Category Archives: Health Policy

Cartoon – U.S Healthcare Options

Posted on by • Posted in 2020 Election Issues, ACA, Cartoon, Economic Crisis, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Job, Job Market, Job Search, Job Security, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Surprise Bills, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

Cartoon – US Healthcare Options | HENRY KOTULA

The coronavirus is a moving target

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Research, Clinical Trials, Coronavirus, Economic Crisis, Economy Reopening, Evidence-Based Plan, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Scientists, Vaccination, Vaccine • Leave a comment

https://www.axios.com/coronavirus-research-treatment-vaccines-aedfbf2c-cf09-4a36-ac99-2afb04298e5d.html

The coronavirus is a moving target for efforts to tackle it - Axios

Solutions for COVID-19 are being developed at the same time as knowledge about the disease evolves, a serious challenge for doctors treating patients and for researchers trying to create vaccines and treatments.

Why it matters: What was first thought of as a respiratory infection now appears much more complex, making efforts to tackle the disease more complicated.

“We’re laying the track as the train is moving and the train is coming very fast,” says Mark Poznansky, director of the Vaccine & Immunotherapy Center at Massachusetts General Hospital. “That is an extraordinary place to be at the global level.”

What’s happening: When the world first encountered COVID-19 four months ago, it was deemed a respiratory infection that hammers the lungs. That’s still the case but in recent weeks, clinicians have been reporting wide-ranging manifestations of the disease in some people.

  • Some of this could be that, with enough cases, there are outliers and anomalies. But that underscores that doctors and researchers are learning as they go.

Details: Renal failure, sepsis, damaged blood vessels, skin lesions, stroke, gastrointestinal problems and blood clots in the lungs and kidneys are being seen in some COVID-19 patients.

  • 20% of hospitalized patients in one study in Wuhan, China had heart damage.
  • 31% of people with the disease studied in a Danish ICU had blood clots.

“It comes across more as a systemic disease exhibited initially as a respiratory disease,” says Poznansky. It’s unclear whether the cause is the virus itself, the immune system’s response to it, or the treatment received.

That has implications for developing vaccines. The goal is to prevent infection but not exacerbate the immune effects in response to the virus.

  • “Is [a vaccine] protective or not in a context where we don’t know what exactly defines a protective immune response to COVID-19?” asks Poznansky.
  • The evolving understanding underscores the need to have multiple vaccines in development. (The current count is 123, per the Milken Institute’s tracker.)

What to watch: The changing percent of the disease will feature in regulatory discussions.

  • “This is the question companies will be discussing with regulators: which surrogate endpoints are acceptable as a proxy for going all the way to the worst possible outcomes in a patient?” says Phyllis Arthur, vice president of infectious diseases and diagnostics policy at biotech trade organization BIO.

The bottom line: Pandemics bring a potent mix of uncertainty and urgency to science that experts say requires both nimbleness and rigor to navigate.

  • “This is what a pandemic is like. It’s uncomfortable,” says Arthur. “You need to move swiftly and do good, solid, evidence-based, risk-benefit ratio assessments and understand what you know and don’t know, and make evidence based policy decisions knowing you don’t have perfect information.”

 

 

 

Doctors keep discovering new ways the coronavirus attacks the body

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https://www.washingtonpost.com/health/2020/05/10/coronavirus-attacks-body-symptoms/?arc404=true&utm_campaign=29774&utm_medium=email&utm_source=

Coronavirus Causes Damage to Organs Other Than the Lungs, Doctors ...

Damage to the kidneys, heart, brain — even ‘covid toes’ — prompts reassessment of the disease and how to treat it

Deborah Coughlin was neither short of breath nor coughing. In those first days after she became infected by the novel coronavirus, her fever never spiked above 100 degrees. It was vomiting and diarrhea that brought her to a Hartford, Conn., emergency room on May 1.

“You would have thought it was a stomach virus,” said her daughter, Catherina Coleman. “She was talking and walking and completely coherent.”

But even as Coughlin, 67, chatted with her daughters on her cellphone, the oxygen level in her blood dropped so low that most patients would be near death. She is on a ventilator and in critical condition at St. Francis Hospital, one more patient with a strange constellation of symptoms that physicians are racing to recognize, explain and treat.

“At the beginning, we didn’t know what we were dealing with,” said Valentin Fuster, physician-in-chief at Mount Sinai Hospital in New York City, the epicenter of the U.S. outbreak. “We were seeing patients dying in front of us. It was all of a sudden, you’re in a different ballgame, and you don’t know why.”

Today, there is widespread recognition the novel coronavirus is far more unpredictable than a simple respiratory virus. Often it attacks the lungs, but it can also strike anywhere from the brain to the toes. Many doctors are focused on treating the inflammatory reactions it triggers and its capacity to cause blood clots, even as they struggle to help patients breathe.

Learning about a new disease on the fly, with more than 78,000 U.S. deaths attributed to the pandemic, they have little solid research to guide them. The World Health Organization’s database already lists more than 14,600 papers on covid-19. Even the world’s premier public health agencies, including the Centers for Disease Control and Prevention, have constantly altered their advice to keep pace with new developments.

