A brewing physician-health system disconnect

https://mailchi.mp/7d224399ddcb/the-weekly-gist-july-3-2020?e=d1e747d2d8

Addressing The Consumer-First Disconnect - B&T

We’re hearing from medical groups around the country that in the past few weeks, office visit volumes have quickly approached pre-COVID levels. Some are even busier, running at 110 percent of their February volumes, or more. At the same time, practice has become more stressful, with doctors balancing virtual care with in-person visits, new safety procedures slowing operations, and staff and patients worried about COVID exposure. Everything feels different, and irrespective of the number of patients on today’s schedule, all of the changes make a physician feel like she’s working harder than before.

A chief clinical officer from a Midwestern health system relayed the discord this has created when discussing incentives: “Our doctors were fully on board with the need to reduce salaries back in April, so we all took a 15 percent pay cut through the summer. Now that they’re busy again, they want to be bumped back to 100 percent. But the system’s financial picture hasn’t changed.

The growing disconnect between how hard many staff are working and the economic reality of the system isn’t unique to doctors. But physicians, most of whom have their compensation tied to individual productivity, may feel it more acutely. While there are no easy solutions, it’s critical to discuss this disconnect openly, rather than letting resentment fester under the surface.

The pandemic has brought to light the brittleness of health system and physician practice finances. Prescient systems will use this moment to work with their doctors to rethink practice and align compensation with the financial success of the system, while meeting doctors’ needs for stability and security.

 

 

Meeting growing consumer demand for “care anywhere”

https://mailchi.mp/7d224399ddcb/the-weekly-gist-july-3-2020?e=d1e747d2d8

 

While COVID-19 provided a big push for doctors and health systems to rapidly expand telemedicine visits and other kinds of remote patient interactions, many report that they are now seeing telemedicine visits decline sharply, as in-person visits return.

While it’s natural to be glad that “things are returning to normal”, backing off virtual care is short-sighted, as recent experiences have set new expectations for patients. Survey data shows consumers like using telehealth services, both because they’re more convenient (65 percent) and help avoid COVID infection (63 percent)—and 51 percent say they would continue using them after the pandemic ends.

We’re increasingly convinced that virtual physician visits are just one part of a continuum of care that can be delivered in the convenience and safety of the patient’s home. The graphic below highlights the range of consumer-focused virtual care solutions, from asynchronous chat interactions all the way to hospital care delivered at home.

Health systems that can deliver “care anywhere”—an integrated platform of virtual services consumers can access from home (or wherever they are) for both urgent needs and overall health management, coordinated with in-person resources—have an unprecedented opportunity to build loyalty at a time when consumers are seeking a trusted source of safe, available care solutions.

 

 

America celebrates a grim milestone

https://mailchi.mp/7d224399ddcb/the-weekly-gist-july-3-2020?e=d1e747d2d8

Epidemic vs. Pandemic, What Is the Difference Between an Epidemic ...

 

As the nation headed into the 4th of July weekend, the number of new COVID cases hit a string of daily highs, reaching a record high of more than 55,000 on Thursday. States across the South and Sunbelt, especially those that lifted stay-at-home orders early, saw the worst spikes.

Florida broke a new record with more than 10,000 cases on Thursday, and Georgia also experienced a new daily high. Hospitalizations continued to rise sharply in several states as well. Many hospitals reported a shift in COVID admissions toward younger, otherwise healthy adults, reports borne out by the lower death rate than that experienced in the initial surge of cases in the Northeast. (Advances in the management of severely ill COVID patients have also brought death rates down.)

In a Senate hearing on Tuesday, top White House health advisor Dr. Anthony Fauci said that the US was “not in total control” of the pandemic, and predicted that daily new case counts could top 100,000 if more stringent measures are not taken.

California, Florida, and other states took steps to roll back reopening efforts, and Texas Gov. Greg Abbott abruptly reversed direction and ordered a statewide mask mandate. Welcome news, but likely too late to prevent cities like Houston from exceeding available ICU capacity. Cases in the city have skyrocketed across the past month, with its positive test rate hitting 20 percent yesterday; its cancer and children’s hospitals began admitting COVID-positive adults to provide added capacity.

