Category Archives: Health Policy

It’s Official: CDC Recommends Public Wear Face Masks

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Public Health, Public Safety, Vaccination, Vaccine • Leave a comment

https://www.medpagetoday.com/infectiousdisease/covid19/85800?xid=NL_breakingnewsalert_2020-04-04&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=CDCMasksAlert_040420&utm_term=NL_Daily_Breaking_News_Active

A computer rendering of the coronavirus

Stresses use of cloth coverings, not medical grade, for ordinary people.

The CDC is now recommending that everyone should wear a cloth face covering when out in public places to protect others in case they are unknowingly infected with the virus.

Late Friday night, the agency updated its consumer-facing web page for COVID-19 self-protection as follows:

  • Cover your mouth and nose with a cloth face cover when around others.
  • You could spread COVID-19 to others even if you do not feel sick.
  • Everyone should wear a cloth face cover when they have to go out in public, for example to the grocery store or to pick up other necessities.
  • Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
  • The cloth face cover is meant to protect other people in case you are infected.
  • Do NOT use a face mask meant for a healthcare worker.
  • Continue to keep about 6 feet between yourself and others. The cloth face cover is not a substitute for social distancing.

Because there is currently no vaccine nor approved treatment, the agency stressed that the best strategy for preventing illness is still to avoid exposure to the virus. Even asymptomatic people can spread coronavirus to others, the CDC stressed.

During a White House briefing on Friday evening, President Trump underscored the CDC’s advice to Americans who are not clinicians, that they not wear “medical-grade or surgical -grade” masks. These are now in shortage at many hospitals, forcing administrators to adopt last-ditch strategies to extend supplies.

But Trump said he has no plans to follow the recommendation himself to wear a mask in public. “I’m choosing not to do it,” he said at the Friday briefing.

The SARS-CoV-2 virus is transmitted primarily through person-to-person contact from people who are in close contact, meaning less than 6-feet apart; through respiratory droplets, projected in a sneeze or cough that land in the mouths and noses of people nearby and can be inhaled into their lungs, but importantly the virus can also be transmitted through talking.

Researchers reported earlier in the week that the coronavirus could be spread through normal breathing and speech. Large droplets remain one method of transmission, when they are inhaled by a person nearby or through contact with a contaminated surface and later touching one’s face. However, researchers noted that tiny particles in the air can also carry the virus.

Former FDA Commissioner Scott Gottlieb, MD, recommended last weekend that “everyone, including people without symptoms, should be encouraged to wear nonmedical fabric face masks while in public.”

While asymptomatic transmission of the virus outside of China was discovered in late January, White House officials had initially suggested that it was not an important driver of transmission. “You really need to just focus on the individuals that are symptomatic,” HHS Secretary Alex Azar told ABC News in March.

 

Decentralized leadership raises questions about Trump coronavirus response

Posted on by • Posted in Actions, Blame, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Health Policy, Leadership, Leadership Alignment, Leadership Centralized, Leadership Continuity, Leadership Decentralized, Leadership Implementation, Pandemic, Plan, Planning, Responsibility, Strategic Leadership, Strategy, Strategy Disconnected • Leave a comment

https://thehill.com/homenews/administration/491093-decentralized-leadership-raises-questions-about-trump-coronavirus

The rotating cast of officials appearing behind President Trump to detail the government’s response to the coronavirus are leading to new criticisms that they reflect a scattered approach from the White House that too often leaves states fending for themselves.

Top Trump administration officials say the appearances by a broad range of administration officials shows the “all of government” undertaken to combat the coronavirus.

But some current and former government officials see a disconnected strategy where it can be unclear who’s in charge of what or whether there is a coordinated long-term plan.

 

How hospital capacity varies dramatically across the country

Posted on by • Posted in Access, Access & Quality of Healthcare, Center for Medicare and Medicaid Services (CMS), Coronavirus, Health Policy, Health System, Hospital, Hospital Bed Shortage, Pandemic, Public Health, Public Safety • Leave a comment

https://www.healthcaredive.com/news/how-hospital-capacity-varies-dramatically-across-the-country/574892/

POPULATION                                    BED COUNT 

20M                      10M people                            0                          0                         25k beds                     50k

LUMEDX (@Lumedx) | Twitter

Healthcare Dive analyzed data to paint a picture of hospital capacity, pinpointing areas with a higher ratio of people to beds and signaling where there is a risk for capacity issues.

Fewer hospital beds in select regions make them especially vulnerable to the novel coronavirus as it’s expected to spread from big city hot spots to other areas of the country.

