Category Archives: Coronavirus

Cartoon – Long-Term Unemployed (Please Give)

Posted on by • Posted in 2020 Election Issues, Cartoon, Coronavirus, Economic Crisis, Economic Stimulus, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Policy, Job, Job Loss, Job Market, Job Search, Job Security, Market Outlook, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

Sack cartoon: Unemployment benefits | Star Tribune

US weekly jobless claims hit 1.4 million, post second straight weekly increase

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Cash, Cash Reserves, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Financial Pressure, Financial Transparency, Financial Viability, Financially Distressed, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Liquidity, Market Outlook, Market Uncertainty, National Strategy, Pandemic, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.businessinsider.com/us-jobless-claims-unemployment-insurance-labor-market-filings-recession-coronavirus-2020-7

  • US jobless claims for the week that ended Saturday totaled 1.43 million, the Labor Department said Thursday. That came in slightly below the consensus economist estimate of 1.45 million.
  • It marked a second consecutive weekly increase after the prior week’s report ended a 15-week streak of declines. This week’s report brought total filings over a 19-week period to more than 54 million.
  • Continuing claims, the aggregate total of people receiving unemployment benefits, totaled 17 million for the week that ended July 18.

More than a million Americans filed for unemployment benefits last week, reflecting the continued high level of pandemic-induced layoffs as the US rolls back its economic-reopening efforts.

New US weekly jobless claims totaled 1.43 million in the week that ended Saturday, the Labor Department reported Thursday. That was slightly below the consensus economist estimate of 1.45 million compiled by Bloomberg. It also was a minor increase over the prior week’s 1.3 million filings, a reading that marked the first gain in 15 weeks.

In just a few months, the more than 54 million unemployment claims filed during the coronavirus pandemic have far surpassed the 37 million during the 18-month Great Recession. The latest figure is more than double the 665,000 filed during the Great Recession’s worst week.

“A combination of uncertainty from rising virus cases to the withdrawal of financial support is concerning for an already fragile recovery,” said Daniel Zhao, senior economist at Glassdoor. “The economy is still in deep risk of falling sideways – where conditions improve so sluggishly that the effects of the crisis become increasingly permanent.”

Continuing claims, which represent the aggregate total of people receiving unemployment benefits, came in at 17 million for the week that ended July 18, a decline from the prior period’s revised number.

Stubbornly high weekly claims for unemployment insurance add to growing concerns that the economic recovery from the pandemic-induced recession is stagnating as coronavirus cases increase. A number of states have had to pause or roll back their reopening plans to deal with COVID-19 spikes, harming the economic recovery.

Going forward, industry watchers will be waiting to see what the July jobs report shows. The report, due August 7, reflects a reference period that includes last week, when initial jobless claims ticked up for the first time in 15 weeks. That could foreshadow a negative headline jobs number in July, although the nonfarm payroll report has become increasingly difficult to predict.

Last week, the additional $600 unemployment benefit from the CARES Act expired, meaning that soon millions of Americans will see a significant decrease in weekly income. The GOP this week introduced its proposal, the HEALS Act, that would cut the weekly benefit to $200 until states could implement a program that’d replace 70% of wages for most filers.

In the week ending July 25, there were 829,697 initial claims from 50 states reporting for Pandemic Unemployment Assistance, the program that extended benefits to gig workers and independent contracts. The total applications for all state programs for the week ending July 11 was 30.2 million. 

 

 

 

 

Envisioning the future of health system strategy

Posted on by • Posted in Consumer Loyalty, Consumer Preferences, Consumer-Centered Care Pathway, Consumerism, Coronavirus, Health System, Hospital, Hospital Industry, Market Outlook, Market Uncertainty, Strategic Alignment, Strategic Leadership, Strategy • Leave a comment

https://mailchi.mp/0fa09872586c/the-weekly-gist-july-31-2020?e=d1e747d2d8

We’ve spent the past five months working with our health system members to develop a perspective on the impact of the coronavirus pandemic on strategy, discussing what’s changed and what hasn’t, and where leaders should focus moving forward. The above graphic provides an overview of that perspective.

We think about the future across three time periods:

The “near future”, which will largely be dominated by concerns about reopening and recovering clinical operations and financial stability;

The “next future”, which we view as a period of strategic realignment during which we’ll see a “land grab” for advantage among payers, providers, and disruptors;

And the “far future”, in which the fundamental structure of the industry—how healthcare is organized, delivered, and paid for—will see more dramatic changes based on the evolution of economic and policy drivers.

Over time, “market uncertainty” caused by the uncertain course of the disease itself, along with societal and political shifts, will give way to “industry uncertainty”, under which a new competitive landscape will begin to develop.

Across those time horizons, health system strategy should focus on agile and decisive actions to respond to the environment—ensuring a safe and reliable return to normal clinical operations, taking best advantage of the opportunity to play new roles in the delivery of care (e.g., virtual and home-based services), and over time, building a full-scale, consumer-centric care ecosystem.

That’s a lot of rhetoric, but the hard work lies beneath—requiring systems to execute on several key fronts, from ensuring efficient, “systematized” operations, to building sustainable payment and pricing approaches, to adopting a relentless focus on services that earn and maintain consumer loyalty over time. We’ll have more to share on all of these ideas across the coming months, as our work with members continues. What’s clear now is that we’re not going back to the old way of doing things—we’re heading toward a “brave new world” of healthcare delivery.

