Category Archives: Clinical Testing

Coronavirus Live Updates: W.H.O. Walks Back Claim That Asymptomatic Transmission is Rare

Posted on by • Posted in Clinical Testing, Contact Tracing, Coronavirus, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Scientists, Social Distancing, Supply Chain, World Health Organization (WHO) • Leave a comment

Virus spreaders who never show symptoms 'very rare,' WHO says ...

Seven million people have been infected worldwide, and new cases hit a high globally on Sunday, according to the W.H.O. Central banks are seeking new tools to offset the downturn.

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New Jersey’s governor said on Tuesday that he was lifting the stay-at-home order that he issued in March. “With more and more of our businesses reopening, we’re no longer requiring you to stay at home,” he said.

The W.H.O. walked back an earlier assertion that asymptomatic transmission is ‘very rare.’

A top expert at the World Health Organization on Tuesday walked back her earlier assertion that transmission of the coronavirus by people who do not have symptoms is “very rare.”

Dr. Maria Van Kerkhove, who made the original comment at a W.H.O. briefing on Monday, said that it was based on just two or three studies and that it was a “misunderstanding” to say asymptomatic transmission is rare globally.

“I was just responding to a question, I wasn’t stating a policy of W.H.O. or anything like that,” she said.

Dr. Van Kerkhove said that the estimates of transmission from people without symptoms come primarily from models, which may not provide an accurate representation. “That’s a big open question, and that remains an open question,” she said.

Scientists had sharply criticized the W.H.O. for creating confusion on the issue, given the far-ranging public policy implications. Governments around the world have recommended face masks and social distancing measures because of the risk of asymptomatic transmission.

A range of scientists said Dr. Van Kerkhove’s comments did not reflect the current scientific research.

“All of the best evidence suggests that people without symptoms can and do readily spread SARS-CoV-2, the virus that causes Covid-19,” scientists at the Harvard Global Health Institute said in a statement on Tuesday.

“Communicating preliminary data about key aspects of the coronavirus without much context can have tremendous negative impact on how the public and policymakers respond to the pandemic.”

A widely cited paper published in April suggested that people are most infectious about two days before the onset of symptoms, and estimated that 44 percent of new infections are a result of transmission from people who were not yet showing symptoms.

Dr. Van Kerkhove and other W.H.O. experts reiterated the importance of physical distancing, personal hygiene, testing, tracing, quarantine and isolation in controlling the pandemic.

The debate over transmission erupted a day after the W.H.O. said that cases had reached a new single-day global high — 136,000 on Sunday, with three-quarters in just 10 countries, mostly in the Americas and South Asia. The coronavirus has already sickened more than seven million people worldwide and killed at least 405,400, according to a New York Times database.

The Pan American Health Organization said on Tuesday that 3.3 million people in South and Central America have been infected with the coronavirus. Dr. Carissa F. Etienne, the agency’s director, said that many areas are experiencing exponential growth in infections and death.

In India, health experts are warning of a looming shortage of hospital beds and doctors to treat patients as the country grapples with a sharp surge of infections. India reported 10,000 new infections in the past 24 hours, for a total of at least 266,500, and has surpassed Spain to become one of the five countries with the highest caseloads.

Rajnish Sinha, the owner of an event management company in Delhi, struggled to find a hospital bed for his 75-year-old father-in-law, who tested positive for the virus on Tuesday.

“This is just the beginning of the coming disaster,” Mr. Sinha said. “Only God can save us.”

 

 

 

 

How Many More Will Die From Fear of the Coronavirus?

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Chronic Care Management, Chronic Conditions, Clinical Testing, Contact Tracing, Coronavirus, Deferred Healthcare, Emergency Care, Employer-Based Health Insurance, Fear, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Office Visit, Out of Pocket Expenses, Pandemic, Physician, Preexisting Conditions, Preventable Disease, Preventative Care, Public Health, Public Safety, Quarantine, Social Distancing, Telemedicine, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Unintended Consequences, Virtual Healthcare, Virtual Visit • Leave a comment

Fear of contracting the coronavirus has resulted in many people missing necessary screenings for serious illnesses, like cancer and heart disease.

