A D.C. protest without people: Activists demand PPE for health care workers on front line of coronavirus pandemic

https://www.washingtonpost.com/local/a-dc-protest-without-people-activists-demand-ppe-for-health-care-workers-on-front-line-of-coronavirus-pandemic/2020/04/17/e4a915b4-80d6-11ea-a3ee-13e1ae0a3571_story.html?fbclid=IwAR25nXMi24JerZwm0uFL47exQtEkyWEPh5-tFp1eFO2O4zfzUmdltOfpd3A&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

 

Activists in D.C. demand PPE for healthcare workers on frontline ...

Spaced six feet apart on the West Lawn of the Capitol, the faces of front-line health-care workers looked out over the nation’s capital. Some wore masks. Others held signs imploring lawmakers for more personal protective equipment.

But these workers were not there in the flesh. Friday’s protest was peopleless.

With mandatory social distancing guidelines and stay-at-home orders in effect throughout the region, and given the grueling demands of their jobs as the deadly coronavirus continues to spread, it would have been nearly impossible to assemble 1,000 health-care workers outside Congress this week.

Instead, volunteers put up 1,000 signs to stand on the lawn in their absence.

Activists who are used to relying on people power to amplify messages and picket lawmakers have been forced to use alternative protest tactics amid the pandemic.

Half a dozen volunteers with liberal activist group MoveOn pressed lawn signs into the grass outside the Capitol as the sun peaked over the Statue of Freedom.

On each sign was a message.

Some, bearing the blue Star of Life seen on the uniforms of doctors, first responders and emergency medical technicians, reiterated a hashtag that has made the rounds on social media for weeks, accompanying posts from desperate front-line workers who say they are running out of necessary protective equipment: #GetUsPPE.

Others showed photos of medical workers in scrubs and hair nets and baseball caps. Some wore face shields and plastic visors. Others donned gloves.

One barefaced doctor in a white lab coat held up a hand-drawn sign. “Trump,” it said. “Where’s my mask?”

Health-care providers in hospitals, clinics, nursing homes, assisted-living facilities and rehabilitation centers have for weeks begged for more PPE to protect themselves and their vulnerable patients.

States and hospitals have been running out of supplies and struggling to find more. The national stockpile is nearly out of N95 respirator masks, face shields, gowns and other critical equipment, the Department of Health and Human Services announced last week.

“Health-care workers are on the front lines of this crisis, and they’re risking their lives to save ours every day, and our government, from the very top of this administration on down, has not used the full force of what they have with the Defense Production Act to ensure [workers] have the PPE they need and deserve,” said Rahna Epting, the executive director of MoveOn. “We wanted to show that these are real people who are demanding that this government protect them.”

Unlike protests that have erupted from Michigan to Ohio to Virginia demanding that states flout social distancing practices and reopen the economy immediately, organizers with MoveOn said they wanted to adhere to health guidelines that instruct people not to gather in large groups.

“Normally, we’d want everyone down here,” said MoveOn volunteer Robby Diesu, 32, as he looked out over the rows of signs. “We wanted to find a way to show the breadth of this problem without putting anyone in harm’s way.”

A large white sign propped at the back of the display announced in bold letters: “Social distancing in effect. Please do not congregate.”

The volunteers who put up the signs live in the same house and have been quarantining under the same roof for weeks. Still, as they worked, several wore masks over their face to protect passersby — even though there were few.

A handful of joggers stopped to take pictures as the sun rose.

One man, who spoke on the condition of anonymity because he is a government employee, said he supported the idea.

“I’m so used to seeing protests out here by the Capitol that it really is bizarre to see how empty it is,” he said. “But this is really impressive to me.”

By sharing images and video on social media of front-line workers telling their stories, MoveOn organizers said they hope to galvanize people in the same way as a traditional rally with a lineup of speakers.

Activists planned to deliver a petition to Sen. Chris Murphy (D-Conn.) with more than 2 million signatures urging Congress to require the delivery of more PPE to front-line workers. Murphy has been a vocal critic of the Trump administration’s coronavirus task force and its reliance on private companies to deliver an adequate amount of critical gear, such as N95 respirator masks, medical gowns, gloves and face shields, to health-care workers.

“In this critical hour, FEMA should make organized, data-informed decisions about where, when, and in what quantities supplies should be delivered to states — not defer to the private sector to allow them to profit off this pandemic,” the senator wrote last week in a letter to Vice President Pence, co-signed by 44 Democratic and two independent senators.

