Category Archives: Infectious Virus

Coronavirus Doesn’t Recognize Man-Made Borders

Posted on by • Posted in 2020 Election Issues, Access, Access & Quality of Healthcare, Chronic Care Management, Chronic Conditions, Chronic Diseases, Clinical Testing, Contact Tracing, Coronavirus, Economic Crisis, Economic Stimulus, Economy Reopening, Essential Health Benefits, Essential Workers, Health Policy, Health System, Hospital, Hospital Bed Shortage, Infection Control, Infection Control Plan, Infectious Virus, Intensive Care (ICU), Mortality, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing, Supply Chain • Leave a comment

Coronavirus Doesn’t Recognize Man-Made Borders

Coronavirus Doesn't Recognize Man-Made Borders - California Health ...

From El Centro Regional Medical Center, the largest hospital in California’s Imperial County, it takes just 30 minutes to drive to Mexicali, the capital of the Mexican state of Baja California. The international boundary that separates Mexicali from Imperial County is a bridge between nations. Every day, thousands of people cross that border for work or school. An estimated 275,000 US citizens and green card holders live in Baja California. El Centro Regional Medical Center has 60 employees who reside in Mexicali and commute across the border, CEO Adolphe Edward told Julie Small of KQED.

Now these inextricably linked places have become two of the most concerning COVID-19 hot spots in the US and Mexico. While Imperial County is one of California’s most sparsely populated counties, it has the state’s highest per capita infection rate — 836 per 100,000, according to the California Department of Public Health. This rate is more than four times greater than Los Angeles County’s, which is second-highest on that list. Imperial County has 4,800 confirmed positive cases and 64 deaths, and its southern neighbor Mexicali has 4,245 infections and 717 deaths.

The COVID-19 crisis on the border is straining the local health care system. El Centro Regional Medical Center has 161 beds, including 20 in its intensive care unit (ICU). About half of all its inpatients have COVID-19, Gustavo Solis reported in the Los Angeles Times, and the facility no longer has any available ventilators.

When Mexicali’s hospitals reached capacity in late May, administrators alerted El Centro that they would be diverting American patients to the medical center. “They said, ‘Hey, our hospitals are full, you’re about to get the surge,’” Judy Cruz, director of El Centro’s emergency department, recounted to Rebecca Plevin in the Palm Springs Desert Sun.

By the first week of June, El Centro was so overburdened that “a patient was being transferred from the hospital in El Centro every two to three hours, compared to 17 in an entire month before the COVID-19 pandemic,” Miriam Jordan reported in the New York Times.

Border Hospitals Filled to Capacity

Since April, hospitals in neighboring San Diego and Riverside Counties have been accepting patient transfers to alleviate the caseload at the lone hospital in El Centro, but the health emergency has escalated and now those counties need relief. “We froze all transfers from Imperial County [on June 9] just to make sure that we have enough room if we do have more cases here in San Diego County,” Chris Van Gorder, CEO of Scripps Health, told Paul Sisson in the San Diego Union-Tribune. El Centro patients are now being airlifted as far as San Francisco and Sacramento.

According to the US Census Bureau, nearly 85% of Imperial County residents are Latino, and statewide, Latinos bear a disproportionate burden of COVID-19. The California Department of Public Health reports that Latinos make up 39% of California’s population but 57% of confirmed COVID-19 cases.

Nonessential travel between the US and Mexico has been restricted since March 21, with the measure recently extended until July 21. However, jobs in Southern California, such as in agricultural fields and packing houses, require regular movement between the two countries. “I’m always afraid that people are imagining this rush on the border,” Andrea Bowers, a spokesperson for the Imperial County Public Health Department, told Small. “It’s just folks living their everyday life.”

These jobs, some of which are considered essential because of their role in the food supply chain, may have contributed to the COVID-19 crisis on the border. Agricultural workers often lack access to adequate personal protective equipment and are unable to practice physical distancing. They also are exposed to air pollution, pesticides, heat, and more — long-term exposures that can cause the underlying health conditions that raise the risk of death for COVID-19 patients.

