Predicting COVID-19’s Long-Term Impact on the Home Health Care Market

Posted on June 14, 2020 by henrykotula • Posted in American Hospital Association (AHA), Center for Medicare and Medicaid Services (CMS), Coronavirus, Economic Crisis, Economic Stimulus, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Financially Distressed, Health Insurance Coverage Adequacy, Home Care, Home Health, Job, Job Market, Job Search, Job Security, Market Consolidation, Medicare, Mergers & Acquisitions, Nursing Home, Out of Pocket Expenses, Palliative Care, Patient-Driven Groupings Model (PDGM), Unemployment, Unemployment Insurance • Leave a comment

Predicting COVID-19’s Long-Term Impact on the Home Health Care Market

The Patient-Driven Groupings Model (PDGM) and its unintended ripple effects were supposed to be the dominant story this year for the nation’s 12,000 or so Medicare-certified home health care providers. But the coronavirus has rewritten the script for 2020, throwing most of the industry’s previous projections out the window.

While PDGM — implemented on Jan. 1 — will still shape home health care’s immediate future, several other long-term trends have emerged as a result of the coronavirus and its impact on the U.S. health care system.

These trends include unexpected consolidation drivers and the sudden embrace of telehealth technology, the latter of which is a development that will affect home health providers in ways both profoundly positive and negative. Unforeseen, long-term trends will also likely include drastic overhauls to the Medicare Home Health Benefit, a revival of SNF-to-home diversion and more.

Now that providers have had roughly three full months to adapt to the coronavirus and transition out of crisis mode, Home Health Care News is looking ahead to what the industry can expect for the rest of 2020 and beyond.

‘Historic’ consolidation will still happen, with some unexpected drivers

Although the precise extent was often up for debate, most industry insiders predicted some level of consolidation in 2020, driven by PDGM, the phasing out of Requests for Anticipated Payment (RAPs) and other factors.

That certainly appeared to be true early on in the year, with Amedisys Inc. (Nasdaq: AMED), LHC Group Inc. (Nasdaq: LHCG) and other home health giants reporting more inbound calls related to acquisition opportunities or takeovers of financially distressed agencies.

In fact, during a fourth-quarter earnings call, LHC Group CEO and Chairman Keith Myers suggested that 2020 would kick off a “historic” consolidation wave that would last several years.

“As a result of this transition in Q4 and the first few months of 2020, we have seen an increase in the number of inbound calls from smaller agencies looking to exit the business,” Myers said on the call. “Some of these opportunities could be good acquisition candidates, and others we can naturally roll into our organic growth through market-share gains.”

Most of those calls stopped with the coronavirus, however.

Although the vast majority of home health agencies have experienced a decline in overall revenues during the current public health emergency, many have been able to compensate for losses thanks to the federal government’s multi-faceted response.

For some, that has meant taking advantage of the approximately $1.7 billion the U.S. Centers for Medicare & Medicaid Services (CMS) has distributed through its advanced and accelerated payment programs. For others, it has meant accepting the somewhat murky financial relief sent their way under the Provider Relief Fund.

In addition to those two possible sources of financial assistance, all Medicare-certified home health agencies have benefitted from Congress’s move to suspend the 2% Medicare sequestration until Dec. 31.

Eventually, those coronavirus lifelines and others will be pulled back, kickstarting M&A activity once again.

“We believe that a lot of the support has stopped or postponed the shakeout that’s occurring in home health — or that we anticipated would be occurring around this time,” Amedisys CEO and President Paul Kusserow said in March. “We don’t believe it’s over, though.”

Not only will consolidation happen, but some of it will be fueled by unexpected players.

With the suspension of elective surgeries and procedures, hospitals and health systems have lost billions of dollars. Rick Pollack, president and CEO of the American Hospital Association (AHA), estimated that hospitals are losing as much as $50 billion a month during the coronavirus.

“I think it’s fair to say that hospitals are facing perhaps the greatest challenge that they have ever faced in their history,” Pollack, whose organization represents the interests of nearly 5,000 hospitals, told NPR.

To cut costs, some hospitals may look to get rid of their in-house home health divisions. It’s a trend that may already be happening, too.

The Home Health Benefit will look drastically different

With a mix of temporary and permanent regulatory changes, including a redefinition of the term “homebound,” the Medicare Home Health Benefit already looks very different now than it did three months ago. But the benefit will likely go through further retooling in the not-too-distant future.

Broadly, the Medicare Part A Trust Fund finances key services for beneficiaries.

While vital to the national health care infrastructure, the fund is going broke — and fast. In the most recent CMS Office of the Actuary report released in April, the Trust Fund was projected to be entirely depleted by 2026.

The COVID-19 virus has only accelerated the drain on the fund, with some predicting it to run out of money two years earlier than anticipated. A group of health care economics experts from Harvard and MIT wrote about the very topic on a joint Health Affairs op-ed published Wednesday.

“COVID-19 is causing the Medicare Part A program and the Hospital Insurance (HI) Trust Fund to contend with large reductions in revenues due to increased unemployment, reductions in salaries, shifts to part-time employment from full time and a reduction in labor force participation,” the group wrote. “In addition to revenue declines, there was a 20% increase in payments to hospitals for COVID-related care and elimination of cost sharing associated with treatment of COVID.”

Besides those and other cost pressures, Medicare is simultaneously expanding by about 10,000 new people every day. The worst-case scenario: the Medicare Part A Trust Fund goes broke closer to 2024.

There are numerous policy actions that can be taken to reduce the financial strain on the trust fund. In their op-ed, for example, the team of Harvard and MIT researchers suggested shifting all of home health care under Part B.

In 2018, Medicare spent about $17.9 billion on home health benefits, with roughly 66% of that falling under Part B, which typically includes community-based care that isn’t linked to hospital or nursing home discharge. Consolidating all of home health care into Part B would move billions of dollars away from Part A, in turn expanding the Trust Fund’s lifecycle.

“Such a policy change would move nearly $6 billion in spending away from the Part A HI Trust Fund but would put upward pressure on the Part B premium,” the researchers noted.

Of course, all post-acute care services may still undergo a transformation into a unified payment model one day. However, the coronavirus has devastated skilled nursing facility (SNF) operators, who were already dealing with the Patient-Driven Payment Model (PDPM), a payment overhaul of their own.

Regulators may shy away from introducing further disruption until SNFs have a chance to recover, a process likely to take years — if not decades.

Previously, the Trump administration had estimated that a unified payment system based on patients’ clinical needs rather than site of care would save a projected $101.5 billion from 2021 to 2030.

Telehealth will be a double-edged sword

The move toward telehealth was a long-term trend that home health providers were cognizant of before COVID-19, even if some clinicians were personally skeptical of virtual visits. But because the virus has demanded social distancing, telehealth has forced its way into health care in a manner that would have been almost unimaginable in 2019.

In late April, during a White House Coronavirus Task Force briefing, President Donald Trump indicated that the number of patients using telehealth had increased from about 11,000 per week to more than 650,000 people per week.

Meanwhile, MedStar Health went from delivering just 10 telehealth visits per week to nearly 4,000 per day.

Backed by policymakers, technology companies and consumers, telehealth is likely here to stay.

“I think the genie’s out of the bottle on this one,” CMS Administrator Seema Verma said in April. “I think it’s fair to say that the advent of telehealth has been just completely accelerated, that it’s taken this crisis to push us to a new frontier, but there’s absolutely no going back.”

The telehealth boom could mean improved patient outcomes and new lines of business for home health providers. But it could also mean more competition moving forward.

For telehealth to be a true game-changer for home health providers, Congress and CMS would need to pave the way for direct reimbursement. Currently, a home health provider cannot get paid for delivering virtual visits in fee-for-service (FFS) Medicare.

Sen. Susan Collins (R-Maine) has floated the idea of introducing legislation that would allow for direct telehealth reimbursement in the home health space, but, so far, no concrete steps have been taken — at least in public. With a hyper-polarized Congress and a long list of other national priorities taking up the spotlight, it’s impossible to guess whether home health telehealth reimbursement will actually happen.

While home health providers can’t directly bill for in-home telehealth visits, hospitals and certain health care practitioners can. That regulatory imbalance could lead to providers being used less frequently as “the eyes and ears in the home,” some believe.