 

 

 

 

‘I’m fighting a war against COVID-19 and a war against stupidity,’ says CMO of Houston hospital

Posted on by • Posted in 2020 Election Issues, Coronavirus, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Herd Immunity, Leadership Decentralized, Leadership Trust, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, School Reopening, Social Distancing, Trust, Truth, Vaccination, Vaccine, Wishful Thinking • Leave a comment

https://www.beckershospitalreview.com/hospital-physician-relationships/i-m-fighting-a-war-against-covid-19-and-a-war-against-stupidity-says-cmo-of-houston-hospital.html?utm_medium=email

 

After two hours of sleep a night for four months and seeing a member of his team contract the virus, Joseph Varon, MD, is growing exasperated.

“I’m pretty much fighting two wars: A war against COVID and a war against stupidity,” Dr. Varon, MD, CMO and chief of critical care at United Memorial Medical Center in Houston, told NBC News. “And the problem is the first one, I have some hope about winning. But the second one is becoming more and more difficult.”

Dr. Varon noted that whether it’s information backed by science or common sense, people throughout the U.S. are not listening. “The thing that annoys me the most is that we keep on doing our best to save all these people, and then you get another batch of people that are doing exactly the opposite of what you’re telling them to do.”

In an interview with NPR, Dr. Varon said he has woken up at dawn every day for the past four months and has headed to the hospital. There, he spends six to 12 hours on rounds before seeing new admissions. He then returns home to sleep two hours, at most.

He said his staff is physically and emotionally drained. 

UMMC nurse Christina Mathers spoke with NBC News from a hospital bed in the segment, noting that she had recently tested positive for COVID-19 after not feeling well during one of her shifts. “All the fighting, all the screaming, all the finger pointing — enough is enough,” Ms. Mathers told NBC. “People just need to listen to us. We’re not going to lie. Why would we lie?” 

Ms. Mathers has worked every other day since April 29, according to The Atlantic, which created a photo essay of Dr. Varon and the UMMC team at work.

 

 

A large racial divide exists in the concern over ability to pay for COVID-19 treatment

Posted on by • Posted in 2020 Election Issues, ACA, Chronic Care Management, Chronic Conditions, Chronic Diseases, Coronavirus, Deferred Healthcare, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses, Preexisting Conditions, Prescription Drugs, Short Term Health Insurance, Skinny Health Plans, Social Determinants of Health, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vaccine • Leave a comment

https://www.healthcarefinancenews.com/news/large-racial-divide-exists-concern-over-ability-pay-covid-19-treatment

Nonwhite adults say they’re either “extremely concerned” or “concerned” about the potential cost of care.

People of color are far more likely to worry about their ability to pay for healthcare if they are diagnosed with COVID-19 than their white counterparts, according to a new survey from nonprofit West Health and Gallup.

By a margin of almost two to one (58% vs. 32%), nonwhite adults report that they are either “extremely concerned” or “concerned” about the potential cost of care. That concern is three times higher among lower-income than higher-income households (60% vs. 20%).

The data come from an ongoing survey about Americans’ experiences with and attitudes about the healthcare system. The latest findings are based on a nationally representative sample of 1,017 U.S. adults interviewed between June 8 and June 30.

There’s also a disturbing trend when it comes to medication insecurity. Overall, 24% of U.S. adults say they lacked money to pay for at least one prescribed medicine in the past 12 months, an increase from 19% in early 2019. Among nonwhite Americans, the burden is growing even more quickly. Medication insecurity jumped 10 percentage points, from 21% to 31%, compared with a statistically insignificant three-point increase among white Americans (17% to 20%).

WHAT’S THE IMPACT?

All of this results in what Tim Lash, chief strategy officer for West Health, called a “significant and increasing racial and socioeconomic divide” in Americans’ views on the cost of healthcare and the impact it has on their lives. When polling started in 2019, one in five Americans were unable to pay for prescription medications within the past 12 months. That number now stands at one in four. The bottom line is that the situation is getting worse.

Amid broad concern about paying for the cost of COVID-19 or other medical expenses, health insurance benefits are likely more important than ever to U.S. workers. The survey found that 12% of workers are staying in a job they want to leave because they are afraid of losing healthcare benefits, a sentiment that is about twice as likely to be held by nonwhite workers as white workers (17% vs. 9%).

However, Americans step across racial lines in their overwhelming support for disallowing political contributions by pharmaceutical companies, and for government intervention in setting price limits for government-sponsored research and a COVID vaccine.

Nearly 9 in 10 U.S. adults (89%) think the federal government should be able to negotiate the cost of a COVID-19 vaccine, while only 10% say the drug company itself should set the price. Similarly, 86% of U.S. adults say there should be limits on the price of drugs that government-funded research helped develop.

Regarding the influence of pharmaceutical companies on the political process, 78% of adults say political campaigns should not be allowed to accept donations from pharmaceutical companies during the coronavirus pandemic.

THE LARGER TREND

Concerns over payment aren’t the only race-related disparities found in healthcare. Dr. Garth Graham, the vice president of community health at CVS Health, said during AHIP’s Institute and Expo in June that although African Americans make up 13% of the U.S. population, they account for about 24% of COVID-19 deaths.