Comite Civico del Valle, a nonprofit focused on environmental health and civic engagement in Imperial Valley, set up 40 air pollution monitors throughout the county and found that levels of tiny, dangerous particulates violated federal limits, Solis reported.

“I can tell you there’s hypertension, there’s poor air pollution, there’s cancers, there’s asthma, there’s diabetes, there’s countless things people here are exposed to,” David Olmedo, an environmental health activist with Comite Civico del Valle, told Solis.

Fear of New Surges

With summer socializing in full swing, health experts worry that COVID-19 spikes will follow. Imperial County saw surges after Mother’s Day and Memorial Day, probably because of lapsed physical distancing and mask use at social events.

Latinos in California are adhering to recommended public health behaviors to slow the spread of the virus. CHCF’s recent COVID-19 tracking poll with Ipsos asked Californians about their compliance with recommended behaviors. Eighty-four percent of Californians, including 87% of Latinos, say they routinely wear a mask in public spaces all or most of the time. Seventy-two percent of Californians, including 73% of Latinos, say they avoid unnecessary trips out of the home most or all of the time, and 90% of Californians, including 91% of Latinos, say they stay at least six feet away from others in public spaces all or most of the time.

A Push to Reopen Anyway

Most counties in California have met the state’s readiness criteria for entering the “Expanded Stage 2” phase of reopening. Imperial County has not. In the past two weeks, more than 20% of all COVID-19 tests in the county came back positive, the Sacramento Bee reported. The state requires counties to have a seven-day testing positivity rate of no more than 8% to enter Expanded Stage 2.

Still, the Imperial County Board of Supervisors is pushing Governor Gavin Newsom for local control over its reopening timetable. The county has a high poverty rate — 24% compared with the statewide average of 13% — and “bills are stacking up,” Luis Pancarte, chairman of the board, said on a recent press call.

He worries that because neighboring areas like Riverside and San Diego have opened some businesses with physical distancing measures in place, Imperial County residents will travel to patronize restaurants and stores. This movement could increase transmission of the new coronavirus, just as reopening Imperial County too soon could as well.

More than 1,350 residents have signed a petition asking Newsom to ignore the Board of Supervisor’s request, Solis reported. The residents called on the supervisors to focus instead on getting the infection rate down and expanding economic relief for workers and businesses.

Cruz, who has been working around the clock to handle the county’s COVID-19 crisis, agrees with the petitioners. The surges after Mother’s Day and Memorial Day made her “really concerned about unlocking and letting people go back to normal,” she told Plevin. “It’s going to be just like those little gatherings that happened [on holidays], but on a bigger scale.”

 

 

 

 

Re-examining the delivery of high-value care through COVID-19

Posted on by • Posted in 2020 Election Issues, Access, Access & Quality of Healthcare, Affordability, Chronic Care Management, Chronic Conditions, Clinical Unmet Needs, Dept of Health and Human Services (HHS), Emergency Care, Evidence, Evidence-Based Care, Evidence-Based Plan, Health Insurance Benefit Design, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Prices, High Value Care, Infection Control, Infection Control Plan, Infectious Virus, Low-Value Care, Medicaid, Medicare, Non-Essential Care, Out of Pocket Expenses, Pandemic, Population Health, Primary Care, Quality, Quality of Care, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Unnecessary Care, Vaccination • Leave a comment

https://thehill.com/opinion/healthcare/502851-examining-the-delivery-of-high-value-care-through-covid-19#bottom-story-socials

Re-examining the delivery of high-value care through COVID-19 ...

Over the past months, the country and the economy have radically shifted to unchartered territory. Now more than ever, we must reexamine how we spend health care dollars. 