“We don’t know why there are so many disease presentations,” said Angela Rasmussen, a virologist at the Center for Infection and Immunity at Columbia University’s Mailman School of Public Health. “Bottom line, this is just so new that there’s a lot we don’t know.”

More than four months of clinical experience across Asia, Europe and North America has shown the pathogen does much more than invade the lungs. “No one was expecting a disease that would not fit the pattern of pneumonia and respiratory illness,” said David Reich, a cardiac anesthesiologist and president of Mount Sinai Hospital in New York City.

It attacks the heart, weakening its muscles and disrupting its critical rhythm. It savages kidneys so badly some hospitals have run short of dialysis equipment. It crawls along the nervous system, destroying taste and smell and occasionally reaching the brain. It creates blood clots that can kill with sudden efficiency and inflames blood vessels throughout the body.

It can begin with a few symptoms or none at all, then days later, squeeze the air out of the lungs without warning. It picks on the elderly, people weakened by previous disease, and, disproportionately, the obese. It harms men more than women, but there are also signs it complicates pregnancies.

 

 

CommonSpirit came up with a new plan to restart elective procedures. Here’s what it says

Posted on by • Posted in Center for Medicare and Medicaid Services (CMS), Communication, Coronavirus, Elective Procedures, Elective Surgery, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.fiercehealthcare.com/hospitals-health-systems/commonspirit-gives-tookit-to-hospitals-how-to-restart-elective-surgical?mkt_tok=eyJpIjoiWldSbVlqVTFPV0l4T1dGaSIsInQiOiIwSWp6WDBDRk9GK2U5T1hkYnpsRzRleSsyQlhFb1NrR1BpbHBwZFVHSlBNOVc4cjhuQVRBZUIzRnZVQVA1UFV0ekVoUWJnZDVLeDNoQitqSmJ2c0ZpbXBcL3lLbVQ0RGlKRXlzVzNSbkthaUpUV0twQ2Z4emFGaTViemFcL1N6WTZrIn0%3D&mrkid=959610

CommonSpirit came up with a new plan to restart elective ...

Like a lot of major health systems, CommonSpirit Health is making strides to reopen elective procedures canceled due to COVID-19.

Some facilities have already resumed some surgical procedures, and others are going to start scheduling such procedures as soon as Monday.

To get started, officials say, the health system giant recently created a toolkit that they sent to its 137 hospitals that stretch across more than 20 states outlining testing, screening and supply protocols. CommonSpirit’s toolkit builds on a framework put out in recent weeks by the American Hospital Association, the American College of Surgeons and other provider groups.

A key message: Hospitals must also make sure to keep one eye on the virus and its ongoing spread in the community on a daily basis and be ready to respond accordingly. CommonSpirit says that facilities need to coordinate with local and state authorities.

“The virus isn’t going away because we reopened,” Barbara Pelletreau, senior vice president for patient safety at CommonSpirit, told FierceHealthcare.

Here’s a look at what else the health system’s new toolkit advises:

1. Assess: The toolkit offers five phases of surgical care, Pelletreau said. In the first phase, a facility must look at how to reassess the health status of patients since the cancellation of their procedure, she said.

Hospitals must adhere to the Centers for Medicare & Medicaid Services’ requirement that there is a physical examination and history of a patient within 30 days of any procedure. “This will verify if there has been no significant interim change in patient’s health status,” the toolkit said.

Hospitals can rely on telehealth for part of this evaluation.

Testing is also a critical part of the restart. Facilities should test patients before surgical procedures and tell patients to remain at home before the results come in to limit any new potential exposure.

A hospital must also create a process to determine next steps if patient testing is not available or results haven’t come back in time for the surgery.

2. Designate leadership and coordinate: As they prepare to get going again, facilities should establish a prioritization policy committee that has members from surgery, anesthesia and nursing.

The committee should examine which types of procedures should get priority to resume.

3. Ensure they have enough PPE: They also need to make sure they have enough personal protective equipment (PPE) to handle not just any new procedures but also another wave of COVID-19 cases.

For instance, one part of the toolkit recommends a facility to have a minimum of four days of PPE on hand and projection of new inventory arriving for the next two weeks.

As facilities ramp up, they must ensure they have enough primary and adjunct personnel. A hospital must also put out guidelines for who is present during intubation and extubation of the patient and how to use PPE.

Communication

However, a key element is harder to address: confidence among patients.

“In the end, you can have all the clinical facts. But it is, ‘How do you feel about your safety?’” Pelletreau said. “How do you feel about going to the grocery store or a hospital that delivers amazing medical care?”

Pelletreau said that CommonSpirit is now also working on messaging to its own employees and to the community to assure patients it is safe to return to the hospital for needed medical care. That includes several communication resources to show examples of the work it is doing, from ramped-up testing to more stringent cleaning protocols, to ensure surgical procedures can be performed safely.