Seriously ill people avoided hospitals and doctors’ offices. Patients need to return. It’s safe now.

More than 100,000 Americans have died from Covid-19. Beyond those deaths are other casualties of the pandemic — Americans seriously ill with other ailments who avoided care because they feared contracting the coronavirus at hospitals and clinics.

The toll from their deaths may be close to the toll from Covid-19. The trends are clear and concerning. Government orders to shelter in place and health care leaders’ decisions to defer nonessential care successfully prevented the spread of the virus. But these policies — complicated by the loss of employer-provided health insurance as people lost their jobs — have had the unintended effect of delaying care for some of our sickest patients.

To prevent further harm, people with serious, complex and acute illnesses must now return to the doctor for care.

Across the country, we have seen sizable decreases in new cancer diagnoses (45 percent) and reports of heart attacks (38 percent) and strokes (30 percent). Visits to hospital emergency departments are down by as much as 40 percent, but measures of how sick emergency department patients are have risen by 20 percent, according to a Mayo Clinic study, suggesting how harmful the delay can be. Meanwhile, non-Covid-19 out-of-hospital deaths have increased, while in-hospital mortality has declined.

These statistics demonstrate that people with cancer are missing necessary screenings, and those with heart attack or stroke symptoms are staying home during the precious window of time when the damage is reversible. In fact, a recent poll by the American College of Emergency Physicians and Morning Consult found that 80 percent of Americans say they are concerned about contracting the coronavirus from visiting the emergency room.

Unfortunately, we’ve witnessed grievous outcomes as a result of these delays. Recently, a middle-aged patient with abdominal pain waited five days to come to a Mayo Clinic emergency department for help, before dying of a bowel obstruction. Similarly, a young woman delayed care for weeks out of a fear of Covid-19 before she was transferred to a Cleveland Clinic intensive care unit with undiagnosed leukemia. She died within weeks of her symptoms appearing. Both deaths were preventable.

The true cost of this epidemic will not be measured in dollars; it will be measured in human lives and human suffering. In the case of cancer alone, our calculations show we can expect a quarter of a million additional preventable deaths annually if normal care does not resume. Outcomes will be similar for those who forgo treatment for heart attacks and strokes.

Over the past 12 weeks, hospitals deferred nonessential care to prevent viral spread, conserve much-needed personal protective equipment and create capacity for an expected surge of Covid-19 patients. During that time, we also have adopted methods to care for all patients safely, including standard daily screenings for the staff and masking protocols for patients and the staff in the hospital and clinic. At this point, we are gradually returning to normal activities while also mitigating risk for both patients and staff members.

The Covid-19 crisis has changed the practice of medicine in fundamental ways in just a matter of months. Telemedicine, for instance, allowed us to pivot quickly from in-person care to virtual care. We have continued to provide necessary care to our patients while promoting social distancing, reducing the risk of viral spread and recognizing patients’ fears.

Both Cleveland Clinic and Mayo Clinic have gone from providing thousands of virtual visits per month before the pandemic to hundreds of thousands now across a broad range of demographics and conditions. At Cleveland Clinic, 94 percent of diabetes patients were cared for virtually in April.

While virtual visits are here to stay, there are obvious limitations. There is no substitute for in-person care for those who are severely ill or require early interventions for life-threatening conditions. Those are the ones who — even in the midst of this pandemic — must seek the care they need.

Patients who need care at a clinic or hospital or doctor’s office should know they have reduced the risk of Covid-19 through proven infection-control precautions under guidelines from the Centers for Disease Control and Prevention. We’re taking unprecedented actions, such as restricting visiting hours, screening patient and caregiver temperatures at entrances, encouraging employees to work from home whenever possible, providing spaces that allow for social distancing, and requiring proper hand hygiene, cough etiquette and masking.

All of these strategies are intended to significantly reduce risk while allowing for vital, high-quality care for our patients.

The novel coronavirus will not go away soon, but its systemic side effects of fear and deferred care must.

