Fearing a ‘Twindemic,’ Health Experts Push Urgently for Flu Shots

Fearing a 'Twindemic,' Health Experts Push Urgently for Flu Shots ...

There’s no vaccine for Covid-19, but there’s one for influenza. With the season’s first doses now shipping, officials are struggling over how to get people to take it.

As public health officials look to fall and winter, the specter of a new surge of Covid-19 gives them chills. But there is a scenario they dread even more: a severe flu season, resulting in a “twindemic.”

Even a mild flu season could stagger hospitals already coping with Covid-19 cases. And though officials don’t know yet what degree of severity to anticipate this year, they are worried large numbers of people could forgo flu shots, increasing the risk of widespread outbreaks.

The concern about a twindemic is so great that officials around the world are pushing the flu shot even before it becomes available in clinics and doctors’ offices. Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention has been talking it up, urging corporate leaders to figure out ways to inoculate employees. The C.D.C. usually purchases 500,000 doses for uninsured adults but this year ordered an additional 9.3 million doses.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has been imploring people to get the flu shot, “so that you could at least blunt the effect of one of those two potential respiratory infections.”

In Britain, Prime Minister Boris Johnson has been waging his own pro flu-shot campaign. Last month, he labeled people who oppose flu vaccines “nuts” and announced the country’s largest ever rollout of the shots. In April, one of the few reasons Australia allowed citizens to break the country’s strict lockdown was to venture out for their flu shots.

The flu vaccine is rarely mandated in the U.S. except by some health care facilities and nursery schools, but this month the statewide University of California system announced that because of the pandemic, it is requiring all 230,000 employees and 280,000 students to get the flu vaccine by November 1.

A life-threatening respiratory illness that crowds emergency rooms and intensive care units, flu shares symptoms with Covid-19: fever, headache, cough, sore throat, muscle aches and fatigue. Flu can leave patients vulnerable to a harsher attack of Covid-19, doctors believe, and that coming down with both viruses at once could be disastrous.

The 2019-20 flu season in the United States was mild, according to the C.D.C. But a mild flu season still takes a toll. In preliminary estimates, the C.D.C. says that cases ranged from 39 million to 56 million, resulting in up to 740,000 hospitalizations and from 24,000 to 62,000 flu-related deaths.

According to the C.D.C., flu season occurs in the fall and winter, peaking from December to February, and so was nearing its end as the pandemic began to flare in the United States in March.

But now, fighting flu proactively during the continuing pandemic presents significant challenges: not only how to administer the shot safely and readily, but also how to prompt people to get a shot that a majority of Americans have typically distrusted, dismissed and skipped.

With many places where the flu shot is administered en masse now inaccessible — including offices and plants that offered it free to employees on site and school health clinics — officials have been reaching out to local health departments, health care providers and corporations to arrange distribution. From now through Oct. 31, publicity campaigns will blast through social media, billboards, television and radio. Because the shot will be more difficult to access this year, people are being told to get it as soon as possible, although immunity does wane. There will be flu shot tents with heaters in parking lots and pop-up clinics in empty school buildings.

Because of the efforts, vaccine makers are projecting that a record 98 million flu shots will be given this year in the United States, about 15 percent more than doses ordered last year. The Kaiser Permanente health care system will be flooding more than 12 million of its members with flu shot reminders via postcard, email, text and phone calls.

Pharmacies and even supermarkets are expected to play a bigger role than they have in previous years. As of this week, Walgreens and CVS will have flu shots available. Walgreens will be hosting additional off-site flu vaccine clinics in community centers and churches. To reduce contact time, CVS is allowing patients to fill out paperwork digitally.

In New York City, which averages about 2,000 flu-related deaths a year, the health department has been reaching out to hundreds of independent pharmacies to administer the shots, because they are often located in outer-borough neighborhoods where the coronavirus has been rampaging. The health department has a detailed online flu vaccine locator.

“Access is a problem for all adult vaccines,” said L. J. Tan, chief strategy officer for the Immunization Action Coalition, a nonprofit group that works to increase vaccination rates, who was an early promoter of the term twindemic. “Adults may think, If I can get the flu shot easily, I might consider it.”

But as difficult as getting the flu shot to people safely will be, perhaps harder still will be persuading them to actually get it. In the 2018-19 flu season in the United States, only 45.3 percent of adults over 18 got the vaccine, with rates for those ages 18 to 50 considerably lower.

Skepticism to this vaccine runs high, particularly in communities of color because of longstanding distrust and discrimination in public health.2017 study in the journal Vaccine noted that, compared with white people, “African Americans were more likely to report barriers to vaccination, were more hesitant about vaccines in general and the flu vaccine specifically, more likely to believe in conspiracy theories and use naturalism as an alternative to getting vaccinated.”

Across all demographic groups, perhaps the most striking reason given for avoiding the flu vaccine is that people do not see it as efficacious as, say, the measles vaccine.

Indeed, it is a good vaccine but not a great one. It must be repeated annually. Immunity takes up to two weeks to kick in. But its efficacy also depends on how accurately infectious disease centers worldwide forecast which strains are expected to circulate in the coming year. And then those strains can mutate.

Although the flu shot confers immunity at all ages over six months, it can be less complete in people over 65. Depending on many factors, the shot’s effectiveness in a given year can range from 40 to 60 percent.

“But a vaccine not given won’t protect anyone,” said Dr. Jane R. Zucker, assistant commissioner for the Bureau of Immunization at the New York City Health Department, which has been hosting webinars for providers about how to have conversations about the flu shot with hesitant patients.

As health officials note, should a vaccinated person contract the flu, the severity will almost certainly be reduced, hospitalization rarely necessary. Especially with Covid-19 raging, public officials reason, those odds look pretty good.

Another reason people give for not getting the shot is they think it makes them sick.

“People who say ‘I’ll never get it because it gives me the flu’ have not had the flu and don’t know what it is,” said Patsy Stinchfield, senior director of infection prevention at Children’s Minnesota.