As the U.S. has become the next epicenter of the outbreak, hospitals are preparing for the worst. The pathogen threatens to overwhelm their facilities and resources, especially if mitigation efforts fail to blunt a surge of COVID-19 patients.

The latest figures from the Johns Hopkins Coronavirus Resource Center report more than 143,000 confirmed cases in the U.S. and more than 2,500 deaths as of Monday.

The New York City metro area has the most beds compared to the rest of the country. Still, that is not enough capacity to meet the crushing demand.

To illustrate hospital capacity across the country, Healthcare Dive sought to compare bed counts to population, and found population size isn’t always indicative of the number of beds available.

Population size is not always indicative of bed capacity in the top 20 metro areas

Below are the 20 most populated metro areas in the U.S., sorted by population. As you move down the chart, population size decreases, but bed counts do not always. Areas like D.C. and Seattle have fewer beds relative to population size, while Miami and Philadelphia have more beds relative to population.

Some areas like Washington, D.C., have relatively fewer beds compared to their population, while others like Miami, Philadelphia and St. Louis have more beds relative to the number of people in the region.

Some hospitals are turning to hotels and tents, and Vice President Mike Pence has said he’s working with the Department of Defense to get field hospitals and other options online.

Still, researchers cautioned there is a long way to go to meet projected demands. If America’s healthcare system was able to free up half of its beds by discharging patients, the country would still need three times as many beds, Ashish Jha, director of the Harvard Global Health Institute, told reporters during a call on Tuesday. That projection assumes 40% of Americans get infected over the next six months.

“What we know right now is that capacity to manage patients varies dramatically from community to community,” Jha said.

Areas with the highest ratio of people per bed

To paint a picture of hospital capacity across the country, Healthcare Dive used CMS cost reports and population data to calculate the ratio of people per bed in metropolitan areas and regions. In other words, how many residents are there for a single bed? It’s a way to pinpoint areas with a higher ratio of people to beds, signaling areas potentially at risk for capacity issues.

HOW HEALTHCARE DIVE ANALYZED HOSPITAL BED COUNTS

Hospitals certified by Medicare are required to submit annual cost reports to CMS, which include a vast array of information from bed counts to financials. Hospital beds analyzed in this report do not include all the beds a hospital may have reported to CMS.

Healthcare Dive excluded nursery, labor and delivery beds and psychiatric hospitals. In addition, due to the inconsistent reporting in ICU beds, Healthcare Dive did not highlight areas with higher ratios of people per ICU bed. It’s also important to note that some hospitals may have opened or closed since these latest CMS cost reports were published.

Healthcare Dive analyzed specific geographic areas, in this case metropolitan CBSAs, or core-based statistical areas, which are geographic areas that consist of an urban center of 50,000 people or more.

In the U.S., about 42% of the more than 143,000 cases are concentrated in New York, overwhelming available resources. Still, case counts are swelling in areas outside of New York including Chicago, Detroit and New Orleans. Indicating the outbreak is likely to be widespread in America.

Healthcare Dive found the Bloomsburg-Berwick, Pennsylvania, area has the lowest ratio in the nation with 86 people for each bed. Most areas have much higher ratios, the median being around 400 people per bed when comparing CBSAs. The metro area of New York City sits in the middle with 405 people per bed.

The Greeley, Colorado area has the nation’s highest ratio of people per bed, according to the data. About 60 miles northeast of Denver and with a population of more than 314,000, there are 1,397 people for every one hospital bed in the Greeley area.

The CMS data shows a total of 225 hospital beds in the Greeley area, operated by Banner Health’s North Colorado Medical Center.

However, a new 50-bed hospital opened recently and was not included in the most recent cost reports. It is operated by UCHealth.

Still, while those numbers may seem grim, Colorado’s hospital leaders cautioned that the state can and is working to tap into additional resources, citing freestanding emergency rooms and ambulatory surgical centers.

It’s imperative to look beyond just one locale or one hospital and consider the resources of the state as a whole, Colorado’s hospital leaders told Healthcare Dive.

Colorado has a total of 10,293 hospital beds (12,558 licensed beds) and at least 973 ICU beds, the Colorado Hospital Association said.

“It’s going to take the whole system for us to get through this,” Julie Lonborg, senior vice president at the Colorado Hospital Association, told Healthcare Dive.

There are only one or two hospitals in almost all of the 10 regions with the highest ratio of people per bed. Rounding out the top 10 areas with the highest ratio of people per bed following Greeley, include Albany, Oregon; Gettysburg, Pennsylvania; Merced, California; California-Lexington Park, Maryland; Bremerton-Silverdale, Washington; Lawrence, Kansas; Monroe, Michigan; Provo-Orem, Utah; and Ogden-Clearfield, Utah.