A new SNF-to-home diversion wave will emerge

Over the past two decades, many home health providers have been able to expand their patient census by poaching patients from SNFs. Often referred to as SNF-to-home diversion, the approach didn’t just benefit home health providers, though. It helped cut national health care spending by shifting care into lower-cost settings.

At first, the stream of SNF residents being shifted into home health care was like water being shot from a firehose: In 2009, there were 1,808 SNF days per 1,000 FFS Medicare beneficiaries, a March 2018 analysis from consulting firm Avalere Health found. By 2016, that number plummeted to 1,539 days per 1,000 beneficiaries — a 15% drop.

In recent years, that steady stream has turned into a slow trickle, with more patients being sent to home health care right off the bat. In the first quarter of 2019, 23.3% of in-patient hospital discharges were coded for home health care, while 21.1% were coded for SNFs, according to data from analytics and metrics firm Trella Health.

Genesis HealthCare (NYSE: KEN) CEO George Hager suggested the initial SNF-to-home diversion wave was over in March 2019. Kennett Square, Pennsylvania-based Genesis is a holding company with subsidiaries that operate hundreds of skilled nursing centers across the country.

“To anyone [who] would want [to] or has toured a skilled nursing asset, I would challenge you to look at the patients in our building and find patients that could be cared for in a home-based or community-based setting,” Hager said during a presentation at the Barclays Global Healthcare Conference. “The acuity levels of an average patient in a skilled nursing center have increased dramatically.”

Yet that was all before the coronavirus.

Over the last three months, more than 40,600 long-term care residents and workers have died as a result of COVID-19, according to an analysis of state data gathered by USA Today. That’s about 40% of the U.S.’s overall death toll.

CMS statistics place that number closer to 26,000.

In light of those figures and infection-control issues in congregate settings, home health providers will see a new wave of SNF-to-home diversion as robust as the first. As the new diversion wave happens, providers will need to be prepared to care for patients with higher acuity levels and more co-morbidities.

“[That’s going to change] the psyche of the way people are going to view SNFs and long-term care facilities for the rest of our generation,” Bruce Greenstein, LHC Group’s chief strategy and innovation officer, said during a June presentation at the Jefferies Virtual Healthcare Conference. “You would never want to put your parent in a facility if you don’t have to. You want options now.”

One stat to back up this idea: Over 50% of family members are now more likely to choose in-home care for their loved ones than they were prior to the coronavirus, according to a survey from health care research and consulting firm Transcend Strategy Group.

Separate from SNF-to-home diversion, hospital-to-home models will also likely continue to gain momentum after the coronavirus.

There will be a land grab for palliative care

Over the past two years, home health providers have aggressively looked to expand into hospice care, partly due to the space’s relatively stable reimbursement landscape. Amedisys — now one of the largest hospice providers in the U.S. — is the prime example of that.

During the COVID-19 crisis, palliative care has gained greater awareness. Generally, palliative care is specialized care for people living with advanced, serious illnesses.

“Right now, we are seeing from our hospital partners and our community colleagues the importance of palliative care, including advanced care as well as appropriate pain and symptom management,” Capital Caring Chief Medical Officer Dr. Matthew Kestenbaum previously told HHCN. “The number of palliative care consults we’re being asked to perform in the hospitals and in the community has actually increased. The importance of palliative care is absolutely being shown during this pandemic.”

As community-based palliative care programs continue to prove their mettle amid the coronavirus, home health providers will increasingly consider expanding into the market to further diversify their services.

Currently, just 10% of community-based palliative care programs are operated by home health agencies.

Demand will reach an all-time high

The home health industry may ultimately shrink in terms of raw number of agencies, but the overall size of the market is very likely to expand at a faster-than-anticipated pace.

In years to come, home health providers will still ride the macro-level tailwinds of an aging U.S. population with a proven preference to age in place — that hasn’t changed. But because of SNF-to-home diversion and calls to decentralize the health care system with home- and community-based care, providers will see an increase in referrals from a variety of sources.

In turn, home health agencies will need to ramp up their recruitment and retention strategies.

There’s already early evidence of this happening.

Last week, in St. Louis, Missouri, four home-based care agencies announced that they were hiring a combined 1,000 new employees to meet the surge in demand, according to the St. Louis Dispatch.

Meanwhile, Brookdale Senior Living Inc. (NYSE: BKD) similarly announced plans to hire 4,500 health care workers, with 10% of those hires coming from the senior living operator’s health care services segment.

Bayada Home Health Care likewise announced plans to ramp up hiring.

“We are absolutely hiring more people now than ever,” Bayada CEO David Baiada previously told HHCN. “The need for services — both because of societal and demographic evolution, but also because of what we anticipate as a rebound and an increase in the demand for home- and community-based care delivery as a result of the pandemic — is requiring us to continue to accelerate our recruitment efforts.”

The bottom line: The coronavirus may have presented immediate obstacles for home health providers, but the long-term outlook is brighter than ever.

How The Rapid Shift To Telehealth Leaves Many Community Health Centers Behind During The COVID-19 Pandemic

Posted on June 14, 2020 by henrykotula • Posted in Access, Access & Quality of Healthcare, Center for Medicare and Medicaid Services (CMS), Community Health Centers (CHCs), Coronavirus, Economic Crisis, Economic Stimulus, Health Equity, Health Inequity, Health Policy, HIPAA, Medicaid, Medicare, Payment Parity, Primary Care, Telemedicine, The CARES Act, Vulnerable Populations • Leave a comment

https://www.healthaffairs.org/do/10.1377/hblog20200529.449762/full/

How to reduce the impact of coronavirus on our lives - The ...

The COVID-19 pandemic has transformed the landscape of ambulatory care with rapid shifts to telehealth. Well-resourced hospitals have quickly made the transition. Community health centers (CHCs), which serve more than 28 million low-income and disproportionately uninsured patients in rural and underserved urban areas of the United States, have not fared as well since ambulatory visits have disappeared, resulting in furloughs, layoffs, and more than 1,900 temporary site closures throughout the country. Government officials have taken notice, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act infused $1.32 billion toward COVID-19 response and maintaining CHC capacity.

Many states have directed insurers to temporarily cover COVID-19-related services via telehealth while mandating parity of reimbursement for telehealth visits with in-person visits for their Medicaid program.

Preparedness Of Community Health Centers For Telehealth

Despite the changes, many health centers may not be ready to implement high-quality telehealth. A study using 2016 data showed that only 38 percent of CHCs used any telehealth. In our review of 2018 Uniform Data System data—the most recent available—from a 100 percent sample of US CHCs, we found that our nation’s health centers are largely unprepared for this transformation.

Across the US, 56 percent of 1,330 CHCs did not have any telehealth use in 2018 (exhibit 1). Of those without telehealth use, only about one in five were in the process of actively implementing or exploring telehealth. Meanwhile, 47 percent of the centers using telehealth were doing so only with specialists such as those at referral centers, rather than with patients. Of those using telehealth, the majority (68 percent) used it to provide mental health services; fewer used it for primary care (30 percent) or management of chronic conditions (21 percent), suggesting that most CHCs with telehealth capabilities prior to COVID-19 were not using it for the most frequent types of services provided at CHCs.

CHCs not using telehealth reported several barriers to implementation (exhibit 2). Thirty-six percent cited lack of reimbursement, 23 percent lacked funding for equipment, and 21 percent lacked training for providing telehealth. Although most barriers were similar in both urban and rural regions, a greater proportion of rural clinics compared to urban clinics (18 percent versus 7 percent) reported inadequate broadband services as an issue.

The COVID-19 pandemic has laid bare the enormous disparities in telehealth capacity. Without adequate telehealth capacity and support, many CHCs will be left without means of providing the continuous preventive and chronic disease care that can keep communities healthy and out of the hospital. During the crisis, the Health Resources and Services Administration estimates that CHCs have seen 57 percent of the number of weekly visits compared to pre-COVID-19 visit rates, 51 percent of which have been conducted virtually, suggesting that many CHC patients have forgone care that they would have otherwise received. Given CHCs serve a disproportionate share of low-income, racial/ethnic minority, and immigrant populations—populations hardest hit by the COVID-19 pandemic—any disruption to CHC capacity may exacerbate the racial disparities that have rapidly emerged.