“What you’re feeling is your body’s immune response to the virus’s antigens,” said Ms. Stinchfield, a member of the C.D.C.’s influenza work group. “You may feel flu-ish. And that’s a good thing. It’s your body’s way of saying, ‘I am ready for the flu, and I won’t get as sick if I get the real one.’”

Public campaigns will describe the shot as a critical weapon during the pandemic. “Hopefully people will say, ‘There’s no Covid vaccine so I can’t control that, but I do have access to the flu vaccine and I can get that,’” Ms. Stinchfield said. “It gives you a little power to protect yourself.”

Other campaigns will emphasize familial and community responsibility.

Usually, flu vaccine compliance rates among people ages 18 to 49 are low. Vermont’s, for example, is only about 27 percent.

Christine Finley, the state’s immunization program manager, believes that rates will improve because of the pandemic’s stay-at-home households. “People are more aware that the risks they take can negatively impact others,” she said. “They’re often taking care of young children and older parents.”

If any example could prove instructive about protective behavior and flu vaccines during the coronavirus epidemic, it could well be Australia.

Australia’s flu vaccine rate tends to be modest, but this year demand was high. The government’s rollout of the shot began earlier than usual for the June-through-August winter because the coronavirus pandemic was exploding. Though the government had also issued strict no-entry limits among many states and territories and bans on international travel, the flu shot was one of the few reasons people could emerge from lockdown.

The prevalent strain circulating in the country is Type A, the most common and virulent form of flu, said Dr. Kelly L. Moore, a public health expert at the Vanderbilt University School of Medicine.

According to the C.D.C., Type A is the most likely to circulate globally. It mutates readily, particularly as it jumps between animals and humans.

“There are two strains of Type A influenza in the vaccine,” Dr. Moore said, “and so the very best way to protect yourself is to get the shot.”

Reported cases of flu in Australia have dropped 99 percent compared with 2019.

Australia’s milder-than-usual flu season is likely the result of a number of factors — strong flu vaccination uptake, social distancing, but also severely decreased movement of people,” said Dr. Jonathan Anderson, a spokesman for Seqirus, a supplier of flu vaccine.

But though American public health authorities usually look to Australia’s flu season as a predictive, Australians say this year it’s not a reliable indicator.

“This situation is of no comfort as these measures do not apply to the United States where the populace has never been effectively physical distancing,” nor have the country’s entry restrictions been as onerous, said Dr. Paul Van Buynder, a public health professor at Griffith University in Queensland, Australia.

All that Americans can do is get vaccinated against flu, he added, because circulation of the coronavirus remains high.

“It is likely they will have a significant influenza season this northern winter,” he said.

 

 

 

 

 

10 best, worst states for healthcare in 2020

https://www.beckershospitalreview.com/rankings-and-ratings/10-best-worst-states-for-healthcare-in-2020-080320.html

2020's Best & Worst States for Health Care

Americans in Massachusetts receive the best healthcare in the country, while those in Georgia receive the worst, according to an analysis by WalletHub, a personal finance website. 

To identify the best and worst states for healthcare, analysts compared the 50 states and the District of Columbia across 44 different measures of healthcare cost, access and outcomes. The metrics ranged from average hospital expenses per inpatient day to share of patients readmitted to hospitals. Read more about the methodology here.

Here are the 10 states with the highest overall rank across cost, access and outcomes, according to the analysis: 

1. Massachusetts

2. Minnesota

3. Rhode Island

4. District of Columbia

5. North Dakota

6. Vermont

7. Colorado

8. Iowa

9. Hawaii

10. South Dakota

Here are the bottom 10 states on healthcare cost, access and outcomes combined:

1. Georgia

2. Louisiana

3. Alabama

4. North Carolina

5. Mississippi

6. Arkansas

7. Tennessee

8. South Carolina

9. Texas

10. Alaska

Access the full list here

 

 

 

 

Fewer than 10% of primary care practices have stabilized operations amid COVID-19 pandemic

https://www.fiercehealthcare.com/practices/fewer-than-10-primary-care-practices-have-stabilized-operations-amid-covid-19-pandemic?mkt_tok=eyJpIjoiWTJGaE1qTTRaalpsT1dGayIsInQiOiJTNWFxb3VcL3J3ZmE4ZWV0bFwvOGJCYUc0Ukd3TWp4WlM1SzBzT01aeVJIUGlsSWkwNTlVajJxekJqUUsrcWoxZ0IwTUNqVlhTWVJLQmZkSk1XNGtKVEdCOWg3NmRWeFdldFpsSmlONnFvTTFGQ2l1bzQ4S3ZqNWpoaUx2d1pHaSs1In0%3D

Fewer than 10% of primary care practices have stabilized ...

Four months into the COVID-19 pandemic, fewer than 10% of U.S. primary care practices have been able to stabilize operations.

Nearly 9 in 10 primary care practices continue to face significant difficulties with COVID-19, including obtaining medical supplies, meeting the increasing health needs of their patients, and finding sufficient resources to remain operational, according to a recent survey of close to 600 primary care clinicians in 46 states.

Only 13% of primary care clinicians say they are adapting to a “new normal” in the protracted pandemic, the survey found.

More than four months into the pandemic and at a time when 39 states are experiencing an increase of COVID-19 cases, fewer than 4 in 10 clinicians feel confident and safe with their access to personal protective equipment, according to the survey from the Larry A. Green Center in partnership with the Primary Care Collaborative, which was conducted July 10 to July 13.

Among the primary care clinicians surveyed, 11% report that staff in their practice have quit in the last four weeks over safety concerns.

A primary care provider in Ohio said this: “The ‘I can do 4-6 weeks of this’ transition to ‘this feels like a new/permanent normal’ is crushing and demoralizing. Ways to build morale when everyone is at a computer workstation away from other staff (and patients) feels impossible.”