The data shows the total bed capacity in a region, but does not take into account the patients currently occupying those beds. However, in an effort to free up existing beds, many hospitals have halted elective surgeries, including in Greeley to free up resources and staff to be able to respond to a potential surge.

“UCHealth Greeley Hospital is caring for a large number of patients at this time, and by working together as a large system, UCHealth is able to redirect patients and admissions to other facilities to help even out our capacities at this and other hospitals,” Kelly Tracer, a spokesperson for the hospital, told Healthcare Dive.

In fact, many hospitals plan to lean on the larger systems they’re a part of to shuffle resources to respond to the pandemic.

In Gettysburg, Pennsylvania, there are 76 hospital beds and 1,353 people per hospital bed. WellSpan Health, which operates Gettysburg Hospital, said it plans to coordinate its response by using its eight other hospitals in different areas and some 200 locations.

“We are taking a comprehensive approach to this issue, developing a network of more than 10 outdoor testing locations across our five-county region and temporarily repurposing several of our outpatient medical practices to care locations dedicated solely for the treatment of patients who are suspected or confirmed to have COVID-19 and have non-emergency medical needs,” according to a statement WellSpan Health provided Healthcare Dive.

Other locations with the highest people per bed ratio are converting existing space into dedicated areas to treat COVID-19 patients to prepare for a crush of patients, including in Lawrence, Kansas, with 893 people for every bed.

Lawrence Memorial Hospital in Lawrence, Kansas, about 40 miles west of Kansas City, is prepared to up its capacity to 205, LMH said in a statement. The hospital reported 136 beds to CMS but said it is licensed for 174.

“At any given time we have upwards of 100 patients,” Traci Hoopingarner, vice president of clinical care and chief nursing officer for LMH Health, said in a statement.

As New York continues to grapple with mounting cases, leaders are issuing dire warnings to the rest of the country.

“New York is the canary in the coal mine. What happens to New York is going to wind up happening in California and Washington state and Illinois. It’s just a matter of time,” New York Gov. Andrew Cuomo said.

Below is an interactive table of hospital bed availability in different metros across the country. Search for your metro area to find the corresponding hospital capacity.

 

The Navy Fired the Captain of the Theodore Roosevelt. See How the Crew Responded.

Posted on by • Posted in Communication, Coronavirus, Credibility, Crisis, Crisis Management, Health Policy, Honesty, Infection Control, Infectious Virus, Integrity, Judgement, Leadership, Leadership Cares, Pandemic, Trust, Truth • Leave a comment

The Navy Fired Captain Crozier After His Letter on the Coronavirus ...

The rousing show of support provided another gripping scene to emerge from the coronavirus pandemic: the rank and file cheering a boss they viewed as putting their safety ahead of his career.

It was a send-off for the ages, with hundreds of sailors aboard the aircraft carrier Theodore Roosevelt cheering Capt. Brett E. Crozier, the commander who sacrificed his naval career by writing a letter to his superiors demanding more help as the novel coronavirus spread through the ship.

The rousing show of support provided the latest gripping scene to emerge from the coronavirus pandemic: the rank and file shouting their admiration for a boss they viewed as putting their safety ahead of his career.

The memes were quick to sprout on social media. On Reddit, one depicted Captain Crozier forced to choose between rescuing his career or his sailors from a burning building; he chooses his sailors. On Twitter, a slew of videos showed Captain Crozier’s walk down the gangway in Guam, most of them depicting him as a hero struck down by his superiors for trying to save the lives of his crew. “Wrongfully relieved of command but did right by sailors,” wrote Twitter user Dylan Castillo, alongside a video of Captain Crozier leaving his ship.

But in removing Captain Crozier from command, senior Navy officials said they were protecting the historic practice that complaints and requests have to go up a formal chain of command. They argued that by sending his concerns to 20 or 30 people in a message that eventually leaked to news organizations, Captain Crozier showed he was no longer fit to lead the fast-moving effort to treat the crew and clean the ship.

His removal from prestigious command of an aircraft carrier with almost 5,000 crew members has taken on an added significance, as his punishment is viewed by some in the military as indicative of the government’s handling of the entire pandemic, with public officials presenting upbeat pictures of the government’s response, while contrary voices are silenced.

The cheering by the sailors is the most public repudiation of military practices to battle the virus since the pandemic began. At the Pentagon, officials expressed concern about the public image of a Defense Department not doing enough to stay ahead of the curve on the virus.