With celebrations scheduled across the nation this weekend, including another large event today at Mount Rushmore to be attended by President Trump, where masking and social distancing will be optional, it seems certain that we will continue to reap the whirlwind of careless behavior and hasty reopening for the rest of this month and beyond.

And looming in just six weeks—students return to schools and colleges.

US coronavirus update: 2.7M cases; 130K deaths; 33.5M tests conducted.
 

 

 

 

12 hospitals laying off workers in response to COVID-19

https://www.beckershospitalreview.com/finance/12-hospitals-laying-off-workers-in-response-to-covid-19.html?utm_medium=email

Facing a financial squeeze, hospitals nationwide are cutting jobs

To address the financial fallout from the COVID-19 pandemic, hospitals across the nation are looking to cut costs by implementing furloughs, layoffs or pay cuts. 

U.S. hospitals are expected to lose $323.1 billion this year due to the pandemic, according to a recent report from the American Hospital Association. The total includes $120.5 billion in financial losses that hospitals are projected to see from July through December, as well as $202.6 billion in losses that were projected between March and June. The losses were largely due to a lower patient volume after canceling elective procedures. 

Although Congress allocated $175 billion to help hospitals offset some of the revenue losses and expense increases to prepare for the pandemic, hospitals have said it is not enough.

Nearly 270 hospitals and health systems have furloughed workers in response to the pandemic and several others have implemented layoffs. 

Below are 12 hospitals and health systems that have announced layoffs since June 1:

1. Trinity Health furloughs, lays off another 1,000 workers
Trinity Health, a 92-hospital system based in Livonia, Mich., will lay off and reduce work schedules of 1,000 employees.

2. Ohio children’s hospital cuts jobs
Dayton (Ohio) Children’s Hospital said it has cut jobs to help offset financial losses due to the COVID-19 pandemic.

3. Munson Healthcare to cut 25 leadership positions
Traverse City, Mich.-based Munson Healthcare cut 25 leadership positions to help offset financial losses amid the COVID-19 pandemic.

4. Erlanger lays off 93 nonclinical employees
Chattanooga, Tenn.-based Erlanger Health System has cut 93 nonclinical positions to help offset financial damage from the COVID-19 pandemic. The layoffs come after the health system cut 11 leadership positions June 12, including the CEO of Erlanger Western Carolina Hospital in Murphy, N.C., and made staff and pay cuts in March.

5. Michigan Medicine to lay off 738 employees by end of June
Ann Arbor-based Michigan Medicine planned to eliminate 738 positions by the end of June amid financial challenges from the COVID-19 pandemic.

6. Pennsylvania health system cuts 10% of workforce amid pandemic losses
As part of a restructuring effort to cut pandemic-related losses, State College, Pa.-based Mount Nittany Health System plans to lay off 10 percent of its workforce, or about 250 employees.

7. TriHealth eliminates 440 positions to cut costs
Cincinnati-based TriHealth cut 440 positions as part of a plan to trim at least $140 million in expenditures this year.

8. Layoffs hit U of Kansas Health System
The University of Kansas Health System St. Francis Campus in Topeka laid off employees after previously implementing furloughs.

9. Tower Health to cut 1,000 jobs
Citing a $212 million loss in revenue through May due to the COVID-19 pandemic, West Reading, Pa.-based Tower Health plans to cut 1,000 jobs.

10. Colorado hospital cuts 22 positions
Parkview Medical Center in Pueblo, Colo., eliminated 22 positions in response to the COVID-19 pandemic.

11. Arkansas Children’s cuts 42 positions
Little Rock-based Arkansas Children’s Hospital said it is eliminating 42 jobs as part of cost-savings measures in response to the COVID-19 pandemic.

12. North Carolina health system cuts 10% of workforce, closes clinics
Citing a financial hit from the COVID-19 pandemic, Lumberton, N.C.-based Southeastern Health will permanently close several clinics, cut 10 percent of its workforce and reduce executive pay.

