Survey finds nearly one-third of rehired workers laid off again

https://thehill.com/policy/finance/510524-survey-finds-nearly-one-third-of-rehired-workers-laid-off-again

Survey finds nearly one-third of rehired workers laid off again

Nearly a third of the laid off workers who were able to go back to their previous jobs have been laid off again, according to a Cornell survey released Tuesday.

The survey was conducted by RIWI from July 23 to Aug. 1, as a slew of states experiencing major COVID-19 outbreaks slammed the breaks on their economic reopenings and reimposed social distancing restrictions.

Danielle Goldfarb, head of global research at RIWI, said it was a sign that a second wave of layoffs was well underway.

“Official and private sectors jobs data have not yet picked up the significant share of American workers that have already been re-laid off,” said Goldfarb.

“Since the impact is actually worse in states that have not seen COVID surges, these data indicate a systemic problem and a much deeper recession than the mainstream data suggest,” she said.

The survey found that about 37 percent of people who were not self-employed were laid off after the pandemic struck in March, but over half (57 percent) had been called back to work since then.

But of those, 31 percent had been laid off again and another 26 percent had been told there was a possibility they would lose their jobs.

A deeper dive into the data, however, suggested that the second round of layoffs may be less about the resurgence of the virus than the loss of aid. It found only small differences in “healthier” states, those not experiencing a surge, than in places with new outbreaks.

One possible reason for the additional layoffs are problems with businesses that had remained afloat with the help of forgivable loans from the federal Paycheck Protection Program (PPP).

The funds, which started rolling out the door in April, were supposed to be enough to cover eight weeks of salary and expenses.

“The RIWI dataset output clearly shows that a substantial portion of the job growth experienced in May and June resulted from anomalies associated with PPP requirements, as opposed to underlying economic strength,” said Daniel Alpert, a senior fellow and adjunct professor of macroeconomics at Cornell Law School.

Congress has made scant progress in negotiating a new COVID-19 response bill which is expected to include an extension of the PPP and may allow businesses to apply for a second loan.

The survey was completed by 6,383 respondents, though some questions had smaller samples because they were only applicable to some people.

The margins of error for the survey questions ran from plus or minus 1.5 percent to plus or minus 3.9 percent.

 

 

 

 

Pandemic reveals flaws of unemployment insurance programs

https://thehill.com/policy/finance/510368-pandemic-reveals-flaws-of-unemployment-insurance-programs

Pandemic reveals flaws of unemployment insurance programs

The lapse of enhanced jobless benefits amid a record-breaking crush of applications is exposing the flaws and shortcomings of how the U.S. provides unemployment insurance.

The economic toll of the coronavirus pandemic has torn holes in a federal safety net woven by individual systems for every state plus the District of Columbia, Puerto Rico and the Virgin Islands. More than 30.2 million Americans were on some form of unemployment insurance as of mid-July, with the Labor Department reporting a growing number of new applications in subsequent weeks.

Friday’s expiration of a $600 weekly add-on to state benefits plunged those vulnerable Americans into financial peril.

Congressional Democrats and Trump administration officials are now deadlocked over negotiations for a broader coronavirus relief package that’s expected to include some form of federal unemployment benefits.

But short-staffed unemployment offices across the U.S. grappling with outdated technology and unprecedented demand would face challenges from implementing a scaled-down or more complicated approach to the weekly payments.

Economists and labor market experts also warn that any solution that emerges from the negotiations would take weeks, if not months, to get up and running, risking a potentially catastrophic fiscal cliff for tens of millions of U.S. households.

“You ought to be able to deliver the program that’s on the books,” said Douglas Holtz-Eakin, former director of the Congressional Budget Office and a White House economist under former President George W. Bush.

“The states, collectively, seem to have not kept up the systems and we now have a big problem because of that,” he added.

The unprecedented size and speed of the pandemic-driven economic collapse has posed a brutal challenge for state unemployment agencies. After 10 years of steady economic expansion, the labor market quickly went from the lowest unemployment rate in 50 years to the highest level of joblessness since the Great Depression.

New claims for unemployment benefits were averaging roughly 200,000 nationwide a week before the pandemic — a manageable level for state agencies that had largely been neglected during the longest stretch of growth in modern U.S. history. But the coronavirus lockdowns spurred 3.3 million new claims between March 15 and March 22, a then-record that would be doubled the following week. Before the COVID-19 outbreak, the previous record was 695,000 from the first week of October 1982.

A little more than four months after the pandemic hit, state agencies are now processing roughly 2 million new claims a week for both unemployment insurance and Pandemic Unemployment Assistance (PUA), a program designed to cover those who don’t qualify for typical benefits.

“On some level, you can’t really blame states for not being prepared for that level of onslaught,” said Michele Evermore, senior policy analyst at the National Employment Law Project.

“Usually, you see the recession starting up and state agencies say ‘You know, this looks like a recession here, so let’s start to staff up.’ This came on all at once, so we’ve had these neglected, antiquated systems and then there’s all these other stressors.”

The U.S. economy has been in recession since February, according to the National Bureau of Economic Research.

Processing the massive surge of unemployment claims on shoddy technology would have been hard enough for states. Adding enhanced benefits and PUA claims to the mix strained state agencies even more.