We will continue to give vigilant attention to Covid-19 while urgently addressing the other deadly diseases that haven’t taken a pause during the pandemic. For patients with medical conditions that require in-person care, please allow us to safely care for you — do not delay. Lives depend on it.

 

 

 

South Asia emerges as a new coronavirus hotspot

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, False Hope, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Wishful Thinking • Leave a comment

https://www.axios.com/india-coronavirus-cases-south-asia-pakistan-5447da22-7418-43f7-a17a-d247b92e4205.html

Featured image

India opened up restaurants, shopping malls and places of worship today even as it recorded a record-high 9,971 new coronavirus cases, the third-most worldwide behind Brazil and the U.S.

Why it matters: Lockdowns are being lifted in South Asia — home to one-quarter of the world’s population — not because countries are winning the battle against COVID-19, but because they simply can’t sustain them any longer.

Flashback: For a time, South Asia was cited as a source of optimism because relatively few cases and deaths were being recorded despite large, dense populations.

  • Lockdowns came relatively early, with varying severity (India’s was considerably stricter than Pakistan’s, for example).
  • Outbreaks have continued to accelerate, however. Pakistan’s daily case count is now on par with the U.K.’s and six times Germany’s, adjusted for population.
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios
Data: The Center for Systems Science and Engineering at Johns Hopkins; Chart: Naema Ahmed/Axios

Limited testing means South Asia’s outbreaks could actually be far more severe. India, for example, is testing at one-twentieth the rate of the U.S.

  • John Clemens, an epidemiologist at ICDDR,B (formerly the International Centre for Diarrheal Disease Research, Bangladesh), estimates that Bangladesh’s capital, Dhaka, may have up to 750,000 cases — 12 times the official tally, per the Economist.
  • The official numbers still show India, Pakistan and Bangladesh with the third-, seventh- and tenth-most new cases in the world over the past three days, respectively.

Bhramar Mukherjee, a professor at the University of Michigan who has been modeling India’s outbreak, tells Axios that while some states have hit initial peaks, she doesn’t expect a national peak until late July or August.

  • While the transmission rate has slowed, “you see this steady rise in cases because the population is so large.” She expects the numbers to fall slowly after the peak, unlike the trajectory in Europe.
  • The numbers can be unreliable, Mukherjee says, with some states fearing that testing symptomatic people will cause them to “look bad” as cases rise.
  • She also worries that India didn’t use the lockdown period to build up testing and hospital capacity.
  • “It’s really chaos unfolding in Mumbai and Delhi, and I think unfortunately India is going to be at the top of the list in terms of cases,” she says.

Zoom in: Mumbai has launched an app to help people locate hospitals with empty beds, but such is the scarcity that they’re often full by the time patients arrive, WSJ reports. Some die without ever receiving treatment.

  • Morgues are overfull t00. There are reports of patients being treated in rooms that also contain dead bodies.
  • Public hospitals in Delhi, home to 26 million people, are also reportedly full and turning people away.

The coronavirus likely arrived in Mumbai with wealthy people returning from abroad, before spreading among poorer people and to slums where social distancing is hardly an option.

  • That pattern has been seen elsewhere in the developing world, including in cities like Rio de Janeiro.
  • There’s an additional complication in India’s case, though. After initially failing to account for migrant workers when implementing the lockdown, the government started to transport them to their home villages on special busses and trains.
  • The virus traveled too. 71% of cases recorded in Bihar, a state in eastern India, have been linked to returning workers, Foreign Policy reports.

The bottom line: South Asian governments attempted to balance health and hunger, knowing they could only shut down their largely informal economies for so long.

  • But with health care systems already stretched and case counts continuing to rise, they’re opening up with more hope than confidence.

 

Shutdowns prevented 60 million coronavirus infections in the U.S., study finds

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https://www.washingtonpost.com/health/2020/06/08/shutdowns-prevented-60-million-coronavirus-infections-us-study-finds/?fbclid=IwAR3J402h_abt63p-JDNEEBrNwrZ_nRjQza8OKxtV9xmtt4n5Oky-droY_-c&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Shutdowns prevented 60 million coronavirus infections in the U.S. ...