 

 

6 latest hospital credit rating downgrades

https://www.beckershospitalreview.com/finance/6-latest-hospital-credit-rating-downgrades-0702.html?utm_medium=email

credit ratings | Özde Kurter

The following six hospital and health system credit rating downgrades occurred since June 1. They are listed below in alphabetical order.

1. Care New England (Providence, R.I.) — from “BB” to “BB-” (Fitch Ratings); from “BB-” to “B+” (S&P Global Ratings)

2. Holy Redeemer Health System (Meadowbrook, Pa.) — from “Ba1″ to Ba2” (Moody’s Investors Service); from “BBB-” to “BB+” (Fitch Ratings)

3. Indiana (Pa.) Regional Medical Center — from “Baa2” to “Baa3” (Moody’s Investors Service)

4. Mon Health (Morgantown, W.Va.) — from “BBB+” to “BBB” (S&P Global Ratings)

5. Nuvance Health (Lagrangeville, N.Y.)  — from “A3” to “Baa2” (Moody’s Investors Service)

6. Virginia Mason Medical Center (Seattle)  — from “BBB” to “BBB-” (S&P Global Ratings)

 

 

Despite COVID-19, less dramatic decline in Q2 M&A than expected, Kaufman Hall reports

https://www.fiercehealthcare.com/hospitals/despite-covid-less-dramatic-decline-q2-m-a-than-expected-kaufman-hall-reports?mkt_tok=eyJpIjoiT1RJMlpqWTNPREJtTmpGaSIsInQiOiJ0enNDdXU5R0ZEdUJmSE1GcXl5UHd4VjdcL1FQcWE3ckN2YmhLVUhnazNFNlhUOEdLQndTcnRnXC9TbWNzWDhZMW5KWEhtMUxJRDRFdG1uXC84NGVhTHZ5QklGK0Fyc2dadXVcL0phNWFaVGY1SGlVVzN6NFRxVlRLOE9mRmdHR2VmdDgifQ%3D%3D&mrkid=959610

Mergers and acquisitions deals consolidation

While the COVID-19 pandemic has done a financial number on organizations across the healthcare industry, it did not stymie mergers and acquisition deals as much as anticipated, according to a new report.

Kaufman Hall officials said in their latest M&A report that deals in the second quarter declined in comparison to the same quarter a year earlier.

However, they said, two “transformational” deals announced in June pushed the quarter to a far less dramatic decline in deal activity relative to the underlying performance measures in the sector—and could even indicate deals will ramp up in the near future.

“I don’t think there could’ve been any sort of realistic expectations of what might’ve happened as a result of the pandemic,” the report’s author Anu Singh, managing director and leader of the mergers, acquisitions and partnerships practice, told Fierce Healthcare.

“I think there was a feeling that because of what this would do to financial performance and maybe the trajectory of the industry participants themselves, there was a thought this would perhaps significantly slow down transaction activity as well,” Singh said. “And, as the quarter played out, there was not a significant … drop in the level of activity.”

Deals in the second quarter included Steward Health Care’s acquisition by a group of affiliated physicians and Advocate Aurora Health proposed a merger with Beaumont Health. Lifespan and Care New England Health System in Rhode Island also resumed partnership talks.

“What we were, perhaps, a little surprised to see is there still was large scale transformational system partnership. There still was large portfolios of for-profit or hospital management companies looking to retool their portfolio,” Singh said. “There still was a need for community hospitals to look upwards to find the benefits of larger health systems.”

Overall, the report says, there were 14 deals in the second quarter, down from 19 deals in the same quarter a year earlier and down from 29 deals in the first quarter of 2020.

The report also found:

  • At more than $800 million, the second quarter had one of the highest figures for average size of seller by revenue ever recorded by Kaufman Hall. The historic high previous recorded in 2018 was $409 million.
  • Total transacted revenue for the quarter was just over $12 billion.
  • Nine of the 14 transactions were by for-profit hospital and health systems. None of the transactions in the last quarter were completed by academic medical centers or religiously affiliated health systems.

Impact of COVID-19

So what does the second quarter say about the potential future impact of the COVID-19 pandemic on deals? Singh wrote that while health systems paused their activities for a while, the pandemic may also have “strengthened their rationale” for partnering up in the first place.

