Category Archives: Coronavirus

I’m a Doctor in Italy. We Have Never Seen Anything Like This.

Posted on by • Posted in Coronavirus, Health Policy, Healthcare Providers, Infection Control, Infectious Virus, Pandemic, Tragedy • Leave a comment

Image result for I’m a Doctor in Italy. We Have Never Seen Anything Like This.

My country’s health care system may soon collapse.

MILAN — None of us have ever experienced a tragedy like it.

We know how to respond to road accidents, train derailments, even earthquakes. But a virus that has killed so many, which gets worse with each passing day and for which a cure — or even containment — seems distant? No.

We always think of calamity as something that will happen far from us, to others far away, in another part of the world. It’s a kind of superstition. But not this time. This time it happened here, to us — to our loved ones, our neighbors, our colleagues.

I’m an anesthesiologist at the Policlinico San Donato here in Milan, which is part of the Lombardy region, the heart of the Italian coronavirus outbreak. On Feb. 21, the day on which the first case was recorded, our hospital, which specializes in cardiac surgery, offered to help with the care of patients with Covid-19. Along with other hospitals, we created a task force of intensive care doctors to be sent to hospitals in the “red zone.”

All planned surgeries were postponed. Intensive care beds were given over to the treatment of coronavirus patients. Within 24 hours, the hospital created new intensive care places by converting operating theaters and anesthetic rooms. And 40 more beds were dedicated to patients suspected or proven to have the virus, though not in a serious condition.

But the increases in cases are astounding. As of Tuesday, nationwide, there were 31,506 cases, of which 2,941 recovered and 2,503 died. Lombardy, the region most affected, has 16,220 cases, with 1,640 dead, 879 in intensive care — 56 more than the day before — and 2,485 clinically cured. With these numbers, the country’s health care system may soon collapse.

The patients who arrive remain for many days, straining medical resources. Already across northern Italy — in Lombardy, Veneto, Emilia-Romagna and Marche — health care systems are under enormous stress. Medical workers are exhausted. As the virus spreads, other regions will soon find themselves in the same situation.

Fortunately, Lombardy and the national government adopted aggressive containment measures 10 days ago. By the end of this week — after 15 days, the incubation period of the infection — we will see whether such measures have been effective. Only then might we see a slowing down in the spread of the virus.

It cannot come too soon. There has been speculation that doctors may be forced to decide whom to treat, leaving some without immediate care. That’s not my experience: All patients at my hospital have received the treatment they require. But that may not last. If the number of patients infected does not start to drop, our resources won’t stretch to cover them. At that point, triaging patients — to give priority to those with more chances of survival — may become standard practice.

My colleagues, at the Policlinico and throughout the country, are showing a great spirit of sacrifice. We know how much we are needed right now; that gives us strength to withstand fatigue and stress. How long such resistance will last, I cannot say. Some colleagues have tested positive for the coronavirus, and a few have needed intensive care. For us all, the dangers are great.

As an anesthesiologist devoted to surgical emergencies, I haven’t had many direct dealings with coronavirus patients. But there was one. An elderly man in a fragile condition, he was set to have tumor removed. The surgery proceeded as normal: I put him to sleep, and he awoke four hours later, without pain.

That was in mid-February. A week later, the telltale symptoms began to show: a high fever, a cough. Before long, pneumonia. Now he’s in intensive care, intubated and in a critical condition. He is one of many who have become a number without a name, one of those that represent the worsening of the situation.

I hope the beginning of the end of this outbreak will be soon. But we will know that it’s coming only if and when the infections begin to decline.

The population’s calm response to the restrictive rules imposed by the government, the experience gained in the management of critically ill patients and the rumors of new treatments for the infection are grounds for hope. Perhaps the containment measures will work, and the news at the end of the week will be good.

But for now, we are in the thick of tragedy.

 

 

 

Health providers seek at least $1B in next coronavirus stimulus bill

Posted on by • Posted in American Hospital Association (AHA), American Medical Association (AMA), American Nurses Association, Coronavirus, Economic Stimulus, Elective Surgery, Financial Pressure, Financially Distressed, Health Policy, Health System, Hospital, Hospital Industry • Leave a comment

https://thehill.com/policy/healthcare/487813-providers-ask-for-at-least-1-billion-for-next-coronavirus-stimulus-bill

Health providers seek at least $1B in next coronavirus stimulus bill

Lawmakers should allocate at least another $1 billion in emergency funding for the coronavirus response, according to a letter from health care provider groups to congressional leaders.

The letter from the American Hospital Association, American Medical Association and American Nurses Association urged lawmakers to ensure that the next economic stimulus package includes funding to ensure that hospitals, health systems, physicians and nurses are “directly supported” for preparedness response.

The groups said the additional funding is needed for specific priorities, including ramping up infection controls, increasing the number of patient beds, building or retrofitting separate areas to screen and treat coronavirus patients and obtaining scarce protection supplies like masks and ventilators.

The groups also said hospitals and nurses need financial support because of the impact of canceling elective surgeries and procedures due to shortages of protective equipment, as well as patient fears.

“Such cancellations could have devastating financial implications for hospitals, physicians and nurses already at financial risk and may limit access to care,” the groups wrote.

The House early Saturday passed legislation aimed at mitigating the economic impact of the coronavirus epidemic, including provisions that would ensure that workers can take paid sick or family leave, bolster unemployment insurance and guarantee that all Americans can get free diagnostic testing for the coronavirus.

The Senate is expected to vote on the bill later this week, as the House still needs to pass “technical” corrections.

 

 

 

This Is One Anxiety We Should Eliminate for the Coronavirus Outbreak

Posted on by • Posted in 2020 Election Issues, Coronavirus, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Network, Out of Pocket Expenses, Out-of-Network, Pandemic, Surprise Bills, Underinsured, Uninsured • Leave a comment

Image result for This Is One Anxiety We Should Eliminate for the Coronavirus Outbreak

A patient can do everything right and still face substantial surprise medical bills.

In his recent Oval Office speech, President Trump pledged that Americans won’t receive surprise bills for their coronavirus testing.

The goal is good; we need people who are lightly symptomatic to be tested without fear of high personal costs. But it was an empty promise. Unless swift action is taken, surprise bills are coming. And they could exacerbate a public health crisis that is already threatening to spiral out of control.