He attributed some of the driving factors for these particular COVID-19-related disparities to the social determinants of health, the over-predominance of African American and Latino frontline workers, and the higher incidence-rates of chronic illness such as diabetes and hypertension in minority groups.

On June 19 – Juneteenth, as it’s known for many Black Americans – 36 Chicago hospitals penned an open letter declaring that systemic racism is a “public health crisis.”

“Systemic racism is a real threat to the health of our patients, families and communities,” the letter reads. “We stand with all of those who have raised their voices to capture the attention of Chicago and the nation with a clear call for action.”

 

 

 

 

Some providers face daunting repayment deadline for Medicare advance loans

Posted on by • Posted in Cash, Cash Reserves, Center for Medicare and Medicaid Services (CMS), Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Health Policy, Health System, Hospital, Hospital Industry, Liquidity, Medicare, Medicare Advance Payments • Leave a comment

https://www.fiercehealthcare.com/hospitals/some-providers-face-daunting-aug-1-repayment-deadline-for-medicare-advance-loans?mkt_tok=eyJpIjoiWkRReFlqRmpaamRtWVdabSIsInQiOiJFTEp3SjQ3NG01NXcwRTg3Z0hCZkdTRlwvOURSeEVlblwvRlFUWlZcL09ONjZGNVEybzl3ekl3VFd2ZEgxSjY2NGQ0TkFIRFdtQ0ZDWUx0ak96NU15d09qMWcrdm9BMFUxOSszcVI0T21rak5raEN0aE5Kb0VUUGFcL254QnBjMjdCbzkifQ%3D%3D&mrkid=959610

Starting this month, some providers are facing the prospect of their Medicare payments garnished to repay COVID-19 loans.

The pressing Aug. 1 deadline has sparked concerns from some experts and hospital groups that worry providers couldn’t afford to lose out on Medicare revenue as they combat revenue losses caused by the pandemic. While the program was intended to be a short-term solution, COVID-19 surges are proving that is not the case for some hospitals.

At the onset of the pandemic in March, the Centers for Medicare & Medicaid Services (CMS) extended the advance payment program, which has been used previously to help providers beset by disasters such as hurricanes. Providers and suppliers could apply for advance Medicare payments to offset massive losses sparked by declines in patient volumes due to COVID-19.

Most providers could get up to 100% of their Medicare payments for a three-month period, and inpatient acute care hospitals, children’s hospitals and some cancer hospitals can request up to 100% for a six-month period. Critical access hospitals could have gotten up to 125% over six months.

CMS had given out $100 billion of loans before suspending the program.

“It was very effective because the process was already in place,” said Denise Burke, a partner with the healthcare compliance and operations group for law firm Waller Lansden Dortch & Davis.

The goal behind the program is to help providers stay afloat and was meant to be a short-term solution, as repayment starts 120 days after a provider gets the first payment. But that is the problem, experts say.

“It was intended as a short-term bridge so they could get through the summer before everything returned to normal, only problem is nothing has returned to normal,” said Dan Mendelson, founder and former president of consulting firm Avalere Health.

Now, repayment for the first loans are due on Aug. 1 as more and more states are seeing massive surges of COVID-19. Some major hospital systems, such as HCA and CHS, have been able to offset massive declines in revenue thanks to the loans and money from a $175 billion provider relief fund passed by Congress.

Hospitals have one year from the date of the accelerated payment to repay the balance of the loan, but Medicare Part A providers and Part B suppliers have 210 days from the accelerated payment to repay.

“CMS should think about relative to financial position of the provider,” Mendelson said. “Some providers are doing just fine and can repay loans just like everybody else.”

After the 120-day period is up, CMS will take 100% of Medicare claims payments that would have gone to the provider to offset the balance of the loan.

But it remains unclear whether CMS can change the terms of the repayment to give providers and suppliers more time, especially if they are struggling.

“CMS moves deadlines all the time,” Mendelson said. “The question is whether they can or are willing to exercise this discretion in this case.”

It also is unlikely that CMS will resume the program, which some provider groups have also called for.

“It seems unlikely CMS will continue to allocate money through the advance payment program that has fewer terms and conditions than allocating through provider relief fund,” Burke said, referring to the $175 billion fund that Health and Human Services is still allocating.

CMS did not return a request for comment as of press time.

A major problem for some hospitals is they may not have the liquidity available to repay the loans.

“There are a lot of hospitals struggling right now because volumes are off,” Mendelson said. “This comes down to the fact that people are staying away from the hospital to the extent they possibly can.”

Provider groups such as the American Hospital Association are imploring Congress to forgive the loans, or at the very least change the repayment terms.

For instance, some groups want to lower the interest rates to 50 or 25% of a Medicare payment as opposed to 100%.

But talks on a new COVID-19 relief package have stalled so far no deal has emerged.

Senate Republicans released their own package earlier this week that includes another $25 billion for providers and gives liability protections for hospitals and other businesses. But the package doesn’t include changes to the loans.

 

 

 

Nope, Kids Not ‘Almost Immune’ to COVID-19 at Georgia Camp

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Childcare, Coronavirus, Crisis, Crisis Management, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, School Reopening, Social Distancing • Leave a comment

https://www.medpagetoday.com/infectiousdisease/covid19/87849?xid=fb_o&trw=no&fbclid=IwAR2HZ0s8huLi4I5pgLbA-21a4g65bl1kH6j1r_cWfJpyOwvkJrfHJMFCKEU

Nope, Kids Not 'Almost Immune' to COVID-19 at Georgia Camp ...