“It took time to upgrade those systems. It took time to hire and train new staff who could deal with the volumes of the calls, and all in a pandemic, when face-to-face contact and training and being together in office were not possible,” said Julia Pollak, labor economist at job recruitment and posting company ZipRecuriter.

“So it’s easy to see in hindsight why it all fell apart.”

Enhanced unemployment benefits are among the biggest obstacles to reaching a deal on what’s likely to be the last coronavirus relief package before the election. While President Trump and Republicans are divided over how and whether to extend the federal boost, Democrats are largely united behind extending the benefits and reducing them gradually along a curve tied to the unemployment rate.

Speaker Nancy Pelosi (D-Calif.) has called for including such a mechanism, known as an automatic stabilizers, in the coronavirus package being negotiated.

Rep. Don Beyer (D-Va.), vice chair of the Joint Economic Committee, introduced a separate bill designed to tackle economic downturns beyond the coronavirus recession. His measure would establish a six-tier system for reducing the federal benefit in line with a state’s unemployment rate.

The approach was endorsed by former Federal Reserve Chairman Ben Bernanke, who oversaw the central bank’s response to the Great Recession, and his successor, Janet Yellen.

“Every time you get close to a cliff and there’s a political battle and political price to be paid, probably by both sides, rather than just saying ‘This is what’s needed,’ let’s kick it in,” Beyer said in an interview.

“We talked to economists all across the country and virtually everyone we talked to said this makes the most sense.”

But Republican lawmakers and right-leaning economists have pushed back on efforts to codify mandatory spending and make decisions now about what will be needed to mitigate future crises.

“It’s hard for me to understand why it’s appropriate now to anticipate the economic conditions in the future and tie the hands of future elected representatives of Congress,” Holtz-Eakin said.

“It forked out $2.3 trillion in [the CARES Act] across the board in ways that got to small businesses, to households, to the employed, the unemployed. If you’re going to have one in 100-year events, that’s how you deal with them,” he added.

Republicans have instead proposed replacing the flat $600 weekly boost with a percentage of the worker’s pre-pandemic earnings in addition to what is prescribed by each state. While the wage-replacement is more tailored, Evermore warned that making the necessary calculations for each claimant could overwhelm an already teetering system.

“If you told states that they had to do a percentage replacement — oh, my gosh, that’s a recipe for crashing everything,” she said.

“It’s just not how the system is set up to work.”

 

 

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

 

What it’s like to be a nurse after 6 months of COVID-19 response

https://www.healthcaredive.com/news/what-its-like-to-be-a-nurse-6-months-coronavirus/581709/

Those on the front lines of the fight against the novel coronavirus worry about keeping themselves, their families and their patients safe.

That’s especially true for nurses seeking the reprieve of their hospitals returning to normal operations sometime this year. Many in the South and West are now treating ICUs full of COVID-19 patients they hoped would never arrive in their states, largely spared from spring’s first wave.

And like many other essential workers, those in healthcare are falling ill and dying from COVID-19. The total number of nurses stricken by the virus is still unclear, though the Centers for Disease Control and Prevention has reported 106,180 cases and 552 deaths among healthcare workers. That’s almost certainly an undercount.

National Nurses United, the country’s largest nurses union, told Healthcare Dive it has counted 165 nurse deaths from COVID-19 and an additional 1,060 healthcare worker deaths.

Safety concerns have ignited union activity among healthcare workers during the pandemic, and also given them an opportunity to punctuate labor issues that aren’t new, like nurse-patient ratios, adequate pay and racial equality.

At the same time, the hospitals they work for are facing some of their worst years yet financially, after months of delayed elective procedures and depleted volumes that analysts predict will continue through the year. Many have instituted furloughs and layoffs or other workforce reduction measures.

Healthcare Dive had in-depth conversations with three nurses to get a clearer picture of how they’re faring amid the once-in-a-century pandemic. Here’s what they said.

Elizabeth Lalasz, registered nurse, John H. Stroger Hospital in Chicago

Elizabeth Lalasz has worked at John H. Stroger Hospital in Chicago for the past 10 years. Her hospital is a safety net facility, catering to those who are “Black, Latinx, the homeless, inmates,” Lalasz told Healthcare Dive. “People who don’t actually receive the kind of healthcare they should in this country.”

Data from the CDC show racial and ethnic minority groups are at increased risk of getting COVID-19 or experiencing severe illness, regardless of age, due to long-standing systemic health and social inequities.

CDC data reveal that Black people are five times more likely to contract the virus than white people.

This spring Lalasz treated inmates from the Cook County Jail, an epicenter in the city and also the country. “That population gradually decreased, and then we just had COVID patients, many of them Latinx families,” she said.

Once Chicago’s curve began to flatten and the hospital could take non-COVID patients, those coming in for treatment were desperately sick. They’d been delaying care for non-COVID conditions, worried a trip to the hospital could risk infection.

A Kaiser Family Foundation poll conducted in May found that 48% of Americans said they or a family member had skipped or delayed medical care because of the pandemic. And 11% said the person’s condition worsened as a result of the delayed care.

When patients do come into Lalasz’s hospital, many have “chest pain, then they also have diabetes, asthma, hypertension and obesity, it just adds up,” she said.