As demand for coronavirus testing surges and beds start to fill with the sick, hospitals and clinics will roll out contingency plans that call on any available resources in their communities. Test samples will be sent to whichever private laboratories have capacity, patients will be transferred from overloaded hospitals to less-crowded locations and physicians and nurses will make greater use of telemedicine.

Emergency rooms will be slammed with visits from the worried well and the dangerously sick alike. College students are already being sent home and will seek treatment far from the universities that offer them health insurance.

All of this will be chaotic.

To their credit, health insurers recognize the need to eliminate out-of-pocket spending that might discourage people from seeking care. At a meeting earlier this week with Vice President Mike Pence, they publicly committed to eliminating deductibles and co-pays for coronavirus testing. The federal government is also taking some needed steps to eliminate or ease cost-sharing.

But insurance companies aren’t the ones sending surprise bills. They’re coming from private labs and emergency-room doctors and other providers of health care services — and they weren’t at Vice President Pence’s meeting.

A patient with insurance through work or the health-insurance exchanges can be surprise-billed when she seeks medical care at a hospital or clinic that’s in her insurance “network” — but then receives medical care from a person or an institution that’s outside the network.

That out-of-network provider will first send a bill to the patient’s insurer. But if the insurer doesn’t pay the full amount, the provider may bill the patient directly for the remaining balance. Because the provider is basically free to name its own price, these surprise bills can be wildly inflated.

In a coronavirus pandemic, a patient can do everything right and still face substantial surprise bills. Take someone who fears that she may have contracted Covid-19. After self-quarantining for a week, she develops severe shortness of breath. Her partner rushes her to the nearest in-network emergency room. But she’s actually seen by an out-of-network doctor — who may soon send her a hefty bill for the visit.

Matters get worse if the in-network hospital is approaching capacity and the patient is healthy enough to be sent to a hospital across town with spare beds. If the second hospital is outside her insurance network, she could potentially receive a second surprise bill. A third could come from the ambulance that transfers her — it too might not be in-network, and no one will think to check during a crisis. She could get a fourth surprise bill if her coronavirus tests are sent to an out-of-network lab. And so on.

Even in normal times, patients with private insurance receive roughly one surprise bill for every 10 inpatient hospital admissions.

These are not normal times.

Federal law currently provides little protection. The Affordable Care Act does cap an individual’s out-of-pocket spending — but the cap only applies to in-network care. For surprise bills, the sky is the limit.

Reputable providers will appreciate that now is not the time for price gouging. But many won’t and will seek to exploit people’s medical needs for financial gain, much as they did before the coronavirus began to spread. They may calculate that can collect enough money charging exorbitant fees for out-of-network services — and still make it to an airport ahead of a mob carrying pitchforks and torches.

We need more than gauzy commitments from the president. We need a law to ban bills incurred from out-of-network providers for medical care associated with the coronavirus outbreak. Unless that commitment is ironclad, people may not believe it. And if they don’t believe it, they won’t get tested.

To date, Congress — cowed by a furious public relations campaign led by private equity and specialty physicians — has been unable to pass a law banning routine surprise billing. Though Congress has moved closer to a watered-down deal in recent months, neither the House nor the Senate has actually passed a bill.

The coronavirus should refocus Congress’s attention. At a minimum, the legislature should quickly pass a temporary measure to limit out-of-network charges for coronavirus testing and treatment.

In the meantime, states can take action. About half have already passed surprise-billing laws, including California and New York, two of the hardest-hit states. But the laws in many states are patchy: Some cover only emergency room care, others don’t contain a legal mechanism for cutting back on excessive bills, and none are tailored for the current outbreak.

Already, reports of people who have received eye-popping bills for coronavirus testing or emergency room visits are circulating. As these stories proliferate, people will become even more reluctant to get tested or treated when they should. That will obscure the spread of the virus, complicate efforts to adopt measures for social distancing, and lead to unnecessary deaths.

It’s a national disgrace that the United States didn’t ban surprise bills in a time of relative prosperity and security. It could become a public health calamity if we do not end them in a world with coronavirus.

 

 

 

Experts agree that Trump’s coronavirus response was poor, but the US was ill-prepared in the first place

Posted on by • Posted in 2020 Election Issues, ACA, Centers for Disease Control & Prevention (CDC), Coronavirus, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Infection Control, Infectious Virus, Life Expectancy, Market Consolidation, Market Failure, Market Power, Mortality, Out of Pocket Expenses, Out-of-Network, Pandemic, Public Health, Public Safety, Safety Net Hospitals, Safety-Net Providers, Sick Leave, Surprise Bills, Underinsured, Uninsured, Vaccination, Vaccine • Leave a comment

https://theconversation.com/experts-agree-that-trumps-coronavirus-response-was-poor-but-the-us-was-ill-prepared-in-the-first-place-133674?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20March%2017%202020%20-%201565314971&utm_content=Latest%20from%20The%20Conversation%20for%20March%2017%202020%20-%201565314971+Version+A+CID_6ce2ffeb273f535ccdcb368c4649a7ee&utm_source=campaign_monitor_us&utm_term=Experts%20agree%20that%20Trumps%20coronavirus%20response%20was%20poor%20but%20the%20US%20was%20ill-prepared%20in%20the%20first%20place

As the coronavirus pandemic exerts a tighter grip on the nation, critics of the Trump administration have repeatedly highlighted the administration’s changes to the nation’s pandemic response team in 2018 as a major contributor to the current crisis. This combines with a hiring freeze at the Centers for Disease Control and Prevention, leaving hundreds of positions unfilled. The administration also has repeatedly sought to reduce CDC funding by billions of dollars. Experts agree that the slow and uncoordinated response has been inadequate and has likely failed to mitigate the coming widespread outbreak in the U.S.

As a health policy expert, I agree with this assessment. However, it is also important to acknowledge that we have underfunded our public health system for decades, perpetuated a poorly working health care system and failed to bring our social safety nets in line with other developed nations. As a result, I expect significant repercussions for the country, much of which will disproportionately fall on those who can least afford it.

Decades of underfunding

Spending on public health has historically proven to be one of humanity’s best investments. Indeed, some of the largest increases in life expectancy have come as the direct result of public health interventions, such as sanitation improvements and vaccinations.

Even today, return on investments for public health spending is substantial and tends to significantly outweigh many medical interventions. For example, one study found that every US$10 per person spent by local health departments reduces infectious disease morbidity by 7.4%.