While an important first step, policy makers cannot simply infuse more funding to CHCs and expect them to withstand the challenges of the COVID-19 era. We recommend three targeted strategies to help CHCs adapt and perhaps even thrive beyond COVID-19: legislate permanent parity in telehealth reimbursement for all insurers; allocate sufficient funding and guidance for telehealth equipment, personnel, training, and protocols; and implement telehealth systems tailored to vulnerable populations.

Permanent All-Payer Parity For Telehealth Reimbursement

Payment parity—where telehealth is reimbursed at the same level as an in-person visit—is a crucial issue that must be addressed and instituted beyond the current public health emergency. Without commensurate reimbursement for telehealth, CHCs cannot maintain patient volume or make the long-term investments necessary to remain financially viable. A “global budget” of paying CHCs a fixed payment per patient per month would give practices flexibility in how and where to treat the patient, although this may be politically and practically challenging. Meanwhile, payment parity has already been implemented and could simply be permanently codified into existing reimbursement schemes, giving providers the option to select the best mode of treatment without making financial trade-offs.

In reviewing state telehealth policies during COVID-19, all states have implemented temporary executive orders or released guidance on telehealth access—although with significant variations. At least 22 states have explicitly implemented telehealth parity for Medicaid. For Medicare, the Centers for Medicare and Medicaid Services (CMS) expanded access to telehealth beyond designated rural areas, loosened HIPAA requirements around telehealth platforms, and instituted parity in reimbursement with in-person visits.

To build on these significant steps, states should mandate telehealth parity across all payers and cover all services provided at CHCs, not just COVID-19-related care. At least 12 states have mandated all-payer parity for telehealth. Meanwhile, private insurers have individually adjusted telehealth policies on a state-by-state basis if there was no statewide mandate. Nevertheless, all payers should reimburse at parity given the patchwork quilt of insurance plans that exists at CHCs.

Furthermore, state legislatures and CMS should look to extend parity beyond the current COVID-19 emergency so that CHCs can make sustainable investments that continue to benefit patients. Even as states reopen, in-person visits are unlikely to return to their previous volume as the threat of infection continues to loom. Temporary measures should be made permanent so that CHCs can make sustainable investments that continue to benefit patients.

Funding And Guidance For Equipment, Personnel, Training, And Protocols

For telehealth to function smoothly and reduce errors, proper hardware and software are critical, including telephone service, computers, broadband internet access, and electronic health records. The Federal Communications Commission (FCC) released funding to procure telehealth services and devices and some CHCs have received private funding; similar targeted funding mechanisms from states and the federal government are necessary at scale to equip hundreds of CHCs with the necessary telehealth capabilities.

However, merely having technology is not sufficient. Proper personnel with appropriate training are key to a high-functioning telehealth system along with support from information technology specialists. Additionally, CHCs need ancillary systems in place to allow for the effective use of phone and video visits. Empanelment systems to attribute patients to providers can allow for longitudinal follow-up even with telehealth. Daily huddles and team-based care can enhance the inherent complexities of coordinating care remotely. Protocols should be tailored for different specialties and services such as nutrition management and social work. Meanwhile, a robust e-consult referral network should allow primary care providers at CHCs to easily connect patients to specialty care when necessary. Adding robust protocols and systems will allow for the successful implementation and scaling of telehealth.

For example, groups of CHCs called the Health Center Controlled Networks (HCCNs), which have traditionally collaborated to leverage health information technology, are positioned to harness their economies of scale and group purchasing power to widely adopt new infrastructure while standardizing protocols. They could be a means to accelerate the adoption of telehealth technologies, trainings, and care models to optimize the use of telehealth across CHCs.

Telehealth Support For Vulnerable Patients

The patient population seen by CHCs presents unique challenges that not all ambulatory practices, particularly those in affluent neighborhoods, may face. Health centers care for many immigrant patients with limited English proficiency. Thus, clinics need financial support to contract with telehealth interpreter and translation services to provide equitable access and care. Better yet, all telehealth platforms contracting with CHCs should be required to provide multilingual support to deliver equitable access to telehealth services.

Moreover, many low-income patients lack health and digital literacy. Virtual telehealth platforms should design applications such that interfaces are intuitive and easy to navigate. They should provide specialized support to guide patients who are not familiar with telehealth systems. Additionally, insurers can reimburse CHCs that provide patient navigators, care coordinators, and shared decision-making support that bridge the health literacy divide.

Many around the US also do not have access to high-speed internet, consistent telephone services, and phones or computers with video conferencing capabilities. First, to allow for flexible access to telehealth for all patients, insurers should permanently waive geographic and originating site restrictions that limit the type and location of facilities from which patients can use telehealth. Second, insurers should waive audio-video requirements and consistently reimburse for phone-only visits to accommodate patients without video conferencing. Third, the type of services covered by telehealth should be expanded—ranging from primary care to physical therapy to nutrition counseling to behavioral health.

To address disparities in ownership of digital devices, taking a page out of the book of educators in low-income neighborhoods, local governments could loan laptops and smartphones or supply internet hotspots and phone-charging stations for these communities to enable access. Additionally, insurers could reimburse for the FCC Lifeline program to provide affordable communication services and cellular data to low-income populations to maintain their outpatient care.

Conclusions

As the COVID-19 pandemic sweeps through the US, health care delivery will never be the same. Health centers are struggling as many have been largely unprepared for the abrupt swing toward telehealth. COVID-19 may pose long-lasting damaging effects on CHCs and the patient populations that they serve. Nonspecific federal and state funding will allow CHCs to survive; however, deliberate action is needed to enhance telehealth capacities and ensure long-term resilience.

Similar to the Association of American Medical Colleges’ recent letter to CMS to make various telehealth changes permanent, both CMS and state governments should take immediate action by making permanent parity in reimbursement for telehealth services by all payers. State and federal policy should direct payers to lift onerous restrictions on the types of services covered via telehealth, audio/video requirements, and geographic and originating sites of telehealth services. States and payers should also explore innovative solutions to expand access to cellular data services and digital devices that allow low-income patients to digitally “get to their appointment,” similar to non-emergency medical transportation. Local governments should invest in digital infrastructure that expands broadband coverage and provides internet or cellular access points for people to engage in telehealth. Additionally, CHCs should come together under HCCNs to harness their group purchasing power to rapidly implement telehealth infrastructure that provides multilingual support and other tools that bridge gaps in digital literacy. Finally, best practices, trainings, and protocols should be standardized and disseminated across CHC networks to optimize the quality of telehealth.

By reorienting the goals for implementing telehealth, policy makers, payers, and providers can empower health centers to thrive into the future and meet the nation’s underserved patients where they are, even during the pandemic. In the long run, telehealth can increase access and equity—but only if the right investments are made now to fill the gaps laid bare by COVID-19.

States are wrestling on their own with how to expand testing, with little guidance from the Trump administration

Posted on June 13, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Economic Crisis, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.washingtonpost.com/politics/states-are-wrestling-on-their-own-with-how-to-expand-testing-with-little-guidance-from-the-trump-administration/2020/06/09/d02672f4-9bab-11ea-ad09-8da7ec214672_story.html?utm_campaign=Newsletter%20Weekly%20Roundup%3A%20Healthcare%20Dive%3A%20Daily%20Dive%2006-13-2020&utm_medium=email&utm_source=Sailthru

In Maryland, drive-through coronavirus testing sites are now open to all residents, whether or not they show signs of illness.

In Oregon, by contrast, officials have said that generally only people with symptoms of covid-19, the illness associated with the coronavirus, should be tested — even in the case of front-line health-care workers.

In Rhode Island, officials have proactively tested all of the state’s 7,500 nursing home residents, including those with no symptoms, and are developing plans to test more people in high-risk workplaces, such as restaurants and grocery stores.

The wide range of approaches across the country comes as the federal government has offered little guidance on the best way to test a broad swath of the population, leaving state public health officials to wrestle on their own with difficult questions about how to measure the spread of the virus and make decisions about reopening their economies.

Faced with conflicting advice from experts in the field, states are using different tests that vary in reliability and have adopted a variety of policies about who else should get tested and when — particularly when it comes to asymptomatic people who are considered low-risk for the illness.