Like leaders in many other sectors, healthcare leaders are reevaluating their business and may be examining their healthcare delivery models, Singh said.

The pandemic may have been a catalyst for more organizations to work together to serve patients, which could support reevaluation of the potential for future deals. As an example, Singh pointed in the report to Lifespan and Care New England, which had suspended talks for a potential deal in 2019 but restarted talks after the two systems began “working together in unprecedented ways,” in response to the crisis.

Finally, for-profit health systems have continued to reshape their portfolios over the quarter, with six of the 14 transactions representing divestitures by major for-profit health systems including Community Health Systems, Quorum and HCA.

“For many organizations, it’s going to serve as a reminder or a catalyst that there is safety in scale,” Singh said. “There is safety in being part of a large system that has more deployable resources and maybe more capabilities to deal with situations like that.”

 

Hospitals in new COVID-19 hot spots face delicate balancing act with elective surgeries

https://www.fiercehealthcare.com/hospitals/hospitals-new-covid-19-hotspots-face-delicate-balancing-act-elective-surgeries?mkt_tok=eyJpIjoiT1RJMlpqWTNPREJtTmpGaSIsInQiOiJ0enNDdXU5R0ZEdUJmSE1GcXl5UHd4VjdcL1FQcWE3ckN2YmhLVUhnazNFNlhUOEdLQndTcnRnXC9TbWNzWDhZMW5KWEhtMUxJRDRFdG1uXC84NGVhTHZ5QklGK0Fyc2dadXVcL0phNWFaVGY1SGlVVzN6NFRxVlRLOE9mRmdHR2VmdDgifQ%3D%3D&mrkid=959610

Hospitals in new COVID-19 hot spots face delicate balancing act ...

Some hospital systems located in states that are seeing huge spikes of COVID-19 are continuing to perform elective procedures and developing strategies to avoid a total shutdown.

The experiences of hospitals in states such as Florida and Arizona could inform how systems will handle new surges of COVID-19 cases, especially if a second surge of the virus arrives in the fall. Hospitals have been reticent to shut down surgical procedures, which are pivotal to their bottom line and also impact patient care.

“We are not turning it all the way off,” said Marjorie Bessel, M.D., chief clinical officer for Banner Health, referring to elective procedures. “Our surgeries are needed and medically necessary and people need to have those surgeries done.”

The 28-hospital system has a large footprint in Arizona, which is experiencing a major spike in cases. Bessel said 45% of Arizona COVID-19 patients are in a Banner Health facility.

Like many states, Arizona’s governor required hospitals to shutter elective procedures to ensure there is enough capacity and personal protective equipment (PPE) for COVID-19 patients. The governor lifted the shutdown May 1, and Banner has slowly ramped up delayed or canceled elective procedures.

“We attempted to reduce the backlog of people who had been waiting or wait-listed,” Bessel told Fierce Healthcare. “We didn’t quite get back to full normal operations, but we got close.”

That progress has been hindered now as COVID-19 cases soar in the state.

But instead of doing a full shutdown, Banner is implementing a tiered and step-wise approach to surgeries.

“One of the things that we are going to try is to do surgeries for patients that don’t need an inpatient stay,” Bessel said. “We are gonna try that and see how that works for us.”

The system is also tightly monitoring the patients that need an intensive care unit stay after their surgery. Banner can transfer patients to other facilities to ensure it has enough capacity.

“We look at our [patient] census almost hourly throughout the day and the night and make these adjustments to best meet the needs of those in the community,” she said.

Tampa General Hospital in Florida resumed elective procedures back in early May and is still performing surgeries as COVID-19 cases rise. The hospital told Fierce Healthcare that it treats COVID-19 patients in a “negative-pressure unit that is separate from other areas of the hospital.”

The hospital has 81 of these rooms and 100 hospitals and has a surge plan to adjust capacity when necessary.

Another important factor for hospitals is to communicate with patients about what is going on. Tampa General, for instance, issued a release on when it is appropriate to go to the emergency room and outlined the procedures for screening patients of COVID-19 to assuage fears.