However, despite their importance to national well-being, public health expenditures have been neglected at all levels. Since 2008, for example, local health departments have lost more than 55,000 staff. By 2016, only about 133,000 full-time equivalent staff remained. State funding for public health was lower in 2016-2017 than in 2008-2009. And the CDC’s prevention and public health budget has been flat and significantly underfunded for years. Overall, of the more than $3.5 trillion the U.S. spends annually on health care, a meager 2.5% goes to public health.

Not surprisingly, the nation has experienced a number of outbreaks of easily preventable diseases. Currently, we are in the middle of significant outbreaks of hepatitis A (more than 31,000 cases), syphilis (more than 35,000 cases), gonorrhea (more than 580,000 cases) and chlamydia (more than 1,750,000 cases). Our failure to contain known diseases bodes ill for our ability to rein in the emerging coronavirus pandemic.

Failures of health care systems

Yet while we have underinvested in public health, we have been spending massive and growing amounts of money on our medical care system. Indeed, we are spending more than any other country for a system that is significantly underperforming.

To make things worse, it is also highly inequitable. Yet, the system is highly profitable for all players involved. And to maximize income, both for- and nonprofits have consistently pushed for greater privatization and the elimination of competitors.

As a result, thousands of public and private hospitals deemed “inefficient” because of unfilled beds have closed. This eliminated a significant cushion in the system to buffer spikes in demand.

At any given time, this decrease in capacity does not pose much of a problem for the nation. Yet in the middle of a global pandemic, communities will face significant challenges without this surge capacity. If the outbreak mirrors anything close to what we have seen in other countries, “there could be almost six seriously ill patients for every existing hospital bed.” A worst-case scenario from the same study puts the number at 17 to 1. To make things worse, there will likely be a particular shortage of unoccupied intensive care beds.

Of course, the lack of overall hospitals beds is not the most pressing issue. Hospitals also lack the levels of staffing and supplies needed to cope with a mass influx of patients. However, the lack of ventilators might prove the most daunting challenge.

Limits of the overall social safety net

While the U.S. spends trillions of dollars each year on medical care, our social safety net has increasingly come under strain. Even after the Affordable Care Act, almost 30 million Americans do not have health insurance coverage. Many others are struggling with high out-of-pocket payments.

To make things worse, spending on social programs, outside of those protecting the elderly, has been shrinking, and is significantly smaller than in other developed nations. Moreover, public assistance is highly uneven and differs significantly from state to state.

And of course, the U.S. heavily relies on private entities, mostly employers, to offer benefits taken for granted in other developed countries, including paid sick leave and child care. This arrangement leaves 1 in 4 American workers without paid sick leave, resulting in highly inequitable coverage. As a result, many low-income families struggle to make ends meet even when times are good.

Can the US adapt?

I believe that the limitations of the U.S. public health response and a potentially overwhelmed medical care system are likely going to be exacerbated by the blatant limitations of the U.S. welfare state. However, after weathering the current storm, I expect us to go back to business as usual relatively quickly. After all, that’s what happened after every previous pandemic, such as H1N1 in 2009 or even the 1918 flu epidemic.

The problems are in the incentive structure for elected officials. I expect that policymakers will remain hesitant to invest in public health, let alone revamp our safety net. While the costs are high, particularly for the latter, there are no buildings to be named, and no quick victories to be had. The few advocates for greater investments lack resources compared to the trillion-dollar interests from the medical sector.

Yet, if altruism is not enough, we should keep reminding policymakers that outbreaks of communicable diseases pose tremendous challenges for local health care systems and communities. They also create remarkable societal costs. The coronavirus serves as a stark reminder.

 

 

BIG PHARMA PREPARES TO PROFIT FROM THE CORONAVIRUS

Posted on by • Posted in 2020 Election Issues, Big Pharma, Conflicts of Interest, Coronavirus, Dept of Health and Human Services (HHS), Food and Drug Administration (FDA), For-Profit, High Drug Prices, National Institute of Health (NIH), Pandemic, Pharmaceutical Industry, Pharmacy Benefits Management, Public Funding • Leave a comment

Big Pharma Prepares to Profit From the Coronavirus

Image result for BIG PHARMA PREPARES TO PROFIT FROM THE CORONAVIRUS

AS THE NEW CORONAVIRUS spreads illness, death, and catastrophe around the world, virtually no economic sector has been spared from harm. Yet amid the mayhem from the global pandemic, one industry is not only surviving, it is profiting handsomely.

“Pharmaceutical companies view Covid-19 as a once-in-a-lifetime business opportunity,” said Gerald Posner, author of “Pharma: Greed, Lies, and the Poisoning of America.” The world needs pharmaceutical products, of course. For the new coronavirus outbreak, in particular, we need treatments and vaccines and, in the U.S., tests. Dozens of companies are now vying to make them.

“They’re all in that race,” said Posner, who described the potential payoffs for winning the race as huge. The global crisis “will potentially be a blockbuster for the industry in terms of sales and profits,” he said, adding that “the worse the pandemic gets, the higher their eventual profit.”

The ability to make money off of pharmaceuticals is already uniquely large in the U.S., which lacks the basic price controls other countries have, giving drug companies more freedom over setting prices for their products than anywhere else in the world. During the current crisis, pharmaceutical makers may have even more leeway than usual because of language industry lobbyists inserted into an $8.3 billion coronavirus spending package, passed last week, to maximize their profits from the pandemic.

Initially, some lawmakers had tried to ensure that the federal government would limit how much pharmaceutical companies could reap from vaccines and treatments for the new coronavirus that they developed with the use of public funding. In February, Rep. Jan Schakowsky, D-Ill., and other House members wrote to Trump pleading that he “ensure that any vaccine or treatment developed with U.S. taxpayer dollars be accessible, available and affordable,” a goal they said couldn’t be met “if pharmaceutical corporations are given authority to set prices and determine distribution, putting profit-making interests ahead of health priorities.”

When the coronavirus funding was being negotiated, Schakowsky tried again, writing to Health and Human Services Secretary Alex Azar on March 2 that it would be “unacceptable if the rights to produce and market that vaccine were subsequently handed over to a pharmaceutical manufacturer through an exclusive license with no conditions on pricing or access, allowing the company to charge whatever it would like and essentially selling the vaccine back to the public who paid for its development.”