Organizers said the signs would remain on the Capitol lawn all day, but that the demonstration was only the beginning of a spate of atypical ones the group expects to launch this month.

Epting described activists’ energy as “more intense” than usual as the pandemic drags on.

“The energy is very high, the intensity is very high,” she said. “That’s forcing us to be creative and ingenuitive in order to figure out how to protest in a social distancing posture and keep one another safe at the same time.”

 

 

 

 

A landmark post-COVID physician group acquisition in California

https://mailchi.mp/39947afa50d2/the-weekly-gist-april-17-2020?e=d1e747d2d8

Brown & Toland Reviews | Glassdoor

Blue Shield of California announced last Friday that its healthcare services division, Altais, is acquiring Brown & Toland Physicians, a multispecialty network of 2,700 physicians serving 350,000 patients in the greater San Francisco Bay Area. Brown & Toland, formed in 1993, is a clinically-integrated network of independent physicians that has received much attention nationally for its risk-based contracting as both a Medicare Pioneer Accountable Care Organization, as well for its landmark contract to manage state workers and retirees in the California Public Employees’ Retirement System (CalPERS).

While few details of the deal have been released, Altais says it will provide Brown & Toland with both capital for growth, and a technology platform that includes practice management, analytics tools, telehealth and electronic health record assistance. Brown & Toland’s CEO, Kelly Robinson, said the partnership would enable the group to expand geographically.

While Blue Shield’s purchase of Brown & Toland is the first noteworthy payer acquisition of physician practices we’ve seen in the post-COVID era, it’s likely just the first of many to follow in coming months. As we reported last week, the majority of physician groups—especially smaller independent practices—are suffering significant financial strain, which will likely make groups of all sizes more open to partnership options.

Recent reports suggest that payers in particular may be weathering the economic shocks of the crisis relatively well. This week UnitedHealth Group (UHG) announced it exceeded Q1 earnings targets, and would maintain its pre-COVID earnings guidance for the year, citing savings from cancelled routine care and elective procedures. Should payers continue to fare well, it’s likely that UHG and other health plans could enjoy an advantage in deploying the capital necessary to roll up distressed physician practices.

 

 

 

 

Not jumping to conclusions on coronavirus treatment

https://mailchi.mp/39947afa50d2/the-weekly-gist-april-17-2020?e=d1e747d2d8

A Closer Look At Remdesivir, An Experimental Coronavirus Drug ...

Early reports of hastened recoveries among patients taking the antiviral drug remdesivir sent manufacturer Gilead Sciences’ stock soaring over 8 percent this morning, and contributing to an overall uptick in the market. The gains came after a scoop by healthcare news site STAT, which obtained a copy of an internal webinar from University of Chicago Medicine, where an infectious disease specialist discussed positive results from their early experience with remdesivir. The system recruited 125 patients into Gilead’s Phase 3 clinical trials for the drug; 113 patients had severe disease. The presenting physician reported rapid reductions in fever and improvements in respiratory symptoms, noting that just two patients had died, and most of the participating patients had already been discharged—on average after just six days, suggesting a long course of drug treatment may not be necessary.

The STAT leak comes on the heels of a NEJM article late last week, which reported clinical improvement of over two-thirds in COVID-19 patients who received remdesivir. Critics were quick to point out  numerous flaws in the study, including lack of a control group, cherry-picking of patients, and the deep involvement of the manufacturer in study design, many of which also apply to the University of Chicago report.

In the thick of the pandemic, doctors and patients’ families are understandably motivated to get very sick patients access to any treatment that may help—but the resulting frenzy following the publication of early results may make it even harder to get good data to understand what works, and what doesn’t.

In the words of one expert, “Fast trials are generally not very interpretable, interpretable trials are generally not fast”. In the search for a “COVID-19 cure”, it’s highly unlikely that any single drug will provide a cure for the viral illness, and the only way we’ll know if a treatment is truly working is to wait for the results of randomized, controlled trials—despite how frustrating it is to muster the patience to do so.

 

 

 

 

Beginning the long, winding journey back from coronavirus

https://mailchi.mp/39947afa50d2/the-weekly-gist-april-17-2020?e=d1e747d2d8

45cat - The Beatles - The Long And Winding Road / For You Blue ...