Even with mitigation measures, attack rates outpaced the Diamond Princess cruise ship.

President Trump’s repeated statements that children are “almost immune” to COVID-19 got a fact check from state and federal public health investigators examining an outbreak at a Georgia summer camp.

Among 597 Georgia residents, including campers, staff members, and trainees, the attack rate was 44%, reported Christine M. Szablewski, DVM, of the Georgia Department of Public Health, and colleagues.

The attack rate was highest among staff members (56%). Younger children ages 6-10 had a rate of 51%, those ages 11-17 had a rate of 44%, and those ages 18-21 had a rate of 33%, the authors wrote in an early edition of the Morbidity and Mortality Weekly Report.

By contrast, 19% of Diamond Princess cruise ship passengers tested positive for COVID-19 in February and March.

Among 136 cases with symptom information available, 26% reported no symptoms, with the authors specifically characterizing asymptomatic transmission as “common.” The flip side of that figure, however, is that a minimum of 100 children did develop symptoms. The report did not address symptom severity, outcomes, or transmission after leaving camp, as the investigation is still continuing, the authors indicated.

“This investigation adds to the body of evidence demonstrating that children of all ages are susceptible to SARS-CoV-2 infection and, contrary to early reports, might play an important role in transmission,” Szablewski and colleagues wrote.

Until recently, data on U.S. children contracting COVID-19, a key point in the argument to reopen schools, were scarce and conflicting. But recent evidence chipped away at the claim that kids are unaffected, with new research emerging this week about the association between school closures and declines in number of cases and deaths. Researchers also found children under age 5 may have far more SARS-CoV-2 viral nucleic acid in their noses than adults, which raises questions about their ability to transmit the virus.

While sleepover camps are not schools, and staff members are not teachers, the authors said the camps adopted CDC guidelines for youth and summer programs. All trainees, staff members, and campers provided documentation of a negative test for SARS-CoV-2. Cloth masks were required for staff members, though not campers, and the camp did not open doors and windows for increased ventilation, as recommended. Campers engaged in “a variety of indoor and outdoor activities,” including “daily vigorous singing and cheering,” they said.

The session was scheduled for June 21-27, and on June 23, a teenage staff member left after developing chills one day prior. The staff member tested positive for SARS-CoV-2. On June 24, campers were sent home, and on June 27, the camp was closed.

However, the damage was done. After excluding out-of-state attendees, researchers examined data from 597 Georgia residents at the camp. Campers were a median age of 12, and 53% were girls, while staff members were a median age of 17, and 59% were girls.

Of the 344 available testing results, 76% were positive for SARS-CoV-2. Not surprisingly, they found attack rates increased with increased time spent at the camp. Average occupancy was 15 per cabin, with a median attack rate of 50% among 28 cabins with one or more positive cases.

Among 100 patients reporting symptom data, two-thirds had fever, about 60% had headache, and 46% had a sore throat.

While the researchers said “consistent and correct” use of cloth masks, as well as physical distancing measures, should be emphasized to mitigate transmission in “congregate settings,” they acknowledged that “the multiple measures adopted by the camp were not sufficient to prevent an outbreak in the context of substantial community transmission.”

“An ongoing investigation will further characterize specific exposures associated with infection, illness course, and any secondary transmission to household members,” the group added.

 

 

 

 

How Many People in the U.S. Are Hospitalized With COVID-19? Who Knows?

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Data, Data Analytics, Data Control, Data Governance, Data Interpretation, Data Management, Data Ownership, Data Sharing, Dept of Health and Human Services (HHS), Health Policy, Health System, Hospital, Hospital Industry, Pandemic, Public Health, Public Safety, Transparency • Leave a comment

https://www.propublica.org/article/how-many-people-in-the-us-are-hospitalized-with-covid-19-who-knows?utm_source=sailthru&utm_medium=email&utm_campaign=dailynewsletter&utm_content=feature

 

The Trump administration told hospitals to stop reporting data to the CDC, and report it to HHS instead. Vice President Mike Pence said the information would continue to be released publicly. It hasn’t worked out as promised.

In mid-July, the Trump administration instructed hospitals to change the way they reported data on their coronavirus patients, promising the new approach would provide better, more up-to-the-minute information about the virus’s toll and allow resources and supplies to be quickly dispatched across the country.

Instead, the move has created widespread confusion, leaving some states in the dark about their hospitals’ remaining bed and intensive care capacity and, at least temporarily, removing this information from public view. As a result, it has been unclear how many people are in hospitals being treated for COVID-19 at a time when the number of infected patients nationally has been soaring.

Hospitalizations for COVID-19 have been seen as a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Since early in the pandemic, hospitals had been reporting data on COVID-19 patients to the U.S. Centers for Disease Control and Prevention through its National Healthcare Safety Network, which traditionally tracks hospital-acquired infections.

In a memo dated July 10, the U.S. Department of Health and Human Services told hospitals to abruptly change course — to stop reporting their data to the CDC and instead to submit it to HHS through a new portal run by a company called TeleTracking. The change took effect within days. Vice President Mike Pence said the administration would continue releasing the data publicly, as the CDC had done.

