama, Missouri and Tennessee, have been more aggressive in their push to reopen.” (E)
“Several health systems in Chicago canceled elective procedures June 1 after a weekend packed with public transit disruptions and protests following the death of George Floyd, according to The Chicago Tribune.
For example, University of Chicago Medicine closed its outpatient centers June 1 in six Chicago neighborhoods, including Orland Park, South Loop, River North, River East, South Shore and Hyde Park.
It also closed its COVID-19 testing sites and canceled elective surgeries at some facilities, according to the report.” (F)
Mass protests that have erupted over police brutality toward black people in America are raising concerns about the risk of spreading the coronavirus. But some health experts, even as they urge caution, said they support the demonstrations — because racism also poses a dire health threat…
Health experts urged protesters not to sing and shout to reduce the threat of person-to-person transmission. And they cautioned that police tactics such as tear gas and pepper spray could exacerbate the situation by prompting people to cough and gasp for air.
The New York City Department of Health and Mental Hygiene issued a list of tips for demonstrators to lower their risk of contracting COVID-19, such as covering their faces and staying in small groups.
“Don’t yell; use signs & noise makers instead,” the department advised…
But the risks of congregating during a global pandemic shouldn’t keep people from protesting racism, according to dozens of public health and disease experts who signed an open letter in support of the protests.
“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter said…
Local governments should not break up crowded demonstrations “under the guise of maintaining public health,” the experts said in their open letter. They urged law enforcement agencies not to use tear gas, smoke and other irritants, saying they could make people more susceptible to infection and worsen existing health conditions.
The medical professionals also acknowledged the potential for COVID-19 cases to rise in the days to come, and they called for public health agencies to boost access to care and testing in affected communities.” (G)
“Mass protests over police brutality have shuttered coronavirus testing sites, complicated efforts to track people who have been exposed and set off fears among local officials that the unrest could spark fresh waves of virus infection.
Testing sites in Pennsylvania, Florida, California and Illinois closed after violence broke out over the weekend, limiting cities’ ability to track the virus just as thousands of people participate in crowded demonstrations across the country.
It comes at a risky time. Public health officials are already worried about caseloads rising and hospitals filling as states reopen and people venture out — sometimes in defiance of ongoing social distancing guidelines. And many of the neighborhoods affected by the violence are already bearing a disproportionate burden of the epidemic, as black Americans are getting sick and dying at far higher rates than white Americans…
Those concerns were palpable in hard-hit New York, where a few private testing sites closed or reduced hours amid the protests. Gov. Andrew Cuomo and Mayor Bill de Blasio imposed an 11 p.m. curfew in New York City, one week before it was finally set to start reopening.
“We spent all this time closing down, locked down, masks, social distancing and then we turn on the television and you see mass gatherings that could potentially be infecting hundreds and hundreds of people after everything we’ve done,” Cuomo said Monday. “We have to take a minute and ask ourselves what are we doing here?”…
“We don’t have a vaccine. We don’t have medication,” said Dr. Umair Shah, who heads the Harris County Health Department in Texas. “We’re relying on people to socially distance and wear facial coverings and avoiding large crowds. When you put those elements straight into protests — it’s completely antithetical to each other.”…
“If people have been protesting, they might not want to share with the health department where they were, especially if there were incidents in that area,” Dr. Jeffrey Klausner, a professor at UCLA’s public health school and a former health official for San Francisco, said. “There’s a brick wall [preventing information sharing] between health departments and any criminal justice efforts, but people don’t know that, so they may be reluctant to answer their phone and be completely forthcoming about their behaviors and movements.”
Those fears could be exacerbated, other health leaders fear, by Minnesota Public Safety Commissioner John Harrington using the term “contact tracing” in a weekend press conference to describe his efforts to find people who took part in looting and rioting over the weekend.
