Author Archives: henrykotula

Making coronavirus testing easy, accurate and fast is critical to ending the pandemic – the US response is falling far short

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Failure, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Positivity Rate, Positivity Rate - High, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, School Reopening, Scientists, Social Distancing, World Health Organization (WHO) • Leave a comment

https://theconversation.com/making-coronavirus-testing-easy-accurate-and-fast-is-critical-to-ending-the-pandemic-the-us-response-is-falling-far-short-142366

Making coronavirus testing easy, accurate and fast is critical to ...

For many people in the U.S., getting tested for COVID-19 is a struggle. In Arizona, testing sites have seen lines of hundreds of cars stretching over a mile. In Texas and Florida, some people were waiting for five hours for free testing.

The inconvenience of these long waits alone discourages many people from getting tested. With the surge in cases, many public testing sites have been reaching maximum capacity within hours of opening, leaving many people unable to get tested for days. Those that do get tested often face a week-long wait to get their test results.

Every person who isn’t tested could be spreading COVID-19 unknowingly. These overstretched testing programs are a weak link in the U.S. pandemic response.

I study public health policy to combat infectious disease epidemics. The key to overcoming this pandemic is to slow transmission of the virus by preventing contagious people from infecting others. A widespread quarantine would accomplish this, but is economically and socially burdensome. Testing offers a way to identify contagious people so they can be isolated to prevent the spread of the disease. This is especially important for COVID-19 because an estimated 40% or more of all people infected with SARS-CoV-2 have few or no symptoms so testing is the only way to identify them.

Some states are doing much better than others. But as a whole, the U.S. is falling far short of the amount of testing needed to control the pandemic. What are the challenges the U.S. is facing? And what is the way forward?

Testing should be free, easy, fast and accurate

The ultimate goal of testing is for everyone, regardless of symptoms, to know at all times whether they are infected with the coronavirus. To achieve this level of testing, tests should be free, very easy to perform and provide accurate results quickly.

Ideally, free COVID-19 tests would be delivered to everyone directly. The tests would be simple to perform – like a saliva test – and would give a perfectly accurate result within minutes. Everyone could test themselves weekly or anytime they were going to be in close contact with other people.

In this ideal scenario, most, if not all, contagious people would be detected before they could spread the virus to others. And because of the rapid results, there would be no burden of quarantining between doing the test and getting the result.

Researchers are working on better-quality tests, but access is a problem of infrastructure, not science. Right now, nowhere in the U.S. comes close to meeting surging demand for testing.

One of the worst cases: Texas

The difficulty of getting a COVID-19 test varies by state, but currently, people in Texas face some of the biggest obstacles, which results in far fewer tests being done than is needed to control the pandemic.

First, Houston – which is experiencing a surge in cases – and many testing sites across the state recommend or offer testing only to people who have symptoms, were exposed to a COVID-19 case or are a member of a high-risk group.

Even people recommended for testing still face challenges. It is possible to request an appointment for a free COVID-19 test, but testing facilities can handle only so many patients a day and testing slots fill up quickly. Even if someone gets an appointment, they may face an hours-long wait at the testing site.

Finally, public health experts recommend that people who may have been exposed to COVID-19 should quarantine at home for 14 days or until they receive a negative test result. In Texas, patients are supposed to get results through an online portal in three to five days, but many labs have been taking seven to nine days to return results. These long delays mean people face a much higher burden of quarantining while waiting for results.

All of these challenges make it clear that Texas is simply not testing enough people to keep the spread of COVID-19 in check.

To gauge the success of COVID-19 testing programs, epidemiologists use a measure called test positivity. This is simply the percentage of tests that come back positive. The lower the test positivity, the better, because that means very few cases are going undetected. A high test-positivity rate is usually a sign that only the sickest people are getting tested and many cases are being missed.

The World Health Organization guidelines say that if more than 1 out of 20 COVID-19 tests comes back positive – a test positivity of more than 5% – this is an indication that a lot of cases are not diagnosed and the epidemic is not under control. 

Texas currently has a test-positivity of around 16%, which means that a lot of infected people are not getting tested and may be unknowingly spreading the disease.

One of the best cases: New Mexico

In stark contrast to Texas is New Mexico, which has one of the strongest testing programs in the U.S.