It was another brutal week in the coronavirus pandemic, with more than 2.1M cases and nearly 150,000 deaths worldwide. The US continued to be the hardest-hit country, reaching a daily record 4,591 deaths from COVID-19 on Thursday. The national death toll is now more than 35,000, though there are signs that the number of new cases in the US has begun to plateau, raising hopes that the worst days may be drawing to a close. Meanwhile, with strict stay-at-home measures continuing in most places across the country, the economic toll of the virus mounted. New unemployment claims rose by another 5.2M, bringing the estimated number of American jobs claimed by the virus to 22M, eliminating a decade’s worth of job growth, and raising the unemployment rate to an estimated 17 percent.

As the growth in new cases flattened, attention turned this week to plans to “reopen” the American economy. Despite insisting early in the week that he alone would decide when and how to reopen the country, President Trump yesterday unveiled a set of non-binding, “Opening Up America Again” guidelines for state and local officials to use in judging when to loosen restrictions. The guidelines suggest a three-stage, gated approach, gradually allowing individuals and employers to return to normal activities based on criteria including disease trends, hospital capacity, and the availability of robust testing. Progressing from one stage to the next is predicated on maintaining a downward trajectory in new cases—with any signs of a resurgence indicating a need to reimpose restrictions.

Missing from the White House plan are specific details about how states, cities, and healthcare providers are to procure and pay for the many millions of tests and extensive contact tracing that will need to be available to allow businesses, public transport systems, and other essential services to resume activity. By week’s end, about 3.5M coronavirus tests had been conducted nationally, but the daily number of tests conducted has plateaued, and the test-positivity rate is still troublingly high. Public health experts continue to warn that testing must ramp up significantly before any steps toward reopening can be considered, a difficult challenge given widespread reports of shortages of testing supplies and trained lab technicians. To bolster testing capacity, the Centers for Medicare and Medicaid Services (CMS) this week nearly doubled the amount it will pay laboratories to analyze tests using high-throughput equipment.

Three coalitions of states—in the Northeast, Midwest, and West Coast—were formed this week to coordinate regional efforts to reopen the economy. Among the issues they’ll need to address: interstate travel restrictions, coordinated purchasing of critical supplies, investments in contact tracing capabilities, and ongoing surveillance of the virus’ spread. With federal agencies taking a back seat to states (“You are going to call your own shots,” the President told governors on a call this week), it became clear that the road back from the coronavirus pandemic will be circuitous, with a patchwork of different timelines and approaches in different locations based on local conditions and resources.

In the words of William Gibson, “The future is here—it’s just not very evenly distributed.”

 

 

 

 

Coronavirus tracked: the latest figures as the pandemic spreads

https://www.ft.com/coronavirus-latest

 

A graphic with no description

The human cost of the coronavirus outbreak has continued to mount, with more than 2.2m cases confirmed globally and more than 141,900 people known to have died from the disease.  The World Health Organization has declared the outbreak a pandemic and it has spread to more than 190 countries around the world.  This page provides an up-to-date visual narrative of the spread of Covid-19 so please check back regularly because we will be refreshing it with new graphics and features as the story evolves.

A graphic with no description

Focus of Covid-19 deaths has switched from Asia to Europe — and now the US. Streamgraph and stacked column charts, showing regional daily deaths of patients diagnosed with coronavirus

A graphic with no description

 

 

 

 

 

To save lives, social distancing must continue longer than we expect

https://www.washingtonpost.com/outlook/2020/04/08/save-lives-social-distancing-must-continue-longer-than-we-expect/?fbclid=IwAR0mNfbcEn9yfF8wfYRsWX9pufLcaArlhqXc8ETSOeSN3_2VdAob0V7WPYQ

To save lives, social distancing must continue longer than we ...

The lessons of the 1918 flu pandemic.

After weeks of quarantine, school closures and binge-watching movies, Americans are getting restless. In a recent interview on “The View,” California Gov. Gavin Newsom (D) warned that complacency and cabin fever were his biggest concerns, and he urged audiences to “stick with this.”

He is right. More than 100 years ago, during the worst contagious crisis in human history (so far), the influenza epidemic of 1918-1919 took 40 million to 100 million lives worldwide and inspired a huge implementation of social distancing measures such as school closures, bans on public gatherings, isolation and quarantine.

But the experience of 1918 also reminds us that early, layered (i.e., more than one at the same time) and lengthy mitigation measures are the best strategy. For social distancing to work, it must be sweeping and enforced across a wide swath of the community. Essential businesses will, of course, need to continue. All other places where people congregate should cease operations for the time being. In 1918, social distancing measures were kept in place for many weeks, if not months, even if people and businesses did not always support them. But the key lesson: This approach worked.