While the COVID-19 pandemic has exposed challenges with health care in America, we see two overarching opportunities for change:

1) the under-delivery of evidence-based care that materially improves the lives and well-being of Americans and

2) the over-delivery of unnecessary and, sometimes, harmful care.

The implications of reallocating our health care spending to high-value services are far-ranging, from improving health to economic recovery. 

To prepare for coronavirus patients and preserve protective equipment, clinicians and hospitals across the country halted non-urgent visits and procedures. This has led to a substantial reduction in high-value care: emergency care for strokes or heart attacks, childhood vaccinations, and routine chronic disease management. However, one silver lining to this near shutdown is that a similarly dramatic reduction in the use of low-value services has also ensued.

As offices and hospitals re-open, we have a once in a century opportunity to align incentives for providers and consumers, so patients get more high-value services in high-value settings, while minimizing the resurgence of low-value care. For example, the use of pre-operative testing in low-risk patients should not accompany the return of elective procedures such as cataract removal. Conversely, benefit designs should permanently remove barriers to high-value settings and services, like patients receiving dialysis at home or phone calls with mental health providers.   

People with low incomes and multiple chronic conditions are of particular concern as unemployment rises and more Americans lose their health care coverage. Suboptimal access and affordability to high-value chronic disease care prior to the COVID-19 pandemic was well documented  As financially distressed providers re-open to a new normal, hopeful to regain their financial footing, highly profitable services are likely to be prioritized.

Unfortunately, clinical impact and profitability are frequently not linked. The post-COVID reopening should build on existing quality-driven payment models and increase reimbursement for high-value care to ensure that compensation better aligns with patient-centered outcomes.

At the same time, the dramatic fall in “non-essential care” included a significant reduction in services that we know to be harmful or useless. Billions are spent annually in the US on routinely delivered care that does not improve health; a recent study from 4 states reports that patients pay a substantial proportion (>10 percent) of this tab out-of-pocket. This type of low-value care can lead to direct harm to patients — physically or financially or both — as well as cascading iatrogenic harm, which can amplify the total cost of just one low-value service by up to 10 fold. Health care leaders, through the Smarter Health Care Coalition, have hence called on the Department of Health and Human Services Secretary Azar to halt Medicare payments for services deemed low-value or harmful by the USPSTF. 

As offices and hospitals reopen with unprecedented clinical unmet needs, we have a unique opportunity to rebuild a flawed system. Payment policies should drive incentives to improve individual and population health, not the volume of services delivered. We emphasize that no given service is inherently high- or low-value, but that it depends heavily on the individual context. Thus, the implementation of new financial incentives for providers and patients needs to be nuanced and flexible to allow for patient-level variability. The added expenditures required for higher reimbursement rates for highly valuable services can be fully paid for by reducing the use of and reimbursement for low-value services.  

The delivery of evidence-based care should be the foundation of the new normal. We all agree that there is more than enough money in U.S. health care; it’s time that we start spending it on services that will make us a healthier nation.

 

 

 

Two Trump campaign staffers who attended rally test positive for coronavirus

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Mixed Message, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Perception, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.axios.com/trump-campaign-rally-tulsa-coronavirus-d3b09725-129c-4aa4-ba2a-1ea868a6ecdd.html?stream=health-care&utm_source=alert&utm_medium=email&utm_campaign=alerts_healthcare

How TikTok Teens Taking Tickets Lowered Trump's Tulsa Rally Crowd ...

Two members of the Trump campaign staff who attended the president’s rally in Tulsa on Saturday have tested positive for the coronavirus, according to the campaign’s communications director Tim Murtaugh.

The big picture: The campaign says the two staffers wore face masks during the entire event, which drew thousands of supporters. Health officials, including several in Tulsa, had urged the campaign to delay the rally, warning of the risk of spreading the virus. Six campaign staffers for the president were quarantined after testing positive before the rally last week.