First, public health officials there encourage everyone to get tested for COVID-19 regardless of symptoms or exposure. The state has also prohibited health providers from charging patients for tests. People seeking a test have the option to walk in or to make an appointment ahead of time, whichever is more convenient.

All of this relatively good access to testing has resulted in one of the highest per capita testing rates in the country, at over 20,000 tests per 100,000 people, and a test-positivity rate of around 4%. New Mexico’s testing program is diagnosing a relatively high proportion of cases despite the state experiencing a recent surge.

New Mexico still has room for improvement. Long lines, wait times and limited capacity are becoming more common as cases surge, but the foundation of a strong testing program has helped the state cope with the increase in cases.

 

The big-picture problems

The pre-pandemic infectious disease testing capabilities in the U.S. are clearly unable to meet the current demand. A nationwide response is needed, and there are three things that Congress, the federal government and local governments can do to help ensure COVID-19 tests will be easy to get, fast and accurate.

First, Congress can provide funding to stimulate the testing supply chain, scale up existing testing programs and promote innovation in test development.

Second, governments can improve the management and coordination of testing programs to more efficiently use existing resources.

And third, innovative testing methods that reduce the need for lab capacity – like paper-strip tests and pooled testing – need be approved and implemented more quickly.

Every little improvement in testing capabilities means more COVID-19 cases can be caught before the virus is transmitted. And slowing the spread of the virus is the key to overcoming the pandemic.

 

 

 

 

Test positivity rate: How this one figure explains that the US isn’t doing enough testing yet

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Positivity Rate - High, Positivity Rate - Low, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, School Reopening, Scientists, Social Distancing, World Health Organization (WHO) • Leave a comment

https://theconversation.com/test-positivity-rate-how-this-one-figure-explains-that-the-us-isnt-doing-enough-testing-yet-143340

Test positivity rate: How this one figure explains that the US isn ...

The U.S. has performed more coronavirus tests than any other country in the world. Yet, at the same time, the U.S. is notably underperforming in terms of suppressing COVID-19. Confirmed cases – as well as deaths – are surging in many parts of the country. Some people have argued that the increase in cases is solely due to increased testing.

I am a statistician who studies how mathematics and statistics can be used to track diseases. The claim that the increase in cases is only caused by increases in testing is just not true. But how do public health officials know this?

Testing, confirmed cases and total cases

COVID-19 testing has two purposes. The first is to confirm a diagnosis so that medical treatment can be appropriately rendered. The second is to do surveillance for tracking and disease suppression – including finding those who may be asymptomatic or only have mild symptoms – so that individuals and public health officials can take actions to slow the spread of the virus.

At a White House briefing on July 13, the president said, “When you test, you create cases.”

The problem with this statement is that anyone who is infected with the coronavirus is, by definition, a case. Since taking a COVID-19 test does not cause a person to get coronavirus, just like taking a pregnancy test does not cause one to become pregnant, the president’s claim is false. Testing does not create cases.

However, because many COVID-19 cases are asymptomatic, many people are infected and don’t know it. What COVID-19 testing does do is identify unknown cases. And thus it does increase the number of cases that are known, or otherwise called the confirmed case count.

Finding unknown cases is good, not bad, because identifying those who are COVID-19-positive allows individuals and public health officials to take actions that slow the spread of the disease. When public health officials find cases, they can begin contract tracing. When a person finds out they are infected, they will know to quarantine.

Since the beginning of the pandemic, the U.S. has performed more total tests and more tests per capita than any other country, though as of late July the U.K., Russia and Qatar were performing more tests per capita per day. But counting the total number of tests or the tests per capita is not the right way to judge success of a testing program.

As it says on the Johns Hopkins testing comparison page, a country’s “testing program should be scaled to the size of their epidemic, not the size of the population.” Sure, the U.S. might have a big testing program, but it has a massive epidemic. The U.S. needs an equally massive testing program if health officials want to have an accurate picture of what’s really going on.

Test positivity rate

So how do public health officials know if they are doing enough testing?

Better than simply counting total number of tests, the test positivity rate is a useful measure of whether enough tests are being done. The test positivity rate is simply the fraction of tests that come back positive. It is calculated by dividing the number of positive tests by the total number of tests. Generally, a lower test positivity rate is good.

