Dean Baquet, The Times’s executive editor, believes that 2020 will go down as a signature year in history, alongside years like 1968, 1945 and 1865. “It will long be remembered and studied as a time when more than 1.5 million people globally died during a pandemic, racial unrest gripped the world, and democracy itself faced extraordinary tests,” he writes.
Those words come from Dean’s introduction to The Times’s annual Year in Pictures feature. Here, my colleagues on The Morning and I have chosen a dozen of those pictures that we think best summarize 2020. But we obviously have room here for only a fraction of the year’s photographs — so I encourage you to check out the full selection.
As you do, ask yourself which pictures you would have selected if you had to pick only 12 to sum up 2020.
Early in the year, the virus hit Western Europe harder than any other place in the world. In March, a coronavirus patient was examined at his home in Cenate Sotto, Italy.The pandemic forced people to find new ways to socialize. Circles painted on the grass at Domino Park in Brooklyn helped people spend time safely outdoors in May.Donald Trump became only the fourth elected president in the last century not to win re-election, joining Herbert Hoover, Jimmy Carter and George H.W. Bush. Trump departed Air Force One in August after returning from a campaign rally.Joe Biden struggled badly early in the Democratic primaries, only to rally to win the nomination and the presidency. He prayed at the Corinthian Baptist Church in Des Moines in January.Climate change wrought destruction on the planet in multiple ways during 2020. In Azusa, Calif., a wildfire burned more than 4,200 acres during the most active wildfire year on record for the West Coast.The killing of George Floyd in May inspired mass demonstrations against police brutality across the country. In Minneapolis, officers confronted protesters on May 31.Protesters marched in New York in June as anger spread across the country.Around the world, people spent far more time at home this year than usual. In São Paulo, Brazil, residents gathered at their windows in March to protest the government’s pandemic response.The pandemic led to a sharp economic downturn in much of the world. In May, people lined up for food distribution at a church in Brooklyn.More than 1.5 million people around the world have died from Covid complications. Mourners gathered in April at a cemetery in Brazil where workers were busy digging lines of open graves.Amid illness, death and separation in 2020, people also experienced great joys — even if they sometimes required adaptation. In April, Precious Anderson, a Covid-19 patient, was shown her newborn baby for the first time with the help of a live video feed at a hospital in Brooklyn.
Many hospitals are temporarily or permanently reducing the size of their workforce as they grapple with depleted revenues and the thorny question of when they can return to normal operating capacity. Here’s a tracker to follow the latest updates.
Hospitals across the country, financially battered as they face the dual challenges of sick COVID-19 patients and a precipitous decline in patient volume, are struggling to balance quickly shifting staffing needs. While some face and others brace for intense demand, many have announced furloughs of specialists and others that work in elective surgeries that have been drastically scaled back.
Thousands of healthcare workers at hospitals big and small have been asked not to return to work, and it’s still unclear how soon non-essential services will return. While some governors announce plans to reopen businesses, others have extended stay-at-home orders.
Most recent data from the U.S Bureau of Labor doesn’t cover the second half of March or early April, but during the first half of March, the healthcare industry shed 43,000 jobs — reversing a decade of growth in the sector. According to BLS data, the industry added 49,000 jobs in March 2019.
“Even our emergency room has seen a significant drop in patients coming in,” Sue Philips, an ICU nurse at Palomar Pomerado Health in Northern San Diego, told Healthcare Dive.
Phillips is a spokesperson with National Nurses United, the country’s largest nurses union. Palomar Health, which runs three medical centers in northern San Diego County, recently instituted 21-day temporary layoffs of 221 employees.
On April 28, Palomar announced that most of those layoffs were becoming permanent. The system laid off 5% of its workforce, eliminating 317 positions. Fifty of those employees were clinical RNs, mostly in part-time positions, and the rest spread across the organization ranging from clerical staff to technicians.
Due to a 50% decrease in patient volumes, Palomar lost $10 million in revenue in March alone, according to a statement. In April the system said it stands to lose $20 million or more.
“I’m an ICU nurse, so my job is pretty much protected,” Phillips said. “But you didn’t think you were expendable until you became expendable, and that’s a hard pill for nurses and caregivers to swallow.”