“In the first few months of the pandemic, the country pulled together to stop the spread of the virus, and it seemed like we were making progress. Primary care clinicians and practices were working hard, against tremendous challenges,” said Rebecca Etz, Ph.D., co-director of The Larry A. Green Center in a statement.

“But now the country is backsliding, and it’s clear that primary care doesn’t have enough strength to deal with the rising number of cases. If primary care were a COVID-19 patient, it would be flat on its back,” Etz said.

The survey conducted by the Larry A. Green Center is part of an ongoing series looking at the attitudes of primary care clinicians and patients during the COVID-19 pandemic and the abilities of practices to meet patients’ needs.

Close to 40% of primary care providers report they are maxed out with mental exhaustion and 18% say they spend each week wondering if their practice or job will still be there next week.

In addition to feeling stressed, clinicians and their practices are also experiencing upheaval. The survey found that 22% of clinicians report skipped or deferred salaries, and 78% report preventive and chronic care is being deferred or delayed by patients.

Primary care clinicians report that 42% of in-person volume is down but overall contact with patients is high, while 39% report not being able to bill for the majority of work delivered, the survey found.

“Given the rapidly rising infection rates and persistent lack of PPE, more than a third of primary care clinicians are reporting feeling unsafe at the office, and 20% are cutting back on face-to-face visits while doing more remote outreach,” said Ann Greiner, president and CEO of the Primary Care Collaborative in a statement.

Greiner said this is a clear signal that payers must advance or retain parity for telehealth and telephonic calls.

“It also is a clarion call to move to a new payment system that doesn’t rely on face-to-face visits and that is prospective so practices can better manage patient care,” she said.

Providers say they need more support from private insurers, particularly when it comes to reimbursing for telehealth and telephone visits. 

According to the survey, a primary care doctor in Illinois said, “Recently told we would not be able to conduct telephone visits due to lack of reimbursement. I work in a low-income Medicare population which has low health literacy and no technology literacy. We were 80% telephone and 20% Zoom and in-office. This further exemplifies the extreme health care disparities in the U.S.”

 

 

 

What ‘Racism Is a Public Health Issue’ Means

https://www.smithsonianmag.com/science-nature/what-racism-public-health-issue-means-180975326/?utm_source=smithsoniandaily&utm_medium=email&utm_campaign=20200720-daily-responsive&spMailingID=43001584&spUserID=MTA5MDI1MDg0MjgxOQS2&spJobID=1801530184&spReportId=MTgwMTUzMDE4NAS2&fbclid=IwAR027OjpNcyZKM6Jd5aTYhgVaTzaO5lBqI4hCl1xsrKgQRL1bFYH538YIMA

What 'Racism Is a Public Health Issue' Means | Science ...

Epidemiologist Sharrelle Barber discusses the racial inequalities that exist for COVID-19 and many other health conditions.

Throughout the COVID-19 pandemic, whether cases are flaring up, slowing to a simmer, or back on the rise in areas across the United States, the data makes one fact apparent: The viral disease has disproportionally sickened and killed marginalized communities. A New York Times analysis of data from almost 1,000 counties that reported racial breakdowns of COVID-19 cases and fatalities revealed that, compared to white Americans, African Americans and Hispanics were three times more likely to experience and two times more likely to die from the illness. The Navajo Nation has, per capita, more confirmed cases and deaths than any of the 50 states.

Many factors, like access to healthcare and testing, household size, or essential worker status, likely contribute to the pandemic’s outsized toll on communities of color, but experts see a common root: the far-reaching effects of systemic racism.

That racism would have such an insidious effect on health isn’t a revelation to social epidemiologists. For decades, public health experts have discussed “weathering,” or the toll that repeated stressors experienced by people of color take on their health. Studies have demonstrated the link between such chronic stress and high blood pressure, the increased maternal mortality rate among black and indigenous women, and the elevated prevalence of diabetes in black, Latino and especially Native American populations. The pandemic has laid bare these inequities. At the same time, outcry over systemic racism and police brutality against African Americans has roiled the nation, and the phrase, “Racism is a public health issue” has become an internet refrain.

What exactly is the nebulous concept of “public health”? According to Sharrelle Barber, a Drexel University assistant professor of epidemiology, the concept goes beyond the healthcare setting to take a more holistic look at health in different populations. “The charge of public health,” Barber told Smithsonian, “is really to prevent disease, prevent death, and you prevent those things by having a proper diagnosis of why certain groups might have higher rates of mortality, higher rates of morbidity, et cetera.”

Below is a lightly edited transcript of Smithsonian’s conversation with Barber, who studies how anti-black racism impacts health, about the many ways in which racism is a public health crisis:

When people say, “Racism is a public health problem,” what, in broad strokes, do they mean?

We’ve been observing racial inequities in health for decades in this country. W.E.B. DuBois, who was a sociologist, in The Philadelphia Negro showed mortality rates by race and where people lived in the city of Philadelphia at the turn of the 20th century and found striking inequalities based on race. Fast forward to 1985, 35 years ago, and we have the [Department of Health and Human Services-sponsored] Heckler Report, one of the most comprehensive studies the country had undertaken, which again found striking inequalities across a wide range of health outcomes: infant mortality, cancer, stroke, et cetera.

There are various explanations for why these racial inequalities exist, and a lot of those have erroneously focused on either biology or genetics or behavioral aspects, but it’s important to examine the root causes of those inequities, which is structural racism…Racism is a public health problem, meaning racism is at the root of the inequities in health that we see, particularly for blacks in this country. So whether it’s housing, criminal justice, education, wealth, economic opportunities, healthcare, all of these interlocking systems of racism really are the main fundamental drivers of the racial inequities that we see among black Americans.

What are some specific factors or policies that have set the foundations for these health inequities?