“To weaponize contact tracing — which is critical to help safely reopen our economy and ensure those most impacted by Covid-19 such as low-income communities and communities of color are safe — is unconscionable and undercuts any efforts to end this pandemic,” said David Harvey, who heads the National Coalition of STD Directors. He called it a “gross and dangerous mischaracterization of an essential public health function.”” (H)
“Republicans said Tuesday night that they were moving President Trump’s convention speech out of Charlotte, N.C., and to another city, after coming to a stalemate with Democratic officials in the state about safety and crowd size restrictions because of the coronavirus.” (I)
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….
“All those essential workers have to get up every morning to put food on the shelves and go to the hospitals to provide healthcare under extraordinary circumstances,”
N.Y. will pay benefits for workers who died fighting the pandemic.
There are 62,344 cases of COVID-19 among healthcare personnel in the U.S., and 291 have died, new data from the CDC shows. (L)
to read PARTS 1-29 in chronological order, highlight and click on
Throughout the Coronavirus pandemic I have worried non-stop about the staff at Jersey City Medical Center. I was President and CEO of the Medical Center for seventeen years and saw first-hand, time after time, how JCMC’s courageous staff of “front-liners” always responded to the challenges of inconceivable emergencies.
JCMC is a regional, safety-net, level II trauma center, teaching hospital. Rapid Response is part of the hospital’s DNA. For example:
The first World Trade Center bombing was in 1993. As a nearby EMS service we sent all our ambulances through the Holland Tunnel into Manhattan. They got caught in the gridlock, were useless, and we didn’t get them back for three days and had to rely on Mutual Assist to cover our home turf.
In the mid 1990’s we had a 4-alarm arson fire in the hospital. The extraordinary efforts of the JCFD saved the day and 400 patients as we were evacuating the smoke-filled hospital, hampered by archaic elevators and narrow, dark stairways.
And on September 11th 2001, the Medical Center was the lead New Jersey responder to the World Trade Center attacks, as thousands of evacuees were ferried across the Hudson River to Jersey City.
While I was not involved in Super Storm Sandy in 2015, the new Jersey City Medical Center opened in 2004 was hard hit even though it had been built to withstand the “100 year flood plain.” JCMC persevered while the hospitals in nearby Hoboken and North Bergen were totally evacuated.
So these “front-liners” deserve unique recognition as they stand in harms way to protect us during the most challenging of emergencies.
An article today about contact tracers in Paterson, New Jersey, reminded me that others are essential as well, even if working from home.
“States and cities around the country have begun with varying degrees of success to ramp up efforts to put contact tracing in place on a large scale. Last week, Gov. Philip D. Murphy of New Jersey said that his state would hire up to several thousand contact tracers to assist the 800 now working for local and county health departments.
In New York, Gov. Andrew M. Cuomo of New York has announced that the state will build an army of up to 17,000 contact tracers. A political tangle between agencies has complicated efforts to expand tracing in New York City, the epicenter of the pandemic in the United States, but Mayor Bill de Blasio said on Sunday that he hoped to have 1,000 tracers in place by June.
Twenty miles to the west of New York City, Paterson, a poor, largely nonwhite city of about 150,000, has been tracing the virus at a level that could be the envy of larger cities. The team has been able to successfully investigate and trace about 90 percent of the more than 5,900 positive virus cases in Paterson, said the city’s top health officer, Dr. Paul Persaud…
As of Saturday, 306 Paterson residents have died, giving the city a death rate of 5.1 percent among those who have tested positive, compared to 7 percent statewide…
When the first cases began to appear in Paterson in mid-March, the Board of Health added two dozen employees who had been trained in communicable disease investigation last year to join their regular team of two disease detectives.
Since then, the full team, which the board calls its Covid-19 strike force, has grown to nearly 50 of the 60 board employees. Joining a dozen public health nurses are clerical staff, translators and health inspectors…
The contact-tracing team mostly works from their homes, making calls and entering their interview results into the state’s communicable disease reporting system. Once a week, they put on their masks and come to the city’s small public health headquarters to confer about the crush of cases.
During last week’s meeting, Andre Sayegh, the city’s mayor, handed out a sheet showing a line curve that tracked the city’s progress: From a high of about 260 daily positives on April 15, the city is now at about 50 to 70 cases per day, a level not seen since March….
