Cartoon – Doctor’s Prescription
Author Archives: henrykotula
Cartoon – What does your mask say about you?
Cartoon – Profile in Courage vs. Cowardice
Beware the office toilet
https://mailchi.mp/647832f9aa9e/the-weekly-gist-august-14-2020?e=d1e747d2d8
Returning to the office after months of lockdown may bring an unexpected risk for workers. According to the New York Times, the CDC recently closed some of its Atlanta offices after finding that its water sources contained Legionella, the bacteria that causes Legionnaire’s disease.
The bacteria can grow in stagnant water systems, including plumbing and air conditioning units. After a prolonged absence, inhaled vapors from flushing toilets, running taps or restarted air conditioners can carry Legionella into the lungs.
While older individuals with lung conditions are most vulnerable, Legionnaire’s pneumonia carries a 10 percent fatality rate—leading the CDC to publish reopening guidelines for building operators that include flushing long-dormant systems with heated water and additional disinfectant in advance of reopening, and the suggestion that at-risk individuals should wear an N95 respirator or facepiece when aerosol generation is likely. (Unsurprisingly, the guidelines have been criticized as overly vague and lacking prescriptive advice.)
As if we all didn’t have enough to worry about, don’t forget to bring a N95 mask for any bathroom breaks during your first day back at the office! (Or maybe just hold it.)
Home as the center of “care anywhere”
https://mailchi.mp/647832f9aa9e/the-weekly-gist-august-14-2020?e=d1e747d2d8
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. 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.
The graphic above outlines the key components of a comprehensive home-based care model,
which requires the integration of three main elements:
a technology backbone,
a supply chain to provide services like labs and diagnostics,
and a tiered, flexible workforce.
Of course, these infrastructure needs will increase with care acuity level, ranging from a simple virtual visit to home-delivered vaccination, all the way to hospital-level care at home. Delivering safe, accessible care within the home can be the foundation for an access platform that creates ongoing consumer loyalty—especially for systems who can build a financial model less dependent on payers’ long-term support for telemedicine reimbursement “parity”.
Prosecuting the case against the COVID response
https://mailchi.mp/647832f9aa9e/the-weekly-gist-august-14-2020?e=d1e747d2d8
This week, in her debut as running mate to presidential candidate Joe Biden, California Sen. Kamala Harris gave a preview of one of the Democratic ticket’s key arguments for the fall campaign, making a full-throated, prosecutorial case against the Trump administration’s handling of the coronavirus pandemic.
“The virus has impacted almost every country,” Harris said, “but there’s a reason it has hit America worse than any other advanced nation. It’s because of Trump’s failure to take it seriously from the start.”
After receiving a briefing from public health experts on Thursday, Biden and Harris argued for a more comprehensive, aggressive national strategy to battle the virus, including major federal investment in contact tracing, a national mask mandate, and guaranteed free access to a COVID vaccine when it becomes available.
The remarks came as the US experienced the deadliest day of the summer so far, with nearly 1,500 COVID fatalities on Wednesday, and a seven-day rolling average of over 1,000 deaths per day for the last 17 days. Meanwhile, a new analysis by the New York Times, using data from the Centers for Disease Control and Prevention (CDC), indicated that the true US death toll from COVID may be as much as 35 percent higher than the reported total of 167K—a finding based on “excess deaths” above normal levels since March.
As President Trump continued to urge schools to reopen for in-person instruction nationwide, the White House released new guidance for ensuring students’ safe return to school. The guidance encouraged social distancing, frequent handwashing, better ventilation of school facilities, and the use of outdoor settings wherever possible.
Despite the President’s claim last week that children are “virtually immune” from the virus, a new analysis from the American Academy of Pediatrics and the Children’s Hospital Association showed that 97,000 children tested positive for COVID in the last two weeks of July alone, a 40 percent increase in the total number of known cases over that period.
About 340,000 children have tested positive so far, representing about 9 percent of all US cases. As schools face pressure to reopen, those numbers are likely to mount, and early-opening school districts in Georgia, Tennessee, Indiana, and Mississippi are already struggling to keep schools open amid rising cases.
Federal assistance to help schools deal with what seems like inevitable rounds of positive cases and closures is not forthcoming, however: after failing to reach a deal on another round of COVID relief, lawmakers have left Washington until September.
US coronavirus update: 5.2M cases; 167K deaths; 64.6M tests conducted.
COVID-19 long haulers on months of debilitating symptoms: ‘They don’t know how to make me better’
https://www.yahoo.com/lifestyle/covid-19-long-haulers-debilitating-symptoms-210633981.html
This group of individuals, nicknamed the “long haulers,” are people of all ages, races and genders. Survivors of the virus who, months later, find themselves battling a constellation of debilitating side effects that disrupt their ability to function. In a study released by Indiana University School of Medicine this August, in partnership with COVID-19 nonprofit Survivor Corps, long haulers describe nearly 100 side effects, from fatigue and body aches to night sweats and neuropathy.