“The states are on their own,” said Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, noting that the kind of guidance the federal government routinely gives in screening for flu and other outbreaks “has been absent” in the covid-19 pandemic. “There has been no coordination.”

That means that while tests are available to anyone who wants them in states such as Kentucky and Georgia and some large cities such as Detroit and Los Angeles, state officials in Idaho and Louisiana continue to recommend that only sick people get tested.

The lack of a unified national strategy has left Americans uncertain about whether and how to be tested and is hampering reopening plans, experts warn.

Many officials now worry that protests in more than 100 U.S. cities in recent days after the death of George Floyd in police custody, which have drawn thousands of people packed closely together, could spark new infections.

So far, about 460,000 Americans are being tested a day — 0.15 percent of the population, and still shy of the 900,000 to 30 million that experts say need to be tested daily to capture the extent of the virus’s spread.

“The case numbers we’re seeing are probably massively undercounted,” said Divya Siddarth, a researcher who helped devise a testing strategy for Harvard University’s Safra Center that emphasizes finding and suppressing the disease in areas with fewer cases. “These [lower prevalence] regions are likely to reopen, and they’ve barely done any tests.”

The lack of clear information is forcing businesses large and small, schools, universities and professional sports organizations to make their own decisions about how much testing they need to be safe.

Some institutions have announced their own plans for universal testing. The National Hockey League, for example, has said it plans to test all players daily as part of a plan to resume play in June. The University of Arizona has developed its own antibody test that’s available to all students and local health-care workers.

Under a law passed earlier this year, the Trump administration is required to develop a national testing strategy. But an 81-page document submitted to Congress by the Department of Health and Human Services late last month was not released publicly and offered few detailed recommendations.

The Washington Post obtained a copy of the plan, which set a goal for states of testing at least 2 percent of their residents in May and June. But how to meet that benchmark and whether to go further was left up to state leaders who were required to submit plans this month to HHS for review.

The Centers for Disease Control and Prevention has recommended universal testing for residents of nursing homes, which have been especially hit hard by the coronavirus. But the HHS document said the CDC was still working on guidelines for other large populations of mostly asymptomatic people — including at universities, prisons and “critical infrastructure worksites” — as well as those for integrating testing into reopening work places.

Mia Palmieri Heck, a spokeswoman for HHS, said the federal government “has provided prescriptive criteria about testing asymptomatic individuals when they affect highly vulnerable populations such as individuals who live in nursing homes, working in or visiting health-care clinics or communal dining spaces.” She added that federal experts have also been advising states on developing plans to more broadly test people without symptoms to determine community spread.

The question of asymptomatic testing is particularly tricky given that the CDC late last month said that its researchers now believe as many as 35 percent of people infected with the coronavirus never show symptoms of disease.

Typifying the kind of conflicting information facing states, a World Health Organization official sparked global confusion on Monday when she said it is “very rare” for people with no symptoms to transmit the disease. After significant pushback from researchers, the official said Tuesday that scientists continue to believe that people without symptoms do in fact spread the virus — but more research is needed to understand by how much.

She noted that some modeling shows as much as 41 percent of transmission may be due to asymptomatic people.

“In some ways, this may be the Achilles’ heel of the entire testing challenge for this virus,” said Ashish Jha, director of the Harvard Global Health Institute, who has advocated for increasing the number of people getting tested.

Local and state health officials worry that the lack of coherent strategy could result in tests becoming widely available for the affluent, while remaining limited for those with fewer resources, including minority communities that have already been disproportionately affected by the virus.

At the University of Arizona, officials plan to reserve molecular swab tests, which determine if a person is currently infected, for symptomatic students and their contacts. Each test is about $50 to $75 dollars; there are 60,000 students, staff and faculty and each would have to be tested repeatedly.

“Maybe the NFL can afford that; we can’t, and I don’t know any university that can,” said Robert C. Robbins, the university’s president.

‘Box the virus in’

When coronavirus cases began to mount in March, a severe shortage of test kits and supplies meant tests were sharply rationed. Even after it was clear that the virus was spreading in the United States, the CDC at first recommend only testing people who had visited China or been in contact with someone who had.

Later, federal officials suggested that younger, healthy people did not necessarily need testing even if they were experiencing coronavirus symptoms, reasoning that the tests should be reserved for hospitalized patients for whom a positive result might make a difference in treatment plan.

As tests have become more available, officials have begun to recommend that anyone who is experiencing signs of illness, even a mild cough or sore throat, get one.

The goal is to identify and quarantine people with the disease, and then use contact tracers to track down people who have interacted with that person and quarantine them as well.

“Testing is just part of a comprehensive strategy,” former CDC director Tom Frieden said. “As you emerge from that sheltering situation, you box the virus in.”

But when it comes to testing people without symptoms, state recommendations vary.

About at least half of states aim to test people identified as contacts of known positive cases, according to a Post tally, as was recommended in new guidance from the CDC this week. But many others tell those people to self-isolate for 14 days.

“Every state is figuring this out on its own, little bit by little bit,” said Philip Chan, medical director for the Rhode Island Department of Health.

Nearly all states have set aside thousands of tests for people in congregate settings — residential settings where large numbers of people live in proximity, especially nursing homes and prisons.

But only a handful of states have so far satisfied the CDC goal to test everyone living in a nursing home, where the age and underlying medical conditions of residents make them especially vulnerable to covid-19 outbreaks.

Some states have also prioritized testing front-line health-care workers and other people working elbow-to-elbow in manufacturing facilities, particularly meatpacking plants, which have been hit hard by the virus.

Even states that have conducted widespread testing in such facilities face difficult questions about whether a single round of testing is sufficient, given that people could easily contract the virus at any time, including after testing negative.

“There’s not a lot of communication between the states and there’s not a lot of specifics, so everybody’s kind of going on their own,” Wroblewski said.

A tricky disease

A number of states and large cities, such as Detroit and Los Angeles, have opened drive-through testing sites like those offered in Maryland, a mode of mass testing used effectively overseas in South Korea and elsewhere.

Experts have warned that drive-through sites often fail to collect enough information from those tested to follow up effectively. They also prioritize people who choose to show up, tending to mean tests go to better educated and informed residents and not necessarily those most likely to have been exposed to the virus.

In Macon, Ga., the Moonhanger Group set up drive-through testing for employees returning to work at their four restaurants. But they did not wait for the results, or for all employees to get tested, before reopening on May 26.

“We were confident, based on the low number of positive results reported in Bibb county, that none of our employees would test positive and we hoped to share that news with the public,” owner Wes Griffith wrote on Facebook. “Unfortunately and surprisingly, we have employees who have tested positive. All of them were a-symptomatic.” Griffith did not respond to a request for comment.

Three of the four restaurants had to quickly close again, pending further testing.

In Georgia, public officials are advertising on radio and social media to encourage anyone to get tested at drive-through sites.

Those tested have included political leaders, who got tested largely to encourage others to do so too, only to find themselves “shocked” when their results came back positive, said Phillip Coule, chief medical officer of the Augusta University Health System, which is partnering with the state on testing.

“It’s a great demonstration of how tricky this disease is,” he said.

Other states have downplayed asymptomatic testing as unreliable or a poor use of resources.

Coule noted that the message, “If you want a test, you can get a test,” puts the onus for deciding who should get tested on individuals, rather than prioritizing the highest-risk or the most vulnerable. One of his patients, he noted, sought a test because he wanted to honeymoon in St. Lucia and needed a negative result to enter the country.

Oregon only opened testing to front-line workers and long-term care residents without symptoms in April and continues not to recommend asymptomatic testing, saying on the state website that it is “not useful” because the false negative rate is high. Viral tests have been estimated to have up to a 20 percent false negative rate.

At a recent news conference, Oregon Health Authority Chief Medical Officer Dana Hargunani said people without symptoms are “unlikely or certainly less likely to cause transmission of the virus.”

‘It’s like a war’

For states looking to figure out who to test and when, advice from national experts has been abundant — but not always consistent.

Proposals from academics and other experts vary widely in their recommendations of the numbers of tests that should be performed each day, and many do not offer guidance about who should be tested.

Some researchers have recommended focusing on parts of the country that have few cases in hopes of stamping out the disease.

“We should quickly get resources to places where the disease can be suppressed, then backfill tests in the places currently overwhelmed,” said Glen Weyl, an economist at Microsoft, who worked on the Harvard University proposal. “It’s like a war — you have to more troops than the enemy in order to win a battle.”