Almost immediately, the CDC pulled its historical data offline, only to repost it under pressure a couple days later. Meanwhile the website for the administration’s new portal promised to update numbers on a daily basis, but, as of Friday morning, the site hadn’t been updated since July 23. (HHS is posting some data daily on a different federal website but not representative estimates for each state.)

“The most pernicious portion of it is that at the state level and at the regional level we lost our situational awareness,” said Dave Dillon, spokesman for the Missouri Hospital Association. “At the end of this, we may have a fantastic data product out of HHS. I will not beat them up for trying to do something positive about the data, but the rollout of this has been absolutely a catastrophe.”

The Missouri Hospital Association had taken the daily data submitted by its hospitals to the CDC and created a state dashboard. The transition knocked that offline. The dashboard came back online this week, but Dillon said in a follow-up email, “the data is only as good as our ability to know that everyone is reporting the same data, in the correct way, for tracking and comparison purposes at the state level.”

Other states, including Idaho and South Carolina, also experienced temporary information blackouts. And The COVID Tracking Project, which has been following the pandemic’s toll across the country based on state data, noted issues with its figures. “These problems mean that our hospitalization data — a crucial metric of the COVID-19 pandemic — is, for now, unreliable, and likely an undercount. We do not think that either the state-level hospitalization data or the new federal data is reliable in isolation,” according to a blog post Tuesday on the group’s website.

Making matters more complicated, the administration has changed the information that it is requiring hospitals to report, adding many elements, such as the age range of admitted COVID-19 patients, and removing others. As of this week, for instance, HHS told hospitals to stop reporting the total number of deaths they’ve had since Jan. 1, the total number of COVID-19 deaths and the total number of COVID-19 admissions. (Hospitals still report daily figures, just not historical ones.)

“Massachusetts hospitals are continuing to navigate the dramatic increase of daily data requirements,” the Massachusetts Health and Hospital Association said in a newsletter on Monday. “MHA and other state health officials continue to raise concerns about the administrative burden and questionable usefulness of some of the data.”

“Hospitals across the country were given little time to adjust to the unnecessary and seismic changes put forth by the U.S. Department of Health and Human Services, which fundamentally shift both the volume of data and the platforms through which data is submitted,” the association’s CEO, Steve Walsh, said in the newsletter.

A number of state websites also noted problems with hospital data. For days, the Texas Department of State Health Services included a note on its dashboard that it was “reporting incomplete hospitalization numbers … due to a transition in reporting to comply with new federal requirements.” That came just as the state was experiencing a peak in COVID-19 hospitalizations.

California likewise noted problems.

A spokesperson for HHS acknowledged some bumps in the transition but said in an email: “We are pleased with the progress we have made during this transition and the actionable data it is providing. We have had some states and hospital associations report difficulty with the new collection system. When HHS identifies errors in the data submissions, we work directly with the state or hospital association to quickly resolve them.

“Our objective with this new approach is to collaborate with the states and the healthcare system. The goal of full transparency is to acknowledge when we find discrepancies in the data and correct them.”

Last week, HHS noted, 93% of its prioritized list of hospitals, excluding psychiatric, rehabilitation and religious nonmedical facilities, reported data at least once during the week. (The guidance to hospitals asks them to report every day.)

Asked about the lack of timely data on its public website, HHS said it will update the site to “make it clear that the estimates are only updated weekly.” HHS is now posting a date file each day on healthdata.gov with aggregate information on hospitalizations by state.

But unlike the prior releases from CDC, which provided estimates on hospital capacity based on the responses, this file only gives totals for the hospitals that reported data. It’s unclear which hospitals did not report, how large they are, or whether the reported data is representative.

It’s also unclear if it’s accurate. New York state, for instance, reported that fewer than 600 people were currently hospitalized with COVID-19, as of Friday. Federal data released the same day pegged the number of suspected and confirmed COVID-19 hospitalizations at around 1,800.

Louisiana says more than 1,500 people are currently hospitalized with COVID-19. The federal data puts the figure at fewer than 700.

Nationally, The COVID Tracking Project reports that more than 56,000 people were hospitalized around the country with the virus, as of Thursday.

The data released by HHS on Friday puts the figure at more than 70,000.

NPR reported this week that it had found irregularities in the process used by the Trump administration to award the contract to manage the hospital data. Among other things, HHS directly contacted TeleTracking about the contract and the agency used a process that is more often used for innovative scientific research, NPR reported.

An HHS spokesperson told NPR that the contract process it used is a “common mechanism … for areas of research interest,” and said that the system used by the CDC was “fraught with challenges.”

Ryan Panchadsaram, co-founder of the tracking website CovidExitStrategy.org, has been critical of the problems created by the hospital data changeover.

“Without real-time accurate monitoring, you can’t make quick and fast and accurate decisions in a crisis,” he said in an interview. “This is just so important. This indicator that’s gone shows how the health system in a state is doing.”

Dillon of the Missouri Hospital Association said the administration could have handled this differently. For big technology projects, he noted, there is often a well-publicized transition with information sessions, an educational program and, perhaps, running the old system and the new one in parallel.

This “was extremely abrupt,” he said. “That is not akin to anything you would expect from HHS about how you would implement a program.”