Congress has attempted to financially support struggling hospitals through ongoing coronavirus relief legislation, approving some $175 billion thus far. But without knowing what will come next, hospitals are attempting to remain nimble while reining in one of their most costly expenses — paying employees.
The following information is based on publicly reported data, along with interviews with hospital representatives and union members.
It’s not an exhaustive list, but features nonprofit and for-profit hospital systems that reported revenue above $10 billion in 2019. It also takes a look at smaller, more regionally based systems that have announced similar cutbacks.
Click on link above to use the dropdown to find a company.
Healthcare job losses reached staggering levels amid stay-at-home orders and the widespread cancellation of elective procedures when the COVID-19 pandemic first hit this spring. Dentists and ambulatory services were particularly hard hit.
While the industry has since recovered many of the 1.3 million jobs lost this April, it’s still 527,000 short from February levels, and monthly gains have slowed since, according to the latest data from the Bureau of Labor Statistics.
At the same time, some of the major hospitals that issued furloughs or layoffs early in the pandemic are now further reducing the size of their workforce.
The stagnation will likely continue, as companies “don’t hire as many people, then lay some people off to also try and save money, because worse times may be ahead,” said Erica Groshen, former BLS commissioner and senior labor economics adviser at Cornell’s School of Industrial and Labor Relations.
One example is Dallas-based Baylor Scott & White, which laid off 3% of its workforce, or 1,200 employees in May. It’s now laying off a third of its corporate finance staff, though some impacted employees are being offered positions with a third-party vendor, the system said in a Monday statement.
Providence Health & Serviceslaid off 183 employees in mostly administrative roles as a result of transitioning work to a third-party vendor, while five employees were laid off “as a result of business need,” according to a WARN notice letter the system sent to an Oregon state agency Nov. 16. It previously issued an unknown number of furloughs across its 51-hospital system.
And Utah-based Intermountain Healthsaid it would cut 250 business-related jobs by offering 750 employees voluntary separation packages on Oct. 13.
The moves come even while hospitals are stretched to the brink from the highest surge of coronavirus cases the country has yet seen. In the past few weeks, many have halted elective procedures and paid steep rates for temporary nursing staff, further straining finances.
And other healthcare establishments, such as some doctor’s offices and medical labs, are still struggling to get reluctant patients back in.
A recent Labor Department survey covering the onset of the pandemic through September found among all healthcare businesses, 64% experienced a decrease in demand while only 13% experienced an increase in demand.
In November, healthcare businesses overall added 46,000 jobs in — fewer than the 58,000 jobs added in October; 53,000 in September; and 75,000 in August, according to BLS data.
Hospitals added about 4,000 jobs in November and are about 100,000 jobs short from February.
The challenge to Jefferson Health’s bid for Albert Einstein was the first action to block a provider deal in years for the FTC. Now, it’s hit a hurdle in the courts, though the agency could still appeal after this dismissal.
“The Court’s ruling is disappointing, and we our considering our options,” an FTC spokesperson said.
FTC has argued that both Jefferson and Einstein compete in acute care and rehab services and vie for inclusion in insurers’ networks.
Pappert’s ruling Monday, and the examples he used, essentially argued that given the number of competitors in the region, insurers could walk away from potential price increases the merged entity may impose by opting to redirect their members to other facilities.
Because there are so many systems, “no insurer can credibly assert that there would be ‘no network’ without a combined Jefferson and Einstein — something the insurers could say when Hershey and Pinnacle, the two largest Harrisburg area hospitals … attempted to merge,” Pappert wrote. He frequently cited the Hershey-Pinnacle case, which also was denied a preliminary injunction in district court but went on to win one in a federal appeals court.
Pappert also noted that no employers testified that they would have difficulty marketing a health plan to employees that excluded Jefferson and Einstein. In fact, the one employer that did weigh in, a school district, said it would be fine without the two.
The court also takes issue with whether the FTC properly defined the relevant markets in the lawsuit, an important hurdle in any case seeking to block a merger.
Pappert, a President Barack Obama appointee, was skeptical of the region’s largest insurer’s opposition to the merger during testimony. Particularly when the second-largest insurer had no concerns with the merger and does not believe it will pay higher rates.
Pappert said Independence Blue Cross, the largest carrier, has a “clear motive, other than antitrust concerns, to oppose this merger.” Together, Jefferson and Einstein own a portion of Health Partners Plans, a Medicaid and Medicare insurance product. HPP operates the second-largest Medicaid plan in Philadelphia, behind IBC’s.