Other researchers have proposed blanketing the country with tests, with a focus on places experiencing clear outbreaks.

Paul Romer, an economist at New York University, said there should be mass testing in hot spots that is quickly expanded to near-universal, constant testing for everyone — 23 million tests a day, noting that the cost of tests have dropped.

“It would be feasible if we just invested and made it happen,” he said.

Other countries have used aggressive and organized testing to help stop the spread of the virus. South Korea — where the first case of the coronavirus was diagnosed on the same day as in the United States — quickly started mass testing at drive-through sites to spot and isolate cases.

The government has also instituted a sophisticated and aggressive effort to trace contacts of any known case, to squelch outbreaks. After several people who visited nightclubs in Seoul tested positive in early May, the government within two weeks tracked down 46,000 people who might have been exposed and tested them all.

In Wuhan, China, the site of the world’s first major coronavirus outbreak, government officials said they tested nearly 10 million of the city’s 11 million residents since mid-May, part of an effort to test universally and ensure the city doesn’t experience a new wave of infections.

Still, many experts agree that completely random asymptomatic testing is not an effective strategy.

A report issued late last month by the Center for Infectious Disease Research and Policy at the University of Minnesota called for ramping up testing nationwide, including in some congregate settings and as part of public health research. But the report found that widespread testing of people without symptoms was not advisable in most workplaces, in schools or in the broader community.

Researchers at the center found such testing could waste precious resources and could cause problems for communities, given that the tests are not fully reliable.

“There’s been far too much of this group think around, ‘test, test, test,’ without understanding what it’s accomplishing,” said Michael Osterholm, the director of the center. “You need the right test, at the right time, for the right reasons.”

The report’s central recommendation: that HHS form a blue-ribbon commission with national experts to formulate advice for states.

Masks now seen as vital tool in coronavirus fight

Posted on June 13, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Economic Crisis, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing, World Health Organization (WHO) • Leave a comment

Masks now seen as vital tool in coronavirus fight

Evidence is mounting that widespread mask-wearing can significantly slow the spread of coronavirus and help reduce the need for future lockdowns.

Public health authorities did not initially put an emphasis on masks, but that’s changed and there is now increasing consensus that they play an important role in hindering transmission of the virus at a time when wearing one has become politicized as some states and businesses have made them a requirement for certain activities.

Wearing a mask is also seen by experts as a relatively easy action that could help avoid much costlier responses like stay at home orders and closing businesses.

“It’s a lot less economically disruptive to wear a mask than to shut society, so I can’t understand some of the resistance to mask wearing,” Tom Frieden, the former director of the Centers for Disease Control and Prevention (CDC), said on a call with reporters on Thursday.

Experts say mask-wearing is not the only response needed to slow the spread of the virus. Avoiding crowds and staying six feet apart from others is also important, as is an effective system of testing and contact tracing so people can quarantine and prevent further spread.

A study from University of Cambridge researchers this week found that widespread mask-wearing can help prevent a resurgence of the virus with less reliance on lockdowns that have proven economically devastating.

The modeling in the study found that if 50 percent or more of the population routinely wore masks, each infected person would on average spread the virus to less than one additional person, causing the outbreak to decline, the university said.

“We have little to lose from the widespread adoption of facemasks, but the gains could be significant,” Renata Retkute, one of the authors of the study, said in a statement.

Scott Gottlieb, the former FDA Commissioner for President Trump, pointed to the study on Twitter this week and wrote: “More widespread masking with higher quality masks could help mitigate a second wave.”

It cannot be ruled out that further lockdowns will be needed, but wearing a mask is one part of a strategy to help avoid them, according to Joshua Sharfstein, vice dean at the Johns Hopkins Bloomberg School of Public Health.

“I think it could substantially help open workplaces, but I’d still want to maximize distancing,” he said.

The emphasis on masks has been slow to develop in some places. The World Health Organization did not issue a recommendation for the general public to wear masks until last week, previously only saying people who are sick and those caring for them should use masks.

In the early days of the outbreak in the United States, there was also concern about the general public using up masks that were in short supply for health workers.

“Seriously people- STOP BUYING MASKS!” Surgeon General Jerome Adams tweeted at the end of February. “They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

That has changed, though, and the general public is now recommended to wear a simple cloth covering that could even be homemade, while leaving more advanced N95 masks for health care workers. The CDC now recommends wearing a mask in public when it is hard to stay six feet away from others, such as in grocery stores and pharmacies. Experts add that wearing a mask is mostly to protect others, not oneself.

“I don’t think it was so obvious from the beginning,” Sharfstein said, pushing back on critics who say authorities were slow to issue mask recommendations. “But it’s become more obvious,” he added.

Public health experts are lamenting, though, that mask-wearing has become politicized as opponents call requirements they wear one an infringement on their personal freedoms.

President Trump did not publicly wear a mask during a May visit to a Ford factory despite the company policy requiring one. He also called it “unusual” that presumptive Democratic presidential nominee Joe Biden wore a mask during a Memorial Day ceremony, though he said he “wasn’t criticizing.”

In Arizona, which has seen a surge in coronavirus cases recently, Gov. Doug Ducey (R) was pressed at a news conference on Thursday by a reporter who asked, “When was the last time you wore a face mask, governor?”

“I’ve got my face masks with me today,” Ducey said, taking some out of his pocket. “And when I’m not physically distancing, I wear them and wash them often.”

Some states, like Massachusetts and New York, have mandated masks when people are in public and cannot stay six feet apart. Asked if he would mandate masks in Arizona, Ducey did not answer directly, but said, “I want people to wear masks when they can’t socially distance.”

Carlos del Rio, a professor of epidemiology at Emory University, compared the situation with mask-wearing to the early days of seatbelts.

“Imagine if today was the ‘60s and we were starting to use seatbelts and you would have some politicians say, ‘Oh, seatbelts don’t make a difference; I like my freedom; I don’t like to be tied down when I’m driving,’” he said.

But, he added: “Over and over the evidence is showing masks work; masks make a difference.”

“I didn’t jump on masks immediately,” he said. “But after a while, I said, ‘Yeah this is what we all need to be doing,’ but I think it took some time.”

Cartoon – No Reason to Panic

Posted on June 12, 2020 by henrykotula • Posted in Cartoon, Coronavirus, Crisis, Crisis Management, Economic Crisis, Leadership, Management, Meeting, Meetings, Pandemic, Panic, Prudent, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

Dow plunges more than 1,800 points as rising COVID-19 cases roil Wall Street

Posted on June 11, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Economic Crisis, Economic Recovery, Economy Reopening, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Expectations, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Market, Job Search, Job Security, Market Outlook, Market Trends, Market Uncertainty, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Wall Street • Leave a comment

Dow plunges more than 1,800 points as rising COVID-19 cases roil Wall Street

Stocks plummeted Thursday as the emergence of new coronavirus hotspots and a caution from the Federal Reserve chairman shook Wall Street after months of steady gains.

The Dow Jones Industrial Average closed with a loss of 1,861 points, plunging 6.9 percent for its worst day of losses since March. The S&P 500 index closed with a loss of 5.9 percent, and the Nasdaq composite sunk 5.3 percent on the day.

All three major U.S. stock indexes closed with their steepest single-day losses since crashing in March amid the beginning of lockdowns imposed to slow the spread of COVID-19. Thursday’s losses come after more than two months of steady recovery toward the record highs seen before the pandemic derailed the economy.

Despite the loss of more than 21 million jobs and the deaths of more than 110,000 Americans due to the coronavirus, investors had gradually upped their bets on a quick economic recovery through April and May as states began loosening business closures and travel restrictions.

The surprise addition of 2.5 million jobs in May, according to the Labor Department, also fueled hopes for a quicker than expected rebound from a recession of unprecedented scale and speed.

But Thursday’s abrupt reversal comes as states across the U.S. see spiking COVID-19 cases and diminishing hospital capacity to handle a new wave of infections.

Week-over-week case counts are rising in half of all U.S. states, and only 16 states plus the District of Columbia have seen their total case counts decline for two consecutive weeks.