After gathering the list of contacts, the case investigator then hands most cases off to a support staff of 20 other workers, who call each contact, tell them they have been exposed and ask them to self-quarantine for two weeks from the date of exposure.
The monitors do daily check-ins with all the contacts and the original patient during quarantine to see how they are feeling and monitor their compliance.
In Paterson, the work has gone on through nights and weekends, and the tracers said it can be tedious and emotionally grueling.
The goal may be to get information from each patient, but just as vital, the tracers said, is to develop enough trust so that their advice is followed.
“Usually, I start the call by saying, ‘I see you had a Covid test, can you tell me why you went?’” Ms. Bertolero said. “One woman said to me, ‘Because my brother died.’ I just had to stop for a bit and tell her how sorry I was.” (B)
ESSENTIAL WORKERS? Of course they are!
“…Frontline workers include, but are not limited to, healthcare workers, protective service workers (police and EMTs), cashiers in grocery and general merchandise stores, production and food processing workers, janitors and maintenance workers, agricultural workers, and truck drivers…
Healthcare workers represent 20 percent of all frontline workers. This includes the relatively high-paying, highly educated group comprised of healthcare practitioners and those in technical occupations (e.g. doctors, registered nurses and pharmacists – about three quarters of all healthcare workers) as well as health-support workers (e.g nursing assistants and home health aides – about one-quarter of this group).” (C)
“We insist that many making minimum wage or close are essential enough that we need them to keep working, but we haven’t found a way yet to properly compensate them for the risk they are taking on when they clock in.
Those essential workers who show up at jobs like grocery stores and fast food chains may only see small financial rewards, such as an extra $2 per hour in hazard pay during this pandemic. Employers are not required to offer it though, so only some workers have received the bump, which may only add up to an extra $80 or so weekly for a full-time worker anyway.
Meanwhile, the CARES Act is allowing for those on unemployment to receive an extra $600 per week in addition to their regular benefit. So a full-time grocery store worker who was taking home $700 every two weeks might now be making $860 with their hazard pay benefit, or perhaps a little more with an increase in hours. Compare with a person on unemployment who could be taking home a benefit of $600 every two weeks plus an extra $600 per week for a total of $1800 over that same pay period.
Some workers feel they are being treated unfairly for being expected to show up to these jobs only to take home less pay than those who are sitting safely at home making unemployment. In a way, the essential workers are trapped. They can’t get unemployment if they quit, but their jobs won’t fire them so long as they’re needed. What this means is that while essential businesses are booming, their employees are receiving none of the gains while taking on most of the risk.” (D)
“Frontline workers have always been the lifeblood of our city. Nurses, janitors, grocery clerks, childcare staff, bus and truck drivers. Every single day, crisis or no crisis, these are the essential workers in our city, our economy, and our society. The COVID-19 crisis does little to change that reality, it only brings into sharper relief these vital New Yorkers, who number more than one million workers amid today’s crisis, or 25 percent of the city’s workforce.
And yet, these same workers whom we trust with our health, our nourishment, our loved ones, and our lives are too often ignored, underpaid, and overworked. They very often lack healthcare, have to travel long distances to get to get to work, and struggle with childcare. Many in New York City are also undocumented, meaning they do all of the above while living in fear of deportation under the current federal administration.
If there is any collateral benefit to the COVID-19 tragedy, it is that the labor and contribution of those in our social service, cleaning, delivery and warehouse, grocery, healthcare, and public transit industries have finally received the attention and respect that they are due. How well we protect, compensate, and care for these workers, then, will be the ultimate litmus test for what we’ve learned from this global pandemic.” (E)
‘New York Gov. Andrew Cuomo said Monday the federal government should pay bonuses to front line coronavirus workers.
According to The Hill, Cuomo made the comments during his daily coronavirus press conference, saying essential workers don’t have the “luxury of staying home.” As a result, Cuomo believes essential workers should receive a 50% bonus over what they’re currently being paid.