By now, many have read of the comparisons between St. Louis, where a decisive health commissioner reacted with amazing rapidity to implement sweeping public health orders, and Philadelphia, which chose to stay open, even going ahead with plans for a huge parade.

St. Louis was rewarded with one of the best outcomes of any large U.S. city. Philadelphia’s fateful decision to carry on with its immense Liberty Loan Parade resulted in a massive spike in influenza cases in the days immediately following. The city endured some of the worst numbers of cases and deaths in the United States as a result.

Philadelphia was hardly alone, however. In Baltimore, the health commissioner dragged his feet when a group of physicians requested that the city ban public gatherings. “We do not consider such drastic steps necessary in view of the extreme low civilian death rate in the city,” he told them. More than 4,100 Baltimoreans lost their lives to the epidemic.

In Atlanta, the mayor sided with business interests and reopened the city after just three weeks of closures, over the vocal objections of his Board of Health. When the board predicted that Atlanta’s epidemic peak would not occur for another nine days, the mayor dismissed the science, arguing that there was no way to foretell future conditions. The city health officer sided with the mayor, mistakenly declaring that the peak had passed. It had not, and Atlanta’s fall wave of the epidemic raged on, unchecked, through the end of 1918. “The influenza situation in Atlanta is up to the people themselves,” the Public Safety Committee declared.

Atlanta may be a more extreme example, but its experience was hardly singular. In every city we studied from this era there was public pressure to quit the social distancing measures as soon as the epidemic seemed to peak and then ebb. Thinking that the proverbial coast was clear, many communities lifted social distancing measures before the battle was truly over. After weeks of being denied their usual social outlets, people were eager to return to a life of normalcy, and they did so in one giant rush. In city after city, masses lined up for movie houses and performance theaters, crowds packed into dance halls and cabarets, and throngs flocked to downtown shopping districts, often on the very day that the closure orders were lifted.

The result? Cases and deaths resurged. Most cities closed their schools once again. But the political, economic and social will to issue another round of sweeping business closures and gathering bans had evaporated as people grew weary of the dislocations of social distancing. In some cities, most notably Denver, Kansas City, Milwaukee and even the vaunted St. Louis, this second peak was even deadlier than the first.

Lastly, 1918 teaches us how quickly an unchecked epidemic can overwhelm our health-care infrastructure. Philadelphia had to erect 32 temporary hospitals just to handle its massive number of influenza cases. On a single day in mid-October, 10 trucks were needed to carry the bodies of indigent victims to the city’s potter’s field. Some of the deceased had to be buried in temporary graves until more permanent plots could be dug.

In Pittsburgh, the epidemic grew so bad that a local sporting club had to donate its tents to use as field hospitals. One San Antonio hospital had to rely on 18 student nurses to tend to hundreds of influenza patients; the 12 regular nurses were all sick with influenza themselves. Nashville’s City Hospital was overrun with cases in a single day. These cities, unfortunately, were not alone in their experiences.

Today we have two notable advantages over those in 1918: We know the causative agent of covid-19, and our medical care is far more advanced. In 1918, scientists believed the epidemic was caused by a bacterium, and the influenza virus would not be discovered for another quarter-century. The standard medical treatment for influenza victims in 1918 consisted of little more than propping patients up to prevent them from choking on their sputum. Today, it is only a matter of time before researchers discover pharmaceutical therapies and develop an effective vaccine against the disease. In 2020, physicians have the ability to drive down the fatality rate of this epidemic through the use ventilators and intensive care units — as long as such lifesaving machines are available.

Our health-care system can only do this, however, if we don’t allow our already-taxed hospitals, physicians and nurses to be overrun with cases. That means that, until an effective vaccine can be developed and deployed, we must “flatten the curve.” This will not be accomplished in a week, or even a month. We must implement and coordinate sweeping non-pharmaceutical interventions on a national level and keep these measures in place as long as necessary. These measures are not perfect. They are slow and plodding. They are socially and economically disruptive. They fracture the routines of our daily lives in myriad ways, large and small. They do not magically end epidemics. But they can save lives.

As we all endure the hardships of the covid-19 pandemic and dislocations of social distancing, we can take heart that together we will save lives. Just as our forebears did a century ago.

And that is the most important lesson of 1918.