“So now we’re also treating people who’ve been delaying care. But after the recent southern state surges, the hospital census started going down again,” she said.

Amy Arlund, registered nurse, Kaiser Permanente Medical Center in Fresno, California:

Amy Arlund works the night shift at Kaiser Fresno as an ICU nurse, which she’s done for the past two decades.

She’s also on the hospital’s infection control committee, where for years she’s fought to control the spread of clostridium difficile colitis, or C. diff., in her facility. The highly infectious disease can live on surfaces outside the body for months or sometimes years.

The measures Arlund developed to control C. diff served as her litmus test, as “the top, most stringent protocols we could adhere to,” when coronavirus patients arrived at her hospital, she told Healthcare Dive.

But when COVID-19 cases surged in northern states this spring, “it’s like all those really strict isolation protocols that prior to COVID showing up would be disciplinable offenses were gone,” Arlund said.

Widespread personal protective equipment shortages at the start of the pandemic led the CDC and the Occupational Safety and Health Administration to change their longstanding guidance on when to use N95 respirator masks, which have long been the industry standard when dealing with novel infectious diseases.

The CDC also issued guidance for N95 respirator reuse, an entirely new concept to nurses like Arlund who say those changes go against everything they learned in school.

“I think the biggest change is we always relied on science, and we have always relied heavily on infection control protocols to guide our practice,” Arlund said. “Now infection control is out of control, we can no longer rely on the information and resources we always have.”

The CDC says experts are still learning how the coronavirus spreads, though person-to-person transmission is most common, while the World Health Organization recently acknowledged that it wouldn’t rule out airborne transmission of the virus.

In Arlund’s ICU, she’s taken care of dozens of COVID positive patients and patients ruled out for coronavirus, she said. After a first wave in the beginning of April, cases dropped, but are now rising again.

Other changing guidance weighing heavily on nurses is how to effectively treat coronavirus patients.

“Are we doing remdesivir this week or are we going back to the hydroxychloroquine, or giving them convalescent plasma?”Arlund said. “Next week I’m going to be giving them some kind of lavender enema, who knows.”

Erik Andrews, registered nurse, Riverside Community Hospital in Riverside, California:

Erik Andrews, a rapid response nurse at Riverside Community Hospital in California, has treated coronavirus patients since the pandemic started earlier this year. He likens ventilating them to diffusing a bomb.

“These types of procedures generate a lot of aerosols, you have to do everything in perfectly stepwise fashion, otherwise you’re going to endanger yourself and endanger your colleagues,” Andrews, who’s been at Riverside for the past 13 years, told Healthcare Dive.

He and about 600 other nurses at the hospital went on strike for 10 days this summer after a staffing agreement between the hospital and its owner, HCA Healthcare, and SEIU Local 121RN, the union representing RCH nurses, ended without a renewal.

The nurses said it would lead to too few nurses treating too many patients during a pandemic. Insufficient PPE and recycling of single-use PPE were also putting nurses and patients at risk, the union said, and another reason for the strike.

But rapidly changing guidance around PPE use and generally inconsistent information from public officials are now making the nurses at his hospital feel apathetic.

“Unfortunately I feel like in the past few weeks it’s gotten to the point where you have to remind people about putting on their respirator instead of face mask, so people haven’t gotten lax, but definitely kind of become desensitized compared to when we first started,” Andrews said.

With two children at home, Andrews slept in a trailer in his driveway for 12 weeks when he first started treating coronavirus patients. The trailer is still there, just in case, but after testing negative twice he felt he couldn’t spend any more time away from his family.

He still worries though, especially about his coworkers’ families. Some coworkers he’s known for over a decade, including one staff member who died from COVID-19 related complications.

“It’s people you know and you know that their families worry about them every day,” he said. “So to know that they’ve had to deal with that loss is pretty horrifying, and to know that could happen to my family too.”

 

 

 

Every sport has a coronavirus plan. MLB’s lasted four days.

https://www.washingtonpost.com/sports/2020/07/27/every-sport-has-coronavirus-plan-mlbs-lasted-four-days/

Cancel the MLB year, maybe by the end of this week.

Forget about the NFL season; it’s never going to happen.

The idea of attempting a college football season — putting amateur athletes at risk — is obscenely unthinkable.

Within days or a couple of weeks, we also may find out just how feasible it is for the NBA, in its Florida bubble, or the NHL, playing in two hub cities in Canada, to finish truncated seasons and crown champions.

Sure, none of that is certain, but Monday morning’s news that at least 14 members of the Miami Marlins and their staff have tested positive for the novel coronavirus in recent days was a Category 5 covid-19 hurricane alert. You couldn’t have a worse MLB start or a grimmer predictor for other games.

With lots of inherent social distancing, baseball was supposed to be the easiest major American team sport to resume, just as leagues in Japan and South Korea have functioned smoothly for months. But MLB couldn’t go even a week without the serious prospect that its 60-game season should be canceled.

“Hey, I’m going to be honest with you: I’m scared. I really am,” said Washington Nationals Manager Dave Martinez, 55, who has a heart condition.

Why is MLB creating a situation where Dusty Baker, 71, the survivor of multiple life-threatening conditions in the past 15 years, manages Houston every day while Texas is a national coronavirus hot spot?