“Consider a proactive approach to communicating with staff, patients, physicians and the community,” the toolkit said. “Recognize the significant interest and questions from our key audiences.”

 

 

 

 

Cartoon – Learning Online

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Coronavirus socialism: Political Cartoons – Redlands Daily Facts

Cartoon – Current State of the Union

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This Week's Cartoons: Coronavirus, Social Media, and Social ...

Cartoon – The Coronavirus War

Posted on by • Posted in 2020 Election Issues, Cartoon, Clinical Testing, Coronavirus, Crisis, Crisis Management, Front Lines, Health Policy, Healthcare Providers, Infection Control, Infectious Virus, Leadership Decentralized, Mortality, Nurses, Pandemic, Pass the Buck, Personal Protective Equipment (PPE), Physician, Public Health, Public Safety, Quarantine, Social Distancing, Supply Chain • Leave a comment

Coronavirus first responders now the frontline in two wars: Darcy ...

Cartoon – Sign of Coronavirus Times

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Crisis, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Out of Pocket Expenses, Preexisting Conditions, Surprise Bills • Leave a comment

The Coronavirus Scream - Truthdig: Expert Reporting, Current News ...

Minneapolis Fed president: ‘The worst is yet to come on the job front’

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Cash, Cash Reserves, Clinical Testing, Contact Tracing, Economic Crisis, Economy Reopening, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Financially Distressed, Health Insurance Coverage Adequacy, Health Policy, Infection Control, Infectious Virus, Job, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Public Health, Public Safety, Quarantine, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://thehill.com/homenews/sunday-talk-shows/497006-minneapolis-fed-president-the-worst-is-yet-to-come-on-the-job?rnd=1589121753

Minneapolis Fed president: 'The worst is yet to come on the job ...

The president of the Federal Reserve Bank of Minneapolis said Sunday that the “worst is yet to come” after a record of 20 million people lost their jobs amid furloughs and layoffs sparked by the coronavirus pandemic in April. 

“I mean the worst is yet to come on the job front, unfortunately,” Neel Kashkari said on ABC’s “This Week.”

“We may be in an environment of gradual relaxing and then having to clamp back down again around the country as the virus continues to spread,” he added. “To solve the economy, we must solve the virus. Let’s never lose sight of that fact.”

Kashkari also contradicted White House economic adviser Larry Kudlow’s prediction for a financially strong half of 2020 and full 2021 when ABC’s George Stephanopoulos asked if that was realistic.

“You know, I wish it were,” he responded. “What I’ve learned in the last few months, unfortunately, this is more likely to be a slow, more gradual recovery.”

The Minneapolis Fed president said a “robust economy” would require a breakthrough in vaccines, testing and therapies. 

“I don’t know when we’re going to have that confidence,” he said, adding, “and ultimately, the American people are going to decide how long the shutdown is.”

The Department of Labor reported last week that the unemployment rate had reached 14.7 percent, which is the highest since the U.S. began tracking in 1948. More than 33 million people have applied for unemployment claims since mid-March. 

Speaking earlier Sunday on “This Week,” Kudlow acknowledged that “very difficult” unemployment numbers could likely be reported in May. But he added that there is a “glimmer of hope” within the unemployment data, with 80 percent of the claims involving those who were furloughed or going through temporary layoffs. 

 

 

 

 

Infectious disease expert: ‘We are going to see a growth in cases’ in coming weeks

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https://thehill.com/homenews/sunday-talk-shows/497011-infectious-disease-expert-we-are-going-to-see-a-growth-in-cases-in?rnd=1589123649

Infectious disease expert: 'We are going to see a growth in cases ...

Columbia University infectious diseases expert Jeffrey Shaman predicted Sunday that the U.S. will see a growth in coronavirus cases in coming weeks as some states loosen restrictions.

Shaman said on NBC’s “Meet the Press” that Trump administration officials have not taken full advantage of the past eight weeks of near-total lockdowns, saying that the period would have “benefitted enormously from consistent messaging” from the White House.

“We do need to start picking ourselves up where we are” he said, pointing to countries that appear to have successfully contained the spread of the virus, such as South Korea, Germany and New Zealand.

“They did this because they tested so aggressively and they used contact tracing and they were able to quarantine people who were becoming infectious,” he said.  “Once you’ve done that, then you’re in this position of strength where reopening the economy is not going to lead necessarily to the rebound in cases that I’m expecting, given this patchwork response that we have right now and the reopenings taking place in some states.”

“What I think we’re probably going to see over coming weeks, probably towards the end of the month, is we’re just going to start to see a growth in cases,” he added. “It’s not going to happen over the next week or two, it’s going to come in with a lag. That built-in delay means any changes we do to social distancing because of reopening, we’re not going to realize for a couple of weeks that we’re already into some period of growth.”

Multiple states have moved to reopen portions of their economy shuttered by state-at-home orders imposed to prevent the spread of coronavirus.

The Labor Department reported last week that a record 20 million Americans lost their jobs in April amid the pandemic.