Shutdown orders prevented about 60 million novel coronavirus infections in the United States and 285 million in China, according to a research study published Monday that examined how stay-at-home orders and other restrictions limited the spread of the contagion.

A separate study from epidemiologists at Imperial College London estimated the shutdowns saved about 3.1 million lives in 11 European countries, including 500,000 in the United Kingdom, and dropped infection rates by an average of 82 percent, sufficient to drive the contagion well below epidemic levels.

The two reports, published simultaneously Monday in the journal Nature, used completely different methods to reach similar conclusions. They suggest that the aggressive and unprecedented shutdowns, which caused massive economic disruptions and job losses, were effective at halting the exponential spread of the novel coronavirus.

“Without these policies employed, we would have lived through a very different April and May,” said Solomon Hsiang, director of the Global Policy Laboratory at the University of California at Berkeley, and the leader of the research team that surveyed how six countries — China, the United States, France, Italy, Iran and South Korea — responded to the pandemic.

He called the global response to covid-19, the disease caused by the virus, “an extraordinary moment in human history when the world had to come together,” and said the shutdowns and other mitigation measures resulted in “saving more lives in a shorter period of time than ever before.”

The two reports on the effectiveness of the shutdowns come with a clear warning that the pandemic, even if in retreat in some of the places hardest hit, is far from over. The overwhelming majority of people remain susceptible to the virus. Only about 3 percent to 4 percent of people in the countries being studied have been infected to date, said Samir Bhatt, senior author of the Imperial College London study.

“This is just the beginning of the epidemic: we’re very far from herd immunity,” Bhatt said Monday in an email. “The risk of a second wave happening if all interventions and precautions are abandoned is very real.”

In a teleconference with reporters later, Bhatt said economic activity could return to some degree so long as some interventions to limit viral spread remain in place: “We’re not saying the country needs to stay locked down forever.”

The Berkeley study used an “econometric” model to estimate how 1,717 interventions, such as stay-at-home orders, business closings and travel bans, altered the spread of the virus. The researchers looked at infection rates before and after the interventions were imposed. Some of these interventions were local, and some regional or national. The researchers concluded that the six countries collectively managed to avert 62 million test-confirmed infections.

Because most people who are infected never get tested, the actual number of infections that were averted is much higher — about 530 million in the six countries, the Berkeley researchers estimated.

Timing is crucial, the Berkeley study found. Small delays in implementing shutdowns can lead to “dramatically different health outcomes.” The report, while reviewing what worked and what made little difference, is clearly aimed at the many countries still early in their battle against the coronavirus.

“Societies around the world are weighing whether the health benefits of anti-contagion policies are worth their social and economic costs,” the Berkeley team wrote. The economic costs of shutdowns are highly visible — closed stores, huge job losses, empty streets, food lines. The health benefits of the shutdowns, however, are invisible, because they involve “infections that never occurred and deaths that did not happen,” Hsiang said.

That spurred the researchers to come up with their estimates of infections prevented. The Berkeley team did not produce an estimate of lives saved.

One striking finding: School closures did not show a significant effect, although the authors cautioned that their research on this was not conclusive and the effectiveness of school closures requires further study. Banning large gatherings had more of an effect in Iran and Italy than in the other countries.

In discussing their findings Monday with reporters in the teleconference, leaders of the two research teams said challenges exist in crafting their models and thus there are uncertainties in the final estimates.

Bhatt, for example, said the model used by his team is highly sensitive to assumptions about the infection fatality rate, estimates for which have varied among researchers and from one country to another. He said his team was heartened to see that its estimates for the number of people infected so far is generally consistent with antibody surveys that attempt to calculate the attack rate of the virus.

Ian Bolliger, one of the Berkeley researchers, acknowledged the difficulty in obtaining reliable numbers for coronavirus infections given the haphazard pattern of testing for the virus. Both research teams said the peer review process had made their findings more robust.

 

 

 

 

The patients stayed away—will they come back?

