Category Archives: Evidence-based Leadership

Provider groups push back against Trump claims that doctors are inflating COVID-19 numbers

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing • Leave a comment

https://www.healthcarefinancenews.com/news/provider-groups-push-back-against-trump-claims-doctors-are-inflating-covid-19-numbers

More than half of US states broke records in daily COVID-19 cases this month

The president’s comments at a recent rally are false and contribute to the spread of misinformation, they say.

Hospital groups are pushing back against President Trump’s claims this week that doctors are over-reporting COVID-19 deaths for financial gain. Trump made the comments at a Wisconsin rally on Saturday.

“You know some countries they report differently,” Trump is quoted as saying in Newsweek. “If somebody’s sick with a heart problem, and they die of COVID they say they die of a heart problem. If somebody’s terminally ill with cancer and they have COVID, we report them. And you know doctors get more money and hospitals get more money. Think of this incentive. … We’re going to start looking at things.”

WHAT’S THE IMPACT
 
Hospitals and health systems are eligible to receive higher payments for complex coronavirus-related treatment under the  Coronavirus Aid, Relief and Economic Security Act, under which they receive a Medicare add-on payment of 20%. However, American Hospital Association President and CEO Rick Pollack refuted Trump’s claims.

Asked to respond, the AHA referred to a viewpoint article written by Pollack in September, in which he sought to dispel what he called certain “myths.”

“Hospitals do not receive extra funds when patients die from COVID-19,” Pollack said. “They are not over-reporting COVID-19 cases. And they are not making money on treating COVID-19.

“The truth is, hospitals and health systems are in their worst financial shape in decades due to the coronavirus. In some cases, the situation is truly dire. An AHA report estimates total losses for our nation’s hospitals and health systems of least $323 billion in 2020. There is no windfall here.”

Pollack also noted that healthcare organizations adhere to strict coding guidelines and use the COVID-19 code for Medicare claims only for confirmed cases. Inappropriate coding can result in criminal penalties and exclusion from the Medicare program altogether.

In a more recent and direct response to the president’s latest comments, American Medical Association President Dr. Susan Bailey bemoaned that physicians are being pulled into a public battle over the legitimacy and motivation behind their work.

“The assault on public health and the undermining of efforts to defeat COVID-19 began with unfounded suspicions about the science and evidence of this novel coronavirus and how it spreads,” Bailey said on Tuesday. “It grew with speculation about harmful and unproven treatments for COVID-19, false claims that masks were a source of infections, and by misleading suggestions that increased testing alone explains why case counts are surging.

“It expanded again with inaccurate, dangerous statements about children being ‘almost immune’ from the most serious effects of COVID-19, a reckless plan of ‘focused protection’ and naturally acquired ‘herd immunity’ as a pathway out of this pandemic, and most recently with wild and highly offensive claims that physicians are inflating the number of COVID-19 cases and deaths to increase our incomes.”

Bailey said that many public health officials have been threatened and intimidated, prompting some to quit or retire, and decried the “campaign of misinformation” as a betrayal of public trust that threatens the work being done to treat and contain the virus.

“Our AMA will always stand on the side of patients and physicians, of science and evidence, and of free and honest conversations that build the trust that is so crucial to our work,” she said. “We will not hesitate to call out political intimidation and fear-driven rhetoric that undermines this trust or that interferes with our ability to deliver the very best care to patients.”

The American College of Emergency Physicians also issued a statement, calling Trump’s assertions “reckless” and “false.”

“To imply that emergency physicians would inflate the number of deaths from this pandemic to gain financially is offensive, especially as many are actually under unprecedented financial strain as they continue to bear the brunt of COVID-19,” ACEP wrote. “These baseless claims not only do a disservice to our health care heroes but promulgate the dangerous wave of misinformation which continues to hinder our nation’s efforts to get the pandemic under control and allow our nation to return to normalcy.”

THE LARGER TREND

The numbers of COVID-19 cases continue to bring grim news, especially in the U.S., which struggled early in the pandemic to secure testing capacity and necessary personal protective equipment for frontline healthcare workers.

As of Wednesday morning, the Johns Hopkins University coronavirus tracker showed more than 8.7 million confirmed cases of the virus in the U.S., with the death toll climbing to over 226,000. Both lead the world. Second on the list is India (7,990,322 cases, 120,010 deaths), while Brazil comes in third (5,439,641 cases, 157,946 deaths).