 

Coronavirus threat rises across U.S.: ‘We just have to assume the monster is everywhere’

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Courage, Cowardice, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Federal Emergency Management Agency (FEMA), Health Equity, Infection Control, Infection Control Plan, Infectious Virus, Leadership Alignment, Leadership Culture, Leadership Decentralized, Leadership Integrity, Leadership Political, Leadership Trust, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Pandemic Fatigue, Public Health, Public Safety, Quarantine, School Reopening, Social Distancing, Strategic Alignment, Strategy Disconnected, Underinsured, Unemployment, Unemployment Insurance, Uninsured, World Health Organization (WHO) • Leave a comment

https://www.washingtonpost.com/health/coronavirus-threat-rises-across-us-we-just-have-to-assume-the-monster-is-everywhere/2020/08/01/cdb505e0-d1d8-11ea-8c55-61e7fa5e82ab_story.html?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

The coronavirus is spreading at dangerous levels across much of the United States, and public health experts are demanding a dramatic reset in the national response, one that recognizes that the crisis is intensifying and that current piecemeal strategies aren’t working.

This is a new phase of the pandemic, one no longer built around local or regional clusters and hot spots. It comes at an unnerving moment in which the economy suffered its worst collapse since the Great Depression, schools are rapidly canceling plans for in-person instruction and Congress has failed to pass a new emergency relief package. President Trump continues to promote fringe science, the daily death toll keeps climbing and the human cost of the virus in America has just passed 150,000 lives.

“Unlike many countries in the world, the United States is not currently on course to get control of this epidemic. It’s time to reset,” declared a report released this week by Johns Hopkins University.

Another report from the Association of American Medical Colleges offered a similarly blunt message: “If the nation does not change its course — and soon — deaths in the United States could be well into the multiple hundreds of thousands.”

The country is exhausted, but the virus is not. It has shown a consistent pattern: It spreads opportunistically wherever people let down their guard and return to more familiar patterns of mobility and socializing. When communities tighten up, by closing bars or requiring masks in public, transmission drops.

That has happened in some Sun Belt states, including Arizona, Florida and Texas, which are still dealing with a surge of hospitalizations and deaths but are finally turning around the rate of new infections.

There are signs, however, that the virus is spreading freely in much of the country. Experts are focused on upticks in the percentage of positive coronavirus tests in the upper South and Midwest. It is a sign that the virus could soon surge anew in the heartland. Infectious-disease experts also see warning signs in East Coast cities hammered in the spring.

“There are fewer and fewer places where anybody can assume the virus is not there,” Gov. Mike DeWine (R) of Ohio said Wednesday. “It’s in our most rural counties. It’s in our smallest communities. And we just have to assume the monster is everywhere. It’s everywhere.”

Dire data

An internal Trump administration briefing document prepared by the Federal Emergency Management Agency and obtained Friday by The Washington Post counted 453,659 new infections in the past week.

Alaska is in trouble. And Hawaii, Missouri, Montana and Oklahoma. Those are the five states, as of Friday, with the highest percentage increase in the seven-day average of new cases, according to a Post analysis of nationwide health data.

“The dominoes are falling now,” said David Rubin, director of the PolicyLab at Children’s Hospital of Philadelphia, which has produced a model showing where the virus is likely to spread over the next four weeks.

His team sees ominous trends in big cities, including Baltimore, Chicago, Detroit, Indianapolis, Kansas City, Louisville, Philadelphia, St. Louis and Washington, with Boston and New York not far behind. And Rubin warns that the expected influx of students into college towns at the end of this month will be another epidemiological shock.

“I suspect we’re going to see big outbreaks in college towns,” he said.

Young people are less likely to have a severe outcome from the coronavirus, but they are adept at propelling the virus through the broader population, including among people at elevated risk. Numbers of coronavirus-related hospitalizations in the United States went from 36,158 on July 1 to 52,767 on July 31, according to The Post’s data. FEMA reports a sharp increase in the number of patients on ventilators.

The crisis has highlighted the deep disparities in health outcomes among racial and ethnic groups, and data from the Centers for Disease Control and Prevention this week showed that hospitalization rates due to the coronavirus are roughly five times higher among Black, Hispanic and Native Americans than Whites.

Thirty-seven states and Puerto Rico will probably see rising daily death tolls during the next two weeks compared with the previous two weeks, according to the latest ensemble forecast from the University of Massachusetts at Amherst that combines more than 30 coronavirus models.

There are glimmers of progress. The FEMA report showed 237 U.S. counties with at least two weeks of steady declines in numbers of new coronavirus cases.

But there are more than 3,100 counties in America.

“This is not a natural disaster that happens to one or two or three communities and then you rebuild,” said Beth Cameron, vice president for global biological policy and programs at the Nuclear Threat Initiative and a former White House National Security Council staffer focused on pandemics. “This is a spreading disaster that moves from one place to another, and until it’s suppressed and until we ultimately have a safe and effective and distributed vaccine, every community is at risk.”

A national strategy, whether advanced by the federal government or by the states working in tandem, will more effectively control viral spread than the current patchwork of state and local policies, according to a study from researchers at the Massachusetts Institute of Technology published Thursday in the Proceedings of the National Academy of Sciences.

The coordination is necessary because one state’s policies affect other states. Sometimes, that influence is at a distance, because states that are geographically far apart can have cultural and social ties, as is the case with the “peer states” of New York and Florida, the report found.

“The cost of our uncoordinated national response to covid-19, it’s dramatic,” said MIT economist Sinan Aral, senior author of the paper.

Some experts argue for a full six-to-eight-week national shutdown, something even more sweeping than what was instituted in the spring. There appears to be no political support for such a move.