Martinez added that before long his team may see more players “opt out,” as Ryan Zimmerman and Joe Ross already have. Once the defections start, the cascade won’t stop until the sport must call a halt.

“Now we REALLY get to see if MLB is going to put players health first,” tweeted Los Angeles Dodgers left-hander David Price, who passed on $11.8 million by opting out of this partial season. “Remember when [Commissioner Rob] Manfred said players health was PARAMOUNT?! Part of the reason I’m at home right now is because players health wasn’t being put first. I can see that hasn’t changed.”

Underneath all the discussions and elaborate plans to reopen various sports — MLB, the NBA and NHL now, and the NFL and college football by the end of next month — has been one naive assumption: If the virus hit a team, it would infect one or two players. Maybe three. But the sense was things still would be manageable. You could still field a team.

When did this become the highest of all human goals?

The danger and the damage would not be “too bad.” In this, we see Americans’ national tendency toward willful pandemic ignorance being played out on a small, crystal-clear stage so everyone can get the message.

For months, we have watched healthy people, mostly young, swarm into bars or hit the beaches with an apparent sense that community spread was a fiction or not something that applied to them. Maybe, the fantasy went, one person in the wrong bar would get the virus.

Now we learn differently. Now we see the truth.

Over a dozen Marlins and counting.

The immediate consequences of the Marlins’ outbreak were the postponements of their home opener against the Baltimore Orioles and the Philadelphia Phillies’ home game against the New York Yankees, who would have been occupying the clubhouse those Marlins just showered and dressed in Sunday.

The wider effect: Back to normal, or even semi-normal, in sports was shattered just days after being reintroduced.

What does this mean?

Some events have ambiguous consequences. We won’t know their impact for some time. But in rare cases, one event may have enormous impact, just as the positive virus test for the NBA’s Rudy Gobert in mid-March resulted in the shutdown of every major sport within 48 hours.

This is such a moment — but perhaps bigger.

Why are we here? The answer is simple yet inexplicably unacknowledged in wide swaths of this country: The pandemic is not under control until you stop it, suppress it, dominate it and crush the curve.

Though many other countries have done it, America has not come within a million miles of that outcome.

As I pointed out in a column last week, when a league says, Given what we are seeing with covid-19 hitting our teams, maybe we should cancel the season, the correct response is “get rid of the word ‘maybe.’ ”

The entire American experience of this pandemic has been: Don’t embolden the virus by acknowledging its threat. Try to outrun it, hide from it, say it’s not so bad and will go away.

That just breeds a disaster, and now that disaster has hit MLB just days into its season. The Cincinnati Reds also have multiple positive tests. The Atlanta Braves have been without two catchers who have symptoms, though no positive tests. Nationals star Juan Soto is inactive after a positive test.

Do we need a longer list?

You can’t be much healthier, as a group, than a pro baseball team. You can’t be much better protected or tested more often than an MLB team. The Marlins are close to the safest possible case. And now, less than a week into their season, at least half of the team has the coronavirus!

That is what is meant by “community spread.” That is what is meant by an “outbreak” in an epidemic. All of us have worried that one or two players — or people in the MLB community — would have bad outcomes from the virus if a 60-game season was played. Time to blow up that assumption. If half of the Marlins team can test positive within a few days, then the scale of danger to health — the number of people who may get sick and the severity of the damage they may suffer, including prime-of-life pro athletes — just shot through the ceiling.

Our assumptions, while well-intentioned, have been blown to pieces. And in short order, so will the season of one, or perhaps several, of our sports.

The Marlins are just the latest — but one of the most vivid — illustrations of what America is facing. And how little we are willing to take seriously the true measure of our fearsome enemy.

 

 

 

 

Employers Require COVID Liability Waivers as Conflict Mounts Over Workplace Safety

Employers Require COVID Liability Waivers as Conflict Mounts Over Workplace Safety

After spending a May day preparing her classroom to reopen for preschoolers, Ana Aguilar was informed that the tots would not have to wear face masks when they came back. What’s more, she had to sign a form agreeing not to sue the school if she caught COVID-19 or suffered any injury from it while working there.

Other teachers signed the form distributed by the Montessori Schools of Irvine, but Aguilar said she felt uncomfortable, although it stipulated that staff members would be masked. At 23, she has a compromised immune system and was also worried that she could pass the coronavirus on to her fiancé and other family members.

Aguilar refused to sign, and a week later she was fired. “They said it was my choice to sign the paper, but it wasn’t really my choice,” said Aguilar, who’s currently jobless and receiving $276 a week in unemployment benefits. “I felt so bullied.”

As employers in California and across the country ask employees to return to the workplace, many have considered and some are requiring employees to sign similar waivers, employment lawyers say. And many employees, mostly lower-wage and minority workers in essential jobs, are calling lawyers to complain about the waivers.

“These are illegal agreements that are totally unfair to workers,” said Christian Schreiber, a San Francisco lawyer who represents Aguilar and other employees.

The California State Legislature last year passed a law, AB-51, prohibiting employers from requiring employees or job applicants to sign away their right to pursue legal claims or benefits under state law. The law, which also prohibits firing any employee for refusing to sign, is being challenged in court by business groups.