Fauci: The US is still in the first wave of COVID-19

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https://finance.yahoo.com/news/fauci-the-us-is-still-in-the-first-wave-160137351.html

The U.S. is well into its third peak of the coronavirus, marking a new record for daily cases at more than 83,000 over the weekend.

The total case count has surpassed 8.6 million and the death toll rose above 225,000. Globally, more than 43 million have been affected with more than 1.1 million dead.

In recent days, some experts and reports have referred to this as a third wave, while others refer to it as either an elongated first wave or a second wave.

Dr. Anthony Fauci, the nation’s top infectious disease expert, settled the debate with Yahoo Finance this Monday at its annual All Markets Summit.

“I look at it more as an elongated — and an exacerbation of — the original first wave,” Fauci said.

He explained that while the Northeast has been able to reduce its outbreak, the national baseline never fell to a more manageable number like 10,000 cases per day. Instead it’s stayed high at about 20,000 cases per day.

In addition, for areas which chose to open up after the initial brief national lockdown, some states did not follow strict guidelines.

“We started to see a peak that brought us up to around 70,000 per day,” Fauci said, adding that, “Now as we’re getting into the cold weather, we came back up again to the worst that we’ve ever had, which was over 80,000 per day.”

We’ve never really had waves in the sense of up and then down to a good baseline. It’s been wavering up and down. So now, we’re at the highest baseline. … [It’s] kind of semantics. You want to call it the third wave or extended first wave. No matter how you look at it, it’s not good news,” he added.

A similar debate ensued in the summer, with many pointing to the surge hitting parts of the country that had yet been unaffected, thereby making it the first wave. Some experts say they are used interchangeably, and others say the differentiation is actually only between the local and national levels.

Dr. Shira Doron, an infectious disease physician at Tufts Medical Center echoed Fauci’s declaration of an elongated first wave.

“Only when looking back at the shape of a curve can you truly call something a peak or wave. It’s also important to mention that the overall U.S. graph looks very different than individual state graphs,” Doron said.

“The U.S. as a whole, however, never declined to low levels after its first peak, which is why some people say we are still in the ‘first wave,’” she said.

“Overall, I think it’s more a matter of semantics than something scientific.”

Cartoon – Greatest Threat to America?

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Editorial Cartoons for Wednesday from Times Wire Services

Cartoon – Caught Not Wearing a Face Mask

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Cartoon, Coronavirus, Coronavirus Airborne Transmission, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing • Leave a comment
Granlund cartoon: Face coverings - Opinion - Daily Review Atlas - Monmouth, IL

An early pardon for overweight turkeys?

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Clinical Testing, Contact Tracing, Coronavirus, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Thanksgiving, Vulnerable Populations • Leave a comment

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

Thanksgiving's new leftovers: Turkeys too big for farmers to sell - The Washington Post

Overweight patients infected with COVID-19 have a higher risk of severe disease—but it turns out the pandemic may have brought a reprieve for overweight turkeys. According to a recent Washington Post piece, turkey farmers are facing a glut of, ahem, larger birds, as social distancing and reduced travel are expected to result in fewer people around the Thanksgiving dinner table, and fewer families springing for a 20-pound bird.

Farmers commit to their chicks as early as January, making a bet on the ratio of larger (male) toms versus smaller (female) hens to meet holiday demand, so many were locked into their plans before the pandemic hit. Demand for larger birds has also been hit by fewer orders for piece parts: with fall Renaissance festivals canceled, demand for turkey legs cratered. (Spare a thought for mead brewers as well.) Sadly, these soon-to-be-spared holiday heavyweights are unlikely to spend the winter roaming free—look for a rise in ground turkey supply a few months down the road. 

How to safely celebrate Thanksgiving during the pandemic

Smaller birds for smaller gatherings: just another way our “Pandemic Thanksgiving” will look like none we’ve experienced before.

COVID response leads voters’ healthcare concerns

Posted on by • Posted in 2020 Election Issues, ACA, Asymptomatic Transmission, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Election, Essential Health Benefits, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Supreme Court, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vaccine, Vaccine Distribution, Vaccine Efficacy, Vaccine Safety • Leave a comment

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

The upcoming election has huge implications for healthcare, far beyond how COVID is managed, ranging from how care is covered to how it’s delivered. The graphic above shows a continuum of potential policy outcomes of the November 3rd vote.