Neil Bradley, executive vice president of the U.S. Chamber of Commerce, said fresh federal intervention is necessary in this second wave of closures. Enhanced federal unemployment benefits expired at the end of July, with no agreement on a new stimulus package in sight.

“Congress, on a bipartisan basis, was trying to create a bridge to help individuals and businesses navigate the period of a shutdown,” Bradley said. “Absent an extension of that bridge, in light of a second shutdown, that bridge becomes a pier. And then that’s a real problem.”

With the economy in shambles, hospitals filling up and the public frustrated, anxious and angry, the challenge for national leadership is finding a plausible sea-to-sea strategy that can win widespread support and simultaneously limit sickness and death from the virus.

Many Americans may simply feel discouraged and overtaxed, unable to maintain precautions such as social distancing and mask-wearing. Others remain resistant, for cultural or ideological reasons, to public health guidance and buy into conspiracy theories and pseudoscience.

DeWine is struggling to get Ohio citizens to take seriously the need to wear masks. A sheriff in rural western Ohio told the governor Wednesday that people didn’t think the virus was a big problem. DeWine informed the sheriff that the numbers in his county were higher per capita than in Toledo.

“The way I’ve explained to people, if we want to have Friday night football in the fall, if we want our kids back in school, what we do in the next two weeks will determine if that happens,” DeWine said.

The crucial metric

The coronavirus has always been several steps ahead of the U.S. government, the scientific community, the news media and the general public. By the time a community notices a surge in patients to hospital emergency rooms, the virus has seeded itself widely.

The virus officially known as SARS-CoV-2 can be transmitted by people who are infectious but not symptomatic. The incubation period is typically about six days, according to the CDC. When symptoms flare, they can be ambiguous. A person may not seek a test right away. Then, the test results may not come back for days, a week, even longer.

That delay makes contact tracing nearly futile. It also means government data on virus transmission is invariably out of date to some degree — it’s a snapshot of what was happening a week or two weeks before. And different jurisdictions use different metrics to track the virus, further fogging the picture.

The top doctors on the White House coronavirus task force, Deborah Birx and Anthony S. Fauci, are newly focused on the early warning signs of a virus outbreak. This week, they warned that the kind of runaway outbreaks seen in the Sun Belt could potentially happen elsewhere. Among the states of greatest concern: Indiana, Kentucky, Ohio and Tennessee.

Fauci and Birx have pointed to a critical metric: the percentage of positive test results. When that figure starts to tick upward, it is a sign of increasing community spread of the virus.

“That is kind of the predictor that if you don’t do something — namely, do something different — if you’re opening up at a certain pace, slow down, maybe even backtrack a little,” Fauci said in an interview Wednesday.

Without a vaccine, the primary tools for combating the spread of the virus remain the common-sense “non-pharmaceutical interventions,” including mask-wearing, hand-washing, staying out of bars and other confined spaces, maintaining social distancing of at least six feet and avoiding crowds, Fauci said.

“Seemingly simple maneuvers have been very effective in preventing or even turning around the kind of surges we’ve seen,” he said.

Thirty-three U.S. states have positivity rates above 5 percent. The World Health Organization has cited that percentage as a crucial benchmark for governments deciding whether to reopen their economy. Above 5 percent, stay closed. Below, open with caution.

Of states with positivity rates below 5 percent, nine have seen those rates rise during the last two weeks.

“You may not fully realize that when you think things are okay, you actually are seeing a subtle, insidious increase that is usually reflected in the percent of your tests that are positive,” Fauci said.

The shutdown blues

Some governors immediately took the White House warnings to heart. On Monday, Kentucky Gov. Andy Beshear (D) said at a news conference that he had met with Birx the previous day and was told he was getting the same warning Texas and Florida received “weeks before the worst of the worst happened.”

To prevent that outcome in his state, Beshear said, he was closing bars for two weeks and cutting seating in restaurants.

But as Beshear pleaded that “we all need to be singing from the same sheet of music,” discord and confusion prevailed.

Iowa Gov. Kim Reynolds (R) said Thursday she wasn’t convinced a mask mandate is effective: “No one knows particularly the best strategy.”

Earlier in the week, Tennessee Gov. Bill Lee (R) demurred on masks and bar closures even as he stood next to Birx and spoke to reporters.

“That’s not a plan for us now,” he said. He added emphatically, “We are not going to close the economy back down.”

The virus is spreading throughout his state, and not just in the big cities. Vacationers took the virus home from the honky-tonks of Nashville and blues clubs of Memphis to where they live in more rural areas, said John Graves, a professor at Vanderbilt University studying the pandemic.

“The geographical footprint of the virus has reached all corners of the state at this point,” Graves said.

In Missouri, Gov. Michael L. Parson (R) was dismissive of New York’s imposition of a quarantine on residents from his state as a sign of a worsening pandemic. “I’m not going to put much stock in what New York says — they’re a disaster,” he said at a news conference Monday.

Missouri has no mask mandate, leaving it to local officials to act — often in the face of hostility and threats. In the town of Branson, angry opponents testified Tuesday that there was no reason for a mask order when deaths in the county have been few and far between.

“It hasn’t hit us here yet, that’s what I’m scared of,” Branson Alderman Bill Skains said before voting with a majority in favor of the mandate. “It is coming, and it’s coming like a freight train.”