Only a few employers have forced employees to sign liability waivers, at least partly because these waivers likely would be held unenforceable by courts, lawyers who represent employers say.

“Courts don’t recognize them because of the unequal bargaining power between employers and employees,” said Isaac Mamaysky, a partner at the Potomac Law Group in New York City. “With so many unemployed, people would sign just about anything to get a job.”

Another reason they are considered unenforceable: Workers who get sick or injured on the job generally are compensated through state workers’ compensation systems rather than through the courts, and state laws don’t allow employers to force employees to sign away their right to pursue workers’ comp claims, Mamaysky said.

Companies may have the right to require nonemployees working on their premises to sign COVID waivers. When the New York Stock Exchange reopened in late May, it made floor traders sign a form clearing the exchange of liability if they contracted COVID-19. That was legally permissible because the traders were not exchange employees, an NYSE spokesman said. He declined to say whether any traders have become infected with the virus.

The Las Vegas-based restaurant chain Nacho Daddy, which did require employees to surrender their right to sue over COVID-19, reportedly fired some who refused. Following negative media coverage, Nacho Daddy removed the language that waived legal rights and instead had employees agree to follow safety rules such as masking and social distancing. The company did not respond to a request for comment.

Having employees agree to comply with safety rules is a more common and legally acceptable approach than waivers.

“I suggest my clients go to this reasonable middle ground: Here’s what we promise to you, here’s what we want you to promise to us,” said David Barron, an employment lawyer with Cozen O’Connor in Houston.

Business groups hope Senate Majority Leader Mitch McConnell will make liability waivers unnecessary. He has proposed a Senate bill with broad liability protection for employers for five years against a range of coronavirus-related claims, and says he won’t back any COVID relief bill that doesn’t include such protections. President Donald Trump has said he supports the liability protection.

At least 10 states already have enacted laws providing some form of immunity for businesses from lawsuits brought by employees and others who contract COVID-19. Similar bills are pending in about 10 more states, according to the National Employment Law Project. The California Assembly is considering a liability protection bill for public K-12 schools.

Federal legislation to provide COVID liability relief for employers should protect only those that follow applicable health and safety guidelines, said John Abegg, executive vice president of the U.S. Chamber Institute for Legal Reform, which supports McConnell’s proposal.

But even if McConnell is able to overcome Democratic opposition and pass liability protection as part of a new pandemic economic relief bill, that still wouldn’t shield employers from lawsuits claiming gross negligence or reckless or intentional conduct in failing to implement COVID-19 safety precautions.

Across the country, hospitals and nursing homes, as well as companies like McDonald’s, Walmart and Safeway, have been hit with wrongful death lawsuits filed by families of employees who died from the virus. They typically cite egregious conduct that goes beyond ordinary negligence, potentially erasing any statutory liability relief.

Nearly 50 COVID-related lawsuits have been filed relating to conditions of employment, including exposure to the coronavirus or the lack of protective equipment, according to data collected by the law firm Hunton Andrews Kurth.

In many states, alleging intentional misconduct also may allow workers harmed by COVID-19, and their families, to file lawsuits rather than go through the workers’ compensation system, and thus seek bigger damage awards.

For instance, a suit filed in Alameda County Superior Court in June by the widow of a longtime employee of Safeway’s distribution center in Tracy, California, alleged that the company had concealed a COVID-19 outbreak from workers and informed them that personal protective equipment was not recommended, contrary to guidelines from federal and state authorities.

“I don’t know of any jurisdiction that would allow a waiver against intentional misconduct,” said Louis DiLorenzo, head of the labor and employment practice for Bond Schoeneck & King in New York, who represents employers. “That would encourage misconduct.”

Worker advocates argue that lawsuits like the one against Safeway should be encouraged — rather than blocked by waivers or immunity laws — to bring to light serious public safety problems. Cases against McDonald’s in Oakland and Chicago — in which workers claimed the restaurants had created a “public nuisance” by not taking steps to adequately protect workers and customers from COVID-19 — resulted in court orders in late June for those McDonald’s restaurants to implement safety measures such as masks, social distancing and temperature checks.

“A very tiny number of cases are being filed by workers, and those cases are valuable,” said Hugh Baran, a staff lawyer at the National Employment Law Project. “These are the kinds of claims we should want workers to bring.”

Schreiber said he contacted the Montessori school about Aguilar’s firing, and it offered to reinstate her without having her sign the waiver. But Aguilar declined, saying the school was putting teachers at risk by not requiring pupils to wear masks. The school then offered her six weeks of severance pay, which she is considering.

By refusing to sign the waiver or accept her job back, she said, she was standing up for all the teachers at the school, many of whom have children and can’t afford to lose their job.

“I liked my job and I needed the paycheck,” Aguilar said. “But making you sign these papers is telling you that whatever happens, they really don’t care.”

 

 

 

6 months in: What will the new normal look like for hospitals?

https://www.healthcaredive.com/news/6-months-in-new-normal-hospitals-covid/581524/

Experts say a sustained state of emergency is likely until there is a cure or vaccine for COVID-19.