A good way to think about test positivity is to think about fishing with a net. If you catch a fish almost every time you send the net down – high test positivity – that tells you there are probably a lot of fish around that you haven’t caught – there are a lot of undetected cases. On the other hand, if you use a huge net – more testing – and only catch a fish every once in a while – low test positivity – you can be pretty sure that you’ve caught most of the fish in the area.

According to the World Health Organization, before a region can relax restrictions or begin reopening, the test positivity rate from a comprehensive testing program should be at or below 5% for at least 14 days.

There are two ways to lower a test positivity rate: either by decreasing the number of positive tests or by increasing the total number of tests. A comprehensive testing program does both. By conducting a large number of tests, most cases in the community are detected. Then, individual and government actions can be taken that contain the virus. This results in a declining number of positive tests.

Returning to the fishing metaphor, the goal of a comprehensive testing program is to use a huge net to overfish in the coronavirus lake until there are very few COVID-19 cases left. Using the test positivity rate as a measure of success helps ensure that a testing program is appropriately scaled to the size of an epidemic.

As of July 27, the U.S. as a whole had a test positivity rate of 10%. States where testing programs are robust and the virus is fairly well controlled have test positivity rates well below 5%, like Massachusetts at 2.68% and New York at 1.09%. In places like Mississippi and Arizona that are experiencing large outbreaks, test positivity rates are above 20%.

The right amount of testing

The increases in confirmed cases aren’t occurring just because there is more testing. The high test positivity rates in some locations show that the virus is in fact spreading and growing so testing needs to grow with it. I believe that if the U.S. wants to beat back this virus, one of the first things that needs to happen is to increase testing. We need to deploy larger nets to catch more fish. Yes, we’ll find more cases, but that’s the point.

 

 

 

 

How COVID-19 might increase risk of memory loss and cognitive decline

Posted on by • Posted in 2020 Election Issues, Brain Care, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Long-Term Complications, Coronavirus Treatment, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Immune System Response, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Preexisting Conditions, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://theconversation.com/how-covid-19-might-increase-risk-of-memory-loss-and-cognitive-decline-141940?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20August%207%202020%20-%201698416388&utm_content=Latest%20from%20The%20Conversation%20for%20August%207%202020%20-%201698416388+Version+A+CID_8af0fc3134205f68bf387b5096319fb1&utm_source=campaign_monitor_us&utm_term=How%20COVID-19%20might%20increase%20risk%20of%20memory%20loss%20and%20cognitive%20decline

Of all frightening ways that the SARS-COV-2 virus affects the body, one of the more insidious is the effect of COVID-19 on the brain.

It is now clear that many patients suffering from COVID-19 exhibit neurological symptoms, from loss of smell, to delirium, to an increased risk of stroke. There are also longer-lasting consequences for the brain, including myalgic encephalomyelitis /chronic fatigue syndrome and Guillain-Barre syndrome.

These effects may be caused by direct viral infection of brain tissue. But growing evidence suggests additional indirect actions triggered via the virus’s infection of epithelial cells and the cardiovascular system, or through the immune system and inflammation, contribute to lasting neurological changes after COVID-19.

I am a neuroscientist specializing in how memories are formed, the role of immune cells in the brain and how memory is persistently disrupted after illness and immune activation. As I survey the emerging scientific literature, my question is: Will there be a COVID-19-related wave of memory deficits, cognitive decline and dementia cases in the future?

The immune system and the brain

Many of the symptoms we attribute to an infection are really due to the protective responses of the immune system. A runny nose during a cold is not a direct effect of the virus, but a result of the immune system’s response to the cold virus. This is also true when it comes to feeling sick. The general malaise, tiredness, fever and social withdrawal are caused by activation of specialized immune cells in the brain, called neuroimmune cells, and signals in the brain.

These changes in brain and behavior, although annoying for our everyday lives, are highly adaptive and immensely beneficial. By resting, you allow the energy-demanding immune response to do its thing. A fever makes the body less hospitable to viruses and increases the efficiency of the immune system. Social withdrawal may help decrease spread of the virus.

In addition to changing behavior and regulating physiological responses during illness, the specialized immune system in the brain also plays a number of other roles. It has recently become clear that the neuroimmune cells that sit at the connections between brain cells (synapses), which provide energy and minute quantities of inflammatory signals, are essential for normal memory formation.