But many Republicans opposed adding language to the bill that would restrict the industry’s ability to profit, arguing that it would stifle research and innovation. And although Azar, who served as the top lobbyist and head of U.S. operations for the pharmaceutical giant Eli Lilly before joining the Trump administration, assured Schakowsky that he shared her concerns, the bill went on to enshrine drug companies’ ability to set potentially exorbitant prices for vaccines and drugs they develop with taxpayer dollars.

The final aid package not only omitted language that would have limited drug makers’ intellectual property rights, it specifically prohibited the federal government from taking any action if it has concerns that the treatments or vaccines developed with public funds are priced too high.

“Those lobbyists deserve a medal from their pharma clients because they killed that intellectual property provision,” said Posner, who added that the language prohibiting the government from responding to price gouging was even worse. “To allow them to have this power during a pandemic is outrageous.”

The truth is that profiting off public investment is also business as usual for the pharmaceutical industry. Since the 1930s, the National Institutes of Health has put some $900 billion into research that drug companies then used to patent brand-name medications, according to Posner’s calculations. Every single drug approved by the Food and Drug Administration between 2010 and 2016 involved science funded with tax dollars through the NIH, according to the advocacy group Patients for Affordable Drugs. Taxpayers spent more than $100 billion on that research.

Among the drugs that were developed with some public funding and went on to be huge earners for private companies are the HIV drug AZT and the cancer treatment Kymriah, which Novartis now sells for $475,000.

In his book “Pharma,” Posner points to another example of private companies making exorbitant profits from drugs produced with public funding. The antiviral drug sofosbuvir, which is used to treat hepatitis C, stemmed from key research funded by the National Institutes of Health. That drug is now owned by Gilead Sciences, which charges $1,000 per pill — more than many people with hepatitis C can afford; Gilead earned $44 billion from the drug during its first three years on the market.

“Wouldn’t it be great to have some of the profits from those drugs go back into public research at the NIH?” asked Posner.

Instead, the profits have funded huge bonuses for drug company executives and aggressive marketing of drugs to consumers. They have also been used to further boost the profitability of the pharmaceutical sector. According to calculations by Axios, drug companies make 63 percent of total health care profits in the U.S. That’s in part because of the success of their lobbying efforts. In 2019, the pharmaceutical industry spent $295 million on lobbying, far more than any other sector in the U.S. That’s almost twice as much as the next biggest spender — the electronics, manufacturing, and equipment sector — and well more than double what oil and gas companies spent on lobbying. The industry also spends lavishly on campaign contributions to both Democratic and Republican lawmakers. Throughout the Democratic primary, Joe Biden has led the pack among recipients of contributions from the health care and pharmaceutical industries.

Big Pharma’s spending has positioned the industry well for the current pandemic. While stock markets have plummeted in reaction to the Trump administration’s bungling of the crisis, more than 20 companies working on a vaccine and other products related to the new SARS-CoV-2 virus have largely been spared. Stock prices for the biotech company Moderna, which began recruiting participants for a clinical trial of its new candidate for a coronavirus vaccine two weeks ago, have shot up during that time.

On Thursday, a day of general carnage in the stock markets, Eli Lilly’s stock also enjoyed a boost after the company announced that it, too, is joining the effort to come up with a therapy for the new coronavirus. And Gilead Sciences, which is at work on a potential treatment as well, is also thriving. Gilead’s stock price was already up since news that its antiviral drug remdesivir, which was created to treat Ebola, was being given to Covid-19 patients. Today, after Wall Street Journal reported that the drug had a positive effect on a small number of infected cruise ship passengers, the price went up further.

Several companies, including Johnson & Johnson, DiaSorin Molecular, and QIAGEN have made it clear that they are receiving funding from the Department of Health and Human Services for efforts related to the pandemic, but it is unclear whether Eli Lilly and Gilead Sciences are using government money for their work on the virus. To date, HHS has not issued a list of grant recipients. And according to Reuters, the Trump administration has told top health officials to treat their coronavirus discussions as classified and excluded staffers without security clearances from discussions about the virus.

Former top lobbyists of both Eli Lilly and Gilead now serve on the White House Coronavirus Task Force. Azar served as director of U.S. operations for Eli Lilly and lobbied for the company, while Joe Grogan, now serving as director of the Domestic Policy Council, was the top lobbyist for Gilead Sciences.

 

 

 

Health Insurers aren’t that worried about coronavirus

Posted on by • Posted in 2020 Election Issues, Coronavirus, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Insurance Industry, Health Policy, Pandemic • Leave a comment

https://mail.yahoo.com/d/folders/1/messages/181951?.src=fp

Image result for Health Insurance profits

Health insurance companies are not concerned yet that the new coronavirus is going to drive up their medical claims and spending, Axios’ Bob Herman reports.

The big picture: More people will need expensive hospitalizations to treat COVID-19, which has turned into a full-blown public health emergency.

  • But insurers view the outbreak as an “extension of the flu season,” according to a Wall Street bank that spoke with insurance executives last week.

What they’re saying: Barclays held its health care conference digitally last week, and several insurance executives reiterated their companies’ profit projections for this year — relatively remarkable statements considering economists believe a recession is imminent.

  • “We’re not expecting a material financial impact,” said Matt Manders, a top Cigna executive.

Between the lines: A lot more cases and hospitalizations are coming. But those will be partially offset, from an actuarial perspective, by delays or cancellations of costly elective procedures like joint replacements — something that hospitals are starting to do.

  • “There is a net saving” when non-emergency procedures are eliminated, Anthem CFO John Gallina told Barclays analysts.

The bottom line: The coronavirus is throttling almost every business in America. Large insurers think they’re mostly immune, and if medical claims start to rise uncontrollably, they will increase everyone’s premiums next year.

  • “We would price for this for 2021 to the extent there’s any meaningful impact,” Humana CFO Brian Kane said. “I would imagine the industry will as well.”

 

 

 

The problems with our coronavirus testing are worse than you think

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Safety, Social Distancing, World Health Organization (WHO) • Leave a comment

https://www.axios.com/coronavirus-outbreak-testing-delays-60a25ce6-f08d-438f-b294-358e0c300d95.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Image result for The problems with our coronavirus testing are worse than you think

If the coronavirus outbreak in the U.S. gets really bad — if it stretches on longer than we anticipated, if huge numbers of people get sick, if the disruptions to daily life become even more severe — early flaws in the testing process will bear a lot of the blame.

The big picture: You probably know that there were some early problems with testing, and that they’re getting better — which they are. But those early failures will help define the entire scope of this pandemic, and there’s not much we can do now to reverse the damage.