A merger of Jefferson and Einstein would give the combined entity a 50% stake in HPP, though Jefferson is seeking to buyout the other partner, court dockets claim.
IBC’s CEO, said of the potential insurer competition: “It remains to be seen how we are going to be able to collaborate with anyone who is in direct competition with us as an insurer.”
When Ashley Antonio contracted covid-19 in late March, the Canadian criminal lawyer fought against the common symptoms that come with most cases: fever, body aches, fatigue, headaches.
She would manage her symptoms at home and eventually overcome them, she assured herself. After all, she was a healthy 35-year-old with no underlying conditions who boxed and did strength training four times a week.
Except the symptoms never really went away — they intensified.
Now, 259 days later, Antonio is still suffering the repercussions of a virus that has upended almost every aspect of her life.
She has been in and out of the hospital four times in almost nine months. Her doctors have diagnosed Antonio with arthritis and a condition that causes her heartbeat to dramatically increase when she stands up. Both are long-term effects of the virus, they told her. They also don’t know if, and when, those symptoms will go away.
“Everyone is just told you either recover or you die,” Antonio told The Washington Post on Tuesday. “There’s never talk of all the people that are trapped somewhere in the middle with all of these long-term effects. We’re not recovered. We’re just not covid-positive anymore.”
Antonio is not alone. Doctors still aren’t sure why “long-haulers” continue to suffer the consequences of the disease months later or whether the symptoms will stay with them for the rest of their lives. But public health experts say it’s increasingly clear that many thousands of patients face long-term effects from the virus.
Long-haulers “are in every country, in every language,” Igor J. Koralnik, who started a program for covid-19 neurocognitive problems at Northwestern Memorial Hospital in Chicago, told The Post in October. “It’s going to be a big problem. It’s not going to go away.”
So far, clinicians have learned the long-term effects can impact both the old and the young, regardless of whether the case was mild or required hospitalization. Many long-haulers have turned to social media groups to share their experiences and advice.
Antonio, who lives in Edmonton and whose story was first reported by the CBC, said she had been taking precautions and working from home for a month before she got sick. Her best guess is that she caught the virus on a run to the grocery store. She began feeling symptoms around March 25.
But because she did not have a cough, which doctors and health experts then said was one of covid-19′s main symptoms, Antonio thought she only had a stomach flu.
She stayed home and started to feel like herself again days later. But every time she thought she was recovering, symptoms would return. In the next three months, old symptoms and new, graver ones left Antonio tied to her couch. The fatigue was so bad she could shower only a couple of times a week. Her blood oxygen levels would drop dangerously low whenever she took short steps. One day, her brain was so foggy that she could not remember how to hold a glass.
It wasn’t until mid-May when she was taken to the emergency room for the first time. Alone in her bedroom and fighting a high fever, Antonio began hallucinating. Then, she could not feel half of her body or her face. The hospital tested her for the coronavirus, but her results came back negative so she was sent home. About a week later, she was back. She would return two more times in the following months.
“I had every test you could imagine,” she said. But her doctors could still not figure out what exactly was wrong with her. An emergency room doctor suggested she might have long-term covid-19 effects and referred her to a special clinic.
In June, she tested positive for coronavirus antibodies. In July, doctors at a clinic for coronavirus survivors diagnosed her with arthritis and a condition that causes her heartbeat to raise significantly when standing. “But doctors couldn’t explain why my oxygen was still dropping every time I walked or any other symptoms,” she said.
Antonio turned to other long-haulers for more information, joining a Facebook group where she learned, for example, that she wasn’t alone in smelling cigarettes when no one was smoking near her. Other people experienced random smells too, they told her.
“I had a lot of questions and the doctors didn’t have a lot of answers. It was all so new to everyone,” Antonio said. “I just wanted to see if what I was experiencing was ‘normal.’ It was very comforting to know that I wasn’t alone.”
Although her symptoms persisted, in August, Antonio voluntarily returned to the law firm where she works as a criminal lawyer. Some days, she feels okay. But the increased heart rate, shortness of breath, joint pain and headaches are usually daily ailments. She also still suffers from blurry vision and gets skin rashes. Her doctors have now told her it’s possible that her long-term symptoms will come and go for the rest of her life. For now, Antonio said she is taking it one day at a time.