Unfortunately, this also provides a way in which illnesses like COVID-19 can cause both acute neurological symptoms and long-lasting issues in the brain.

Microglia are specialized immune cells in the brain. In healthy states, they use their arms to test the environment. During an immune response, microglia change shape to engulf pathogens. But they can also damage neurons and their connections that store memory.

During illness and inflammation, the specialized immune cells in the brain become activated, spewing vast quantities of inflammatory signals, and modifying how they communicate with neurons. For one type of cell, microglia, this means changing shape, withdrawing the spindly arms and becoming blobby, mobile cells that envelop potential pathogens or cell debris in their path. But, in doing so, they also destroy and eat the neuronal connections that are so important for memory storage.

Another type of neuroimmune cell called an astrocyte, typically wraps around the connection between neurons during illness-evoked activation and dumps inflammatory signals on these junctions, effectively preventing the changes in connections between neurons that store memories.

Because COVID-19 involves a massive release of inflammatory signals, the impact of this disease on memory is particularly interesting to me. That is because there are both short-term effects on cognition (delirium), and the potential for long-lasting changes in memory, attention and cognition. There is also an increased risk for cognitive decline and dementia, including Alzheimer’s disease, during aging.

 

How does inflammation exert long-lasting effects on memory?

If activation of neuroimmune cells is limited to the duration of the illness, then how can inflammation cause long-lasting memory deficits or increase the risk of cognitive decline?

Both the brain and the immune system have specifically evolved to change as a consequence of experience, in order to neutralize danger and maximize survival. In the brain, changes in connections between neurons allows us to store memories and rapidly change behavior to escape threat, or seek food or social opportunities. The immune system has evolved to fine-tune the inflammatory response and antibody production against previously encountered pathogens.

Yet long-lasting changes in the brain after illness are also closely linked to increased risk for age-related cognitive decline and Alzheimer’s disease. The disruptive and destructive actions of neuroimmune cells and inflammatory signaling can permanently impair memory. This can occur through permanent damage to the neuronal connections or neurons themselves and also via more subtle changes in how neurons function.

The potential connection between COVID-19 and persistent effects on memory are based on observations of other illnesses. For example, many patients who recover from heart attack or bypass surgery report lasting cognitive deficits that become exaggerated during aging.

Another major illness with a similar cognitive complications is sepsis – multi-organ dysfunction triggered by inflammation. In animal models of these diseases, we also see impairments of memory, and changes in neuroimmune and neuronal function that persist weeks and months after illness.

Even mild inflammation, including chronic stress, are now recognized as risk factors for dementias and cognitive decline during aging.

In my own laboratory, I and my colleagues have also observed that even without bacterial or viral infection, triggering inflammatory signaling over a short-term period results in long-lasting changes in neuronal function in memory-related brain regions and memory impairments.

 

Does COVID-19 increase risk for cognitive decline?

It will be many years before we know whether the COVID-19 infection causes an increased risk for cognitive decline or Alzheimer’s disease. But this risk may be decreased or mitigated through prevention and treatment of COVID-19.

Prevention and treatment both rely on the ability to decrease the severity and duration of illness and inflammation. Intriguingly, very new research suggests that common vaccines, including the flu shot and pneumonia vaccines, may reduce risk for Alzheimer’s.

Additionally, several emerging treatments for COVID-19 are drugs that suppress excessive immune activation and inflammatory state. Potentially, these treatments will also reduce the impact of inflammation on the brain, and decrease the impact on long-term brain health.

COVID-19 will continue to impact health and well-being long after the pandemic is over. As such, it will be critical to continue to assess the effects of COVID-19 illness in vulnerability to later cognitive decline and dementias.

In doing so, researchers will likely gain critical new insight into the role of inflammation across the life-span in age-related cognitive decline. This will aid in the development of more effective strategies for prevention and treatment of these debilitating illnesses.

 

 

 

 

Most Americans Still Aren’t Wearing Face Masks Outdoors, Poll Finds

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Partisanship, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Quarantine, School Reopening, Scientists, Social Distancing • Leave a comment

https://www.forbes.com/sites/alisondurkee/2020/08/07/most-americans-still-arent-wearing-face-masks-outdoors-poll-finds/#16327ed43349

Why do so many Americans refuse to wear face masks? Politics is ...