Posted on by • Posted in Clinical Testing, Communication, Contact Tracing, Coronavirus, Emergency Care, Employer-Based Health Insurance, Fear, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Marketing, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Trust, Urgent Care • Leave a comment

https://mailchi.mp/9f24c0f1da9a/the-weekly-gist-june-5-2020?e=d1e747d2d8

Emergency Department Patient Resources

A new analysis from the CDC this week confirmed what we have been hearing anecdotally from health systems for several weeks—as the coronavirus lockdown took hold, there was a precipitous drop in visits to hospital emergency departments. According to the study, visits were down by 42 percent in the month of April compared to the previous year, and despite a rebound in May, were still 26 percent lower than a year ago. Visits in the Northeast dropped the most, as did those among women, and children under 14.

Although visits for minor ailments and symptoms declined the most, even more disconcerting was the drop in visits for chest pain, echoing the concern we’ve heard in many parts of the country that many patients may have suffered minor heart attacks without being treated, or may have waited to be seen until significant damage had been done.

As non-emergent visits have begun to return to many facilities, we continue to hear that emergency department and urgent care volume remains relatively low.

Survey data indicate that patients are fearful of becoming infected with coronavirus if they visit healthcare facilities—especially, it seems, ones where they’ll be forced to wait.

While many providers are investing in messaging campaigns to assure patients it’s safe to return, this nightmarish first-person account by one healthcare insider provides a useful cautionary tale.

Visiting a surgeon for a pre-op consult, she found the experience of visiting a COVID-era hospital downright dystopian. Simply touting safety precautions by itself won’t make patients more comfortable—they’ll need to see and feel that measures are in place to make time spent in a care setting as efficient and reassuring as possible. Otherwise, like the insider in question, they’ll take their business elsewhere. There’s work to be done.

 

Identifying “triple-threat” counties at higher risk of COVID outbreaks

Posted on by • Posted in Clinical Testing, Contact Tracing, Coronavirus, Correctional Facilities, Crisis, Crisis Management, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Meatpacking Plants, Mortality, Nursing Home, Pandemic, Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing, Superspreader Facilities • Leave a comment

https://mailchi.mp/9f24c0f1da9a/the-weekly-gist-june-5-2020?e=d1e747d2d8

“Superspreader facilities”—nursing homes, correctional facilities, and meatpacking plants—have become major COVID hotspots across the US. Many counties are dealing with a large outbreak in one type of tightly-packed facility or another.

Case in point: the outbreak at Cook County Jail in Chicago, which now accounts for a whopping 15.7 percent of all COVID cases in the state of Illinois. Some places, like Colorado’s Weld County, are managing outbreaks across all three types of superspreader facilities.

The graphic above highlights the nearly 260 counties that we’ve termed “triple-threat counties”: those which have all three types of superspreader facilities. The counties are mapped using our Gist Healthcare COVID-19 Risk Factor Index, which identifies particularly vulnerable populations using chronic disease, demographic, and acute care access variables.

The top 10 “triple-threat counties” by risk index score are all in more rural areas of the country with limited acute care access and more vulnerable populations—places where a COVID outbreak is likely to be particularly devastating. Seven of the 10 have a high percentage of African-American or Hispanic/Latino residents, groups with a an outsized burden of COVID-19 illness and death. These risk factors are intersectional; for example, food processing plants employ twice as many Hispanic workers as the national average, and a disproportionate share of long-term care workers are black.

[Click here for more information and interactive data from our analysis of the risk impact of these superspreader facilities.]

 

 

 

 

CDC director: US needs up to 100,000 contact tracers by September to fight coronavirus

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://thehill.com/policy/healthcare/501157-cdc-director-us-needs-30-to-100-thousand-contact-tracers-by-september-to?utm_source=ActiveCampaign&utm_medium=email&utm_content=Does+the+US+Spend+Too+Much+on+Police%3F&utm_campaign=TFT+Newsletter+06042020

CDC director: US needs up to 100,000 contact tracers by September to fight coronavirus

Centers for Disease Control and Prevention (CDC) Director Robert Redfield told Congress on Thursday that the country needs between 30,000 and 100,000 people working on contact tracing in order to help contain the next wave of the coronavirus.

The estimate shows the daunting challenge of hiring an army of people to interview those infected with coronavirus to identify who they have been in contact with so that those people can quarantine and help prevent the spread of the virus.