The study casts doubt on the idea that the COVID-19 is a respiratory illness that lasts only a few weeks, suggesting instead that it may be a vascular disease capable of wreaking havoc on the eyes, skin, heart and brain, long after the sore throat goes away. While some hospitals, such as Mount Sinai in New York, have launched recovery centers for post-COVID care, the Centers for Disease Control and Prevention has released little data on the longterm prognosis for those who survive.
In the interim, it’s the long haulers themselves who are helping demystify their strange new world. Karyn Bishof, a firefighter paramedic in Florida, is one of them. After coming down with sore throat, nausea and fatigue in late March, she tested positive for COVID-19 and was told her case was mild. But as the weeks went on, the symptoms didn’t go away. Over four months later, the fatigue remains constant and along with it, a host of other exhausting side effects.
“I’m dealing with drastic changes in heart rate … My oxygen levels drop into the low 90, sometimes even the low eighties, I’m still dealing with headache, memory issues. I have a lot of trouble recalling things or sometimes finding my words,” Bishof tells Yahoo Life. “I’m still dealing with a runny and stuffy nose on and off. And then just a ton of other neurological issues, cardiac issues, chest pain, shortness of breath. I mean, the list goes on.”
Jessica Hulett, a writer in New York, has been battling similar effects. “The fatigue has been really persistent … All I want to do is go to sleep from like two o’clock on every day, and some days I have to,” says Hulett. “I’ve also started having a lot of like cognitive difficulties. Like I can’t remember things, I can’t focus on things.
Both Hulett and Bishof have struggled to find answers from doctors about what’s happening. “I’ve been talking a lot to my primary care doctor … she has kind of admitted, she’s like, ‘We don’t know, like we don’t know how long you’re going to be sick,’” says Hulett. “We don’t know what’s gonna make you better. We don’t know why you’re still sick.”
Luis Santos, a native-New Yorker who’s been experiencing “crushing fatigue,” cognitive issues and an unexplained spike in his cholesterol since getting COVID-19 in March, is too. “I have a team of about seven or eight doctors … and it’s a very scary thing that all these physicians are saying they don’t know. They don’t know how to make me better,” says Santos. “They’re hoping that with time they get better.”
Natalie Lambert, an associate research professor at IU School of Medicine and the lead author of the long haulers study, says this reaction is common. “I feel like this is a huge problem in health care around the world...We’re just kind of a society where you’re healthy until you can prove that you’re sick,” Lambert tells Yahoo Life. “If you’re experiencing something that’s outside of the standard of medical care, it can be really hard to get answers.”
Lambert, who began talking to patients after seeing a “wide range of COVID-19 symptoms” early on, says she doesn’t blame doctors for the gap in knowledge. “They can only treat you with the appropriate and approved standard treatments,” says Lambert. “They can’t experiment on people — so it’s understandable. But if there’s no answer to your question, what can you do?”
Survivor Corps, a grassroots movement connecting COVID-19 survivors, is trying to figure out just that — hosting webinars, sharing research and creating a Facebook group nearly 100,000 people strong. It’s from this group that Lambert pulled information about side effects, using an open-ended survey that allowed long haulers to add their symptoms.
She says the importance of these individuals, and their stories, can’t be overstated. “They are the world’s experts in the disease at this point in time,” Lambert tells Yahoo Life. “I mean, these patients know more about the disease than the medical community does.”
She hopes her research will serve as validation to long haulers — and proof that they’re not alone. “If you’re experiencing any of these symptoms, lots of people are experiencing these symptoms,” says Lambert. “And if your doctor won’t treat them, continue to advocate for yourself to try to get medical care because some of these can result in very serious health consequences.”
When it comes to the long haulers themselves, they’re urging others not to overlook the seriousness of this virus. “Right now the science for long haulers is showing that [COVID-19] doesn’t care about your age. It doesn’t care about your fitness level,” says Bishof. “It doesn’t care if you’re a firefighter-paramedic, or if you work on your computer from home … Do everything you can to protect yourself and others. This is not just a cold or a flu.”
Cash-Pinched Hospitals Press Congress to Break Virus Fund Logjam
Hospital groups are pressing Congress to put more money into a relief fund for hospitals and providers, even as labor data showed signs of a turnaround for the health-care industry last month.