Any conversation about racial inequities has to start with a conversation about slavery. We have to go back 400-plus years and really recognize the ways in which the enslavement of African people and people of African descent is the initial insult that set up the system of racism within this country. One of the major drivers that I actually study is the link between racial residential segregation, particularly in our large urban areas, and health inequities. Racial residential segregation is rooted in racist policies that date back at least to the 1930s. Practices such as redlining, which devalued black communities and led to the disinvestment in black communities, were then propped up by practices and policies at the local, the state and federal level, for example, things like restrictive covenants, where blacks were not allowed to move into certain communities; racial terror, where blacks were literally intimidated and run out of white communities when they tried to or attempted to move into better communities; and so many other policies. Even when you get the 1968 Fair Housing Act, the system finds a way to reinvent itself to still perpetuate and maintain racism.

Within segregated communities, you have so many adverse exposures, like poor quality housing or lack of access to affordable, healthy foods, lack of access to quality healthcare, and the list goes on. The chronic stressors within these communities are compounded in segregated communities, which then can lead to a wide array of health outcomes that are detrimental. So for example, in the city of Philadelphia, there’s been work that has shown upwards of a 15-year life expectancy difference between racially and economically segregated communities, black communities and wealthier white communities.

I imagine that sometimes you might get pushback from people who ask about whether you can separate the effects of socioeconomic status and race in these differences in health outcomes.

Yeah, that’s a false dichotomy in some ways. Racism does lead to, in many aspects, lower income, education, wealth. So they’re inextricably linked. However, racism as a system goes beyond socioeconomic status. If we look at what we see in terms of racial inequities in maternal mortality for black women, they are three times times more likely to die compared to white women. This disparity or this inequity is actually seen for black women who have a college degree or more. The disparity is wide, even when you control for socioeconomic status.

Let’s talk about the COVID-19 pandemic. How does racism shape the current health crisis?

The COVID-19 pandemic has literally just exposed what me and so many of my colleagues have known for decades, but it just puts it in such sharp focus. When you see the disproportionate impact COVID-19 is having, particularly for blacks, but also we’re seeing emerging data on Indigenous folks, it is just laying bare the ways racism is operating in this moment to produce those inequities.

Essential workers who had to continue to work during periods of stay at home orders across the country were disproportionately black and Latino. These are also often low wage workers. They weren’t given personal protective equipment, paid sick leave, hazard pay, and really had to choose between being exposed and protecting themselves and having an income during this period. So that’s one way racism operates.

Then we know that those individuals aren’t isolated, that they return to homes that often are crowded because of the lack of affordable housing. Again, another system of racism that compounds the effect. Then you think about places like Flint, Michigan, or places that don’t have access to clean water. When we were telling people, “Wash your hands, social distance,” all of those things, there were people who literally could not adhere to those basic public health prevention measures and still can’t.

So many things were working in tandem together to then increase the risk, and what was frustrating for myself and colleagues was this kind of “blame the victim” narrative that emerged at the very onset, when we saw the racial disparities emerge and folks were saying, “Blacks aren’t washing their hands,” or, “Blacks need to eat better so they have better outcomes in terms of comorbidities and underlying chronic conditions,” when again, all of that’s structured by racism. To go back to your original question, that’s why racism is a public health issue and fundamental, because in the middle of a pandemic, the worst public health crisis in a century, we’re seeing racism operate and racism produce the inequities in this pandemic, and those inequities are striking…

If we had a structural racism lens going into this pandemic, perhaps we would have done things differently. For example, get testing to communities that we know are going to be more susceptible to the virus. We would have done that early on as opposed to waiting, or we would have said, “Well, folks need to have personal protective equipment and paid sick leave and hazard pay.” We would have made that a priority…

The framing [of systemic racism as a public health concern] also dictates the solutions you come up with in order to actually prevent death and suffering. But if your orientation is, “Oh, it’s a personal responsibility” or “It’s behavioral,” then you create messages to black communities to say, “Wash your hands; wear a mask,” and all of these other things that, again, do not address the fundamental structural drivers of the inequities. That’s why it’s a public health issue, because if public health is designed to prevent disease, prevent suffering, then you have to address racism to have the biggest impact.

Can you talk about how police brutality fits into the public health picture?

We have to deal with the literal deaths that happen at the hands of the police, because of a system that is rooted in slavery, but I also think we have to pay attention to the collective trauma that it causes to black communities. In the midst of a pandemic that’s already traumatic to watch the deaths due to COVID-19, [communities] then have to bear witness to literal lynchings and murders and that trauma. There’s really good scholarship on the kind of spillover effects of police brutality that impact the lives of whole communities because of the trauma of having to witness this kind of violence that then does not get met with any kind of justice.

It reinforces this idea that one, our lives are disposable, that black lives really don’t matter, because the whole system upholds this kind of violence and this kind of oppression, particularly for black folks. I’ve done studies on allostatic load [the wear and tear on the body as a result of chronic stress] and what it does, the dysregulation that happens. So just think about living in a society that’s a constant source of stress, chronic stress, and how that wreaks havoc on blacks and other marginalized racial groups as well.

 

 

 

 

Diabetes highlights two Americas: One where COVID is easily beaten, the other where it’s often devastating

https://www.usatoday.com/story/news/health/2020/07/27/diabetes-and-covid-two-americas-health-problems/5445836002/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-07-27%20Healthcare%20Dive%20%5Bissue:28706%5D&utm_term=Healthcare%20Dive

What You Need to Know about Diabetes and the Coronavirus | diaTribe

Dr. Anne Peters splits her mostly virtual workweek between a diabetes clinic on the west side of Los Angeles and one on the east side of the sprawling city. 

Three days a week she treats people whose diabetes is well-controlled. They have insurance, so they can afford the newest medications and blood monitoring devices. They can exercise and eat well.  Those generally more affluent West L.A. patients who have gotten COVID-19 have developed mild to moderate symptoms – feeling miserable, she said – but treatable, with close follow-up at home.