TOPLINE

Even as the surging Covid-19 pandemic has inspired a broad majority of Americans to start wearing face masks indoors, the practice still remains rare outside, with a new Gallup poll finding that fewer than half of Americans wear face masks outside in non-socially distanced settings, despite many mask-wearing mandates now requiring them to do so.

KEY FACTS

While 81% of poll respondents say they always or usually wear a mask indoors when social distancing isn’t possible, only 47% say they wear a face mask outdoors when they cannot socially distance.

29% say they “always” wear a mask outdoors and 18% say they “usually” do.

The practice is more common among Democrats, with 64% saying they wear a mask outdoors as compared with 43% of Independents and only 23% of Republicans.

Midwesterners are the least likely to wear masks outside; only 37% in the Midwest region wear masks outside, versus 55% in the Northeast, 47% in the South and 49% in the West.

Research has shown that Covid-19 appears to be more easily transmitted indoors, though outdoor settings still pose some risk, and Gallup notes the poll findings “could indicate a potential for increased spread of the disease” in outdoor venues like beaches.

Many state or local mask-wearing mandates include outdoor settings where social distancing isn’t possible, and multiple areas, including New Jersey and Oregon, have also imposed additional orders specifying masks must be worn outdoors in many circumstances.

CRUCIAL QUOTE

“We know this virus is a lot less lethal outdoors than indoors, but that does not mean it is not lethal,” New Jersey Gov. Phil Murphy said in a statement about his July executive order requiring masks outdoors. “The hotspots we’re seeing across the nation and certain worrisome transmission trends in New Jersey require us to do more.”

BIG NUMBER

66,740: The number of lives that could be saved in the U.S. by December 1 if 95% of people “were to wear masks when leaving their homes,” as projected Thursday by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine. The IMHE’s model projects 295,011 deaths by December, which would drop by 49% to 228,271 with “consistent mask-wearing.”

KEY BACKGROUND

Mask wearing has become a major point of contention as Covid-19 has rapidly spread across the U.S. Though many states and localities have imposed mask-wearing mandates, the orders have been resisted by many GOP governors, including in states like Florida that have been particularly hard-hit by the virus. While President Donald Trump initially made mask-wearing a partisan debate through his refusal to don a mask, the president has shifted to promoting the practice in recent weeks, tweeting a photo of himself in a mask that called mask-wearing “patriotic” and urging supporters to wear a mask in a recent campaign email. Prominent Republicans including Senate Majority Leader Mitch McConnell have also vocally advocated for mask-wearing, with McConnell saying Thursday on CNBC that wearing a mask is “the single most significant thing everybody in the country can do to help prevent the spread.”

 

 

 

 

69% Of Americans Are Concerned That The U.S. Is Reopening Too Quickly Amid The Coronavirus Pandemic

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Case, Economic Recovery, Economy Reopening, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Quarantine, School Reopening, Scientists, Social Distancing, Wishful Thinking • Leave a comment

https://www.forbes.com/sites/mattperez/2020/08/06/69-of-americans-are-concerned-that-the-us-is-reopening-too-quickly-amid-the-coronavirus-pandemic/#719b3e2523f3

69% Of Americans Are Concerned That The U.S. Is Reopening Too ...

TOPLINE

Some 69% of Americans believe that state governments have eased restrictions too soon amid the Covid-19 pandemic, as opposed to opening too slowly, according to a new Pew Research study published on Thursday, as the U.S. grapples with a still-uncontrolled outbreak of the coronavirus.

KEY FACTS

While the Trump administration pushed for states to lift stay-at-home orders throughout the spring to help the battered economy, governors are now being forced to pause or restore some restrictions after a surge in cases this summer.

Around seven-in-ten people believe the most effective way to help economic recovery is to significantly reduce infections across the country, according to the study, and while Trump continues his argument that the U.S. leads the world in cases due to an increase in testing, 60% of Americans believe it’s primarily due to more new infections.

A majority of Democrats and Republicans believe the main reason the outbreak in the U.S. has continued is due to the lack of social distancing and mask wearing, while 58% of adults surveyed believe it’s due to early lifting of restrictions.

