If Americans don’t believe public health officials or medical researchers, perhaps they’ll believe Wall Street. A new analysis released by the investment bank Goldman Sachs this week argues that implementing a national mask-wearing mandate is “worth” about 5 percent of US gross domestic product (GDP). Performing a regression analysis of reported masking behavior among residents of states with state-level mandates, as well as infection rates following the mandate implementation, Goldman’s analysts found that mask mandates result in a 25 percent reduction in the growth rate of infections, as well as a decline in COVID fatalities.
The analysis estimates that implementing a national mandate would increase the percentage of people who wear masks by 15 percentage points, with larger impact in states that currently have low levels of mask compliance. Goldman Sachs had previously constructed an “effective lockdown index”, estimating that the coronavirus pandemic subtracted 17 percent from US GDP between January and April.
Given spikes in COVID infections across Sun Belt states, the analysis found that avoiding potential lockdowns by instead implementing a mask mandate could avoid a further 5 percent decrease in GDP. Both the Centers for Disease Control (CDC) and the World Health Organization (WHO) recommend that the general public wear masks, and a growing body of scientific research indicates that masking significantly reduces the spread of COVID.
Now the bankers have weighed in. We don’t know who still needs to hear this, but please wear a mask when you’re out and about this holiday weekend. Please.
The American public health system has long been considered one of the best in the world, but decades of underfunding have left states and counties woefully ill-equipped to handle the worst pandemic in a century.
An extensive analysis by Kaiser Health News and the Associated Press found that over the past ten years, per-capita spending by state and local public health departments has dropped by 16 and 18 percent, respectively, leaving our public health system “underfunded and under threat, unable to protect the nation’s health”.
Public health departments are mandated to provide a laundry list of critical functions, from restaurant inspections and water testing to immunizations. But over time, many of these functions have been privatized, and staff and budgets reduced. Both were cut further as state budgets tightened.
The federal government has extended $13B in emergency funding, but many local public health departments have still been forced to furlough workers during the pandemic. Citing comparisons to the funding extended during other crises like Zika and the H1N1 influenza, experts are concerned that baseline budgets will continue to decline.
Moreover, public health workers face unprecedented cultural challenges, and are often disrespected by political and clinical leaders. And as public health workers are putting themselves at risk of COVID exposure just to do their jobs, many face resentment and anger from angry citizens who blame them for the policies they are charged to enforce—with some local public health leaders even resigning due to threats and intimidation.
The current crisis has shown that we need a more expansive, and better coordinated public health infrastructure. Getting there will require not just more investment, but repairs to the foundation of this critical national asset.
We’re hearing from medical groups around the country that in the past few weeks, office visit volumes have quickly approached pre-COVID levels. Some are even busier, running at 110 percent of their February volumes, or more. At the same time, practice has become more stressful, with doctors balancing virtual care with in-person visits, new safety procedures slowing operations, and staff and patients worried about COVID exposure. Everything feels different, and irrespective of the number of patients on today’s schedule, all of the changes make a physician feel like she’s working harder than before.
A chief clinical officer from a Midwestern health system relayed the discord this has created when discussing incentives: “Our doctors were fully on board with the need to reduce salaries back in April, so we all took a 15 percent pay cut through the summer. Now that they’re busy again, they want to be bumped back to 100 percent. But the system’s financial picture hasn’t changed.”
The growing disconnect between how hard many staff are working and the economic reality of the system isn’t unique to doctors. But physicians, most of whom have their compensation tied to individual productivity, may feel it more acutely. While there are no easy solutions, it’s critical to discuss this disconnect openly, rather than letting resentment fester under the surface.
The pandemic has brought to light the brittleness of health system and physician practice finances. Prescient systems will use this moment to work with their doctors to rethink practice and align compensation with the financial success of the system, while meeting doctors’ needs for stability and security.
While COVID-19 provided a big push for doctors and health systems to rapidly expand telemedicine visits and other kinds of remote patient interactions, many report that they are now seeing telemedicine visits decline sharply, as in-person visits return.