If President Trump wins a second term and Republicans control at least one house of Congress, there will likely be more attempts to dismantle the ACA, as well as continued privatization of Medicare coverage.

 If Democrats win the presidency and sweep Congress, actions to expand the Affordable Care Act (ACA), or even create a national public option, are on the table—although major healthcare reform seems unlikely to occur until the second half of a Biden term.

In the short term, we’d expect to see more policy activity in areas of bipartisan agreement, like improving price transparency, ending surprise billing and lowering the cost of prescription drugs, regardless of who lands in the White House.
 
While healthcare emerged as the most important issue for voters in the 2018 midterm elections, the COVID pandemic has overshadowed the broader healthcare reform platforms of both Presidential candidates heading into the election. As shown in the gray box, many Americans view the election as a referendum on the Trump administration’s COVID response. Managing the pandemic is one of the most important issues for voters, especially Democrats, who now rank the issue above reducing the cost of healthcare or lowering the cost of drugs. 

In many aspects, the COVID policies of Biden and Trump are almost diametrically opposed, especially concerning the role of the federal government in organizing the nation’s pandemic response.

The next administration’s actions to prevent future COVID-19 surges, ensure safe a return to work and school, accelerate therapies, and coordinate vaccine delivery will remain the most important aspect of healthcare policy well into 2021.

Heading into a “third wave” of the pandemic

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Centers for Disease Control & Prevention (CDC), Clinical Testing, Clinical Trials, Contact Tracing, Coronavirus, Coronavirus Treatment, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Election, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing • Leave a comment

https://mailchi.mp/f2794551febb/the-weekly-gist-october-23-2020?e=d1e747d2d8

The US broke its record for the highest number of new coronavirus cases in a day - Vox

In Thursday’s second and final Presidential debate, former Vice President Joe Biden warned that a “dark winter” lies ahead in the coronavirus pandemic, and with cases, hospitalizations, and deaths on the rise across the country, it now appears that we are headed into a “third wave” of infections that may prove worse than both the initial onset of COVID on the coasts and the summertime spike in the Sun Belt.

Yesterday more than 71,600 new cases were reported nationwide, nearing a late-July record. Thirteen states hit record-high hospitalizations this week, measured by weekly averages, most in the Midwest and Mountain West. Several Northeastern states, which had previously brought the spread of the virus under control, also experienced substantial increases in infections, leading schools in Boston to suspend all in-person instruction. Of particular concern is hospital capacity, which is already being strained in the more rural areas now being hit by COVID cases. With infection spikes more geographically widespread than in earlier waves, fewer medical workers are available to lend support to hospitals in other states, leading to concerns about hospital staffing as admissions rise.
 
As hospitalizations increase, so too will demand for therapeutics to help shorten the course and moderate the impact of COVID. This week, Gilead Sciences’ antiviral drug remdesivir, previously available under an Emergency Use Authorization (EUA) from the federal government, became the first drug to win full approval from the Food and Drug Administration (FDA) to treat patients hospitalized with COVID-19. The approval was based on clinical studies that showed that remdesivir can reduce recovery time, and also includes use for pediatric COVID patients under the age of 11.

Meanwhile, the FDA cleared AstraZeneca to resume US clinical trials of its coronavirus vaccine, which had been suspended for a month following an adverse patient event. It’s widely expected that one or more drug companies will submit their vaccine candidates for EUA sometime next month, although new polling data released this week indicates that the American public is growing more skeptical in their willingness to take an early vaccine against the virus, with only 58 percent of respondents saying they would get the shot when it first becomes available, down from 69 percent in August. (Only 43 percent of Black respondents say they would get the vaccine, compared to 59 percent of Whites—a racial divide that reveals deep distrust based on the history of inequities in the US healthcare system.) 

A long, dark winter': Experts worry about mental health in first full COVID winter - NEWS 1130

In many respects, the coming month will surely prove to be a pandemic turning point, revealing the magnitude of the next wave of COVID, the direction of US public health policy, the prospects for reliable therapeutics, and the timing of a safe and effective vaccine. We’ll soon know whether we are, indeed, headed for a winter of darkness.