Hospitals’ own internal processes have also gotten better amid the COVID-19 pandemic.

“In the operating area, COVID-19 has made us more efficient,” said Michael Zinner, M.D., CEO of the Miami Cancer Institute, which is part of 11-hospital system Baptist Health South Florida. “It has taught us how to move things out of the general operating room into ambulatory and more efficient in the turnovers. It has taught us how to adapt.”

Some states could decide to shut down elective procedures again, which is a move Texas has decided to make in four counties in the state.

Getting and keeping enough PPE

One of the key reasons that states ordered hospitals to shut down surgeries was to preserve enough PPE for COVID-19 care.

But hospital systems say they are in a better place now in terms of PPE than they were at the onset of the pandemic, when a buying spree caused hospitals to fight among each other to get supplies.

“We are a heck of a lot better than we were two months ago,” Zinner said.

He added that Baptist Health even bought a stake in a domestic PPE manufacturer, a move Banner Health made as well.

“Besides the current spike, we were preparing for what we think will be a surge in the fall,” Zinner added.

Another important development for hospitals now is there are guidelines for how to reprocess PPE.

“We have found ways to reprocess some PPE safely so you can reuse it without losing efficacy and take it through a decontamination procedure,” said Michael Calderwood, M.D., an epidemiologist at Dartmouth-Hitchcock Medical Center in New Hampshire.

He pointed to using ultraviolet light and hydrogen peroxide as among methods facilities can use to reprocess their supplies.

The type of PPE that is used in surgeries is also sometimes different than the equipment used to treat COVID-19 patients, Bessel said.

“They use a procedural mask for most of the cases, while the masks in shortage has been the N-95 respirators,” she said.

 

 

 

340 organizations tell Congress to make telehealth permanent

https://www.healthcarefinancenews.com/news/340-organizations-tell-congress-make-telehealth-permanent?utm_source=SFMC&utm_medium=email&utm_campaign=NL-HFN-NewsDay-2020-07-01+-+20200629_101004+-+20200630_102918+-+20200630_181109+-+20200701_104543%e2%80%8b

Advocacy and Policy | Primary Care Collaborative

New report finds the growth of telemedicine visits has plateaued and accounts for a relatively small percentage of rebounding ambulatory care.

On Monday, 340 organizations signed a letter urging Congress to make telehealth flexibilities created during the COVID-19 pandemic, permanent. 

Those signing the letter include national and regional organizations representing a range of healthcare stakeholders in all 50 states, the District of Columbia and Puerto Rico.

Congress quickly waived statutory barriers to allow for expanded access to telehealth at the beginning of the COVID-19 pandemic, providing federal agencies with the flexibility to allow healthcare providers to deliver care virtually.

Stakeholders also want Congress to remove restrictions on the location of the patient to ensure that all patients can access care at home, and other appropriate locations; to maintain and enhance HHS authority to determine appropriate providers and services for telehealth; ensure federally qualified health centers and rural health clinics can furnish telehealth services after the public health emergency; and make permanent the Health and Human Services temporary waiver authority for future emergencies.

While federal agencies can address some of these policies going forward, the Centers for Medicare and Medicaid does not have the authority to make changes to Medicare reimbursement policy for telehealth under current law, stakeholders said.

In a statement separate from the letter to Congress, Lux Research Associate Danielle Bradnan said key concerns for legislators are broadband internet access, payer reimbursement and licensure barriers, since, currently, medical licenses are only valid for specific states.

WHY THIS MATTERS

If Congress does not act before the COVID-19 public health emergency expires, current flexibilities will disappear, according to stakeholders.

The PHE is scheduled to expire in July.

In a tweet late yesterday, Michael Caputo, the assistant secretary of the Department of Health and Human Services for public affairs, said HHS is expected to renew the PHE before it expires. It has already been renewed once.

THE LARGER TREND

The use of telehealth has skyrocketed under in-person restrictions under COVID-19.

Private health plans have followed suit, the letter said, resulting in a 4,300% year-over-year increase in claims for March 2020.

However, a new report from the Commonwealth Fund has found that the growth of telemedicine visits has plateaued and account for a relatively small percentage of rebounding ambulatory care services.