“By all rights they should do much worse, and yet most don’t even go to the hospital,” said Peters, director of the USC Clinical Diabetes Programs.

On the other two days of her workweek, it’s a different story.

In East L.A., many patients didn’t have insurance even before the pandemic. Now, with widespread layoffs, even fewer do. They live in “food deserts,” lacking a car or gas money to reach a grocery store stocked with fresh fruits and vegetables. They can’t stay home, because they’re essential workers in grocery stores, health care facilities and delivery services. And they live in multi-generational homes, so even if older people stay put, they are likely to be infected by a younger relative who can’t.

They tend to get COVID-19 more often and do worse if they get sick, with more symptoms and a higher likelihood of ending up in the hospital or dying, said Peters, also a member of the leadership council of Beyond Type 1, a diabetes research and advocacy organization. 

“It doesn’t mean my East Side patients are all doomed,” she emphasized.

But it does suggest COVID-19 has an unequal impact, striking people who are poor and already in ill health far harder than healthier, better off people on the other side of town.

Tracey Brown has known that for years.

“What the COVID-19 pandemic has done is shined a very bright light on this existing and pervasive problem,” said Brown, CEO of the American Diabetes Association. Along with about 32 million others – roughly 1 in 10 Americans – Brown has diabetes herself.

“We’re in 2020, and every 5 minutes, someone is losing a limb” to diabetes, she said. “Every 10 minutes, somebody is having kidney failure.”

Americans with diabetes and related health conditions are 12 times more likely to die of COVID-19 than those without such conditions, she said. Roughly 90% of Americans who die of COVID-19 have diabetes or other underlying conditions. And people of color are over-represented among the very sick and the dead.

Diabetes and COVID: Coronavirus highlights America's health problems

Diabetes increases COVID risk

The data is clear: People with diabetes are at increased risk of having a bad case of COVID-19, and diabetics with poorly controlled blood sugar are at even higher risk, said Liam Smeeth, dean of the faculty of epidemiology and population health at the London School of Hygiene and Tropical Medicine. He and his colleagues combed data on 17 million people in the U.K. to come to their conclusions.

Diabetes often comes paired with other health problems – obesity and high blood pressure, for instance. Add smoking, Smeeth said, and “for someone with diabetes in particular, those can really mount up.”

People with diabetes are more vulnerable to many types infections, Peters said, because their white blood cells don’t work as well when blood sugar levels are high. 

“In a test tube, you can see the infection-fighting cells working less well if the sugars are higher,” she said.

Peters recently saw a patient whose diabetes was triggered by COVID-19, a finding supported by one recent study.

Going into the hospital with any viral illness can trigger a spike in blood sugar, whether someone has diabetes or not. Some medications used to treat serious cases of COVID-19 can “shoot your sugars up,” Peters said.

In patients who catch COVID-19 but aren’t hospitalized, Peters said, she often has to reduce their insulin to compensate for the fact that they aren’t eating as much.

Low income seems to be a risk factor for a bad case of COVID-19, even independent of age, weight, blood pressure and blood sugar levels, Smeeth said. “We see strong links with poverty.”

Some of that is driven by occupational risks, with poorer people unable to work from home or avoid high-risk jobs. Some is related to housing conditions and crowding into apartments to save money. And some, may be related to underlying health conditions.

But the connection, he said, is unmistakable.

Peters recently watched a longtime friend lose her husband. Age 60 and diabetic, he was laid off due to COVID, which cost him his health insurance. He developed a foot ulcer that he couldn’t afford to treat. He ignored it until he couldn’t stand anymore and then went to the hospital.

After surgery, he was released to a rehabilitation facility where he contracted COVID. He was transferred back to the hospital, where he died four days later.

“He died, not because of COVID and not because of diabetes, but because he didn’t have access to health care when he needed it to prevent that whole process from happening,” Peters said, adding that he couldn’t see his family in his final days and died alone. “It just breaks your heart.”

Taking action on diabetes– personally and nationally

Now is a great time to improve diabetes control, Peters added. With many restaurants and most bars closed, people can have more control over what they eat. No commuting leaves more time for exercise.

That’s what David Miller has managed to do. Miller, 65, of Austin, Texas, said he has stepped up his exercise routine, walking for 40 minutes four mornings a week at a nearby high school track. It’s cool enough at that hour, and the track’s not crowded, said Miller, an insurance agent, who has been able to work from home during the pandemic. “That’s more consistent exercise than I’ve ever done.”

His blood sugar is still not where he wants it to be, he said, but his new fitness routine has helped him lose a little weight and bring his blood sugar under better control. Eating less remains a challenge. “I’m one of those middle-aged guys who’s gotten into the habit of eating for two,” he said. “That can be a hard habit to shake.”

Miller said he isn’t too worried about getting COVID-19.

“I’ve tried to limit my exposure within reason,” he said, noting that he wears a mask when he can in public. “I honestly don’t feel particularly more vulnerable than anybody else.”

Smeeth, the British epidemiologist, said even though they’re at higher risk for bad outcomes, people with diabetes should know that they’re not helpless. 

“The traditional public health messages – don’t be overweight, give up smoking, keep active  – are still valid for COVID,” he said. Plus, people with diabetes should prioritize getting a flu vaccine this fall, he said, to avoid compounding their risk.

(For more practical recommendations for those living with diabetes during the pandemic, go to coronavirusdiabetes.org.)

In Los Angeles, Peters said, the county has made access to diabetes medication much easier for people with low incomes. They can now get three months of medication, instead of only one. “We refill everybody’s medicine that we can to make sure people have the tools,” she said, adding that diabetes advocates are also doing what they can to help people get health insurance.

Controlling blood sugar will help everyone, not just those with diabetes, Peters said. Someone hospitalized with uncontrolled blood sugar takes up a bed that could otherwise be used for a COVID-19 patient. 