Notably, the defense of the firing offered by senior Pentagon officials has centered around Captain Crozier not following the chain of command in writing his letter, which found its way to newspapers. In a circuitous explanation, Thomas B. Modly, the acting Navy secretary, said that Captain Crozier’s immediate superior did not know that the captain was going to write the letter, offering that act as an error in leadership and one of the reasons the Navy had lost confidence in the Roosevelt captain.

But a Navy official familiar with the situation but not authorized to speak publicly about it said that the captain had repeatedly asked his superiors for speedy action to evacuate the ship. His letter, the official said, came because the Navy was still minimizing the risk.

Mr. Modly insisted that his firing the captain for writing a letter asking for more help does not mean that subordinate officers are not allowed to raise criticisms and ask for assistance. “To our commanding officers,” Mr. Modly told reporters on Thursday, “it would be a mistake to view this decision as somehow not supportive of your duty to report problems, request help, protect your crews, challenge assumptions as you see fit.”

But the removal of Captain Crozier will likely have a chilling effect on the willingness of commanders to bring bad news to their superiors.

“There’s no question they had the authority to remove him,” Kathleen H. Hicks, a former top Pentagon official in the Obama administration, said in an email. “The issue is one of poor judgment in choosing to do so. They are fueling mistrust in leader transparency, among service members, families, and surrounding/hosting communities.”

 

 

 

Cartoon – Famous Last Words

Posted on by • Posted in 2020 Election Issues, Cartoon, Clinical Testing, Coronavirus, Credibility, Crisis, Crisis Management, Health Policy, Honesty, Infection Control, Infectious Virus, Integrity, Leadership, Leadership Trust, Pandemic, Public Health, Publicis Health, Trust, Truth, Unintended Consequences • Leave a comment

Granlund cartoon: Famous last words - Opinion - Morning Sun ...

 

How Epidemics of the Past Changed the Way Americans Lived

Posted on by • Posted in Clinical Research, Clinical Research Funding, Communication, Epidemic, Health Policy, Pandemic, Public Debate, Public Discourse, Waste Management • Leave a comment

https://www.smithsonianmag.com/history/how-epidemics-past-forced-americans-promote-health-ended-up-improving-life-this-country-180974555/?fbclid=IwAR1_2pHlIidRC01Bjxr7IFOpUBq1ShM8xXXGBkPFT8J6ZK1PtGgtNh9NJ0s

How Epidemics of the Past Changed the Way Americans Lived ...

Past public health crises inspired innovations in infrastructure, education, fundraising and civic debate.

At the end of the 19th century, one in seven people around the world had died of tuberculosis, and the disease ranked as the third leading cause of death in the United States. While physicians had begun to accept German physician Robert Koch’s scientific confirmation that TB was caused by bacteria, this understanding was slow to catch on among the general public, and most people gave little attention to the behaviors that contributed to disease transmission. They didn’t understand that things they did could make them sick. In his book, Pulmonary Tuberculosis: Its Modern Prophylaxis and the Treatment in Special Institutions and at Home, S. Adolphus Knopf, an early TB specialist who practiced medicine in New York, wrote that he had once observed several of his patients sipping from the same glass as other passengers on a train, even as “they coughed and expectorated a good deal.” It was common for family members, or even strangers, to share a drinking cup.

With Knopf’s guidance, in the 1890s the New York City Health Department launched a massive campaign to educate the public and reduce transmission. The “War on Tuberculosis” public health campaign discouraged cup-sharing and prompted states to ban spitting inside public buildings and transit and on sidewalks and other outdoor spaces—instead encouraging the use of special spittoons, to be carefully cleaned on a regular basis. Before long, spitting in public spaces came to be considered uncouth, and swigging from shared bottles was frowned upon as well. These changes in public behavior helped successfully reduce the prevalence of tuberculosis.

As we are seeing with the coronavirus today, disease can profoundly impact a community—upending routines and rattling nerves as it spreads from person to person. But the effects of epidemics extend beyond the moments in which they occur. Disease can permanently alter society, and often for the best by creating better practices and habits. Crisis sparks action and response. Many infrastructure improvements and healthy behaviors we consider normal today are the result of past health campaigns that responded to devastating outbreaks.

In the 19th century, city streets in the U.S. overflowed with filth. People tossed their discarded newspapers, food scraps, and other trash out their windows onto the streets below. The plentiful horses pulling streetcars and delivery carts contributed to the squalor, as each one dropped over a quart of urine and pounds of manure every day. When a horse died, it became a different kind of hazard. In “Portrait of an Unhealthy City,” Columbia University professor David Rosner writes that since horses are so heavy, when one died in New York City, “its carcass would be left to rot until it had disintegrated enough for someone to pick up the pieces. Children would play with dead horses lying on the streets.” More than 15,000 horse carcasses were collected and removed from New York streets in 1880. Human waste was a problem, too. Many people emptied chamber pots out their windows. Those in tenement housing did not have their own facilities, but had 25 to 30 people sharing a single outhouse. These privies frequently overflowed until workers known as “night soil men” arrived to haul away the dripping barrels of feces, only to dump them into the nearby harbor.