Where Europe’s Second Wave Is Filling Up Hospitals

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Poland has turned its largest stadium into an emergency field hospital. The numbers of Covid-19 patients in Belgium and Britain have doubled in two weeks. And doctors and nurses in the Czech Republic are falling ill at an alarming rate.

As new cases of the virus began to increase again across Europe last month, hospitals were initially spared the mass influx of patients they weathered earlier this spring. Some suggested that the virus had become less deadly, or that older, more vulnerable people would be shielded.

But a second wave of serious illness is here, new data released on Thursday shows, making it clear that the pandemic is still dangerous and that adherence to control measures over the next few weeks will be crucial in preventing hospitals from becoming overrun for a second time this year.

The number of Covid-19 patients in hospitals across the continent is still less than half of the peak in March and April, but it is rising steadily each week, according to data from the European Centre for Disease Prevention and Control. People across much of Europe — including larger countries like France, Italy, Poland and Spain — are now more likely to be hospitalized with Covid-19 than those in the United States.

Bruno Ciancio, the head of disease surveillance at the center, said he was concerned that some of the worst-hit countries now — including the Czech Republic, Poland and Bulgaria — were not as affected this spring, and may not have expanded their hospital capacity or intensive care units.

“The signals were all there in September,” said Mr. Ciancio. “At this point it’s very important that all member states prepare their hospitals to deal with the increase in demand that is coming.”

Hospitalization rates are a key measure of the pandemic’s severity. The rates rise and fall days or weeks behind the tallies of new infections. But infection figures depend heavily on each country’s testing capacity, while seriously ill people tend to enter hospitals whether they have been tested for the virus or not.

Europe’s current wave of infection is due in part to the relative normalcy it experienced this summer. Unlike the United States, where the epidemic rose to a second peak in July and a third peak this month, travelers moved around Europe, college students returned to campus and many large gatherings resumed, all while the virus kept spreading.

Now hospitals are scrambling to prepare for an onrush of Covid-19 patients, at a time when bed and intensive care capacity will already be under strain during the winter flu season.

In Poland, the government converted the country’s largest stadium into a temporary field hospital with room for 500 patients. Hospitals in France, especially in the Paris area, have started to postpone non-emergency surgeries, while others have called back staff on leave. More than one-fifth of Spain’s intensive care beds are occupied by Covid-19 patients, and in Madrid, that figure is closer to 40 percent.

And in the Czech Republic — where the current hospitalization rate surpasses the worst period in Britain — physicians are worried about a shortage of staff. “In some regions, about 10 percent of the medical staff is either already infected or in quarantine,” said Petr Smejkal, the chief of infectious diseases and epidemiology at the Institute of Clinical and Experimental Medicine in Prague.

Mr. Smejkal said the country also lacks specialty workers like respiratory therapists, and that most nurses are not trained to operate ventilators. “I am most worried about personnel, and keeping a safe ratio of doctors to patients and nurses to patients,” he added.

There is hope that no place will experience the level of death that Bergamo, Italy, New York City and Madrid suffered this spring. How the virus spreads is better understood now, and treatments have improved, giving sick people a better chance of survival. Testing has expanded across Europe, allowing countries to identify outbreaks earlier, when they are easier to contain.

But it is unclear how successful those control measures will be, or if political resistance and collective exhaustion over new restrictions will make it harder to get the virus under control for a second time.

Deaths in most of Europe remain at a fraction of the levels seen in the spring. But they have ticked slowly upwards over the last several weeks, and they tend to lag hospitalizations by about a month. Experts say additional increases in deaths are likely over the next couple of weeks.

The COVID Tracking Project

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Data Analytics, Data Consistency, Data Control, Data Gathering, Data Management, Data Sharing, Data Transparency, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Infection Control, Infection Control Plan, Infectious Virus, Mortality, National Strategy, Pandemic, Public Health, Public Opinion, Public Perception, Public Safety, Public Trust, Quarantine, Scientists, Social Distancing, Transparency • Leave a comment

https://covidtracking.com/data/charts/us-daily-positive

The public deserves the most complete data available about COVID-19 in the US. No official source is providing it, so we are.