“I’m definitely worried it will be permanent,” she said. “It’s very overwhelming if I think that this is how the rest of my life is going to be.”
Antonio added: “When I have a good day, I no longer think that it will be over. I know I’ll have bad days again. It makes you feel hopeless.”
The financial challenges caused by the COVID-19 pandemic have forced hundreds of hospitals across the nation to furlough, lay off or reduce pay for workers, and others have had to scale back services or close.
Lower patient volumes, canceled elective procedures and higher expenses tied to the pandemic have created a cash crunch for hospitals. U.S. hospitals are estimated to lose more than $323 billion this year, according to a report from the American Hospital Association.
Hospitals are taking a number of steps to offset financial damage. Executives, clinicians and other staff are taking pay cuts, capital projects are being put on hold, and some employees are losing their jobs. More than 260 hospitals and health systems furloughed workers this year and dozens of others have implemented layoffs.
Below are 15 hospitals and health systems that announced layoffs since Sept. 1, many of which were attributed to financial strain caused by the pandemic.
1. Minneapolis-based Children’s Minnesota is laying off 150 employees, or about 3 percent of its workforce. Children’s Minnesota cited several reasons for the layoffs, including the financial hit from the COVID-19 pandemic. Affected employees will end their employment either Dec. 31 or March 31.
2. Dallas-based Baylor Scott & White Health announced in early December that it will lay off 102 employees in finance and accounting roles. The duties of the affected workers will be outsourced to a third-party vendor in India.
3. Eastern Niagara Hospitalin Lockport, N.Y., announced in early November that it plans to end intensive care unit services and move surgical services from the hospital to a surgery center. The changes will result in the loss of 80 jobs.
4. Detroit Medical Centerconfirmed in November that it laid off employees but declined to disclose the number of employees affected. Clinical staff, administrative assistants and employees at the management level were affected by the layoffs, sources told Crain’s Detroit Business.
5. Mercy Iowa City (Iowa) laid off 29 employees in November to address financial strain tied to the COVID-19 pandemic.
6. NorthBay Healthcare, a nonprofit health system based in Fairfield, Calif., announced Nov. 2 that it is laying off 31 of its 2,863 employees as part of its pandemic recovery plan.
7. Brattleboro Retreat, a psychiatric and addiction treatment hospital in Vermont, notified 85 employees in late October that they would be laid off within 60 days.
8. Oakland, Calif.-based Kaiser Permanente notified the state of Hawaii in November that it planned to lay off 45 employees within 60 days. “The COVID-19 public health crisis has placed unprecedented demands on the entire health care system, including Kaiser Permanente,” a Kaiser spokesperson said in an email to Pacific Business News. “Even before the pandemic, we had been transparent in sharing that Kaiser Permanente Hawaii faced ongoing financial challenges and that we were on a path to address our internal structure in a way that ensured we would be able to continue to deliver high-quality, affordable care and coverage to our members in Hawaii for years to come.” The health system said most of the positions eliminated were administrative or in non-patient facing areas.
9. Citing a need to offset financial losses, Minneapolis-based M Health Fairview said in October it plans to downsize its hospital and clinic operations. As a result of the changes, 900 employees, about 3 percent of its 34,000-person workforce, will be laid off.
10. Lake Charles (La.) Memorial Health System laid off 205 workers, or about 8 percent of its workforce, in October as a result of damage sustained from Hurricane Laura. The health system laid off employees at Moss Memorial Health Clinic and the Archer Institute, two facilities in Lake Charles that sustained damage from the hurricane.
11. Burlington, Mass.-based Wellforcelaid off 232 employees in September as a result of operating losses linked to the COVID-19 pandemic. The health system, comprising Tufts Medical Center, Lowell General Hospital and MelroseWakefield Healthcare, experienced a drastic drop in patient volume earlier this year due to the suspension of outpatient visits and elective surgeries.
12. Baptist Health Floydin New Albany, Ind., part of Louisville, Ky.-based Baptist Health, eliminated 36 positions in late September. The hospital said the cuts, which primarily affected administrative and nonclinical roles, are due to restructuring that is “necessary to meet financial challenges compounded by COVID-19.”