As civic and health leaders began to understand that the frequent outbreaks of tuberculosis, typhoid and cholera that ravaged their cities were connected to the garbage, cities began setting up organized systems for disposing of human urine and feces. Improvements in technology helped the process along. Officials began introducing sand filtration and chlorination systems to clean up municipal water supplies. Indoor toilets were slow to catch on, due to cost, issues with controlling the stench, and the need for a plumbing system. Following Thomas Crapper’s improved model in 1891, water closets became popular, first among the wealthy, and then among the middle-class. Plumbing and sewage systems, paired with tenement house reform, helped remove excrement from the public streets.

Disease radically improved aspects of American culture, too. As physicians came to believe that good ventilation and fresh air could combat illness, builders started adding porches and windows to houses. Real estate investors used the trend to market migration to the West, prompting Eastern physicians to convince consumptives and their families to move thousands of miles from crowded, muggy Eastern cities to the dry air and sunshine in places like Los Angeles and Colorado Springs. The ploy was so influential that in 1872, approximately one-third of Colorado’s population had tuberculosis, having moved to the territory seeking better health.

Some of this sentiment continues today. While we know that sunshine doesn’t kill bacteria, good ventilation and time spent outside does benefit children and adults by promoting physical activity and improving spirits—and access to outdoor spaces and parks still entices homebuyers. This fresh-air “cure” also eventually incited the study of climate as a formal science, as people began to chart temperature, barometric pressure and other weather patterns in hopes of identifying the “ideal” conditions for treating disease.

Epidemics of the past established an ethos of altruism in the U.S. During the 1793 yellow fever epidemic, Philadelphians selflessly stepped up to save their city. With no formal crisis plan, Mayor Matthew Clarkson turned to volunteers collect clothing, food and monetary donations; to pitch a makeshift hospital; and to build a home for 191 children temporarily or permanently orphaned by the epidemic. Members of the Free African Society, an institution run by and for the city’s black population, were particularly altruistic, providing two-thirds of the hospital staff, transporting and burying the dead and performing numerous other medical tasks.

A 20th-century diphtheria outbreak in a small region in the Alaska Territory inspired a national rally of support—and created the Iditarod, the famous dog sled race. When cases of “the children’s disease” began to mount in Nome, Alaska, in January 1925, the town was in trouble. Diphtheria bacteria produces a toxin, making it especially deadly, unless the antitoxin serum is administered. This serum had been readily available for decades, but Nome’s supply had run short, and the town was inaccessible by road or sea in the winter. Leaping into action, 20 of the area’s finest dogsled teams and mushers carried a supply of the serum all the way from Fairbanks—674 miles—in record time, facing temperatures of more than 60 degrees below zero. Their delivery on February 2nd, plus a second shipment a week later, successfully halted the epidemic, saving Nome’s children from suffocation. Newspapers across the country covered the rescue. It was also memorialized in movies (including the animated Balto), with a Central Park statue—and, most notably, with the annual Iditarod race. The significant challenges of delivery by dogsled also sparked investigation into the possibilities of medical transport by airplane, which takes place all the time in remote areas today but was still in its infancy at the time.

Diseases fueled the growth of fundraising strategies. The polio epidemic of 1952 sickened more than 57,000 people across the United States, causing 21,269 cases of paralysis. The situation became so dire that at one point, the Sister Kenny Institute in Minneapolis, a premier polio treatment facility, temporarily ran out of cribs for babies with the disease. In response, the National Foundation of Infantile Paralysis (NFIP), which had been founded in 1938 by President Franklin D. Roosevelt and later came to be known as the March of Dimes, distributed around $25 million through its local chapters. It provided iron lungs, rocking chairs, beds and other equipment to medical facilities, and assigned physicians, nurses, physical therapists, and medical social workers where they were needed. The March of Dimes success has served as the gold standard in public health education and fundraising since its heyday in the 1940s and 1950s.