The first U.S. hospital to knowingly treat a COVID-19 patient was Providence Regional Medical Center in Everett, Washington, on Jan. 20. Since then, every aspect of healthcare has been upended, and it’s becoming increasingly clear all parts of society will have to adapt to a new baseline for the foreseeable future.

For hospitals and doctors’ offices, that means building on a major shift to telemedicine, new workflows to allow for more infection control and revamping the supply chain for pharmaceuticals, personal protective equipment and other supplies. That’s on top of ongoing challenges of burned out workers and staff shortages further exacerbated by the pandemic.

Looking out even further, the industry will have to figure out how to treat potential chronic conditions in COVID-19 survivors and, until an effective vaccine is developed, how to manage new outbreaks of the disease.

Experts say U.S. hospitals are generally in a much better position for dealing with COVID-19 now than they were in March, and providers are learning more every week about the best treatments and care practices.

June survey of healthcare executives conducted by consultancy firm Advis found that 65% of respondents said the industry is prepared for a fall or winter surge, about the inverse of what an earlier survey with that question showed.

“We’ve evolved. We’re in a much better state now than we were in the beginning of the pandemic,” Michael Calderwood, associate chief quality officer at Dartmouth-Hitchcock Medical Center, told Healthcare Dive. “There’s been a lot of learning.”

But the number of positively identified cases has now topped 4 million, and little political will exists to reinstitute widespread shutdowns even in areas where surges have filled ICUs to capacity. No treatment or vaccine for the disease exists or appears imminent. Testing and contract tracing efforts are too few and remain scattered and uncoordinated.

Whether there is a clear nationwide second wave or smaller surges in various parts of the country at different times, hospitals will need to remain in an effective state of emergency that requires constant vigilance until there is a cure or vaccine.

“Until we’re armed with that, we’re always going to have to be working like this. I don’t see any other way,” Diane Alonso, director of Intermountain Healthcare’s abdominal transplant program, told Healthcare Dive.

The fall will bring additional challenges. Flu season usually begins to ramp up in October, and if the strains in wide circulation this year are severe, that will further stress the health system. While some schools have announced they will be virtual-only for the rest of 2020, others are committed to in-person classes. That could mean increased community spread, especially in college towns. Colder weather that forces people indoors — where the novel coronavirus is far more likely to spread — will also be a complicating factor.

So far, hospitals have been reluctant to once again halt elective procedures, though some have had to, arguing that the care is still necessary and can be done safely when the proper protections are in place. But that doesn’t mean volume will rebound to pre-pandemic levels.

“While we think demand will come back, we’ve seen some flattening on demand in certain aspects that may be the new indicator of the new norm in terms of how people seek care,” Dion Sheidy, a partner and healthcare advisory leader at advisory firm KPMG, told Healthcare Dive.

Accelerating trends to provide care outside hospitals

When the number of COVID-19 cases first surged in the U.S. and stay-at-home orders were implemented nationwide, telehealth became a necessary way for urgent care to continue.

Virtual visits skyrocketed in March and April as CMS and private payers relaxed regulations and expanded coverage. Some of that will be rolled back, but much may persist as patients and providers grow more used to using telehealth and platforms become smoother.

Virtual care can’t replace in-person care, of course, and some patients and doctors will prefer face-to-face visits. The middle- to long-term result is likely to be that telehealth thrives for some specialties like psychiatry, but drops substantially from the highest levels during shutdowns throughout the country.

Other care settings outside of the hospital may see upticks as well, including at-home and retail-based primary and urgent care.

Renee Dua, the CMO of home healthcare and telemedicine startup Heal, said the company has seen virtual visits increase eight fold since the pandemic began in the U.S. and a 33% increase in home visits as people seek to continue care while reducing their risk of exposure to the coronavirus.

“The idea that you do not use an office building to get care — that’s why we started Heal — we bet on the fact that the best doctors come to you,” Dua told Healthcare Dive.

And care does need to continue, particularly vital services like vaccinations and pediatric checkups.

“You cannot ignore preventive screenings and primary care because you can get sick with cancer or with infectious diseases that are treatable and preventable,” Dua said.

Movements toward non-traditional settings existed before anyone had heard of COVID-19, but the realities of the pandemic have shifted resources and spurred investment that will have lasting effects, Ross Nelson, healthcare strategy leader at KPMG, told Healthcare Dive.

“What we’re going to see is there going to be an acceleration of the underlying trends toward home and away from the hospital,” he said.

Some of this was already underway. Multiple large health systems have established programs to provide hospital-level care at home and major employers have inked contracts to have primary care delivered to employees at on-site clinics.

PPE, staff shortages lingering

A key problem for hospitals in the first COVID-19 hotspots, such as Washington state and New York City, was a lack of necessary personal protective equipment, including N95 masks, gowns, face shields and gloves.

Also running low were supplies like ventilators and some drugs necessary for putting people on those machines.

While advances have certainly been made, the country did not have enough time to build up those supply stores before new surges in the South and West. The result has been renewed worries that not enough PPE is available to keep healthcare workers safe.

Chaun Powell, group vice president of strategic supplier engagement at group purchasing organization Premier, said “conservation practices continue to be the key to this” as COVID-19 surges roll through the country. The longer those dire situations continue, the more stress is put on the supply chain before it has a chance to recover.