Why it matters: Because we haven’t been doing enough testing, we don’t actually know how many people in the U.S. have coronavirus. We know the official count is too low, and that the number of confirmed cases is likely to explode in the coming weeks as testing improves.

  • But that’s not the only problem. The lack of testing hasn’t just left us in the dark about how bad the situation is; it has also made that situation worse.

By the numbers: Independent researchers estimate that the U.S. has completed about 20,000 coronavirus tests as of Friday.

  • By contrast, South Korea — a success story in controlling the coronavirus — has performed an estimated 250,000 tests.
  • As bad as that discrepancy is, it’s even worse when you consider that the U.S. population is more than six times bigger than South Korea’s (327 million vs. 51 million).

Widespread, accurate testing has been a key component of other countries’ success in bringing their outbreaks under control.

  • When we can quickly and accurately diagnose one patient, we can immediately pinpoint who that person is most likely to have infected, then quarantine those people and test the ones who start to show symptoms, and repeat that process on down the line.
  • We can spot clusters of new cases, so that the public health system can react quickly and focus its resources.

But the U.S. has not been able to do those things on the scale we’d need. And so, experts say, the virus has probably been spreading undetected for weeks.

  • More people than we know about are infected, which means more people than we know about are spreading the virus, which likely means way more people than we know about are infected.

“Our response is much, much worse than almost any other country that’s been affected,” Ashish Jha, a public health expert and the director of Harvard’s Global Health Institute, told NPR last week.

  • “Without testing, you have no idea how extensive the infection is. You can’t isolate people. You can’t do anything,” he said.

Between the lines: This makes other interventions, including individual “social distancing” and the cancellation of big events, even more important.

  • “We have to shut schools, events and everything down, because that’s the only tool available to us until we get testing back up. It’s been stunning to me how bad the federal response has been,” Jha told NPR.

What’s next: Testing capacity in the U.S. is improving quickly. Nationwide, we now have the ability to test about 26,000 people per day, according to former Food and Drug Administration Commissioner Scott Gottlieb.

  • He expects that capacity to “rise substantially” this week.
  • As more people can get tested, we’ll be able to get a handle on how many cases there actually are, and to start focusing attention and resources appropriately.

How we got here: The testing shortfall has been a multi-phase failure.

  • For reasons that remain unknown, the U.S. did not rely on the World Health Organization’s coronavirus test in the earliest days of the outbreak. Instead, the Centers for Disease Control and Prevention set out to make its own.
  • But the CDC’s test didn’t always work. Manufacturing had to be relocated following a possible contamination. And it has taken time to come up with a new one.
  • Regulatory red tape slowed down academic labs that wanted to jump in and develop their own tests, and capacity among private-sector labs is still ramping up.

In the early days, testing was focused narrowly on people who had traveled to China. And that was probably the best way to triage limited resources, but it was never going to be sufficient.

  • China and the U.S. are so thoroughly connected to the rest of the world that cases were always going to spread from China to multiple countries, and so people travelers from multiple countries could bring it into the U.S. From there, people in the U.S. started spreading it themselves.

The bottom line: Yes, the testing capacity is about to catch up. When it does, we will see a tidal wave of new confirmed cases. The fact that we needed to catch up made that tidal wave bigger — made the outbreak worse. And that won’t be undone by more tests now.

 

 

 

 

 

Pandemic Provides Defining Moment for Government Leaders

Posted on by • Posted in Coronavirus, Credibility, Crisis, Infection Control, Infectious Virus, Leadership, Pandemic, Partisanship, Polarization, Political Differences, Trust, Truth • Leave a comment

https://www.governing.com/now/Pandemic-Provides-Defining-Moment-for-Government-Leaders.html?utm_term=READ%20MORE&utm_campaign=Pandemic%20Provides%20Defining%20Moment%20for%20Government%20Leaders&utm_content=email&utm_source=Act-On+Software&utm_medium=email

Image result for crisis leadership

Governors and mayors don’t run for office with the intention of managing emergencies. But when a crisis strikes, they become the public face of government response and need to be ready to communicate accurately and calmly.

Mike DeWine didn’t pull any punches.

At a news conference on Thursday, the Ohio governor announced he was ordering that K-12 schools shut down until April 3 and banning most gatherings of 100 people or more. Ohio had only five confirmed coronavirus cases at that point, but DeWine’s health director Amy Acton, standing by the governor’s side, said they suspected that well over 100,000 state residents were already infected — a number expected to double every five days.

DeWine made it clear that his state, like others, faces massive challenges. In response, he offered resolve but not sugar-coated optimism. “This is temporary. We will get back to normal in Ohio. It won’t happen overnight,” DeWine said. “We must treat this like what it is, and that is a crisis.”

Around the country, other governors and mayors have been offering similar messages. Many are out in front, holding news conferences on a daily basis. Maryland Gov. Larry Hogan announced Thursday that he was putting his lieutenant governor in charge of most state operations so he could devote his full attention to the coronavirus crisis. Michigan Gov. Gretchen Whitmer held a news conference just before midnight on Thursday to announce a statewide school closure.

“Crises and disasters are what separates legislators from executives,” says Jared Leopold, a former communications director for the Democratic Governors Association. “For those executives who face a major disaster, crisis management becomes their defining legacy, whether they like it or not. Nothing else matters.”

Executives become the public face of the government’s response. Whether it’s natural disasters, mass shootings or a pandemic, their role is not only to share information, but to convey the sense that someone is in charge and has a plan that will see the city, state or nation through the worst of times. “That’s what the governor has to do in this situation,” says Bob Taft, a former Ohio governor.

“He’s been very visible, very prompt and as much ahead of the curve as possible in terms of taking decisive action,” Taft says of DeWine. “He’s also putting out good information and he’s obviously listening to the public health experts and the knowledgeable staff on his team.”

There are plenty of examples of politicians winning either acclaim or scorn for their handling of emergency situations. Sen. Joe Manchin’s enduring popularity in West Virginia — he’s the only Democrat still capable of winning statewide election in that increasingly red state — is rooted in his handling of the Sago Mine explosion as governor back in 2006. A year earlier, Mississippi Gov. Haley Barbour won applause for his handling of Hurricane Katrina, while Louisiana Gov. Kathleen Blanco was widely criticized and decided not to run for re-election.