Public health emergencies have inspired innovations in education. Starting in 1910, Thomas Edison’s lab, which had invented one of the first motion picture devices in the 1890s, partnered with anti-TB activists to produce short films on tuberculosis prevention and transmission—some of the first educational movies. Screened in public places in rural areas, the TB movies were also the first films—of any type—that viewers had ever seen. The anti-tuberculosis crusade was also a model for later NFIP efforts to combat polio that relentlessly put that disease at the front of public agenda until an effective vaccination was developed and implemented, and set a standard for future public health campaigns.

Past epidemics fueled the growth of civic debate and journalism in the U.S., too. As far back as colonial times, newspapers built their audiences by providing an outlet for debate on controversial issues, including disease. Founders of the New England Courant—the first paper in Colonial America to print the voices and perspectives of the colonists—launched their paper as a vehicle to oppose smallpox inoculation during the 1721 Boston epidemic. As smallpox ravaged the city, a Boston doctor named Zabdiel Boylston began using inoculation, a practice in which people are intentionally infected with a disease, to produce milder cases and reduce mortality risk. Backed by those opposed to the practice, James Franklin started the Courant to serve as a tool to fight it. Inoculation’s success was demonstrated in 1721 and later smallpox epidemics, eventually convincing even staunch opponents of its value—but by inspiring an outlet to air their concerns, the anti-inoculation camp had made an important contribution to public discourse.

Since colonial times, newspapers, pamphlets, and a host of other outlets have continued to thrive and evolve during outbreaks—updating the public on believed transmission and remedies, announcing store closing and quarantine restrictions, advertising outbreak-related job openings (florists, nurses, grave diggers, coffin makers, to name a few), and serving as spaces for public debate. The cycle continues today, as media powers and regular citizens flock to social media to discuss COVID-19—disseminating information, speculating on its origins, expressing fear of its unknowns.

 

 

 

 

‘I just don’t understand why we’re not doing that’: Fauci calls for nationwide stay-at-home order, despite Trump’s resistance

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Crisis, Crisis Management, Health Policy, Infection Control, Infectious Virus, Leadership, Pandemic, Public Health, Public Safety, Social Distancing • Leave a comment

https://www.washingtonpost.com/politics/2020/04/03/i-just-dont-understand-why-were-not-doing-that-fauci-calls-nationwide-stay-at-home-despite-trumps-resistance/?fbclid=IwAR0wkT53s_ATpUIp8aOHIU00KufxsoX8m5HgukQYwAtdZFMMhEJbmBsjTg0&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Fauci differs with Trump on nationwide stay-at-home orders - The ...

Trump has said certain states can treat the coronavirus outbreak differently. Fauci publicly disagreed Thursday night.

As certain states have continued to lag behind others in issuing stay-at-home orders, the White House has also resisted a more drastic step: demanding that states get with the program.

Vice President Pence made it clear Wednesday that President Trump has decided he doesn’t want to tell states what to do. “At the president’s direction, the White House coronavirus task force will continue to take the posture that we will defer to state and local health authorities on any measures that they deem appropriate,” Pence said.

Pressed again on Thursday after Georgia Gov. Brian Kemp (R) finally got on board with a stay-at-home order, Trump again signaled that the task force won’t seek to compel states. “I think it’s about 85 percent of the states have got the stay at home,” Trump said. “Brian’s a great governor; it’s his decision.”

The thing is, though, Trump is wrong. Eighty-five percent of states are not on board. A New York Times compilation shows that 12 states still have not taken this step. Localities within some of those state have, and the vast majority of the United States is under such orders, population-wise, but this is still not a blanket policy being applied across the country.

And for the first time, Anthony S. Fauci is signaling his frustration with that. After the White House had for days played off this question, the director of the National Institute of Allergy and Infectious Diseases appeared on CNN on Thursday night and for the first time made his position on that issue clear.

“If you look at what’s going on in this country, I just don’t understand why we’re not doing that,” he told Anderson Cooper. “We really should be.”

The question was about a federal mandate and not whether states should take this step themselves, and Fauci was careful to recognize valid questions about states’ rights. But he was also clear that he thinks this should be a nationwide policy, one way or another.

“I think so, Anderson,” Fauci added at another point. “I don’t understand why that’s not happening.”

Part of the reason it’s not happening is that this request has not been enunciated by the president like it was by Fauci on Thursday night. Florida Gov. Ron DeSantis (R) said earlier this week that he was waiting for Trump to tell him what to do. DeSantis eventually succumbed to the pressure himself, but in making his announcement, he cited Trump’s tone about the severity of the issue.

In other words, what the president says matters. And just like Florida and Georgia, all of the 12 remaining holdout states are run by Republican governors. Trump’s say-so would likely carry significant weight with them.