As states experiment with reopening – and re-closing – their economies in response to concerns around rising coronavirus cases, the report found that telemedicine visits have actually been declining since April.

 

 

 

 

COVID-19 to cost hospitals $323 billion, American Hospital Association says

https://www.beckershospitalreview.com/finance/covid-19-to-cost-hospitals-323-billion-american-hospital-association-says.html?utm_medium=email

Catastrophic financial impact of COVID-19 expected to top $323 ...

Hospitals will lose $323.1 billion this year because of the COVID-19 pandemic, according to a new report from the American Hospital Association. 

The total includes $120.5 billion in financial losses the association predicts hospitals will see from July through December on top of $202.6 billion in losses they estimated between March and June. The losses are in large part due to lower patient volumes.

“While potentially catastrophic, these projected losses still may underrepresent the full financial losses hospitals will face in 2020, as the analysis does not account for currently increasing case rates in certain states, or potential subsequent surges of the pandemic occurring later this year,” the AHA said.

Hospitals and health systems are reporting an average decline of 19.5 percent in inpatient volume and 34.5 percent in outpatient volume when compared to baseline levels from last year. Most hospitals don’t expect to return to last year’s levels in 2020.

Read the full report here.

 

 

 

Six months in, coronavirus failures outweigh successes

https://thehill.com/policy/healthcare/public-global-health/505353-six-months-in-coronavirus-failures-outweigh-successes

Covid-19 news: UK deaths fall below five-year average | New Scientist

In the six months since the World Health Organization (WHO) detected a cluster of atypical pneumonia cases at a hospital in Wuhan, China, the coronavirus pandemic has touched every corner of the globe, carving a trail of death and despair as humankind races to catch up.

At least 10.4 million confirmed cases have been diagnosed worldwide, and the true toll is likely multiples of that figure. In the United States, health officials believe more than 20 million people have likely been infected.

A staggering 500,000 people around the globe have died in just six months. More people have succumbed to the virus in the U.S. — 126,000 — than the number of American troops who died in World War I.

But even after months of painful lockdowns worldwide, the virus is no closer to containment in many countries. Public health officials say the pandemic is getting worse, fueled by new victims in both nations that have robust medical systems and poorer developing countries.

“We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over,” WHO Director-General Tedros Adhanom Ghebreyesus said Monday. “Globally, the pandemic is actually speeding up.”

In the U.S., the fierce urgency of March and April has given way to the complacency of summer, as bars and restaurants teem with young people who appear largely convinced the virus poses no threat to them. New outbreaks, especially among younger Americans, have forced 16 states to pause or roll back their reopening plans.

“This is a really challenging point in time. It’s challenging because people are tired of the restrictions on their activity, people are tired of not being able to socialize, not being able to go to work,” said Richard Besser, a former acting director of the Centers for Disease Control and Prevention (CDC) who now heads the Robert Wood Johnson Foundation.

“You have people who have reached that point of pandemic fatigue where they just don’t want to hear it anymore, they just want to go back to their life,” he added.

The number of new U.S. cases has risen sharply in recent weeks, led disproportionately by states in the South, the Midwest and the Sun Belt. More than a quarter-million people tested positive for the coronavirus last week, and more than 40,000 tested positive on three consecutive days over the weekend.

“We are now having 40-plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day if this does not turn around. And so I am very concerned,” Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told a Senate panel on Tuesday.

Public health experts now worry that a rising tide of death is about to crest across the United States. Officials in Alabama, Arizona, California, Mississippi and Texas are reporting a surging number of COVID-19 hospitalizations, leading to fears that health systems could soon be overrun.

“If you’re over the hospital capacity, people will start dying faster,” said Eric Feigl-Ding, an epidemiologist and health economist at the Harvard T.H. Chan School of Public Health and a senior fellow at the Federation of American Scientists.

Already, Arizona has reported more coronavirus deaths per million residents in the last week, at 4.77, than any nation on Earth except Chile and Peru.