“I’ve estimated between 30 and 100,000” contact tracers are needed,” Redfield told the House Appropriations Committee during a hearing Thursday. He acknowledged the figure is “sizable,” though it is actually less than the 300,000 people former CDC director Tom Frieden has estimated the U.S. will need.

He said it is crucial to get the contact tracing system in place by September to try to keep the virus in check ahead of an expected surge in the fall and winter. That could help prevent the type of blunt stay-at-home orders that the U.S. had to implement this spring after missing the window to contain the virus earlier this year.

“We really have to get this built and we have to get it built between now and September,” Redfield said.

Redfield said his agency has met with all 50 states to discuss hiring contact tracers and is pleased that some states have already started to do so. New York City, for example, has hired 1,700 contact tracers. 

He said the CDC Foundation is working to hire personnel to augment state efforts and the CDC has distributed funding to states provided by Congress for the purpose. He added he hopes AmeriCorps is a source of additional staff.

“It is fundamental that we have a fully operational contact tracing workforce that every single case, every single cluster, can do comprehensive contact tracing within 24 to 36 hours, 48 hours at the latest, get it completed, get it isolated, so that we can stay in containment mode as we get into the fall and winter of 2020,” he said.

 

 

 

 

Americans’ deepening financial stress will make the coronavirus a lot harder to contain

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Out of Pocket Expenses, Pandemic, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://theconversation.com/americans-deepening-financial-stress-will-make-the-coronavirus-a-lot-harder-to-contain-139741

Americans' deepening financial stress will make the coronavirus a ...

Preventing deaths from COVID-19 depends on people who get it seeking treatment – which also allows authorities to track down whom they came in contact with to reduce spread.

But, as the economic pain and joblessness caused by the statewide lockdowns continue to grow, more Americans are experiencing severe strains on their personal finances. This threatens our ability to contain the pandemic because those feeling the most financial stress are much less likely to seek medical care if they experience coronavirus symptoms, according to my analysis of a recent Federal Reserve survey.

As an economist who studies how individuals make health care choices, I worry that in the coming months even more people will consider forgoing vital treatment to pay rent or some other bill – especially as the extended unemployment benefits, rent moratoriums and other relief are set to expire soon.

‘Just getting by’

The Fed conducts a survey of the economic health of U.S. households every quarter, most recently near the end of 2019. In April, it conducted a supplementary but similar survey to quickly gauge how people were handling the coronavirus crisis. Results of both surveys were released on May 14.

The Fed tries to measure financial stress in three key ways. Its surveys ask respondents if they are unable to pay all their monthly bills, couldn’t cover a US$400 emergency expense, or are “just getting by” or worse.

Even before the pandemic hit, the picture wasn’t pretty. In October, when the fourth-quarter survey was conducted, 42% of employed respondents reported fitting at least one of these descriptions, while over 8% said they fit all three. Those figures jumped to 72% and 20% for low-income workers.

But by April, tens of millions of people who had jobs in October lost them as most nonessential businesses across the U.S. either closed or reduced their services. The unemployment rate shot up to 14.7% that month – the highest since the Great Depression – and is expected to climb further when the May data are released on June 5.

The Fed’s April survey, however, paints an even broader picture of the economic impact of the pandemic. In that survey, about 28% of the previously employed respondents said they either lost their job, were being furloughed, had their hours cut or were taking unpaid leave. This has been financially devastating to many, with 68% of this group reporting one of the stresses listed above and 28% saying they were experiencing all three, regardless of income level.

Forgoing medical care

Separate questions in the surveys demonstrate just how strong the link is between financial and physical health.

The October survey also asks those respondents if they had skipped a doctor’s visit during the previous 12 months because of the cost. More than 20% of those who reported one of these financial stresses said they had, while almost 46% of those with all three said so.

In April, the Fed asked a more timely question: “If you got sick with symptoms of the coronavirus, would you try to contact a doctor?”

A third of those respondents who also said they’re experiencing all three financial stresses said “no.” This is especially significant because, unlike the October question, it describes a current, known threat, rather than referring to a previous medical issue of unknown severity. And the widely reported urgency and seriousness of the coronavirus suggests someone wouldn’t treat the decision to seek a doctor’s care or advice lightly.