“Do it right, and you’ll be remembered as a leader for decades,” Leopold says. “Do it wrong, and you’ll be voted out of office.”

No One Signs Up for This

Politicians campaign on issues such as taxes and education. No one pledges to provide stalwart leadership if and when there’s a crisis. It doesn’t seem relevant until it happens. But, once elected, they end up being judged by how they respond to the worst challenges.

“People watch very carefully what leaders do during these situations,” says Jay Nixon, who coped with a deadly tornado in Joplin and the Ferguson shooting, along with other challenges, during his tenure as Missouri governor.

Leaders need a plan, Nixon says. It may change daily or even hourly, but having a plan gives them, their teams and the public some sense of where they’re going. They also need to convey information in a reassuring and convincing way. “You have to have a clear source of information that’s not only accurate, but one that people trust,” Nixon says. “Leaders need to remain calm and normal.”

When new governors are elected, they’re often warned by sitting governors they’ll likely need to respond to disaster in some form or other. Taft, who was in office during the 2001 terrorist attacks, said that event opened up governors’ eyes to all manner of contingencies.

“Of course, all governors expect to have to weather emergencies,” he says. “That was something new and different — like today, a whole new set of threats.”

Governors are well-equipped to respond. There’s a whole structured apparatus, whether it’s called an emergency operations center or something else, that offers them plans, a command structure and communications tools to deal with unexpected tragedies.

If you’re a governor, you’re likely to be faced with a flood or a tornado or some other event with devastating consequences you must respond to. No matter their other priorities, they’re always ready to go on an emergency footing.

“To me, governors and states are always well-prepared, because in effect they’re always training for it,” says Scott Pattison, former executive director of the National Governors Association. “Whatever one says about a particular governor, they know that’s the expected role and they step right into it and rise to the occasion.”

The All-Dominant Issue

When executives aren’t seen as responding swiftly and competently, it can imperil both their re-election chances and their broader agendas. It’s a well-established part of political folklore that mayors lose their jobs when cities don’t dig out promptly following snowstorms. “We’ve probably spent as much time on snow as we have on the budget,” Massachusetts Gov. Charlie Baker said not long after taking office in 2015.

Andy Beshear was sworn in as Kentucky’s governor four months ago. Lately, he has been holding daily news conferences to provide updates on caseloads and policy changes. In recent days, he has called for schools to close for two weeks, for church services to be held virtually and for the state’s 200 senior centers to shut down in-person activities. “Let me say once again: We’re going to get through this,” he said on Friday.

People are not looking for uplift, but rather find confidence in knowing that there’s someone in charge offering a serious, smart response, says George C. Edwards III, a political scientist at Texas A&M University. “You get credibility from two things — one, from recognizing the problem as it is, and two, from acting,” he says.

One of Winston Churchill’s most famous wartime speeches begins, “The news from France is very bad.” When asked about the death toll on Sept. 11, 2001, Rudy Giuliani, then New York City’s mayor, said, “The number of casualties will be more than any of us can bear, ultimately.”

“People want reassurance and so (politicians) give it,” Edwards says. “They want to know it’s going to work out. At the same time, what’s critical is credibility, showing you have a firm handle on the crisis.”

No More Rallying Around the Leader

“During crises, people turn to the government for leadership, including what actions to take and how to return to stability,” according to a 2018 communication study. “Leaders are responsible for and expected to minimize the impact of crises, enhance crisis management capacity and coordinate crisis management efforts.”

In Kentucky, Beshear has won praise, so far, for sharing information personally and presenting the advice and counsel offered by public health and safety experts. “Party’s aside (he’s not mine) Beshear has done an excellent job with all this,” Samuel Keathley, a resident of Martin, Ky., tweeted on Thursday. “He’s never seemed panicked; he’s also never made it seem like nothing. He sounds and acts like a leader.”

The 2001 terrorist attacks offer one of the most dramatic examples of a politician winning acclaim for response to a crisis. Within 10 days, President George W. Bush’s approval ratings had jumped from 51 percent to 90 percent, according to Gallup.

“Presidents must take charge of crises right away,” says Matthew Eshbaugh-Soha, who chairs the political science department at the University of North Texas. “If presidents do well, the American people will respond with support.”

That hasn’t happened for President Trump. For weeks, Trump has sought to downplay the crisis, offering optimistic assessments that contradict warnings from federal public health officials. His speech from the Oval Office on Wednesday was hastily written and included a number of factual errors regarding policy positions that had to be quickly walked back by the administration.

“He’s not telling the truth and he is not trusted in that sense,” says Nixon, the former Missouri governor. “He doesn’t have a plan and he seems to be in a completely reactive mode.”

In general, Trump’s style is combative. His presidency has been disruptive, not designed to offer calming reassurance. His supporters have loved him for it, but there are more Americans, as measured by polls, that went into the coronavirus period already distrusting him.

“Trump has a very dedicated base who are absolutely steadfast, but he’s got an even larger opposition coalition that is equally steadfast,” says Edwards, the Texas A&M presidential scholar. “If you already hate him, you’re much less likely to be reassured.”

At the same time, the news media also has a problem when it comes to trust. That’s something predating Trump, but which he has encouraged with his frequent complaints about “fake news.” On Thursday, Megyn Kelly, a former news anchor and correspondent for NBC and Fox News, tweeted that while she didn’t believe Trump was a credible source, “we can’t trust the media to tell us the truth without inflaming it to hurt Trump.”

On Thursday, the city of Murfreesboro, Tenn., posted a statement on its website advising residents not to turn to media outlets for coronavirus information: “Unfortunately, today’s media know that negative or overtly controversial stories receive more attention and thereby generate traffic to their publications, broadcasts and websites.”

That assertion has since been deleted, but it spoke to the polarization that continues even in a country beset by crisis.

According to an ABC News/Ipsos poll released Friday, 47 percent of Democrats are “very concerned” about catching coronavirus, while only 15 percent of Republicans share that level of concern. Just 17 percent of Democrats say they are not concerned about being infected, compared with 44 percent of Republicans.

As the virus spreads and more businesses and activities shut down, public opinion will necessarily shift. No one can say how this will play out. No one can predict the ultimate costs in terms of health and mortality.

“It may take an event of this magnitude to shake people on both sides of the political equation,” Nixon says. “This may be that moment where, as a country, both Democrats and Republicans realized that there are some things that should be analyzed separately from political partisanship.”