Every day, our volunteers compile the latest numbers on tests, cases, hospitalizations, and patient outcomes from every US state and territory.

https://covidtracking.com/

How the coronavirus pandemic could end

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https://www.axios.com/when-will-coronavirus-pandemic-end-ecef1ae7-33b5-474c-8a02-2471742dbe99.html

It’s still the early days of the coronavirus pandemic, but history, biology and the knowledge gained from our first nine months with COVID-19 point to how the pandemic might end.

The big picture: Pandemics don’t last forever. But when they end, it usually isn’t because a virus disappears or is eliminated. Instead, they can settle into a population, becoming a constant background presence that occasionally flares up in local outbreaks.

  • Many emerging viruses become part of the viral ecology. The four coronaviruses that cause the common cold are endemic, circulating in the population, and the influenza strains that cause seasonal flu predictably surge each year.
  • The SARS outbreak in 2003 didn’t go the same way due to biology and behavior: It was much less transmissible than the virus that causes COVID-19, countries contained it quickly, and it has pretty much disappeared.
  • One virus, smallpox, was eradicated through widespread vaccination, and polio may be close, after decades of effort and billions in funding.

What’s happening: The pandemic is deepening in the U.S., Europe and elsewhere in the world.

  • Experts — from the U.K.’s chief scientific adviser to pharmaceutical CEOs to the WHO — increasingly say SARS-CoV-2 is likely to circulate in the population on a permanent basis, mainly due to the foothold the virus has already established.
  • But what damage endemic COVID-19 causes will depend on different factors, including how often people are reinfected, vaccine effectiveness and adoption, and if the virus mutates in any significant way.

“If the vaccine is really effective, like the measles vaccine or the yellow fever vaccine, it’s just going to land like a ton of bricks and suffocate this. Maybe not quite eradicate it — yellow fever and measles are not eradicated — but it’ll be an utter game changer,” UC Irvine epidemiologist Andrew Noymer says.

  • But if the vaccines are less effective — as many experts expect for at least the first generation — COVID-19 may eventually behave more like the seasonal flu, Noymer says. (Still, the death rate of COVID-19 currently well eclipses that of the seasonal flu.)

Reinfection is “the big issue,” says Columbia University’s Jeffrey Shaman, who recently described how reinfection and other factors would affect the spread of SARS-CoV-2 if it became endemic.

  • So far, there are just a handful of documented reinfection cases, but evidence about whether people retain their antibodies after infection is mixed, and a lot of unknowns remain about the likelihood of reinfection.
  • The worst-case scenario would be that there isn’t a vaccine or long-lasting immunity and people get COVID-19 repeatedly and are just as likely to end up in the hospital as with initial infections, Shaman says.

“I would say COVID-19 is already endemic,” says Larry Brilliant, an epidemiologist who worked to eradicate smallpox and now chairs the nonprofit Ending Pandemics.

  • With about 59,000 new cases per day in the U.S. alone, Brilliant says “it is already everywhere.”
  • “It doesn’t really mean very much if it is endemic,” he adds. “The real question is: How does it all end?”

Eventually, COVID-19 could end up in “the retirement village of coronaviruses,” like HIV, which today can be treated to the point of elimination, or circulate at low levels and be kept in check with a vaccine, like measles, Brilliant says, laying out a handful of possible scenarios.

  • Noymer says he suspects that after its “cataclysmic emergence,” COVID-19 may eventually fade into a common cold after a decade or so.

What’s next: “We have to work with it as a virus that we will be contending with for years possibly,” Shaman says. “It doesn’t mean an effective vaccine or treatment won’t be developed. What it means is that holding out hope that we’re going to just get a vaccine and not doing anything else is not the level of preparation we need.”

  • Until we have an effective vaccine and better contact tracing and testing, Johns Hopkins University epidemiologist Justin Lessler says public health measures should continue encouraging the use of face masks and social distancing.
  • If the disease does become endemic, Lessler says it’s likely to eventually become more like a childhood infection because adults will gradually build an immunity. And since children tend to have fewer complications, “it will no longer be the same sort of burden to health that it is now.”

The good news: Viruses can sometimes become milder with time, treatments are already becoming more effective and vaccines can be improved.

  • “Right now we are frightened, depressed and on our back heels. We will be able to conquer this disease,” Brilliant says. “It will be a matter of time and science.”