North Carolina, California, Mississippi and Arkansas are all facing record levels of hospitalizations, and the virus appears to be quickly spreading in Houston, Phoenix, South Carolina and Missouri.

Some market experts also attribute Thursday’s losses to Fed Chairman Jerome Powell’s Wednesday prediction of a “long road” to recovery.

During a Wednesday press conference, Powell said that while the U.S. may see significant job growth in coming months as people return to their jobs,” the country is “still going to face, probably, an extended period where it will be difficult for many people to find work.”

“What we’re trying to do is create an environment in which they have the best chance either to go back to their old job or to get a new job,” he continued.

President Trump, who frequently lashes out at the Fed when markets turn south, blasted the Fed for underestimating how quickly the U.S. economy could recover and how soon a COVID-19 vaccine would be available.

“The Federal Reserve is wrong so often. I see the numbers also, and do MUCH better than they do. We will have a very good Third Quarter, a great Fourth Quarter, and one of our best ever years in 2021. We will also soon have a Vaccine & Therapeutics/Cure. That’s my opinion. WATCH!” Trump tweeted.

Trump’s top economic advisor Larry Kudlow also criticized Powell, urging the Fed chief to ease up on the dour forecasts

“I do think Mr. Powell could lighten up a little when he has these press offerings. You know, a smile now and then, a little bit of optimism,” Kudlow said on Fox Business Network.

“I’ll talk with him and we’ll have some media training at some point.

U.S. Passes 2 Million Coronavirus Cases as States Lift Restrictions, Raising Fears of a Second Wave

Posted on June 11, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Communication, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Messaging, Mortality, Pandemic, Protest, Public Debate, Public Discourse, Public Health, Public Safety, Quarantine, Social Distancing, Vaccination, Vaccine, Vulnerable Populations, World Health Organization (WHO) • Leave a comment

https://www.democracynow.org/2020/6/11/dr_craig_spencer?utm_source=Democracy+Now%21&utm_campaign=a7a0b2232c-Daily_Digest_COPY_01&utm_medium=email&utm_term=0_fa2346a853-a7a0b2232c-192434661

The number of confirmed U.S. coronavirus cases has officially topped 2 million as states continue to ease stay-at-home orders and reopen their economies and more than a dozen see a surge in new infections. “I worry that what we’ve seen so far is an undercount and what we’re seeing now is really just the beginning of another wave of infections spreading across the country,” says Dr. Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center.

AMY GOODMAN: I certainly look forward to the day you’re sitting here in the studio right next to me, but right now the numbers are grim. The number of confirmed U.S. coronavirus cases has officially topped 2 million in the United States, the highest number in the world by far, but public health officials say the true number of infections is certain to be many times greater. Officially, the U.S. death toll is nearing 113,000, but that number is expected to be way higher, as well.

This comes as President Trump has announced plans to hold campaign rallies in several states that are battling new surges of infections, including Florida, Texas, North Carolina and Arizona — which saw cases rise from nearly 200 a day last month to more than 1,400 a day this week.

On Tuesday, the country’s top infectious disease expert, Dr. Anthony Fauci, called the coronavirus his worst nightmare.

DR. ANTHONY FAUCI: Now we have something that indeed turned out to be my worst nightmare: something that’s highly transmissible, and in a period — if you just think about it — in a period of four months, it has devastated the world. … And it isn’t over yet.

AMY GOODMAN: This comes as Vice President Mike Pence tweeted — then deleted — a photo of himself on Wednesday greeting scores of Trump 2020 campaign staffers, all of whom were packed tightly together, indoors, wearing no masks, in contravention of CDC guidelines to stop the spread of the coronavirus.

Well, for more, we’re going directly to Dr. Craig Spencer, director of global health in emergency medicine at Columbia University Medical Center. His recent piece in The Washington Post is headlined “The strange new quiet in New York emergency rooms.”

Dr. Spencer, welcome back to Democracy Now! It’s great to have you with this, though this day is a very painful one. Cases in the United States have just topped 2 million, though that number is expected to be far higher, with the number of deaths at well over 113,000, we believe, Harvard University predicting that that number could almost double by the end of September. Dr. Craig Spencer, your thoughts on the reopening of this country and what these numbers mean?

DR. CRAIG SPENCER: That’s a really good question. So, when you think about those numbers, remember that very early on, in March, in April, when I was seeing this huge surge in New York City emergency departments, we weren’t testing. We were testing people that were only being admitted to the hospital, so we were knowingly sending home, all across the epicenter, people that were undoubtedly infected with coronavirus, that are not included in that case total. So you’re right: The likely number is much, much higher, maybe 5, 10 times higher than that.

In addition, we know that that’s true for the death count, as well. This has become this political flashpoint, talking about how many people have died. We know that it’s an incredible and incalculable toll, over 100,000. Within the next few days, we’ll have more people that have died from COVID than died during World War I here in the United States. So that’s absolutely incredible.

We know that, also, just because New York City was bad, other places across the country might not get as bad, but that doesn’t mean that they’re not bad. So, we had this huge surge, of a bunch of deaths in New York City, you know, over 200,000 cases, tens of thousands of deaths. What we’re seeing now is we’re seeing this virus continue to roll across this country, causing these localized outbreaks.

And this is, I think, going to be our reality, until we take this serious, until we actually take the actions necessary to stop this virus from spreading. Opening up, like we’ve seen in Arizona and many other places, is exactly counter to what we need to be doing to keep this virus under control. So, yeah, I worry that what we’ve seen so far is an undercount and what we’re seeing now is really just the beginning of another wave of infections spreading across the country.

NERMEEN SHAIKH: Well, Dr. Spencer, I want to ask — it’s not just in the U.S. that cases have hit this dreadful milestone. Worldwide, cases have now topped 7 million, although, like the U.S., the number is likely to be much higher because of inadequate testing all over the world. But I’d like to focus on the racial dimension of the impact of coronavirus, not just in the U.S., but also worldwide. Just as one example, in Brazil — and this is a really stunning statistic — that in Rio’s favelas, more people have died than in 15 states in Brazil combined. So, could you talk about this, both in the context of the U.S., and explain whether that is still the case, and what you expect in terms of this racial differential, how it will play out as this virus spreads?

DR. CRAIG SPENCER: Absolutely. What we’re seeing, not just in the United States, but all over the world, is coronavirus is amplifying these racial and ethnic inequities. It is impacting disproportionately vulnerable and already marginalized populations.

Starting here in the U.S., if you think about the fact, in New York City, the likelihood of dying from coronavirus was double if you’re Black or African American or Latino or Hispanic, double than what it was for white or Asian New Yorkers, so we already know that this disproportionate impact on already marginalized and vulnerable communities exists here in the United States, in the financial capital of the world. It’s the same throughout the U.S. A lot of the data that we’re seeing over the past few days, as we’re getting this disaggregated data by race and ethnic background, is that it is hitting these communities much harder than it is hitting white and other communities in the United States.

The statistics that you give for Brazil are being played out all over the world. We know that communities that already lack access to good healthcare or don’t have the same economic ability to stay home and participate in social distancing are being disproportionately impacted.

That is why we need to focus on and think about, in our public health messaging and in our public health efforts, to think about those communities that are already on the margins, that are already vulnerable, that are already suffering from chronic health conditions that may make them more likely to get infected with and die from this disease. We need to think about that as part of our response, not just in New York, not just in the U.S., but in Brazil, in Peru, in Ecuador, in South Africa, in many other countries, where we’re seeing the disproportionate number of cases coming from now.

We’re seeing — you know, I think it was just pointed out that three-quarters of all the new cases, the record-high cases, over 136,000 this past weekend on one day, three-quarters of those are coming from just 10 countries. And we know that that will continue, and it will burn through those countries and will continue through many more.

As of right now, we haven’t seen huge numbers in places like West Africa and East Africa, sub-Saharan Africa, where many people were concerned about initially. Part of that is because they have in place a lot of the tools from previous outbreaks, especially in West Africa around Ebola. But it may be that we need more testing. It may be that we’re still waiting to see the big increase in cases that may eventually hit there, as well.