The response to the coronavirus pandemic has varied widely, and in some parts of the world, both wealthy and developing nations have brought it under control. In the U.S., some states hit hard early on have wrangled transmission under control.

But even in states that have achieved some measure of success, the spikes in cases stand in stark contrast to countries that have bent the epidemiological curves to manageable levels.

Mass screenings in South Korea crushed the spread, and quick action to identify and isolate contacts in more recent hot spots have meant new outbreaks are quickly contained. South Korea, with a population of 51 million, has reported just 316 new cases in the past week, fewer than the number of new cases reported in Rhode Island, a state with slightly more than 1 million residents.

Germany raced to protect its elderly population and rapidly expanded its hospital capacity. It deployed the world’s most successful diagnostics test, developed at a Berlin hospital, on a massive scale. With a population of 83 million, the country has reported 78 coronavirus deaths in the past week; Mississippi, population 3 million, reported 96 coronavirus-related deaths during the same period.

Vietnam imposed mandatory quarantines on contacts, including international travelers, in government-run centers to stop the spread. Among its 95 million residents, Vietnam has confirmed 355 total cases since the outbreak began. Alabama, population 4.9 million, reported 358 cases on Sunday alone.

Those countries have begun loosening restrictions on their populations and their economies, with few signs of major flare-ups.

The United States has begun to open up too but without bending the curve downward, and the results have been disastrous. The number of daily confirmed cases has more than doubled in nine states over the past two weeks and has increased by more than half in 17 more.

“I have really grave concerns that viral transmission is going to get out of control,” Besser said.

In interviews, public health experts and epidemiologists confess to feelings of depression and disgust over the state of the nation’s response. Some remain exasperated that there is still no coordinated national response from the White House or federal agencies.

President Trump has rarely mentioned the virus in recent weeks, aside from using racial epithets and suggesting his administration would slow testing to reduce the number of confirmed cases. He later said he was joking.

“There should be some sort of federal leadership,” Feigl-Ding said. “Every state’s on its own, for the most part.”

Left to their own devices, some states are trending in the right direction. Connecticut, Maryland, New Hampshire, New York, North Dakota, Rhode Island, South Dakota and the District of Columbia have seen their case counts decline for two consecutive weeks or more. New York reported 4,591 new cases in the last week — a startlingly high figure but only a fraction of the 65,000 cases infecting the state during its worst week, in early April.

States with their numbers on the decline have benefited from fast action and strict measures. They’re also viewed as role models for states that are now experiencing surges.

“States who are now on the rapid upslope need to act quickly, take the advice and example of states that have already been through this,” said Abraar Karan, an internist at Brigham and Women’s Hospital and Harvard Medical School. “We know what needs to be done to win this in the short run, and we are working on what needs to happen for the longer term.”

If there is a silver lining, it is that the number of tests American states are conducting on a daily basis has grown to about 600,000, on its way toward the millions the nation likely needs to fully control the spread.

But that silver lining frames a darkening cloud: As the virus spreads, even the higher testing capacity has been strained, and state and local governments are hitting their limits and running low on supplies.

The greater number of tests does not account for the speed of the spread, as Trump has suggested. The share of tests that come back positive has averaged almost 7 percent over the last week, according to The Hill’s analysis of national figures; in the first week of June, just 4.6 percent of tests were coming back positive.

If greater testing were responsible for more cases, the percentage coming back positive should decrease rather than increase. The higher positive rates are an indication the virus is spreading more rapidly.

As with so much else in American life, the coronavirus has become a political battleground. The new front is over face masks, which studies show dramatically reduce transmission. States that have mandated wearing masks in public saw the number of new cases decline by a quarter between the first and third weeks of June; states that do not require masks in any setting saw the number of cases rise by 84 percent over that same span.

“From a public health perspective, it’s demoralizing, it’s tragic … because our public health leaders know what to do to get this under control, but we’re in a situation where the CDC is not out front in a leadership role. We’re not hearing from them every day. They’re not explaining and capturing people’s hearts and minds,” said Besser, the former CDC chief. “If we have a vaccine, that will be terrific if it’s safe and effective. But until that point, these are the only tools we have, these tools of public health, and they’re very crude tools.”