Brown, of the American Diabetes Association, has been advocating for those measures on a national level, as well as ramping up testing in low-income communities. Right now, most testing centers are in wealthier neighborhoods, she said, and many are drive-thrus, assuming that everyone who needs testing has a car.

Her organization is also lobbying for continuity of health insurance coverage if someone with diabetes loses their job, as well as legislation to remove co-pays for diabetes medication.

“The last thing we want to have happen is that during this economically challenged time, people start rationing or skipping their doses of insulin or other prescription drugs,” Brown said. That leads to unmanaged diabetes and complications like ulcers and amputations. “Diabetes is one of those diseases where you can control it. You shouldn’t have to suffer and you shouldn’t have to die.”

 

 

California AG conditionally approves $350M sale of nonprofit to Prime Healthcare

https://www.healthcarefinancenews.com/news/california-ag-conditionally-approves-350m-sale-st-francis-medical-center-prime-healthcare

Prime Healthcare, CEO Prem Reddy settle false-claims suit for $65M

Prime will acquire St. Francis for a net of $350 million, with a $200 million base cash price and $60 million for accounts receivable.

California Attorney General Xavier Becerra has conditionally approved Verity Health’s application to transfer ownership of St. Francis Medical Center to Prime Healthcare. The Attorney General’s decision follows an earlier decision by the U.S. Bankruptcy Court of the Central District of California granting Verity’s request to reject the existing collective bargaining agreements which impose legacy cost structures that it said contributed to bankruptcy.

Becerra noted that his approval of the sale of St. Francis to Prime Healthcare “protect(s) access to care for the Los Angeles communities served” by St. Francis.

“The COVID-19 public health crisis has brought home the importance of having access to lifesaving hospital care nearby in our communities,” he said. “St. Francis Medical Center is not just an asset, it is an indispensable neighbor, it is the workers who serve the patients, and the doctors who save lives. We conditionally approve this sale to keep it that way.”

Prime Healthcare has built a reputation for saving financially distressed hospitals across the U.S., touting improved clinical quality. Healthgrades said Prime had hospitals named among the nation’s 100 best 53 times, and has been the recipient of several Patient Safety Excellence Awards.

The Attorney General’s office conducted an exhaustive review of the transaction for the past several months and carefully considered public input on the proposed transaction. The Attorney General’s approval includes conditions for the sale which Prime is currently reviewing. Pending a final ruling by the Bankruptcy Court, the transaction is expected to be completed this summer.

THE LARGER TREND

In early April, the U.S. Bankruptcy Court approved the Asset Purchase Agreement for the sale of St. Francis Medical Center to Prime. Under the agreement, Prime will acquire St. Francis for a net consideration of over $350 million, including a $200 million base cash price and $60 million for accounts receivable. In addition, Prime has committed to invest $47 million in capital improvements and extend offers of employment to nearly all staff.

The court also recently granted Verity’s request to reject the existing collective bargaining agreements with two unions that represent associates at St. Francis Medical Center, SEIU and UNAC. The court noted that Prime Healthcare was the only party to submit a qualifying bid for St. Francis and that without rejecting the existing CBAs, “St. Francis would not continue to operate as a going concern, and all of the UNAC (and SEIU) represented employees would lose their jobs.”

The court also noted that Prime and Verity had made multiple efforts to negotiate in good faith with the unions, and the parties devoted “hundreds of hours to negotiations,” but ultimately were unable to agree on new CBAs. Further, the court determined that one of the reasons for the hospital’s bankruptcy was the “legacy cost structure imposed by the existing CBAs.”

It then staid that the proposals were rejected “without good cause” by the unions. Prime said it negotiated in good faith and proposed increasingly generous offers to UNAC and SEIU with wages far above its existing agreements at its Los Angeles-area hospitals. Prime’s latest offer to SEIU maintained existing wages for roughly 90% of SEIU members, and increased wages for some of them. Prime said these wages would be substantially higher than those recently voted by SEIU members at three of Prime’s Los Angeles hospitals.

ON THE RECORD

“Receiving conditional approval is an important step in ensuring Prime is able to preserve the St. Francis mission for the benefit of associates, members of the medical staff and most importantly the patients and Southeast Los Angeles community that has relied on St. Francis for 75 years,” said Rich Adcock, CEO of Verity Health.

“We are honored to be selected to continue the St. Francis legacy and are working to review the conditions and finalize the sale as quickly as possible,” said Dr. Sunny Bhatia, CEO, Region I and chief medical officer of Prime Healthcare. “St. Francis’ mission is especially critical during this pandemic and we honor the service of all caregivers. Prime has already started investments at St. Francis that will enhance patient care as we commit to continue every service line, community benefit program, charity care and expand new services to the community.”

 

 

 

Why our “starved” public health system was unprepared for COVID-19

https://mailchi.mp/7d224399ddcb/the-weekly-gist-july-3-2020?e=d1e747d2d8

Exclusive: Health spending in Brazil states as small as USD 20 ...

The American public health system has long been considered one of the best in the world, but decades of underfunding have left states and counties woefully ill-equipped to handle the worst pandemic in a century.

An extensive analysis by Kaiser Health News and the Associated Press found that over the past ten years, per-capita spending by state and local public health departments has dropped by 16 and 18 percent, respectively, leaving our public health system “underfunded and under threat, unable to protect the nation’s health”.

Public health departments are mandated to provide a laundry list of critical functions, from restaurant inspections and water testing to immunizations. But over time, many of these functions have been privatized, and staff and budgets reduced. Both were cut further as state budgets tightened.

The federal government has extended $13B in emergency funding, but many local public health departments have still been forced to furlough workers during the pandemic. Citing comparisons to the funding extended during other crises like Zika and the H1N1 influenza, experts are concerned that baseline budgets will continue to decline.

Moreover, public health workers face unprecedented cultural challenges, and are often disrespected by political and clinical leaders. And as public health workers are putting themselves at risk of COVID exposure just to do their jobs, many face resentment and anger from angry citizens who blame them for the policies they are charged to enforce—with some local public health leaders even resigning due to threats and intimidation.