Democratic mayors in Missouri’s two biggest cities, Kansas City and St. Louis, said that with so many people needing jobs, they are reluctant to follow Birx’s recommendation to close bars.

“The whole-blanket approach to shut everybody down feels a little harsh for the people who are doing it right,” said Jacob Long, spokesman for St. Louis Mayor Lyda Krewson. “We’re trying to take care of some bad actors first.”

Minneapolis Mayor Jacob Frey also got a warning from Birx. On Wednesday, he said all bar drinking must move outside.

“We don’t want to be heading in the direction of everybody else,” said Kristen Ehresmann, director of the infectious-disease epidemiology division at the Minnesota Department of Health. She acknowledged that some options “are really pretty draconian.”

The problem is that less-painful measures have proven insufficient.

“The disease transmission we’re seeing is more than what would have been expected if people were following the guidance as it is laid out. It’s a reflection of the fact that they’re not,” she said.

‘A tremendous disappointment’

Wisconsin Gov. Tony Evers (D) tried to implement broad statewide measures early in the pandemic, only to have his “Safer at Home” order struck down by the state’s Supreme Court.

With cases in his state rising anew, he tried again Thursday, declaring a public health emergency and issuing a statewide mask mandate.

“While our local health departments have been doing a heck of a job responding to this pandemic in our communities, the fact of the matter is, this virus doesn’t care about any town, city or county boundary, and we need a statewide approach to get Wisconsin back on track,” Evers said.

Ryan Westergaard, Wisconsin’s chief medical officer, said he is dismayed by the failures of the national pandemic response.

“I really thought we had a chance to keep this suppressed,” Westergaard said. “The model is a good one: testing, tracing, isolation, supportive quarantine. Those things work. We saw this coming. We knew we had to build robust, flexible systems to do this in all of our communities. It feels like a tremendous disappointment that we weren’t able to build a system in time that could handle this.”

There is one benefit to the way the virus has spread so broadly, he noted: “We no longer have to keep track of people traveling to a hot spot if hot spots are everywhere.”

 

 

 

 

Can we ‘TRUST’ the ‘CARES ACT’ to ‘HEAL’ our nation?

Posted on by • Posted in 2020 Election Issues, Coronavirus, Economic Crisis, Economic Stimulus, Election, Health Policy, Medicare, Medicare Hospital Fund, Pandemic, Partisanship, Social Security, The CARES Act, Transparency, Vote, Voting, Voting by Mail • Leave a comment

https://www.washingtonpost.com/business/2020/08/01/cares-trust-heals-heroes-congress-stimulus/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most

Social Security Error Leads to Unpaid Medicare Coverage

A groan-up look at Congress’s aspirational acronyms for its various stimulus bills.

Two of the things missing from the increasingly bitter debate about how to handle covid-19’s effect on our people, our businesses and our economy are a sense of humor and bipartisanship.

So as a public service, let me try to bring both of those to bear by doing a deep dive into the various pieces of stimulus legislation currently running around in Our Nation’s Capital.

No, I’m not going to give you a detailed, sleep-inducing analysis featuring numbers and experts opining about various provisions. Instead, I’m going to look at the names — which I find hilariously tortured — of the various pieces of legislation.

Possibly because I’m both a recovering English major and a non-Washingtonian, I like to know the full names of the legislation — like the Cares Act — that I’m writing about. And these names are just great. Let’s start with the Cares (or as I prefer to call it, CARES) Act.

Do you know what the full name of that legislation is? Probably not. Okay, I’ll tell you. It’s the Coronavirus Aid, Relief and Economic Security Act. A name clearly invented to produce a seemingly empathetic acronym.

Now, let’s move on to two total groaners — the Democrats’ and Republicans’ proposals for more stimulus legislation. Remember, I’m not talking about the proposals’ provisions — I’m talking about their names. The Democrats’ candidate in the current stimulus battle is the Heroes (or rather HEROES) Act. The full name of this piece of work, which has been passed by the House, is the Health and Economic Recovery Omnibus Emergency Solutions Act. My favorite part is “Omnibus,” which clearly is in the title because an acronym meister needed an O, and Omnibus was better than Outsized or Over-the-top.

Showing that they would not be out-acronymed, the Republicans named their legislation, which is currently kicking around (and being kicked around) in the Senate, the Heals (or HEALS) Act. That stands for Health, Economic Assistance, Liability protection and Schools Act. The lowercase p in “protection” let the acronym mavens call the legislation HEALS rather than HEALPS.

And finally, there’s legislation that’s been around for several years but that I discovered only recently when Mitch McConnell and his crew stuck it into the HEALS Act. It’s a proposal that would let a congressional committee, operating outside of public sight, propose cuts and changes to Social Security, Medicare and some other federal programs that use trust funds. It’s called the Time to Rescue United States Trusts (or TRUST) Act. I’ve looked at it only superficially — but from what I’ve seen, I don’t think there’s any reason to trust it.

I hope you’ve noticed that I’m doing equal-opportunity name mocking: the Cares and Trust acts, which are bipartisan; the Heroes Act, which is Democratic; and the Heals (or HEALPS) Act, which is Republican.

What do I propose to do about these contorted names? I’m glad you asked. My answer, naturally, is to propose a piece of legislation of my own: The Get Rid Of Acronyms Now Act. That, my friends, would be a true GROAN-er.