A number of wealthy nations that experienced severe outbreaks early in the pandemic have exited their first waves and have less cases than states like California and Florida, with 62% of Americans believing the U.S. response to the coronavirus trails other affluent countries.

The survey comes as the Trump administration continues to pressure Democratic-led states to ease restrictions and demand schools reopen for in-person instruction, even threatening to withhold federal funding if they don’t.

CRUCIAL QUOTE

Dr. Anthony Fauci, the government’s lead infectious disease expert, commented on the rise of infections across the nation: “In the attempt to reopen in some situations states did not abide strictly by the guidelines that the task force and the White House has put out. And others that even did abide by it, the people in the state actually were congregating in crowds and not wearing masks.”

KEY BACKGROUND

While initial hotspots like New York and New Jersey were able to lower the infection rate throughout the spring, cases began exploding in southern and western states before the country as a whole could exit the first wave of its outbreak. Cases are now trending down after a record high of 74,818 on July 24, according to the Centers for Disease Control and Prevention, though deaths have been over 1,000 daily the past week and there are still tens of thousands of cases each day. The U.S. leads all other countries in cases with 4.87 million, as well as reported deaths with 159,864.

 

 

 

 

Cartoon – Deferred Healthcare

Posted on by • Posted in 2020 Election Issues, Cartoon, Deferred Healthcare, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses, Preexisting Conditions, Underinsured, Uninsured • Leave a comment

Public Health Coverage Cartoons and Comics - funny pictures from ...

Cartoon – Wheel of Misfortune

Posted on by • Posted in 2020 Election Issues, Cartoon, Chronic Care Management, Chronic Conditions, Chronic Diseases, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses, Preexisting Conditions, Underinsured, Uninsured • Leave a comment

SitNews - Newsmaker Interviews: Good Luck on Sweeping Health Care ...

COVID-19 long-term toll signals billions in healthcare costs ahead

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Chronic Care Management, Chronic Conditions, Chronic Diseases, Coronavirus, Coronavirus Liability, Coronavirus Long-Term Complications, Coronavirus Side Effects, Coronavirus Treatment, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economic Stimulus, Economy Reopening, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Out of Control, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Public Health, Public Safety, Quarantine, School Reopening, Scientists, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured, World Health Organization (WHO) • Leave a comment

https://www.reuters.com/article/us-health-coronavirus-fallout-insight/long-term-complications-of-covid-19-signals-billions-in-healthcare-costs-ahead-idUSKBN24Z1CM?fbclid=IwAR2f9fSnhgGBVvIe1fKX2EO5kKSG7TwUesAMUGrG0jBSfoBrBYltR1e9Nik

COVID-19 long-term toll signals billions in healthcare costs ahead ...

Late in March, Laura Gross, 72, was recovering from gall bladder surgery in her Fort Lee, New Jersey, home when she became sick again.

Her throat, head and eyes hurt, her muscles and joints ached and she felt like she was in a fog. Her diagnosis was COVID-19. Four months later, these symptoms remain.

Gross sees a primary care doctor and specialists including a cardiologist, pulmonologist, endocrinologist, neurologist, and gastroenterologist.

“I’ve had a headache since April. I’ve never stopped running a low-grade temperature,” she said.

Studies of COVID-19 patients keep uncovering new complications associated with the disease.

With mounting evidence that some COVID-19 survivors face months, or possibly years, of debilitating complications, healthcare experts are beginning to study possible long-term costs.

Bruce Lee of the City University of New York (CUNY) Public School of Health estimated that if 20% of the U.S. population contracts the virus, the one-year post-hospitalization costs would be at least $50 billion, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80% of the population became infected, that cost would balloon to $204 billion.

Some countries hit hard by the new coronavirus – including the United States, Britain and Italy – are considering whether these long-term effects can be considered a “post-COVID syndrome,” according to Reuters interviews with about a dozen doctors and health economists.

Some U.S. and Italian hospitals have created centers devoted to the care of these patients and are standardizing follow-up measures.

Britain’s Department of Health and the U.S. Centers for Disease Control and Prevention are each leading national studies of COVID-19’s long-term impacts. An international panel of doctors will suggest standards for mid- and long-term care of recovered patients to the World Health Organization (WHO) in August.