The current crisis has shown that we need a more expansive, and better coordinated public health infrastructure. Getting there will require not just more investment, but repairs to the foundation of this critical national asset.

 

 

 

Hospitals in new COVID-19 hot spots face delicate balancing act with elective surgeries

https://www.fiercehealthcare.com/hospitals/hospitals-new-covid-19-hotspots-face-delicate-balancing-act-elective-surgeries?mkt_tok=eyJpIjoiT1RJMlpqWTNPREJtTmpGaSIsInQiOiJ0enNDdXU5R0ZEdUJmSE1GcXl5UHd4VjdcL1FQcWE3ckN2YmhLVUhnazNFNlhUOEdLQndTcnRnXC9TbWNzWDhZMW5KWEhtMUxJRDRFdG1uXC84NGVhTHZ5QklGK0Fyc2dadXVcL0phNWFaVGY1SGlVVzN6NFRxVlRLOE9mRmdHR2VmdDgifQ%3D%3D&mrkid=959610

Hospitals in new COVID-19 hot spots face delicate balancing act ...

Some hospital systems located in states that are seeing huge spikes of COVID-19 are continuing to perform elective procedures and developing strategies to avoid a total shutdown.

The experiences of hospitals in states such as Florida and Arizona could inform how systems will handle new surges of COVID-19 cases, especially if a second surge of the virus arrives in the fall. Hospitals have been reticent to shut down surgical procedures, which are pivotal to their bottom line and also impact patient care.

“We are not turning it all the way off,” said Marjorie Bessel, M.D., chief clinical officer for Banner Health, referring to elective procedures. “Our surgeries are needed and medically necessary and people need to have those surgeries done.”

The 28-hospital system has a large footprint in Arizona, which is experiencing a major spike in cases. Bessel said 45% of Arizona COVID-19 patients are in a Banner Health facility.

Like many states, Arizona’s governor required hospitals to shutter elective procedures to ensure there is enough capacity and personal protective equipment (PPE) for COVID-19 patients. The governor lifted the shutdown May 1, and Banner has slowly ramped up delayed or canceled elective procedures.

“We attempted to reduce the backlog of people who had been waiting or wait-listed,” Bessel told Fierce Healthcare. “We didn’t quite get back to full normal operations, but we got close.”

That progress has been hindered now as COVID-19 cases soar in the state.

But instead of doing a full shutdown, Banner is implementing a tiered and step-wise approach to surgeries.

“One of the things that we are going to try is to do surgeries for patients that don’t need an inpatient stay,” Bessel said. “We are gonna try that and see how that works for us.”

The system is also tightly monitoring the patients that need an intensive care unit stay after their surgery. Banner can transfer patients to other facilities to ensure it has enough capacity.

“We look at our [patient] census almost hourly throughout the day and the night and make these adjustments to best meet the needs of those in the community,” she said.

Tampa General Hospital in Florida resumed elective procedures back in early May and is still performing surgeries as COVID-19 cases rise. The hospital told Fierce Healthcare that it treats COVID-19 patients in a “negative-pressure unit that is separate from other areas of the hospital.”

The hospital has 81 of these rooms and 100 hospitals and has a surge plan to adjust capacity when necessary.

Another important factor for hospitals is to communicate with patients about what is going on. Tampa General, for instance, issued a release on when it is appropriate to go to the emergency room and outlined the procedures for screening patients of COVID-19 to assuage fears.

Hospitals’ own internal processes have also gotten better amid the COVID-19 pandemic.

“In the operating area, COVID-19 has made us more efficient,” said Michael Zinner, M.D., CEO of the Miami Cancer Institute, which is part of 11-hospital system Baptist Health South Florida. “It has taught us how to move things out of the general operating room into ambulatory and more efficient in the turnovers. It has taught us how to adapt.”

Some states could decide to shut down elective procedures again, which is a move Texas has decided to make in four counties in the state.

Getting and keeping enough PPE

One of the key reasons that states ordered hospitals to shut down surgeries was to preserve enough PPE for COVID-19 care.

But hospital systems say they are in a better place now in terms of PPE than they were at the onset of the pandemic, when a buying spree caused hospitals to fight among each other to get supplies.

“We are a heck of a lot better than we were two months ago,” Zinner said.

He added that Baptist Health even bought a stake in a domestic PPE manufacturer, a move Banner Health made as well.

“Besides the current spike, we were preparing for what we think will be a surge in the fall,” Zinner added.

Another important development for hospitals now is there are guidelines for how to reprocess PPE.

“We have found ways to reprocess some PPE safely so you can reuse it without losing efficacy and take it through a decontamination procedure,” said Michael Calderwood, M.D., an epidemiologist at Dartmouth-Hitchcock Medical Center in New Hampshire.

He pointed to using ultraviolet light and hydrogen peroxide as among methods facilities can use to reprocess their supplies.

The type of PPE that is used in surgeries is also sometimes different than the equipment used to treat COVID-19 patients, Bessel said.

“They use a procedural mask for most of the cases, while the masks in shortage has been the N-95 respirators,” she said.

 

 

 

Cases skyrocketing among communities of color

https://www.axios.com/newsletters/axios-vitals-e9aa531d-4ef5-46ec-aedb-56f2bc9a77c9.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Coronavirus cases skyrocketing among communities of color - Axios

Counties populated by larger numbers of people of color tend to have more coronavirus cases than those with higher shares of white people.

What we’re watching: As the outbreak worsens throughout the South and the West, caseloads are growing fastest in counties with large communities of color.

The big picture: The southern and southwestern parts of the U.S. — the new epicenters of the outbreak — have higher Black and Latino or Hispanic populations to begin with.

  • People of color have seen disproportionate rates of infection, hospitalization and death throughout the pandemic.