Premier’s most recent hospital survey found that more than half of respondents said N95s were heavily backordered. Almost half reported the same for isolation gowns and shoe covers.

Calderwood said there has been improvement, however. “We have a much longer days-on-hand PPE supply at this point and the other thing is, we’ve begun to manufacture some of our own PPE,” he said. “That’s something a number of hospitals have done in working with local companies.”

But the ability to manufacture new PPE in the U.S. also depends on the availability of raw materials, which are limited. That means significant advancements in domestic production are likely several months away, Powell said.

Health systems have stepped up the ability to coordinate and attempt to get equipment where it’s needed most, especially for big-ticket items like ventilators. Providers are more hesitant, however, to let go of PPE without the virus being better contained.

The backstop supposed to help hospitals during a crisis is the national stockpile, which the federal government is attempting to resupply. It doesn’t appear to be enough, though, at least not yet, Calderwood said.

“One thing that concerns me is we did have a national stockpile of PPE, and I get the sense that we’ve kind of burned through that supply,” he said. “And now we’re relying on private industry to meet the need.”

Another problem hospitals face as the pandemic drags on is maintaining adequate staffing levels. Doctors, nurses and other front-line employees are in incredibly stressful work environments. The great potential for burnout will exacerbate existing shortages, just as medical schools are still trying to figure out how to continue with training and education.

“Those areas are concerning to our hospitals because our hospitals depend on a whole myriad of medical staff,” Advis CEO Lyndean Brick said. “Whether it’s physicians, nurses, technicians, housekeepers — that whole staff complement is what’s at the core of healthcare. You can have all the technology in the world but if you don’t have somebody to run it that whole system falls apart.”

On top of that is the increase in labor strife as working conditions have deteriorated in some cases. Nurses have reported fearing for their safety among PPE shortages and alleged lapses in protocol. Brick said she expects strike threats and other actions to continue.

Changing workflows

When COVID-19 cases started ramping up for the first time in the U.S., hospitals throughout the country, acting on CMS advice, shut down elective procedures to prepare their facilities for a potential influx of critical patients with the disease. In some areas, hospitals did have to activate surge plans at that time. Others have done so more recently as the result of increases in the South and West.

But few have resorted to once again halting electives. Brick told Healthcare Dive she doesn’t expect that to change, mostly because hospitals have by and large figured out how to properly continue that care.

She trusts any that can’t do so safely, won’t try.

For the majority of our providers, except in the occasional state where they’re having a real problem right now, I think that we’re going to see elective surgeries still continue,” Brick said. “Because most of our hospitals have capacity right now. They’re able to do this successfully and securely, and it’s really detrimental to patients to not get the care that they need.”

Hospitals rely on elective procedures to drive their revenue, an added motivation to find ways to keep them running even when COVID-19 is detected at greater levels in the community.

Intermountain, based in Salt Lake City, recently performed its 100th organ transplant of the year, ahead of last year’s pace despite the disruption of the COVID-19 crisis.

Alonso, the program director for abdominal transplants, said that while transplants are considered essential services, staff did pause some procedures when electives were halted and have re-evaluated workflow to be as safe as possible to patients, who are at higher risk after surgery because they are immunocompromised.

The hospital developed a triage system to help evaluate what services are necessary based on what level of COVID-19 spread is present in the community and how many beds and staffers are available to treat them.

The system’s main hospital has certain floors and employees designated for COVID-19 treatment. Staff have been reallocated for certain needs like testing and there are plans available if doctors and surgeons need to be deployed to the ICU.

As many outpatient visits as possible are being changed to virtual, but in the building, patients are screened for symptoms and required to wear masks and follow distancing protocols.

At the transplant center, doctors were at one point divided into teams in case someone got sick and coworkers had to self-isolate.

“We went through a dry run where, at the beginning, we shut down incredibly hard to see how we could do it operationally,” Alonso said. Intermountain hasn’t had to do that again, but is ready if such measures become necessary, she said.

Brick and others said that despite the genuinely frightening circumstance brought by the pandemic, hospitals’ responses have been admirable and providers have been quick to adapt. Slow or nonexistent leadership at the federal level, especially in sourcing and obtaining PPE, has been the bigger roadblock.

“Across the board, the whole healthcare industry has responded beautifully to this,” Brick said. “Where our country has fallen down is we don’t have a master plan to deal with this. Our federal leadership is reactionary, and we are not coordinating a master plan to deal with this in the long term. That’s where my concerns are at. My concerns are not at our local hospitals. They have their acts together.”

 

 

 

 

MLB faces its first coronavirus crisis with Marlins outbreak less than a week into season

https://www.washingtonpost.com/sports/2020/07/26/marlins-delay-return-miami-after-apparent-coronavirus-outbreak-among-players/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR1u7AypEX5AoBbLoaKIZ9tSyJqE-khQkODR5GviFpI3LJk8cV6T89CoYcw

Less than a week in, the 2020 Major League Baseball season has already reached its first crisis point, with the Miami Marlins reportedly stuck in Philadelphia and forced to cancel their home opener in Miami on Monday night after as many as a dozen players and coaches tested positive for the coronavirus.