13. Cincinnati-based UC Health laid off about 100 employees in September. The job cuts affected both clinical and non-clinical staff. A spokesperson for the health system said no physicians were laid off.
14. Springfield, Ill.-based Memorial Health System laid off 143 employees in September, or about 1.5 percent of the five-hospital system’s workforce. The health system cited financial pressures tied to the pandemic as the reason for the layoffs.
15. Watertown, N.Y.-based Samaritan Health announced Sept. 8 that it laid off 51 employees and will make other cost-cutting moves to offset financial stress tied to the COVID-19 pandemic.
But there is still one dark cloud hanging over the vaccines that many people don’t yet understand.
The vaccines will be much less effective at preventing death and illness in 2021 if they are introduced into a population where the coronavirus is raging — as is now the case in the U.S. That’s the central argument of a new paper in the journal Health Affairs. (One of the authors is Dr. Rochelle Walensky of Massachusetts General Hospital, whom President-elect Joe Biden has chosen to run the Centers for Disease Control and Prevention.)
An analogy may be helpful here. A vaccine is like a fire hose. A vaccine that’s 95 percent effective, as Moderna’s and Pfizer’s versions appear to be, is a powerful fire hose. But the size of a fire is still a bigger determinant of how much destruction occurs.
I asked the authors of the Health Affairs study to put their findings into terms that we nonscientists could understand, and they were kind enough to do so. The estimates are fairly stunning:
At the current level of infection in the U.S. (about 200,000 confirmed new infections per day), a vaccine that is 95 percent effective — distributed at the expected pace — would still leave a terrible toll in the six months after it was introduced. Almost 10 million or so Americans would contract the virus, and more than 160,000 would die.
This is far worse than the toll in an alternate universe in which the vaccine was only 50 percent effective but the U.S. had reduced the infection rate to its level in early September (about 35,000 new daily cases). In that scenario, the death toll in the next six months would be kept to about 60,000.
It’s worth pausing for a moment on this comparison, because it’s deeply counterintuitive. If the U.S. had maintained its infection rate from September and Moderna and Pfizer had announced this fall that their vaccines were only 50 percent effective, a lot of people would have freaked out.
But the reality we have is actually worse.
How could this be? No vaccine can eliminate a pandemic immediately, just as no fire hose can put out a forest fire.While the vaccine is being distributed, the virus continues to do damage. “Bluntly stated, we’ll get out of this pandemic faster if we give the vaccine less work to do,” A. David Paltiel, one of the Health Affairs authors and a professor at the Yale School of Public Health, told me.
There is one positive way to look at this:Measures that reduce the virus’s spread — like mask-wearing, social distancing and rapid-result testing — can still have profound consequences. They can save more than 100,000 lives in coming months.
In the past seven days, 15,813 people in the U.S. died from the virus, breaking a record that had stood since mid-April.
Letter of Intent offered to acquire Rhode Island-based Care New England Health System
StoneBridge Healthcare, LLC (StoneBridge), an innovative company formed to buy, save and turn around distressed hospitals in the cities and suburbs of America, today announced it has presented a Letter of Intent (LOI) to purchase Rhode Island-based Care New England Health System. StoneBridge would make a significant investment in order to financially stabilize Care New England to allow the health system to continue its mission to transform the future of health care for the communities it serves.
“Care New England Health System has provided outstanding care to its patients for many years, and StoneBridge Healthcare is committed to the continuation of this high standard of care in Rhode Island,” said Joshua Nemzoff, Chief Executive Officer, StoneBridge Healthcare. “We believe that StoneBridge Healthcare is in a strong position to help Care New England to continue delivering cutting-edge care to the communities it serves for years to come.”
StoneBridge has offered a transaction value of $550 million with a purchase price of $250 million and a $300 million investment in capital improvements over six years to further transform the health system. The offer that StoneBridge has submitted includes a provision that will fully fund the employee’s pension plan at closing – a plan that is currently underfunded by more than $125 million. Care New England hospitals include the following: Butler Hospital, Kent Hospital, Women & Infants Hospital of Rhode Island, Care New England Medical Group, the VNA of Care New England, The Providence Center, and a certified accountable care organization (ACO) Integra.