YEARS BEFORE THE COST IS KNOWN

More than 17 million people have been infected by the new coronavirus worldwide, about a quarter of them in the United States.

Healthcare experts say it will be years before the costs for those who have recovered can be fully calculated, not unlike the slow recognition of HIV, or the health impacts to first responders of the Sept. 11, 2001 attacks on the World Trade Center in New York.

They stem from COVID-19’s toll on multiple organs, including heart, lung and kidney damage that will likely require costly care, such as regular scans and ultrasounds, as well as neurological deficits that are not yet fully understood.

A JAMA Cardiology study found that in one group of COVID-19 patients in Germany aged 45 to 53, more than 75% suffered from heart inflammation, raising the possibility of future heart failure.

A Kidney International study found that over a third of COVID-19 patients in a New York medical system developed acute kidney injury, and nearly 15% required dialysis.

Dr. Marco Rizzi in Bergamo, Italy, an early epicenter of the pandemic, said the Giovanni XXIII Hospital has seen close to 600 COVID-19 patients for follow-up. About 30% have lung issues, 10% have neurological problems, 10% have heart issues and about 9% have lingering motor skill problems. He co-chairs the WHO panel that will recommend long-term follow-up for patients.

“On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year,” Rizzi said, adding that even those with mild COVID-19 “may have consequences in the future.”

Milan’s San Raffaele Hospital has seen more than 1,000 COVID-19 patients for follow-up. While major cardiology problems there were few, about 30% to 40% of patients have neurological problems and at least half suffer from respiratory conditions, according to Dr. Moreno Tresoldi.

Some of these long-term effects have only recently emerged, too soon for health economists to study medical claims and make accurate estimates of costs.

In Britain and Italy, those costs would be borne by their respective governments, which have committed to funding COVID-19 treatments but have offered few details on how much may be needed.

In the United States, more than half of the population is covered by private health insurers, an industry that is just beginning to estimate the cost of COVID-19.

CUNY’s Lee estimated the average one-year cost of a U.S. COVID-19 patient after they have been discharged from the hospital at $4,000, largely due to the lingering issues from acute respiratory distress syndrome (ARDS), which affects some 40% of patients, and sepsis.

The estimate spans patients who had been hospitalized with moderate illness to the most severe cases, but does not include other potential complications, such as heart and kidney damage.

Even those who do not require hospitalization have average one-year costs after their initial illness of $1,000, Lee estimated.

‘HARD JUST TO GET UP’

Extra costs from lingering effects of COVID-19 could mean higher health insurance premiums in the United States. Some health plans have already raised 2021 premiums on comprehensive coverage by up to 8% due to COVID-19, according to the Kaiser Family Foundation.

Anne McKee, 61, a retired psychologist who lives in Knoxville, Tennessee and Atlanta, had multiple sclerosis and asthma when she became infected nearly five months ago. She is still struggling to catch her breath.

“On good days, I can do a couple loads of laundry, but the last several days, it’s been hard just to get up and get a drink from the kitchen,” she said.

She has spent more than $5,000 on appointments, tests and prescription drugs during that time. Her insurance has paid more than $15,000 including $240 for a telehealth appointment and $455 for a lung scan.

“Many of the issues that arise from having a severe contraction of a disease could be 3, 5, 20 years down the road,” said Dale Hall, Managing Director of Research with the Society of Actuaries.

To understand the costs, U.S. actuaries compare insurance records of coronavirus patients against people with a similar health profile but no COVID-19, and follow them for years.

The United Kingdom aims to track the health of 10,000 hospitalized COVID-19 patients over the first 12 months after being discharged and potentially as long as 25 years. Scientists running the study see the potential for defining a long-term COVID-19 syndrome, as they found with Ebola survivors in Africa.

“Many people, we believe will have scarring in the lungs and fatigue … and perhaps vascular damage to the brain, perhaps, psychological distress as well,” said Professor Calum Semple from the University of Liverpool.

Margaret O’Hara, 50, who works at a Birmingham hospital is one of many COVID-19 patients who will not be included in the study because she had mild symptoms and was not hospitalized. But recurring health issues, including extreme shortness of breath, has kept her out of work.

O’Hara worries patients like her are not going to be included in the country’s long-term cost planning.

“We’re going to need … expensive follow-up for quite a long time,” she said.