“We all say ‘boy they did a great job, the healthcare workers did a great job, the police — they’re heroes,’” Cuomo said. “Yes, they are, but you know? Thanks is nice but also recognition of their efforts and their sacrifice is also appropriate. They are the ones carrying us through this crisis and this crisis is not over.”…
“Senate Democrats unveiled a proposal Tuesday that would boost the pay of essential workers on the frontlines of the battle against the coronavirus pandemic by potentially tens of thousands of dollars.
As much as $25,000 in hazard pay would be afforded over a period of time to those deemed essential, including employees in health care, drug stores, grocery stores, sanitation workers, truck drivers, transportation workers and all federal employees with frontline positions, such as Postal Service workers.
“Not all heroes wear capes,” Senate Minority Leader Chuck Schumer (D-N.Y.) told reporters on a conference call Tuesday. “For these Americans, working from home is not an option. Social distancing is not an option.”
The raise would be equivalent to $13 per hour and would apply retroactively from the start of the health crisis emergency on January 27 until the end of the year, Schumer said.
Health care workers also could receive a one-time premium of up to $15,000 as part of a program to recruit and retain certain medical employees in fields experiencing shortages. The benefits would be applied retroactively for those already working on the frontlines and to the families of health care workers who’ve died as a result of coronavirus.
“We are asking these workers to take on great risk. They should be compensated for it,” Schumer said. “These Americans are the true heroes of this pandemic, and we need to make sure they are taken care of. They are there for us, so we must be there for them.”” (G)
Heroes among us: Cincinnati essential workers who are battling on the frontlines” (H)
“Marching into the White House briefing room for a hastily called announcement, Mr. Trump declared places of worship “essential” operations that should hold services in person this weekend regardless of state quarantine orders stemming from the coronavirus pandemic that has killed nearly 96,000 people in the United States.
“The governors need to do the right thing and allow these very important, essential places of faith to open right now for this weekend,” Mr. Trump said, reading from a prepared text before leaving after just about a minute without taking questions. “If they don’t do it, I will override the governors. In America, we need more prayer, not less.”” (J)
“New York’s state and local governments will provide death benefits to the families of essential workers who died while fighting the coronavirus pandemic, Gov. Andrew M. Cuomo said on Monday.
“We want to make sure that we remember them, and we thank our heroes of today, and they’re all around us,” Mr. Cuomo said at his daily news briefing.
As people paused on Memorial Day to remember military personnel who died while serving the country, Mr. Cuomo linked the fallen service members to New York’s front-line workers, whom he called today’s “heroes.”
The public employees whose families would receive death benefits included health workers, police officers, firefighters, transit workers and emergency medical workers, the governor said. The benefits would be paid out of state and local pension funds.” (K)
PART 1. January 21, 2020. CORONAVIRUS. “The Centers for Disease Control and Prevention on Tuesday confirmed the first U.S. case of a deadly new coronavirus that has killed six people in China.”
PART 2. January 29, 2020. CORONAVIRUS. “If it’s not contained shortly, I think we are looking at a pandemic..”….. “With isolated cases of the dangerous new coronavirus cropping up in a number of states, public health officials say it is only a matter of time before the virus appears in New York City.”
PART3. February 3, 2020. “The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe…”..Trump appeared to downplay concerns about the flu-like virus …We’re gonna see what happens, but we did shut it down..” (D)
PART 4. February 9, 2020. Coronavirus. “A study published Friday in JAMA found that 41% of the first 138 patients diagnosed at one hospital in Wuhan, China, were presumed to be infected in that hospital.….
PART 5. February 12, 2020. CORONAVIRUS. “In short, shoe-leather public health and basic medical care—not miracle drugs—are generally what stop outbreaks of emerging infections..”
POST 6. February 18, 2020. Coronovirus. “Amid assurances that the (ocean liner) Westerdam was disease free, hundreds of people disembarked in Cambodia…” “ One was later found to be infected”…. “Over 1,000… passengers were in…transit home”…. “This could be a turning point””
PART 7. February 20, 2020. CORONAVIRUS. With SARS preparedness underway in NJ LibertyHealth/ Jersey City Medical Center, where I was President, proposed that our 100 bed community hospital with all single-bedded rooms, be immediately transformed into an EMERGENCY SARS ISOLATION Hospital.