 

 

 

 

Seattle Coronavirus Care: Short in Staff, Supplies and Space

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Emergency Care, Emergency Preparedness, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Leadership, Leadership Flexibility, Leadership Implementation, Mandatory Overtime, Pandemic, Safety Net Hospitals, Safety-Net Providers, Supply Chain, Telemedicine • Leave a comment

https://www.governing.com/now/Seattle-Coronavirus-Care-Short-in-Staff-Supplies-and-Space.html?utm_term=READ%20MORE&utm_campaign=Pandemic%20Provides%20Defining%20Moment%20for%20Government%20Leaders&utm_content=email&utm_source=Act-On+Software&utm_medium=email

Image result for Seattle Coronavirus Care: Short in Staff, Supplies and Space

At ground zero of America’s coronavirus outbreak, Seattle is overwhelmed by patients needing care. Social distancing and persistent hand washing is no longer enough. “The next step is to start thinking about alternate care systems.”

Amid the first signs that the novel coronavirus was spreading in the Seattle area, a senior officer at the University of Washington Medical Center sent an urgent note to staffers.

“We are currently exceptionally full and are experiencing some challenges with staffing,” Tom Staiger, UW Medical Center’s medical director, wrote on Feb. 29. He asked hospital staff to “expedite appropriate discharges asap,” reflecting the need for more beds.

That same day, health officials announced King County’s — and the nation’s — first death from the coronavirus. Now as cases of virus-stricken patients suffering from COVID-19 multiply, government and hospital officials are facing the real-life consequences of shortcomings they’ve documented on paper for years.

Medical supplies have run low. Administrators are searching for ways to expand hospital bed capacity. Health care workers are being asked to work extra shifts as their peers self-isolate.

And researchers this week made stark predictions for COVID-19’s impact on King and Snohomish counties, estimating 400 deaths and some 25,000 infections by April 7 without social-distancing measures.

“If you start doing that math in your head, based on every person who was infected infecting two other people, you can see every week you have a doubling in the number of new cases,” state health oficer Dr. Kathy Lofy said.

Hand-washing, staying home from work and other measures were no longer enough to sufficiently slow the virus, Lofy said.

Hospital administrators are rapidly changing protocols as the outbreak stresses the system, while frontline health care workers are beginning to feel the effects of disruptions to daily life. UW Medicine on Thursday told employees it would begin postponing elective procedures, beginning March 16.

“We’ve seen what has happened in other countries where they’ve had really rapid spread. The health care system has become overwhelmed,” Lofy said. “We want to do everything we can to prevent that from happening here.”

“We’re Always Full”

King and Snohomish counties offer some 4,900 staffed hospital beds, of which about 940 are used for critical care, according to the researchers — with the Institute for Disease Modeling, the Bill & Melinda Gates Foundation and the Fred Hutchinson Cancer Research Center — who modeled the outbreak’s potential growth. “… This capacity may quickly be filled,” they wrote.

Some of Seattle’s largest hospitals were already near capacity before the outbreak. Harborview Medical Center in downtown Seattle operated at 95 percent of its capacity in 2019, based on its licensed 413 beds and the days of patient care it reported to the Department of Health.

Of 81 hospitals that reported data for all of 2019, excluding psychiatric hospitals, the median hospital operated at 50 percent of its licensed capacity, according to a Seattle Times analysis. Many hospitals staff fewer beds than the maximum their license allows for, so the actual occupancy rate is likely higher.

Katharine Liang, a psychiatry resident physician who works rotations for Seattle-area hospitals, said requests for UW Medicine staffers to discharge patients in a timely fashion are not uncommon as administrators seek extra beds.

“The safety net hospitals, we’re always full,” Liang said, referring to medical centers that care for patients without insurance or means to pay.

Susan Gregg, a spokeswoman for UW Medicine, which operates UW Medical Center, Harborview Medical Center, Valley Medical Center and Northwest Hospital, said that each hospital had a surge-capacity plan being adapted for the outbreak.

“Our daily planning sessions monitor our available beds, supply usage and human resources,” Gregg said in a statement.

While Washington state has a robust system for detecting and monitoring infectious diseases, it has struggled to build the capacity to respond to emergencies like the coronavirus outbreak, according to a review of public data and interviews.

On a per-person basis, the state lags most others in nurses and hospital rooms designed to isolate patients with infectious, airborne diseases, according to a nationwide index of health-security measures.

The U.S. Centers for Disease Control and Prevention launched this initiative — called the National Health Security Preparedness Index — in 2013 to comprehensively evaluate the nation’s readiness for public health emergencies.

The state’s greatest strength, according to the index, is in its ability to detect public-health threats and contain them — scoring 8.5 points out of a possible 10, above the national average.

“It’s a leading state now in terms of how testing capabilities are playing out” for COVID-19, said Glen Mays, a professor at the Colorado School of Public Health who directs the index work.

With the scope of the outbreak becoming clear, the focus is turning to an area that is the state’s weakest on the index: providing access to medical care during emergencies.

When it comes to nurses per 100,000 people, Washington state ranked near the bottom — 46th among states and the District of Columbia — in 2018. It ranked 43rd nationally in the number of hospital isolation rooms — commonly referred to as “negative pressure” rooms, which draw in air to prevent an airborne disease from spreading — per 100,000 people and in neighboring states.

“It’s an area of concern,” Mays said of the state’s health care delivery capacity.

This vulnerability is well known to state policymakers. John Wiesman, Washington state’s health secretary, serves on the national advisory committee of the index and has championed its use as a tool for improvement, Mays said. He recalled Washington seeking lessons from other states that have been more successful and building a “medical reserve corps,” another area where the state has lagged.

The state scored 2.5 points for managing volunteers in an emergency in 2013. In 2018, it had improved to just 2.6.

Health Workers Strained

Less than a week after diagnosed cases of COVID-19 grew rapidly in the Seattle area, administrators at several area hospitals had to hunt for additional medical supplies and called for rationing. They also established fast-shifting isolation policies for sick or potentially exposed staffers.

“Hospitals are being very vigilant. If you have the slightest signs of illness, don’t come to work,” said Alexander Adami, a UW Medicine resident, on Monday.

On March 6, UW Medicine directed employees who tested positive for COVID-19, the illness caused by coronavirus, to remain isolated at home for a minimum of seven days after symptoms developed, according to internal UW documents. Hospital workers told workers with symptoms who hadn’t been tested to remain isolated until they were three days without symptoms. Those who tested negative, or had influenza, could return after 24 hours.