Congressional leaders are at a standstill over the next coronavirus-relief package and it could be weeks until lawmakers vote on legislation. Hospital groups have said the $175 billion Congress already approved has been a crucial lifeline to keep hospitals from laying off more staff or potentially closing. Some are worried the money may start to run dry soon.
The coronavirus is prompting many Americans to delay health care, and further funding delays exacerbate the need for assistance, the hospitals warn. Some providers that shed jobs earlier in the pandemic have begun adding them back, but employment levels remain far below where they once were.
“The longer we are in the pandemic the more clear it becomes that this is not going to be a short-term issue,” Beth Feldpush, senior vice president of policy and advocacy at America’s Essential Hospitals, said.
Leaders of both parties back more federal funding to help hospitals and doctors’ offices stay in business. Democrats proposed $100 billion for the industry, as hospital groups such as AEH sought, in virus-relief legislation (H.R. 6800) the House passed earlier this year. Republicans included $25 billion in their counterproposal.
The Health and Human Services Department has promised about $115 billion of the $175 billion in relief Congress approved this year to help health-care providers offset their Covid-19-related losses, according to agency data. That leaves the industry with about $60 billion left.
The U.S. exceeded 5 million confirmed Covid-19 cases Aug. 9, according to data from Bloomberg News and Johns Hopkins University, more than any other country. Almost 165,000 people in the U.S. have died from the virus.
Industry Impact
The health-care industry added more than 126,000 jobs in July, according to data released last week by the Bureau of Labor Statistics. Dentist offices and hospitals, the section of the industry that was laying off tens of thousands of people in April and May, accounted for more than 70,000 of those new jobs.
Still, there were 797,000 fewer health-care jobs compared to before the pandemic, according to BLS.
The virus hit parts of the heath-care industry unevenly. Large health systems such as HCA Healthcare Inc. and Universal Health Services Inc. posted better-than-expected profits for the second quarter of 2020.
Some hospitals that didn’t have much cash-on-hand to start the year are struggling with lower profits and may need added relief if the virus continues to keep Americans from seeking care, industry watchers said.
“No hospital is going to come out of this year better than they were in prior years,” Suzie Desai, senior director for S&P Global Rating’s Not-for-Profit Health Care group, said.
The federal relief funds helped buoy hospitals this year, hospital groups argue. The American Hospital Association estimates that without relief funds, hospitals margins would have been down 15% and could be down 11% at the end of 2020 if the virus continues to spread at its current pace.
The AHA estimated losses for the nation’s hospitals and health systems will reach $323 billion this year.
Verity gets OK to sell 384-bed bankrupt hospital to Prime Healthcare, despite objections
Despite objections for California attorney general and a last-minute attempt from an opposing bidder to block the sale, El Segundo, Calif.-based Verity Health System won bankruptcy court approval to sell a 384-bed hospital in Lynwood, Calif., to Prime Healthcare Services, according to The Wall Street Journal.
California Attorney General Xavier Becerra conditionally approved the sale to Prime in July. Mr. Becerra set 21 conditions for the sale of St. Francis Medical Center to Prime Healthcare, a for-profit provider based in Ontario, Calif.
Verity challenged three of the conditions outlined by the attorney general, saying they were overly burdensome. The disputed conditions revolved around the amount of charity care and community-benefit services the hospital would need to provide.
As a result, the attorney general opposed authorizing the sale and approving Verity’s Chapter 11 liquidation plan, according to the Journal.
U.S. Bankruptcy Judge Ernest Robles overruled the objections, which should allow the $350 million sale to finalize. The judge also said he would approve Verity’s Chapter 11 liquidation plan.
In addition, in late July, Los Angeles-based Prospect Medical Holdings made a last-minute attempt to block Prime from buying St. Francis Medical Center.
Prospect Medical, backed by a private equity firm, reportedly offered to pay $50 million more than Prime and offered to accept all of the attorney general’s conditions.
However, the bankruptcy judge said Prospect lacked standing to oppose the Prime sale, and it didn’t submit its bid until after the deadline passed, according to the report.
Read the full article here.
U.S. records deadliest coronavirus day of the summer
https://www.axios.com/1485-us-coronavirus-death-record-5ee493cc-df91-4549-8c9d-43a5fee0bd87.html
The U.S. reported 1,485 deaths due to the coronavirus on Wednesday, COVID Tracking Project data shows.
Why it matters: It’s the highest single-day COVID-19 death toll since May 15, when the country reported 1,507 deaths. The U.S. has seen a total of 157,758 deaths from the virus.
The big picture: Georgia reported 109 deaths on Wednesday — its second triple-digit day in a row.
- North Carolina confirmed an additional 45 deaths, tying its highest daily number.
Go deeper: 5 states set single-day coronavirus case records last week
HENRY KOTULA 