PART 8. February 24, 2020. CORONAVIRUS. “…every country’s top priority should be to protect its health care workers. This is partly to ensure that hospitals themselves do not become sites where the coronavirus is spread more than it is contained.”
PART 9. February 27, 2020. CORONAVIRUS. Responding to a question about the likelihood of a U.S. outbreak, President Trump said, “I don’t think it’s inevitable…”It probably will. It possibly will,” he continued. “It could be at a very small level, or it could be at a larger level.”
Part 10. March 1, 2020. CORONAVIRUS. Stop Surprise Medical Bills for Coronavirus care. (&) Lessons Learned (or not) In California and Washington State from community acquired cases.
PART 11. March 5, 2020. CORONAVIRUS. “Gov. Andrew Cuomo… would require employers to pay workers and protect their jobs if they are quarantined because of the coronavirus.”
Part 12. March 10, 2020. CORONAVIRUS. “Tom Bossert, Donald Trump’s former homeland security advisor…(said) that due to the coronavirus outbreak, “We are 10 days from the hospitals getting creamed.”
Part 13.. March 14, 2020. CORONAVIRUS. “If I’m buying real estate in New York, I’ll listen to the President….If I’m asking about infectious diseases, I’m going to listen to Tony Fauci,”
PART 14. March 17, 2020. CORONAVIRUS. “ “Most physicians have never seen this level of angst and anxiety in their careers”…. One said “I am sort of a pariah in my family.”
PART 15. March 22, 2020. CORONAVIRUS. “…Crimson Contagion” and imagining an influenza pandemic, was simulated by the Trump administration….in a series of exercises that ran from last January to August.
PART 16. March 27, 2020. CORONAVIRUS. I am not a clinician or a medical ethicist but articles on Coronavirus patient triage started me Googling………to learn about FUTILE TREATMENT
PART 17. April 2, 2020. CORONAVIRUS. Florida allows churches to continue holding services. Gun stores deemed “essential.” “New York’s private and public hospitals unite to manage patient load and share resources.
PART 18. April 9, 2020. CORONAVIRUS. “The federal government’s emergency stockpile of personal protective equipment (PPE) is depleted, and states will not be receiving any more shipments, administration staff told a House panel.
PART 19. April 13, 2020 CORONOAVIRUS. “…overlooked in the United States’ halting mobilization against the novel coronavirus: the personal aides, hospice attendants, nurses and occupational or physical therapists who deliver medical or support services to patients in their homes.”
POST 22. April 29, 2020. CORONAVIRUS. ..the “ACS released a list of 10 issues that should be addressed before a healthcare organization resumes elective surgeries[JM1] ….”
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
POST 24. May 7, 2020. CORONAVIRUS. Former New Jersey governor Chris Christie said: “there are going to be deaths no matter what”… but that people needed to get back to work.
POST 25. May 10, 2020, CORONAVIRUS. “It is scary to go to work,” said Kevin Hassett, a top economic adviser to the president. “I think that I’d be a lot safer if I was sitting at home than I would be going to the West Wing.”
POST 26. May 14, 2020. CORONAVIRUS, “Deep cleaning is not a scientific concept”….”there is no universal protocol for a “deep clean” to eradicate the coronavirus”
POST 27. May 19, 2020. CORONAVIRUS. “Hospital…executives…are taking pay cuts…to help offset the financial fallout from COVID-19.” As “front line” layoffs and furloughs accelerate…
POST 28. May 23, 2020. CORONAVIRUS. ““You’ve got to be kidding me,”..”How could the CDC make that mistake? This is a mess.” CDC conflates viral and antibody tests numbers.
PART 29. May 22, 2020. CORONAVIRUS. “The economy did not close down. It closed down for people who, frankly, had the luxury of staying home,” (Governor Cuomo). But not so for frontline workers!