Relieving the stress

That was back in April, less than a month into the coronavirus lockdowns. If the same questions were asked today, I believe the numbers would look a lot worse.

In the middle of a serious pandemic, we don’t want sick people avoiding treatment because they’re worried they won’t be able to put food on the table. This would likely worsen the spread of the coronavirus and make it a whole lot harder to contain.

As Congress debates additional measures to mitigate the economic and financial effects of the pandemic, it would be wise to keep in mind the connection between financial stress and individual decisions to seek medical care.

 

 

 

 

COVID-19 impact on hospitals worse than previously estimated

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Coronavirus | MSF

Factors such as how many patients would need ICU treatment, average length of stay and fatality risk are straining hospital resources.

When it became evident that the COVID-19 pandemic would spread across the U.S., lawmakers, scientists and healthcare leaders sought to predict what the financial and operational impact on hospitals would be. In those early days, policymakers relied on data from China, where the pandemic originated.

Now, with the benefit of time, the early predictions seriously underestimated the coronavirus’ impacts. University of California Berkeley and Kaiser Permanente researchers have determined that certain factors — such as how many patients would need treatment in intensive care units, average length of stay and fatality risk — are much worse than previously anticipated, and put a much greater strain on hospital resources.

WHAT’S THE IMPACT

Looking primarily at California and Washington, data showed the incidents of COVID-19-related hospital ICU admissions totaled between 15.6 and 23.3 patients per 100,000 in northern and southern California, respectively, and 14.7 per 100,000 in Washington. This incidence increased with age, hitting 74 per 100,000 people in northern California, 90.4 per 100,000 in southern California, and 46.7 per 100,000 in Washington for those ages 80 and older. These numbers peaked in late March and early April.

Those numbers are greater than the initial forecast, especially when factoring in the virus itself. Modeling estimates based on Chinese data suggested that about 30% of coronavirus patients would require ICU care, but in the U.S., the probability of ICU admissions was 40.7%. Male patients are more likely to be admitted to the ICU than females, and also are more likely to die.

Length of stay was also higher than had been predicted. By April 9, the median length of stay was 9.3 days for survivors and 12.7 days for non-survivors. Among patients receiving intensive care, the median stay was 10.5 days, although some patients stayed in the ICU for roughly a month.

Long durations of hospital stay, in particular among non-survivors, indicates the potential for substantial healthcare burden associated with the management of patients with severe COVID-19 — including the need for ventilators, personal protective equipment including N95 masks, more ICU beds and the cancellation of elective surgeries.

The considerable length of stay among COVID patients suggests that unmitigated transmission of the virus could threaten hospital capacity as it has in hotspots such as New York and Italy. Social distancing measures have acted as a stop-gap in reducing transmission and protecting health systems, but the authors said hospitals would do well to ensure capacity in the coming months in a manner that’s responsive to changes in social distancing measures.

THE LARGER TREND

These challenges have placed a financial burden on hospitals that can’t be overstated. In fact, a Kaufman Hall report looking at April hospital financial performance showed that steep volume and revenue declines drove margin performance so low that it broke records.

Despite $50 billion in funding allocated through the CARES Act, operating EBITDA margins fell to -19%. They fell 174%, or 2,791 basis points, compared to the same period last year, and 118% compared to March. This shows a steady and dramatic decline, as EBITDA margins were as high as 6.5% in April.

 

 

Few U.S. adults say they’ve been diagnosed with coronavirus, but more than a quarter know someone who has

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https://www.pewresearch.org/fact-tank/2020/05/26/few-u-s-adults-say-theyve-been-diagnosed-with-coronavirus-but-more-than-a-quarter-know-someone-who-has/?utm_source=Pew+Research+Center&utm_campaign=ef5ba73bf3-EMAIL_CAMPAIGN_2020_05_29_05_11&utm_medium=email&utm_term=0_3e953b9b70-ef5ba73bf3-400197657

28% of U.S. adults say they know someone diagnosed with COVID-19 ...