“As the cost of care has risen and the COVID-19 pandemic has placed a tremendous strain on health systems across the nation, StoneBridge Healthcare is ready to assist Care New England during these challenging times to continue delivering an outstanding continuum of care to the region,” Nemzoff added. “StoneBridge Healthcare has the expertise and financial resources needed to help lead Care New England to a promising future.”
The LOI is not binding, and a Definitive Agreement would be finalized in a short period of time once comprehensive due diligence is performed. StoneBridge is a privately-owned company capitalized through a multi-layered composite finance group that includes nationally known debt and equity sources.
Earlier this year, StoneBridge submitted an offer to acquire the Erlanger Heath System in Tennessee for a transaction value of $475 million. StoneBridge is actively pursuing discussions related to this transaction, which is a system of similar size to Care New England and has also been devastated by the impact of the COVID-19 pandemic.
About StoneBridge Healthcare StoneBridge Healthcare is an innovative company formed to buy, save and turn around deeply distressed hospitals in the cities and suburbs of America. StoneBridge is capitalized through a multi-layered composite finance group that includes nationally known debt and equity sources. The company features a nationally recognized team of experts in healthcare operations, finance, acquisitions and turnarounds.
Our decades of experience, our financial investment and our commitment to expand primary care into the urban areas we serve make our company the only one of its kind. StoneBridge Healthcare plans to purchase and turn around acute care hospitals that are in significant economic distress and could otherwise be forced to close. StoneBridge will identify and buy hospitals that can be saved, and then work urgently to make sure these hospitals survive and succeed.
StoneBridge is committed to responding to the healthcare needs of the urban markets it operates in through an initiative that is known as “The Mission Project.” Using the hospitals it acquires as a base of operations, StoneBridge will bring much-needed services into the community. StoneBridge will listen to and work with local groups to understand the gaps in community care – and then put money and time into offering clinics or other life-changing help. The solutions may look different in each market, but the commitment will be consistent. The hospitals can provide the doctors, nurses, pharmacies, kitchens and vehicles to bring care and support to people where they live. For more information please visit: stonebridgehealthcare.com.
The South Dakota-based health system has suspended talks related to its planned merger with Utah-based Intermountain Healthcare after the sudden departure of its CEO, Kelby Krabbenhoft. Sanford and its new CEO will instead focus on organizational needs, the system said.
The decision to halt merger talks comes about two weeks after Sanford Health and President and CEO Kelby Krabbenhoft mutually agreed to part ways. Krabbenhoft led the 46-hospital system for 24 years, assuming the top position in 1996. A press release noted his contributions to the Sioux Falls, South Dakota-based organization’s growth from a community hospital into a large rural nonprofit spanning 26 states.
Sanford Health did not give an official reason for Krabbenhoft’s sudden departure, but days before the announcement, CNN obtained an email sent by the former CEO to health system staff telling them that he had contracted Covid-19 and recovered. He also said he would not be wearing a mask.
Krabbenhoft said there was “growing evidence” of immunity to the new coronavirus and that wearing a mask “sends an untruthful message that I am susceptible to infection or could transmit it. I have no interest in using masks as a symbolic gesture,” CNN reported. But evidence regarding immunity after recovery from Covid-19 is still limited and some reinfections have been reported.
Bill Gassen, previously serving as chief administrative officer, succeeded Krabbenhoft as the organization’s new leader.
The health system decided to stop merger activity to address other organizational needs as Gassen takes over, according to a press release.
“With this leadership change, it’s an important time to refocus our efforts internally as we assess the future direction of our organization,” Gassen said in the press release. “We continue to prioritize taking care of our patients, our people, and the communities we serve as we look to shape our path forward.”
Sanford and Intermountain declined to comment on whether the organizations are planning to resume talks in the future.
“We are disappointed but understand the recent leadership change at Sanford Health has influenced their priorities,” said Dr. Marc Harrison, president and CEO of Salt Lake City-based Intermountain Healthcare, in the press release. “There’s much to admire about the work that Sanford Health is doing. We continue to share a strong vision for the future of healthcare.”
Had the talks continued and the merger been approved, the combined organization would have included 70 hospitals, 435 clinics and 233 senior care locations. It was expected to generate about $15 billion in total annual revenue.
Intermountain’s Harrison was slated to serve as the combined system’s leader, while Krabbenhoft was to serve as president emeritus.
HENRY KOTULA 