“ The Centers for Disease Control and Prevention is conflating the results of two different types of coronavirus tests, distorting several important metrics and providing the country with an inaccurate picture of the state of the pandemic. We’ve learned that the CDC is making, at best, a debilitating mistake: combining test results that diagnose current coronavirus infections with test results that measure whether someone has ever had the virus. The upshot is that the government’s disease-fighting agency is overstating the country’s ability to test people who are sick with COVID-19. The agency confirmed to The Atlantic on Wednesday that it is mixing the results of viral and antibody tests, even though the two tests reveal different information and are used for different reasons.
This is not merely a technical error. States have set quantitative guidelines for reopening their economies based on these flawed data points.” (A)
“Virginia, Texas, Georgia, and Vermont have said they’ve been adding two numbers to their totals: viral test results and antibody test results.
Viral tests are taken by nose swab or saliva sample, and look for direct evidence someone currently has Covid-19. By contrast, antibody tests use blood samples to look for biological signals that a person has been exposed to the virus in the past.
Combining the two tests’ results into one total could provide an inaccurate picture of where and when the virus spread. It could also overstate a state’s ability to test and track active infections — a key consideration as states ease coronavirus restrictions. Experts have consistently emphasized that for states to reopen safely, adequate testing and tracing is needed.
“You only know how many cases you have if you do a lot of testing,” said Elizabeth Cohen, CNN’s senior medical correspondent. “If you put the two tests together, you fool yourself into thinking you’ve done more testing than you have.”’…
Texas, Virginia and Vermont have said they’ve recognized the data issue and moved to fix it in the past few days. In Georgia, health officials said they’ve been adding antibody tests to their “total tests” number in line with methodology from the Centers for Disease Control and Prevention.” (B)
Viral tests — commonly referred to as PCR tests as most of them use a process known as polymerase chain reaction — are used by health professionals to determine whether or not a person is currently infected with the disease. During the pandemic, viral tests have been the most effective way of being able to diagnose a positive case of COVID-19. They are what state governments have been counting to track the number of confirmed cases of the virus they have.
Antibody, or serology, tests serve a different purpose. Unlike viral tests that are taken by nose swab or saliva sample, antibody tests examine a person’s blood to see if their immune system has created antibodies to combat COVID-19. These tests allow doctors to see if someone has previously been exposed to the virus. As the push for widespread testing in the U.S. has strengthened, antibody tests have been widely produced, many experts have balked at saying that antibodies equate to immunity from COVID-19. Serology tests are also less accurate than PCR tests, increasing the chances for a false negative.
Moreover, a negative test means different things for either test. A negative PCR test indicates to physicians that the patient isn’t currently ill with the disease. But, a negative serology test means that the patient has most likely not been exposed to or infected with COVID-19.
“The viral testing is to understand how many people are getting infected, while antibody testing is like looking in the rearview mirror. The two tests are totally different signals,” Jha told The Atlantic.” (C)
“The Atlanta-based Centers for Disease Control and Prevention and Georgia’s state health department will alter their website data to separate testing data combining antibody and diagnostic test totals.
Wednesday evening, Channel 2 Action News learned Georgia included 57,000 antibody tests in their tally of the number of Georgians who had been tested for COVID-19. That accounted for roughly 15% of the Georgians who were reportedly tested for the virus. When removed from the positive case data, it increased the rate of infected Georgians by 2%.
Simply put, the data inflated the number of Georgians who have been tested for COVID-19. That figure stands around 3%.
The inclusion of the data also offered an “apples-to-oranges” look at the testing. Antibody tests give you a window into the past. COVID-19 test results are used to determine current trends and infections…
Thursday, a CDC spokeswoman told Channel 2 investigative reporter Nicole Carr that the agency would also change its online reporting data in the coming weeks.
“Initially, when CDC launched its website and its laboratory test reporting, viral testing (tests for current infection) were far more commonly used nationwide than serology testing (tests for past infection),” the statement read. “Now that serology testing is more widely available, CDC is working to differentiate those tests from the viral tests and will report this information, differentiated by test type, publicly on our COVID Data Tracker website in the coming weeks.”..