Relatively few Americans say they have been diagnosed with COVID-19 or tested positive for coronavirus antibodies, but many more believe they may have been infected or say they personally know someone who has been diagnosed.

Only 2% of U.S. adults say they have been officially diagnosed with COVID-19 by a health care provider, according to a new Pew Research Center survey. And 2% say they have taken a blood test that showed they have COVID-19 antibodies, an indication that they previously had the coronavirus. But many more Americans (14%) say they are “pretty sure” they had COVID-19, despite not getting an official diagnosis. And nearly four-in-ten (38%) say they’ve taken their temperature to check if they might have the disease.

Although few Americans have been diagnosed with COVID-19 themselves, many more say they know someone with a positive diagnosis. More than one-in-four U.S. adults (28%) say they personally know someone who has been diagnosed by a health care provider as having COVID-19. A smaller share of Americans (20%) say they know someone who has been hospitalized or who has died as a result of having the coronavirus.

Some groups are more likely than others to report personal experiences with COVID-19. For instance, black adults are the most likely to personally know someone who has been hospitalized or died as a result of the disease. One-third of black Americans (34%) know someone who has been hospitalized or died, compared with 19% of Hispanics and 18% of white adults. Black Americans (32%) are also slightly more likely than Hispanic adults (26%) to know someone diagnosed with COVID-19. Public health studies have found black Americans are disproportionately dying or requiring hospitalization as a result of the coronavirus.

28% of U.S. adults say they know someone diagnosed with COVID-19 ...

Areas in the northeastern United States have recorded some of the highest rates of coronavirus cases and fatalities, and this is reflected in the Center’s survey. About four-in-ten adults living in the Northeast (42%) say they personally know someone diagnosed with COVID-19, significantly more than among adults living in any other region. People living in the Northeast (31%) are also the most likely to know someone who has been hospitalized or died as a result of the disease.

One aspect of personal risk for exposure to the coronavirus is whether someone is employed in a setting where they must have frequent contact with other people, such as at a grocery store, hospital or construction site. Given the potential for the spread of the coronavirus within households, risk to individuals is also higher if other members of the household are employed in similar settings. Among people who are currently employed full-time, 35% are working in a job with frequent public contact. Among those working part-time, almost half work (48%) in such a setting. For those living in a household with other adults, 35% report that at least one of those individuals is working in a job that requires frequent contact with other people.

Taken together, nearly four-in-ten Americans (38%) have this type of exposure – either currently working in a job that requires contact with others, living in a household with others whose jobs require contact, or both.

Hispanics (at 48%) are more likely than either blacks (38%) or whites (35%) to have this type of personal or household exposure. An earlier Center analysis of government data found Hispanic adults were slightly more likely to work in service-sector jobs that require customer interaction, and that are at higher risk of layoffs as a result of the virus. In fact, the current Center survey found Hispanics were among the most likely to have experienced pay cuts or job losses due to the coronavirus outbreak.

28% of U.S. adults say they know someone diagnosed with COVID-19 ...

Interpersonal exposure in the workplace is also more widespread among younger adults. And there is a 10 percentage point difference between upper- and lower-income Americans in exposure, with lower-income adults more likely to work in situations where they have to interact with the public, or to live with people who do.

Health experts warn that COVID-19 is particularly dangerous to people who have underlying medical conditions. In the survey, one-third of adults say they have such a condition. Among this group, nearly six-in-ten (58%) say that the coronavirus outbreak is a major threat to their personal health. Among those who do not report having an underlying medical condition, just 28% see the outbreak as a major threat to their health. Americans who have an underlying health condition are also more likely than those who do not to say they’ve taken their temperature to check if they might have COVID-19 (47% vs. 33% of those without a health condition).

Self-reports of an underlying health condition vary greatly by age. Among those ages 18 to 29, just 16% say they have a condition; this rises steadily with age to 56% among those 65 and older. Whites are a little more likely than blacks and Hispanics to report having a health condition, but both blacks (at 54%) and Hispanics (52%) are far more likely than whites (32%) to say that the coronavirus outbreak is “a major threat” to their health.