While it’s natural to be glad that “things are returning to normal”, backing off virtual care is short-sighted, as recent experiences have set new expectations for patients. Survey data shows consumers like using telehealth services, both because they’re more convenient (65 percent) and help avoid COVID infection (63 percent)—and 51 percent say they would continue using them after the pandemic ends.
We’re increasingly convinced that virtual physician visits are just one part of a continuum of care that can be delivered in the convenience and safety of the patient’s home. The graphic below highlights the range of consumer-focused virtual care solutions, from asynchronous chat interactions all the way to hospital care delivered at home.
Health systems that can deliver “care anywhere”—an integrated platform of virtual services consumers can access from home (or wherever they are) for both urgent needs and overall health management, coordinated with in-person resources—have an unprecedented opportunity to build loyalty at a time when consumers are seeking a trusted source of safe, available care solutions.
As the nation headed into the 4th of July weekend, the number of new COVID cases hit a string of daily highs, reaching a record high of more than 55,000 on Thursday. States across the South and Sunbelt, especially those that lifted stay-at-home orders early, saw the worst spikes.
Florida broke a new record with more than 10,000 cases on Thursday, and Georgia also experienced a new daily high. Hospitalizations continued to rise sharply in several states as well. Many hospitals reported a shift in COVID admissions toward younger, otherwise healthy adults, reports borne out by the lower death rate than that experienced in the initial surge of cases in the Northeast. (Advances in the management of severely ill COVID patients have also brought death rates down.)
In a Senate hearing on Tuesday, top White House health advisor Dr. Anthony Fauci said that the US was “not in total control” of the pandemic, and predicted that daily new case counts could top 100,000 if more stringent measures are not taken.
California, Florida, and other states took steps to roll back reopening efforts, and Texas Gov. Greg Abbott abruptly reversed direction and ordered a statewide mask mandate. Welcome news, but likely too late to prevent cities like Houston from exceeding available ICU capacity. Cases in the city have skyrocketed across the past month, with its positive test rate hitting 20 percent yesterday; its cancer and children’s hospitals began admitting COVID-positive adults to provide added capacity.
With celebrations scheduled across the nation this weekend, including another large event today at Mount Rushmore to be attended by President Trump, where masking and social distancing will be optional, it seems certain that we will continue to reap the whirlwind of careless behavior and hasty reopening for the rest of this month and beyond.
And looming in just six weeks—students return to schools and colleges.
US coronavirus update: 2.7M cases; 130K deaths; 33.5M tests conducted.
The June unemployment rate of 11.1 percent, down from a peak of 14.7 percent in April, reflects a continuing, cautious economic recovery. What those numbers don’t show is an increase in employment driven disproportionately by part-time work and industries that are vulnerable to another shutdown.
According to the Labor Department’s survey of American households, many of those workers would work full-time if they could and are working part-time only because of poor economic conditions. The number of people pushed into part-time work has more than doubled since February. Meanwhile, the number of people who work part-time by choice is still down by 23 percent.
The unemployment rate isn’t wrong: Part-time work is still work. However, those jobs have already proved to be vulnerable to a slowing economy. Anyone pushed into part-time work by the coronavirus’s initial shock to the economy may be even more vulnerable in the case of future shutdowns. And part-time workers may not have access to benefits such as health insurance that are available to full-time workers.
The industries that bounced back in May and June are also at the mercy of future shutdowns as coronavirus cases surge across the Sun Belt. For instance, unemployment in leisure and hospitality is still very high but dropped by 10 percentage points from April’s staggering 40 percent. Retail and wholesale unemployment dropped by a third. In contrast, finance, government and professional services have had a slow start to recovery. Unemployment in the information industry actually increased from May to June.
If the greatest gains in employment are in industries that suffered most in the early stages of the pandemic, those gains are vulnerable to future waves of shutdowns. Meanwhile, less-volatile industries may continue to be slow to bounce back. A Congressional Budget Office report predicted that the unemployment rate is expected to stay above its pre-pandemic levels through the end of 2030.