…experts here in Georgia explained the problems that arise from the conclusions drawn when that data is mixed. This comes days after Georgia began removing antibody positives out of case counts.
“When you only count the positives from the viral test, it’s going to look like the number of people who are testing positive as a percentage of all tests is going down, when it, in fact, that may not be the case, or at least it’s exaggerating that effect,” …
“It gets more complicated than that because these tests have different accuracy levels,”… “The percentage of false positives and false negatives is going to be different with each test, so why do you would mix them together? It just clouds what you know about the situation.”…
“In the realization yesterday that that total testing number was almost impossible to interpret called, really, those numbers into question and all the policies that have been based on those numbers into question,”…“And I think rightfully raises concerns in the minds of many Georgians.”
“We really need one coordinated public health response,” he added.” (D)
“In addition, combining antibody testing with diagnostic testing could reduce the number of tests that appear to be producing positive results, lowering the overall “positivity rate.” That’s another important benchmark. The World Health Organization has recommended a positivity rate of 10% or less as a signal of whether enough testing is taking place.” (E)
“How CDC explained its actions: The inflated totals resulted from states reporting their data to the agency in that format, a CDC spokesperson told POLITICO’s Brianna Ehley. Some states are still using a simplified submission form CDC created early on that combines both types of tests, meaning they get bunched together in the federal numbers too.
The agency is now shifting states to a more detailed form that should eliminate that issue, and it plans to break out figures for the two types of tests in the next week or so.
Some questions are still unanswered. CDC wouldn’t say how long it’s been combining the two tests, and it wasn’t until Wednesday — amid questions about its practices — that CDC deleted an assertion on its website that the totals “represent only viral tests.” It’s also unclear how significantly the practice has inflated the testing totals.” (F)
““This is not an intentional misuse of information — it’s part of the fog of the infectious disease war,” said Michael T. Osterholm, a University of Minnesota professor and former state epidemiologist who was sharply critical of the disease control centers early in the pandemic. “We’ve done surveillance for cases, and now we’re all trying to do testing, and it presents unique challenges.”
Whatever the reason, the numbers are fueling Mr. Trump’s frequent — and inaccurate — boasts that the United States is doing more testing “than all other countries combined,” a claim that the fact-checking website PolitiFact has declared “pants on fire wrong.” Governors rely on testing in deciding how far to go in reopening their economies. With all 50 states moving to reopen, accurate tracking is essential.
“We’re like the blind epidemiologists trying to understand the elephant,” said Michael Levy, a professor of epidemiology at the University of Pennsylvania. Health officials, he said, need good reporting to “understand the relationship between the epidemic that we can’t see, and the data that we can see.”
Scott J. Becker, the executive director of the Association of Public Health Laboratories, said there was another reason states were tracking testing: Mr. Trump wants the numbers.
“We’ve never needed to capture test volume. That is what the White House wanted to know, how many tests were being done,” Mr. Becker said, adding, “Ordinarily this all works through the public health system, but in this response, there’s been a drive to have data numbers, at multiple levels.”” (G)
“According to The Atlantic’s COVID Tracking Project, COVID-19 testing capacity in the U.S. has more than doubled over the past month, increasing from about 147,000 tests a day in mid-April to more than 413,000 tests a day as of May 20. Simultaneously, the proportion of positive tests recorded each week fell from 10% to 6% of total tests conducted. Both trends appear encouraging at face value, but given that diagnostic and antibody tests are sometimes being lumped together, it’s impossible to know whether the data reflects reality, The Atlantic reported.
When asked about the mess-up, CDC spokesperson Kristen Nordlund said that the agency “hopes” to separate the data on their COVID Data Tracker within the next few weeks.” (H)
Prequel
POST 23. May 3, 2020. CORONAVIRUS. … what Dr. Fauci really wants,…”is just to go to a baseball game. That will have to wait. The level of testing for the virus is not adequate enough to allow for such mass gatherings.’ (K)