But Trump isn’t just declining to lean on them; he also continues to cling to the idea that certain areas of the country can treat the outbreak differently because they aren’t yet as hard-hit. Asked Wednesday why he wasn’t telling every state to do this, Trump said it was “because states are different.”

“There are some states that don’t have much of a problem,” Trump said. “There is some — well, they don’t have the problem. They don’t have thousands of people that are positive or thousands of people that even think they might have it, or hundreds of people in some cases.”

Trump added: “You have to give a little bit of flexibility. We have a state in the Midwest or if Alaska, as an example, doesn’t have a problem, it’s awfully tough to say close it down.”

About 24 hours later, Fauci offered a diametrically opposed view on this question, saying that every state should have a stay-at-home order. The statement both reinforced that there are certain disconnects between the president and his top health officials and added to pressure on everyone to fall in line.

Plenty of governors have resisted this step, only to succumb to the realities in their states. Fauci is essentially asking: Why are you waiting to be the next one?

 

 

 

 

Drivers of health and the coronavirus

Posted on by • Posted in Coronavirus, Health Policy, Health System, Pandemic, Social Determinants of Health, Social Distancing, Vaccination, Vaccine • Leave a comment

Drivers of health and the coronavirus

Truck drivers under increased pressure due to coronavirus

I don’t have time for a fully formed post or column on this, but I want to make note of a few ways in which the COVID-19 pandemic is intersecting with drivers of health (which include social determinants and health system factors). The following list is not necessarily exhaustive and my focus is on the U.S.

  • Right now the health system cannot offer anything to prevent the consequences of COVID-19 infection. Prevention is entirely within the realm of public health measures and personal behaviors. In this way, this is a lot like HIV/AIDS before the mid-1990s. If one were engaged in an exercise of attributing COVID-19 deaths to various factors, personal behavior — degree of social distancing, hand washing, etc. — would get a significant share.
  • But, individuals do not fully control their own COVID-19 destiny. Not everyone can avoid all risk of exposure. Food and other necessities need to be brought into the house. We want some people to work (e.g., health care workers, those involved in producing and transporting food and medical supplies). Not everyone can control the behavior of everyone else in their household. Teens and young adults might sneak out, despite what their parents say.
  • Among those at highest risk will be people who don’t have the privilege of working from home. They need income and can’t get it without leaving the house. Peeling this onion leads back to the customary markers of socioeconomic status (education, income, rank/class, etc.) as drivers of health.
  • Those with privilege are more likely to find ways to get testing, care, and going forward, probably will be among the first (after health care workers) to get vaccinated. This is how it has always been in the U.S.
  • Policy clearly plays a role. Where leaders were slower to implement changes to increase or require social distancing, outbreaks are more widespread (relative to the counterfactual of those changes made sooner). Even national policy makers were slow to recognize the importance of preparing for a pandemic. Mistakes were made. Balls were dropped. So, policy/government is a driver, of course.
  • Finally, the health system clearly plays a role, not in prevention but in treatment. People can be saved, if the resources are there to save them and they can be accessed. Where and for whom health care is more available and accessible, people will be better off. This is complex because of the intersection of the effectiveness of health care, its accessibility (which is reduced for people losing job-based insurance, otherwise un- or under-insured, or without the resources to pay cost sharing, etc.), and the degree to which the health system has prepared for such a pandemic (which intersects with policy and health economics). So, the health system should get some blame/credit for deaths/saved lives, but it’s not so clear how much.

Fundamentally, it’s interesting how much we are reliant on collective resources — government through policy and shared health care infrastructure. The best thing we can do for ourselves individually is to engage in safe behaviors. But we also need collective action for our future well being. Yes/and, not either/or.

 

 

 

Immigrants on the front lines

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Essential Businesses, Essential Workers, Front Lines, Health Policy, Immigrant Workers, Pandemic, Supply Chain • Leave a comment

https://www.axios.com/newsletters/axios-vitals-b46e0485-d208-4360-bcd9-4d992ec54d95.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Immigrants on the front lines in the coronavirus fight - Axios

 

New data provided to Axios spells out just how outsized a role immigrants play on the high- and low-skilled ends of the economy keeping Americans alive and fed during the coronavirus crisis, Axios’ Stef Kight reports.

By the numbers: Immigrants make up an estimated 17% of the overall U.S. workforce. But the analysis by New American Economy (NAE) shows they’re more than one in four doctors, nearly half the nation’s taxi drivers and chauffeurs and a clear majority of farm workers.

  • Reporting to work in hospitals, restaurant kitchens, cabs or the fields — for jobs deemed “essential” by the government — many documented and undocumented workers are putting themselves at higher risk of COVID-19 infections.