Between the lines: These inequities stem from pre-existing racial disparities throughout society, and have been exacerbated by the U.S. coronavirus response.

  • Black and Hispanic or Latino communities have had less access to diagnostic testing, and people of color are also more likely to be essential workers. That means the virus is able to enter and spread throughout a community without adequate detection, often with disastrous results.

The bottom line: Until we plug the huge holes in the American coronavirus response — like inadequate testing and contact tracing and a lack of protection for essential workers — people of color will continue to bear the brunt of the pandemic.

Go deeper: People of color have less access to coronavirus testing

 

 

 

3 moral virtues necessary for an ethical pandemic response and reopening

https://theconversation.com/3-moral-virtues-necessary-for-an-ethical-pandemic-response-and-reopening-140688?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20June%2026%202020%20-%201662516009&utm_content=Latest%20from%20The%20Conversation%20for%20June%2026%202020%20-%201662516009+Version+A+CID_98447eb9cb25b06b85aed07c7fd721bd&utm_source=campaign_monitor_us&utm_term=3%20moral%20virtues%20necessary%20for%20an%20ethical%20pandemic%20response%20and%20reopening

3 moral virtues necessary for an ethical pandemic response and ...

The health and economic impacts of the coronavirus pandemic are not equally felt. From the United States to Brazil and the United Kingdomlow-wage workers are suffering more than others and communities of color are most vulnerable to the virus.

Despite the disparities, countries are reopening without a plan to redress these unequal harms and protect the broader community going forward. Our ethics research examines the potential for using virtues as a guide for a more moral coronavirus response.

Virtues are applied morals – actions that promote individual and collective well-being. Examples include generosity, compassion, honesty, solidarity, fortitude, justice and patience. While often embedded in religion, virtues are ultimately a secular concept. Because of their broad, longstanding relevance to human societies, these values tend to be held across cultures.

We propose three core virtues to guide policymakers in easing out of coronavirus crisis mode in ways that achieve a better new normalcompassion, solidarity and justice.

1. Compassion

Compassion is a core virtue of all the world’s major religions and a bedrock moral principle in professions like health care and social work. The distinguishing characteristic of compassion is “shared suffering:” Compassionate people and policies recognize suffering and take actions to alleviate it.

As the French philosopher André Comte-Sponville said, compassion “means that one refuses to regard any suffering as a matter of indifference or any living being as a thing.”

Individual acts of compassion abound in the coronavirus crisis, like frontline health care professionals and neighbors who deliver food, among other examples.

Compassion and solidarity on display at New York’s Elmhurst Hospital, during the April peak of the city’s coronavirus outbreak. Noam Galai/Getty Images

Some pandemic-era policies also reflect compassion, such as regulations preventing evictions and expanding unemployment benefits and giving food aid to poor familes.

A compassion-guided reopening aimed at preventing or reducing human suffering would require governments to continually monitor and alleviate the pain of their people. That includes addressing new forms of suffering that arise as circumstances change.

2. Solidarity

In a global pandemic, the actions people do or don’t take affect the health of others worldwide. Such shared emergencies require solidarity, which recognizes both the inherent dignity of each individual person and the interdependence of all people. As United Nations officials have emphasized, “we are all in this together.”

Public health measures like stay-at-home orders, social distancing and wearing masks reflect solidarity. While compliance in the United States has not been universal, data indicate broad approval for these measures. A new study found that 80% of Americans nationwide support staying home and social distancing and 74% support using face coverings in public.

To achieve these acts of solidarity, the leaders most praised in their countries and abroad – from U.S. National Institutes of Health director Dr. Anthony Fauci to New Zealand prime minister Jacinda Ardern – have relied primarily on moral persuasion, not threats of punishment.

By delivering clear information, giving simple and repeated behavioral guidance, and setting a good example, they’ve helped convince millions to take personal responsibility for protecting their community.

Face masks signal that wearers care about protecting others around them. Islam Dogru/Anadolu Agency via Getty Images

3. Justice

Justice focuses on the fair distribution of resources and the social structures that enable what the Dutch philosopher Patrick Loobuyck has called a “condition of equality.”

Justice-oriented policies are necessary for a moral reopening because of the pandemic’s disproportionate health and economic impacts. The evidence clearly shows that communities of colorlow-income populationspeople in nursing homes and those on the margins of society, such as homeless people and undocumented immigrants, are hardest hit.

Justice-oriented policies would aim for equitable balancing of necessary pandemic resources. That means directing testing and health equipment toward vulnerable communities – as identified by COVID-19 tracking data and risk factors like housing density and poverty – and ensuring free, widespread vaccine distribution when it becomes available.

In the U.S., economic justice will also require aggressively investing in minority-run businesses and poorer areas to guard against further harm to owners, employees and neighborhoods.

Similarly, all American school children have lost critical classroom hours, but lower-income children have been disproportionately damaged by remote learning in part due to the digital divide and loss of free lunch programs. Justice would demand channeling additional resources to the students and schools that need them most.

A moral reopening

Using virtues to guide social policies is an old idea. It dates back at least to the Greek thinker Aristotle.

Social distance stickers to prepare Nepal’s empty Tribhuwan International Airport for reopening. Narayan Maharjan/NurPhoto via Getty Images

New Zealand is a good example of virtuous pandemic policymaking, even considering its advantages in having wealth, low density and no land borders. Its coronavirus response included not only aggressive public health measures but also a well articulated message of being united in the COVID-19 fight and recurring government payments so workers did not have to risk their health for their job.

Note that it isn’t enough to apply just one virtue in a crisis of this magnitude. Policies built on compassion, solidarity and justice should be deployed in combination.

A compassionate post-pandemic response that does not address underlying inequalities, for example, ignores certain communities’ specific needs. Meanwhile, tackling specific injustices without engaging everyone in efforts like mask-wearing endangers the public health.

Bolstered by scientific evidence, virtue ethics can help nations reopen not just economically but morally, too.