The outbreak potentially has far-reaching consequences, affecting not only the Marlins, but the Philadelphia Phillies, who hosted the Marlins this weekend; the Baltimore Orioles, who were scheduled to open a series in Miami on Monday night; and the New York Yankees, who start a series in Philadelphia on Monday, in which they would occupy the same visitors’ clubhouse the Marlins just departed.

Major League Baseball has made no formal indication of what it would take to halt the 2020 season, with the ultimate decision resting with Commissioner Rob Manfred. An MLB spokesperson did not immediately return a message seeking comment Monday.

On Sunday, following their game against the Phillies, the Marlins decided to remain overnight at their Philadelphia hotel rather than travel home as scheduled, after three players tested positive. A fourth had tested positive on Friday. The plan, at that point, was to fly home Monday in time for their 7:10 p.m. game at Marlins Park against the Orioles.

In the meantime, the rest of the team’s traveling party was awaiting test results, which according to ESPN, resulted in an additional eight players and two coaches testing positive. Under MLB’s 2020 operations manual, players or coaches who test positive on the road are required to remain in that city and quarantine for 14 days, and must test negative twice at least 24 hours apart to return to the roster.

Unlike most other major sports leagues, MLB decided against the “bubble” model of bringing teams together, under strict quarantine rules, to one or two hub cities to stage its season — an option the players’ union rejected this spring. Instead, the 30 MLB teams are playing in 30 different stadiums and traveling between cities, a step that experts believe increases the degree of difficulty for pulling off a season.

Teams have been granted expanded, 30-man rosters at the start of the season, plus up to an additional 30 reserves who train at an alternative site — which means the Marlins, theoretically, could field a team for its upcoming games, made up of a combination of unaffected players from their big league roster and reserves from their alternative site in nearby Jupiter, Fla.

However, the larger questions are how the Marlins’ outbreak occurred and whether such a crisis, coming within days of teams beginning to travel for games, is cause enough for MLB to take stronger action. Although Florida has among the highest caseload of coronavirus of any state in the United States, the Marlins have been out of the state for nearly a week, having played exhibition games in Atlanta last week before opening their season in Philadelphia.

 

 

 

 

Increasing unemployment alters national payer mix

https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8

 

One in every five workers is now collecting unemployment benefits as the country struggles to get the COVID-19 outbreak under control. A recent Families USA study estimates a quarter of the 21.9M workers that were furloughed or laid off between February and May lost their health insurance. And the payer mix will continue to change as the pandemic wears on.

The graphic below highlights a study from consultancy Oliver Wyman, looking at the impact of rising unemployment (at 15, 20 and 30 percent) on insurance coverage. With each five to ten percent rise in unemployment, the commercially insured population decreases by three to five percentThose who lose employer-sponsored insurance either remain uninsured, buy coverage on the Obamacare marketplaces, or qualify for Medicaid.

Surprisingly, Washington State and California are reporting little to no enrollment growth in Medicaid programs thus far. Experts point to lack of outreach and consumer awareness as key contributors to the slow growth—but Medicaid enrollment will likely begin to rise quickly in coming months as temporary furloughs convert to more permanent layoffs.

The right side of the graphic spotlights the growing number of uninsured individuals in those states with the highest uninsured rates. The previous record for the largest increase in uninsured adults was between 2008 and 2009, when nearly 4M lost coverage. The current pandemic-driven increase has crushed that record by 39 percent.

On average, states are seeing uninsured populations increase by two percent, with some as high as five percent. And the two states with the highest uninsured rates, Florida and Texas, are also dealing with the largest surge in COVID-19 cases and deaths. The ranks of the uninsured will continue to climb as states reimpose shutdowns, government assistance ends, and layoffs grow.

 

 

700+ Chicago nurses reach labor deal after 2-week strike

https://www.beckershospitalreview.com/hr/700-chicago-nurses-reach-labor-deal-after-2-week-strike.html?utm_medium=email

How Have Health Workers Won Improvements to Patient Care? Strikes.

More than 700 nurses who walked off the job for two weeks approved a new contract July 20 with Amita Health Saint Joseph Medical Center Joliet (Ill.), hospital and union officials confirmed to Becker’s.

The nurses are represented by the Illinois Nurses Association, and both sides had been negotiating a new contract since early spring. Nurses had worked without a contract since May 9 and went on strike July 4.

Pay and benefits have been key sticking points at the bargaining table. Additionally, the Illinois Nurses Association had claimed the hospital was not adequately addressing staffing issues.

The new contract includes agreements by the hospital to improve the staffing guidelines on certain units before Dec. 31 and to meet and confer with the union by that date to improve staffing throughout the facility, the union said in a news release. Health insurance premium contributions were also capped at 25 percent for full-time nurses and 35 percent for part-time nurses, the union said.

“While a majority of nurses voted for this contract, there are still many nurses who want to see more progress on safe staffing,” said Pat Meade, RN, one of the lead union negotiators. “We will continue the fight for safe staffing through enforcement of our contract and in Springfield.”

In an emailed statement to Becker’s, hospital spokesperson Tim Nelson said Amita Health is pleased with the agreement and called it “fair and just for all involved.”

The hospital hired temporary nurses from an outside agency to fill in during the strike.

Mr. Nelson said the hospital’s nurses will return to work July 22 for their regularly scheduled shifts.