Be smart: The share of immigrants in some health care roles are higher in states that have been hit hardest by the virus.

  • More than a third of California nurses are immigrants, as well as 29% of nurses in New York and New Jersey, according to NAE data.

Between the lines: A large percentage of farm workers, who help maintain food supplies, are unauthorized immigrants, as the New York Times reported.

  • Immigrants make up a small percentage of delivery workers nationwide, but one-third of delivery workers in New York are unauthorized immigrants, NAE director of quantitative research Andrew Lim told Axios.
  • The $2 trillion aid package does not include assistance for unauthorized immigrants.

 

 

 

 

The rich pull up the drawbridges

Posted on by • Posted in Access, Access & Quality of Healthcare, Concierge Medicine, Coronavirus, Free Market, Health Inequity, Health Insurance Coverage Adequacy, Health Policy, Preexisting Conditions • Leave a comment

https://www.axios.com/coronavirus-rich-drawbridges-7567f493-1bed-494e-926c-be897823a706.html

Animated illustration of a drawbridge made out of a hundred dollar note being pulled up.

From hastily-chartered superyachts to fortresslike country estates, the wealthiest Americans have found places to ride out the pandemic far away from the masses.

Why it matters: The contrast between the rich vs. poor experience of coronavirus exposes class differences — in housing, access to health care, etc. — that are less obvious in normal times.

Where it stands: Even as elected officials tell us that the novel coronavirus does not discriminate — New York Gov. Andrew Cuomo called it “the great equalizer” — it’s still true that the moneyed classes are walling themselves off and, on the whole, suffering less.

  • People with second (and third) homes have stampeded from hot spots like New York City to pastoral and less-afflicted areas — like the Hamptons, Cape Cod, Hilton Head and Palm Beach.
  • Thanks to “concierge medicine,” where people pay hefty annual fees in exchange for near-unlimited access to their doctors, the rich have been getting faster access to COVID-19 tests, plus more attention when they’re sick.

Headlines that tell the story:

  • “Chic Hamptons food stores ransacked by the wealthy amid coronavirus pandemic” (NY Post)
  • “Private jets ‘pour in’ to Martha’s Vineyard as rich flee coronavirus” (The Telegraph)
  • “Billionaires are chartering superyachts for months at a time to ride out the coronavirus pandemic” (Business Insider)
  • “The U.S. has a shortage of coronavirus tests, so the ultra-wealthy are paying concierge doctors to do their own,” (Business Insider)

What they’re saying: “There is an undercurrent of unequal sacrifice,” Chuck Collins, a senior scholar at the progressive Institute for Policy Studies, tells Axios.

Seasonal vacation resorts don’t have the doctors, hospital beds and other resources to care for throngs of sick people — prompting calls for the moneyed interlopers (renters and owners alike) to go home.

  • The mayor of Honolulu wants the Trump administration to suspend nonessential travel to Hawaii.
  • The governor of New Jersey is urging people not to come to the Jersey Shore — even enlisting Mike “The Situation” Sorrentino to spread the “stay home” word.
  • The chiefs of Nantucket Cottage Hospital (which has 15 beds) and Martha’s Vineyard Hospital (25 beds) are asking people to keep off the islands.
  • Angry Cape Cod residents are circulating a (probably doomed) petition to close the bridges to their area.

While the wealthy were among the first in the U.S. to contract the virus (as they’re more apt to travel abroad), the brunt of the pandemic has hurt the working poor.

  • Per the WSJ: “The new coronavirus has struck hardest in working-class neighborhoods in New York City’s outer boroughs, city data shows, underlining how the pandemic has ravaged densely packed lower-income areas where social-distancing guidelines have proved difficult to implement.”

People who live in poverty are more likely to have underlying illnesses that make them more susceptible to coronavirus — asthma, heart disease, hypertension, diabetes.

  • “Income in the United States is our pre-existing condition,” Collins said. “This infection is landing on an extremely unequal society — much more unequal than 40 years ago.”

A tale of two pandemics: As soon as NYC schools closed, real estate agents were flooded with calls from people begging to rent houses in the Hamptons — where a single summer’s lease can easily cost $100,000 — immediately and sight unseen.

  • “You have people calling in and saying, ‘We’re going to be in a car tomorrow, give me a house that I can move into,’ ” Eddie Shapiro, founder and CEO of Nest Seekers International, tells Axios. “We’ve never seen that.”

To drive there, the renters would have had to pass through Queens — the city’s hardest-hit borough — where “apocalyptic” conditions at a 545-bed public hospital in Elmhurst have turned the neighborhood into a poster child for the virus’ wrath.