NERMEEN SHAIKH: Dr. Spencer, you mentioned that on Sunday — it was Sunday where there were 136,000 new infections, which was a first. It was the highest number since the virus began. But even as the virus is spreading, much like states opening in the U.S., countries are also starting to reopen around the world, including countries that have now among the highest outbreaks. Brazil is now second only to the U.S. in the number of infections, and Russia is third, and these countries are opening, along with India and so on. So, could you — I mean, there are various reasons that countries are opening. A lot of them are not able — large numbers of people are not able to survive as long as the country is closed, like, in fact, Brazil and India. So what are the steps that countries can take to reopen safely? What is necessary to arrest the spread of the virus and allow people at the same time to be out?

DR. CRAIG SPENCER: It’s tough, because we know that this virus cannot infect you if this virus does not find you. If there’s going to be people in close proximity, whether it’s in India or Illinois, this virus will pass and will infect you. I have a lot of concern, much as you pointed out, places like India, 1.3 billion people, where they’re starting to open up after a longer period of being locked down, and case numbers are steadily increasing.

You’re right that a lot of people around the world don’t have access to multitrillion-dollar stimulus plans like we do in the United States, the ability to provide at least some sustenance during this time that people are being forced at home. Many people, if they don’t go outside, don’t eat. If they don’t work, you know, their families can’t pay rent or really just can’t live.

What do we do? We rely on the exact same tools that we should be relying on here, which is good public health principles. You need to be able to locate those people who are sick, isolate them, remove them from the community, and try to do contact tracing to see who they potentially have exposed. Otherwise, we’re going to continue to have people circulating with this virus that can continue to infect other people.

It’s much harder in places where people may not have access to a phone or may not have an address or may not have the same infrastructure that we have here in the United States. But it’s absolutely possible. We’ve done this with smallpox eradication decades ago. We need to be doing this good, simple, bread-and-butter, basic public health work all around the world. But that takes a lot of commitment, it takes a lot of money, and it takes a lot of time.

AMY GOODMAN: It looks like President Trump is reading the rules and just doing the opposite — I mean, everything from pulling out of the World Health Organization, which — and if you could talk about the significance of this? You’re a world health expert. You yourself survived Ebola after working in Africa around that disease. And also here at home, I mean, pulling out of Charlotte, the Republican convention, because the governor wouldn’t agree to no social distancing, and he didn’t want those that came to the convention to wear masks. If you can talk about the significance, what might seem trite to some people, but what exactly masks do? And also, in this country, the states we see that have relaxed so much — he might move, announce tomorrow, the convention to Florida. There’s surges there. There’s surges in Arizona, extremely desperate question of whether a lockdown will be reimposed there. What has to happen? What exactly, when we say testing, should be available? And do you have enough masks even where you work?

DR. CRAIG SPENCER: Great. Yes. So, let me answer each of those. I think, first, on the World Health Organization, and really the rhetoric that is coming from the White House, it needs to be one of global solidarity right now. We are not going to beat this alone. I think that that’s been proven. This idea of American exceptionalism now is only true in that we have the most cases of anywhere in the world. We are not going to beat this alone. No country is going to beat this alone. As Dr. Fauci said, this is his worst nightmare. It’s my worst nightmare, as well. This is a virus that was first discovered just months ago, and has now really taken over the world. We need organizations like the World Health Organization, even if it isn’t perfect. And I’ve had qualms with it in the past. I’ve written about it, I’ve spoken about it, about the response as part of the West Africa Ebola outbreak that I witnessed firsthand. But at the end of the day, they do really, really good work, and they do the work that other organizations, including the United States, are not doing around the world, and that protects us. So, we absolutely, despite their imperfections, need to further invest and support them.

In terms of masks, masks may be, in addition to social distancing, one of the few things that really, really helps us and has proven to decrease transmission. We know that if a significant proportion of society — you know, 60, 70, 80% of people — are wearing masks, that will significantly decrease the amount of transmission and can prevent this virus from spreading very rapidly. Everyone should be wearing masks. I think, in the United States right now, we should consider the whole country as a hot zone. And the risk of transmission being very high, regardless of whether you’re in New York or North Dakota, people should be wearing a mask when they’re going outside and when they’re interacting with others that they generally don’t interact with.

We know the science is good. I will say that from a public health perspective, there was some initial reluctance and, really, I guess, some confusion early on about whether people should be using masks. We didn’t have a lot of the science to know whether it would help. We do now. And thankfully, we’re changing our recommendations.

We also were concerned about the availability of masks early on. As you mentioned, there was questions around availability of personal protective equipment, whether we had enough in hospitals to provide care while keeping providers safe. It’s better now, but there are still a lot of people who are saying that they’re reusing masks, that we still need more personal protective equipment. So, for the moment, everyone should be wearing a mask.

AMY GOODMAN: And for the protests outside?

DR. CRAIG SPENCER: Absolutely. Yeah, of course. Just because I think we have personal passions around public health crises, that doesn’t prevent us from being infected. From a public health perspective, of course I have concerns that people who are close and are yelling and are being tear-gassed and are not wearing masks, if that’s all the case, it’s certainly an environment where the coronavirus could spread.

So, what I’ve been telling everyone that’s protesting is exercise your right to protest — I think that’s great — but be safe. We are in a pandemic. We’re in a public health emergency. Wear a mask. Socially distance as much as you possibly can. Wash your hands.

AMY GOODMAN: And are you telling the authorities to stop tear-gassing and pepper-spraying the protesters?

DR. CRAIG SPENCER: I mean, well, one, it’s illegal. You should definitely stop tear-gassing. We know that what happens when people get tear-gassed is they cough, and it increases the secretions, which increases the risk. It increases the transmissibility of this virus.

In addition to that, you know, holding people and arresting them and putting them into small cells with others without masks is also, as we’ve seen from this huge number of cases in places like meatpacking plants or in jails, in prisons, the number of cases have been extremely high in those places. Putting people into holding cells for a prolonged period of time is not going to help; it’s definitely going to increase the transmissibility of this virus.

So, yes, everyone should be wearing a mask. I think everyone should have a mask on when you’re anywhere that your interacting with others can potentially spread this.

I think your other question was around testing. We know that right now testing has significantly increased in the U.S. Is it adequate? No, I don’t think so. I know I hear from a lot of people who say they still have to drive two to three hours to get a test. We still have questions around the reliability of some of serology tests, or the antibody tests. Those are the tests that will tell you whether or not you’ve been previously exposed and now have antibodies to the disease. Some of the more readily available tests just aren’t that great. And so, we can’t use them yet to make really widespread decisions on who might have antibodies, who might have protection and who can maybe more safely go back into society without the fear of being infected.

NERMEEN SHAIKH: Dr. Spencer, we just have 30 seconds. Very quickly, there are 135 vaccines in development. What’s your prognosis? When will there be a vaccine or a drug treatment?

DR. CRAIG SPENCER: We have one drug that shortens the time that people are sick. We don’t know about the impact on mortality. There are other treatments that are in process now. Hopefully some of them work.

In terms of vaccines, we will have a vaccine, very likely, that we know is effective, probably at some time later this year. The bigger process is going to be how do we scale it up to make hundreds of millions of doses; how do we do it in a way that we can get it to all of the people that deserve it, not just the people that can pay for it. I think these are going to be some of the bigger questions and bigger problems that we’re going to face, going forward. But I’m optimistic that we’ll have a vaccine or many vaccines, hopefully, in the next year.

AMY GOODMAN: Dr. Craig Spencer, we want to thank you so much for being with us, director of global health in emergency medicine at Columbia University Medical Center. And thank you so much for your work as an essential worker. Dr. Spencer’s recent piece, we’ll link to at democracynow.org. It’s in The Washington Post, headlined “The strange new quiet in New York emergency rooms.”

When we come back, George Floyd’s brother testifies before Congress, a day after he laid his brother to rest. Stay with us.

Trinity Health gets $2.2B in bailout funds, advance Medicare payments

Posted on June 11, 2020 by henrykotula • Posted in 2020 Election Issues, Balance Sheet, Cash, Cash Reserves, Economic Crisis, Economic Stimulus, Health Policy, Health System, Medicare Advance Payments, Net Income, Nonoperating Income, Operating Expenses, Operating Income, Operating Margin, Operating Performance, Operating Revenue, The CARES Act • Leave a comment

https://www.beckershospitalreview.com/finance/trinity-health-gets-2-2b-in-bailout-funds-advance-medicare-payments.html?utm_medium=email

New Relationships for Health Plans: Accountable Systems of Care ...