Quarantines for sick workers means others must backfill.

“Programs are having to pull residents in other blocks in other hospitals and other clinics to fill gaps,” Adami said. “There simply aren’t enough people.”

School closures further complicate staffing.

Liang, the resident physician who works rotations for several area hospitals, said she had been pulled into an expanded backup pool on short notice to cover shifts.

Liang is the mother of a 1-year-old. On Wednesday, her family’s day care closed, as it typically does when Seattle schools close. Gov. Jay Inslee has ordered all schools in King, Pierce and Snohomish counties to close until late April.

“I’m not really sure what we’re going to do going forward,” Liang said. “My demands at home are increasing, and now, at the same time because of the same problem, my demands at the hospital are increasing as well.”

Adami, a second-year internal medicine resident, said residents were used to taxing hours, and demands had not been much more excessive than usual, but he remained concerned for the future.

“I would be worried about: We eventually get to the point where there are so many health care workers who become sick we have to accept things like saying, All right: Do you have a fever? No? Take a mask and keep working, because there are people to care for,” he said.

One sign of demand: Some hospitals are asking workers at greater risk of COVID-19 to continue in their roles, even after public health officials encouraged people in these at-risk groups among the broader public to stay home.

Staff over the age of 60 “should continue to work per their regular schedules,” a UW Medicine policy statement said. People who are pregnant, immunocompromised or over 60 and with underlying health conditions were “invited to talk to their team leader or manager about any concerns,” noting that hospital workers’ personal protective equipment would minimize exposure risks.

A registered nurse at Swedish First Hill who is over 60 and who has a history of cardiac issues said she told a manager last week of her concern about working with potential or confirmed COVID-19 patients.

She said a manager adjusted her schedule for an initial shift, but couldn’t guarantee that she would be excused from caring for these patients.

Hours later, the nurse said she suffered a cardiac event and was later admitted to another hospital with a stress-induced cardiomyopathy. The nurse did not want to be named for fear of reprisal by Swedish.

“I’m afraid for my life to work in there,” the nurse said. “I don’t think we’re being adequately protected.”

The nurse is now on medical leave.

In a statement, Swedish said it could not comment on an individual caregiver’s specific circumstances, but that employees at a higher risk are able to request reassignment and if it can not be accommodated, they can take a leave of absence.

“Providing a safe environment for our caregivers and patients is always our top priority, but especially during the current COVID-19 outbreak,” according to the statement.

Anne Piazza, senior director of strategic initiatives for the the Washington State Nurses Association said she had heard from a “flood” of nurses with similar concerns.

Additionally, “we are seeing increased demand for nurse staffing and that we do have reports of nurses being required to work mandatory overtime.”

Wuhan was Overwhelmed

China might provide an example of what could happen to the U.S. hospital system if the pace of transmission escalates, according to unpublished work from researchers with Johns Hopkins University, Harvard University and other institutions.

In Wuhan, the people seeking care for COVID-19 symptoms quickly outpaced local hospitals’ ability to keep up, the researchers found. Even after the city went on lockdown in late January, the number of people needing care continued to rise.

Between Jan. 10 and the end of February, physicians served an average of 637 intensive-care unit patients and more than 3,450 patients in serious condition each day.

But by the epidemic’s peak, nearly 20,000 people were hospitalized on any given day. In response, two new hospitals were built to exclusively serve COVID-19 patients; in all, officials dedicated more than 26,000 beds at 48 hospitals for people with the virus. An additional 13,000 beds at quarantine centers were set aside for patients with mild symptoms.

The researchers analyzed what might happen if a Wuhan-like outbreak happened here.

“Our critical-care resources would be overwhelmed,” said Caitlin Rivers, an epidemiologist at Johns Hopkins Center for Health Security who helped lead the study.

“The lesson here, though, is we have an opportunity to learn from their experience and to intervene before it gets to that point.”

Preparing For The Worst

Hospital administrators are stretching to make the most of their staff, avoid burnout and find space for patients flooding into hospitals.

As of Thursday afternoon, there hadn’t been an unusual uptick in hospitals asking emergency responders to divert patients elsewhere, according to Beth Zborowski, a spokeswoman for the Washington State Hospital Association.

Zborowski said administrators are getting creative to deal with shortages of supplies, staff and space, such as potentially hiring temporary workers.

The state is trying to reduce regulations to help scale up staffing.

The state health department’s Nursing Commission said last Friday it would give “top priority” to reviewing applications for temporary practice permits for nurses to help during the COVID-19 crisis.

After the governor’s emergency proclamation, the Department of Health also said it was allowing volunteer out-of-state health practitioners who are licensed elsewhere to practice without a Washington license.

All the doctors with UW Medicine have been trained, or are being trained on how to care for patients via telemedicine. The number of people using the service has increased tenfold since public health officials urged patients to not visit emergency rooms or visit clinics for minor issues, said Dr. John Scott, director of digital health at UW Medicine.

Some hospitals are creating wards for COVID-19 patients. EvergreenHealth, in Kirkland, converted its 8th floor for the use of these patients.

King County officials last week purchased a motel, which could allow patients to recover outside a clinical setting and free up beds.

“These are places for people to recover and convalesce who are not at grave medical risk, and therefore do not need to be in a hospital,” said Alex Fryer, spokesperson for King County Executive Dow Constantine.

Supply problems are ongoing, even after the federal government fulfilled a first shipment that included tens of thousands of N95 respirator masks, surgical masks and disposable gowns from a federal stockpile.

Piazza said the nursing association continues to receive reports that members at area hospitals are being asked to reuse or share personal protective equipment, wear only one mask a shift or conserve masks for use exclusively with COVID-19 confirmed patients.

“We need to address the safety of frontline caregivers,” Piazza said.

State officials placed a second order for supplies last weekend.

Casey Katims, director of federal affairs for Inslee, said three trucks of medical supplies from the federal stockpile arrived Thursday morning, including 129,380 N-95 respirators; 308,206 surgical masks; 58,688 face shields; 47,850 surgical gowns; and 170,376 glove pairs.

If the measures taken now aren’t enough, state officials have contingency plans they’ve been working on “for a while now,” said Lofy, the state health officer.

“The next step is to start thinking about alternate care systems or alternate care facilities. These are facilities that could potentially be used outside the clinic or the health care system walls.”