Trinity Health saw revenue decline in the first nine months of fiscal year 2020, and the Livonia, Mich.-based health system ended the period with an operating loss, according to unaudited financial documents.

Trinity Health saw revenue decline less than 1 percent year over year to $14.2 billion in the first nine months of the fiscal year, which ended March 31. The health system attributed the drop in revenue to the COVID-19 pandemic and the divestiture of Camden, N.J.-based Lourdes Health System in June 2019.

The 92-hospital system’s expenses were also up 1.2 percent year over year. Trinity Health ended the first three quarters of fiscal 2020 with expenses of $14.3 billion. Same-hospital expense growth was driven by increases in labor and supply costs, purchased services and costs related to its conversion to the Epic EHR platform in the Michigan region. The health system said the pandemic added $14.1 million of costs in March.

Trinity Health has taken several steps to reduce operating and capital spending in response to the pandemic, including implementing furloughs and reducing salaries for executives. In early April, Trinity Health announced plans to furlough 2,500 employees, most of whom are in nonclinical roles.

Trinity Health reported an operating loss of $103.5 million for the first nine months of the current fiscal year, compared to operating income of $115.2 million in the same period a year earlier.

After factoring in investments and other nonoperating items, Trinity Health posted a net loss of $883.5 million in the first three quarters of fiscal 2020, down from net income of $457.9 million a year earlier. Nonoperating losses in the first nine months of fiscal 2020 were primarily driven by the pandemic’s effect on global investment market conditions in March, the health system said.

To help offset financial damage, Trinity Health received funds from the $175 billion in relief aid Congress has allocated to hospitals and other healthcare providers to cover expenses and lost revenue tied to the pandemic. The health system said it received a total of $600 million in federal grants in April and May.

Trinity Health also applied for and received $1.6 billion of Medicare advance payments, which must be repaid.

Though Trinity Health is unable to forecast the pandemic’s impact on its financial position, it said the ultimate effect of COVID-19 on its operating margins and financial results “is likely to be adverse and significant.”

US showing signs of retreat in battle against COVID-19

Posted on June 11, 2020 by henrykotula • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Centralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, World Health Organization (WHO) • Leave a comment

US showing signs of retreat in battle against COVID-19

When throngs of tourists and revelers left their homes over Memorial Day weekend, public health experts braced for a surge in coronavirus infections that could force a second round of painful shutdowns.

Two weeks later, that surge has hit places like Houston, Phoenix, South Carolina and Missouri. Week-over-week case counts are on the rise in half of all states. Only 16 states and the District of Columbia have seen their total case counts decline for two consecutive weeks.

But instead of new lockdowns to stop a second spike in cases, states are moving ahead with plans to allow most businesses to reopen, lifting stay-at-home orders and returning to something that resembles normal life.

“There is no — zero — discussion of re-tightening any measures to combat this trend. Instead, states are treating this as a one-way trip. That sets us up for a very dangerous fall, but potentially even for a dangerous summer,” said Jeremy Konyndyk, a senior fellow at the Center for Global Development who oversaw the U.S. Agency for International Development’s Office of Foreign Disaster Assistance during the Obama administration.

The moves suggest that many Americans — anxious to end two-plus months of lockdowns, smarting from the devastating economic toll they have already suffered and focused on the social justice protests that have roiled the nation — are ready to put the coronavirus behind them.

Even as case curves bend upward again, little action has been taken to counter the reversal.

“There are places that I suspect a lot of people are shrugging their shoulders and just rushing forward,” said David Rubin, who runs the PolicyLab at Children’s Hospital of Philadelphia. “I just worry that they might lose control of their epidemic, and that’s what you have to worry about these days.”

The statistics are startling. The average number of confirmed cases over a two-week period has doubled or more in Arizona, Arkansas, Oregon and Utah. Fewer than a quarter of intensive care unit beds in Alabama, Georgia and Rhode Island are available.

In Texas, the number of people admitted to the hospital has grown 42 percent since Memorial Day. Arizona’s top health official has urged hospitals to activate their emergency plans.

North Carolina, California, Mississippi and Arkansas are all reporting record levels of hospitalizations.

Some experts worry Americans have begun to accept the drumbeat of death, numbed by the nearly 2 million cases already confirmed across the country and the 112,000 who have died.

A virus once dismissed as not a serious threat to the nation and later acknowledged as a public health emergency is now becoming just another daily worry to be absorbed.

“One fear is that the U.S. will accept tens of thousands of deaths, as from gun violence, unlike other countries,” said Tom Frieden, director of the Centers for Disease Control and Prevention during the Obama administration.

“It’s not just lives. Unless we protect lives, we won’t get livelihoods back,” said Frieden, who now runs Resolve to Save Lives, a global health nonprofit.

The race to reopen comes even as new research shows the lockdowns were working. The dramatic steps Americans took to stop the virus saved an estimated 5 million infections through April 6, according to research by the Global Policy Lab at the University of California-Berkeley.

President Trump has been perhaps the loudest proponent of reopening, at times putting pressure on states to lift coronavirus restrictions even if the data is flashing warning signs.

World Health Organization (WHO) officials have practically begged nations to be slow and considerate as they move to reopen their economies.

“We need to focus on the now. This is far from over,” Maria Van Kerkhove, the WHO’s technical lead on the coronavirus, told reporters at a virtual press conference Monday. “I know many of us would like this to be over and I know many situations are seeing positive signs. But it is far from over.”

On Wednesday, WHO’s director of emergency programs acknowledged the challenges of lockdown life.

“We fully understand that governments are very reticent to go back into lockdowns that can be damaging to social and economic life,” said Mike Ryan.

“There has to be a balance between lives and livelihoods and the public health control of COVID-19,” Ryan added.

There are few signs that Americans are heeding the warnings.

“We’re just at the beginning of the Memorial Day story, not at the end,” Rubin said. “We are seeing the sea levels rise.”

U.S. tops 2 million confirmed coronavirus cases

Posted on June 11, 2020 by henrykotula • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.cbsnews.com/news/coronavirus-united-states-cases-2-million/

The number of confirmed coronavirus cases in the United States topped 2 million late Wednesday night, according to Johns Hopkins University. The mark was passed with all 50 states in various stages of re-opening and with numerous states experiencing surges in cases and severe strain on their hospitals.

It’s been just five months since the coronavirus caused its first known U.S. fatality, in California, broke out in Washington state and quickly spread around the country.

The next closest nation to the U.S. in terms of number of cases is Brazil, with some 772,000.

The virus has killed almost 113,000 people in the U.S., Johns Hopkins said, and there were more than 7.3 million cases worldwide and 416,000 deaths.

And according to the Reuters News Service, the head of Harvard’s Global Health Institute, Ashish Jha, told CNN Wednesday that, “Even if we don’t have increasing cases, even if we keep things flat, it’s reasonable to expect that we’re going to hit 200,000 deaths sometime during the month of September. And that’s just through September. The pandemic won’t be over in September.”

Seventeen states have reported an increase in average daily new COVID-19 cases compared with two weeks ago, including Florida, California and Texas.

The ongoing pandemic has wreaked havoc on the U.S. economy. Tens of millions of people have filed for unemployment since states shut down to try to limit the virus’ spread. Several major companies, including J.C. Penney, J. Crew, Gold’s Gym and Hertz have filed for bankruptcy.

The Congressional Budget Office predicts the coronavirus could impact the nation until 2029 and cost the economy almost $16 trillion.

On Monday, White House Coronavirus Task Force officials said the police brutality protests around the country may spur a spike in virus cases. Many demonstrators haven’t been heeding public health guidelines for containing the virus, such as wearing masks and social distancing.

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HENRY KOTULA

A Healthcare Leadership Blog

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‘Historic’ consolidation will still happen, with some unexpected drivers

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Telehealth will be a double-edged sword

A new SNF-to-home diversion wave will emerge

There will be a land grab for palliative care

Demand will reach an all-time high

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Preparedness Of Community Health Centers For Telehealth

Permanent All-Payer Parity For Telehealth Reimbursement

Funding And Guidance For Equipment, Personnel, Training, And Protocols

Telehealth Support For Vulnerable Patients

Conclusions

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‘Box the virus in’

A tricky disease

‘It’s like a war’

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