What he’s saying:

“After another round of testing for campaign staff in Tulsa, two additional members of the advance team tested positive for the coronavirus. These staff members attended the rally but were wearing masks during the entire event. Upon the positive tests, the campaign immediately activated established quarantine and contact tracing protocols.”

— Tim Murtaugh

Worth noting: The White House said on Monday it is “scaling back” coronavirus temperature checks for visitors who enter the complex.

 

 

 

 

Why People Are Still Avoiding the Doctor (It’s Not the Virus)

Posted on by • Posted in 2020 Election Issues, ACA, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Debt Collection, Debt Collection Agency, Deferred Healthcare, Economic Crisis, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Market, Job Search, Job Security, Medicaid, Medicare, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Rev Cycle Management, Revenue Cycle, Telemedicine, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

Why People Are Still Avoiding the Doctor (It's Not the Virus ...

At first, people delayed medical care for fear of catching Covid. But as the pandemic caused staggering unemployment, medical care has become unaffordable for many.

At first, Kristina Hartman put off getting medical care out of concern about the coronavirus. But then she lost her job as an administrator at a truck manufacturer in McKinney, Texas.

While she still has health insurance, she worries about whether she will have coverage beyond July, when her unemployment is expected to run out.

“It started out as a total fear of going to the doctor,” she said.

“I definitely am avoiding appointments.”

Ms. Hartman, who is 58, skipped a regular visit with her kidney doctor, and has delayed going to the endocrinologist to follow up on some abnormal lab results.

While hospitals and doctors across the country say many patients are still shunning their services out of fear of contagion — especially with new cases spiking — Americans who lost their jobs or have a significant drop in income during the pandemic are now citing costs as the overriding reason they do not seek the health care they need.

“We are seeing the financial pressure hit,” said Dr. Bijoy Telivala, a cancer specialist in Jacksonville, Fla. “This is a real worry,” he added, explaining that people are weighing putting food on the table against their need for care. “You don’t want a 5-year-old going hungry.”

Among those delaying care, he said, was a patient with metastatic cancer who was laid off while undergoing chemotherapy. He plans to stop treatments while he sorts out what to do when his health insurance coverage ends in a month.

The twin risks in this crisis — potential infection and the cost of medical care — have become daunting realities for the millions of workers who were furloughed, laid off or caught in the economic downturn. It echoes the scenarios that played out after the 2008 recession, when millions of Americans were unemployed and unable to afford even routine visits to the doctor for themselves or their children.

Almon Castor’s hours were cut at the steel distribution warehouse in Houston where he works about a month ago. Worried that a dentist might not take all the precautions necessary, he had been avoiding a root canal.

But the expense has become more pressing. He also works as a musician. “It’s not feasible to be able to pay for procedures with the lack of hours,” he said.

Nearly half of all Americans say they or someone they live with has delayed care since the onslaught of coronavirus, according to a survey last month from the Kaiser Family Foundation. While most of those individuals expected to receive care within the next three months, about a third said they planned to wait longer or not seek it at all.

While the survey didn’t ask people why they were putting off care, there is ample evidence that medical bills can be a powerful deterrent. “We know historically we have always seen large shares of people who have put off care for cost reasons,” said Liz Hamel, the director of public opinion and survey research at Kaiser.

And, just as the Great Recession led people to seek less hospital care, the current downturn is likely to have a significant impact, said Sara Collins, an executive at the Commonwealth Fund, who studies access to care. “This is a major economic recession,” she said. “It’s going to have an effect on people’s demand for health care.”

The inability to afford care is “going to be a bigger and bigger issue moving forward,” said Chas Roades, the co-founder of Gist Healthcare, which advises hospitals and doctors. Hospital executives say their patient volumes will remain at about 20 percent lower than before the pandemic.

“It’s going to be a jerky start back,” said Dr. Gary LeRoy, a physician in Dayton, Ohio, who is the president of the American Academy of Family Physicians. While some of his patients have returned, others are staying away.

But the consequences of these delays can be troubling. In a recent analysis of the sharp decline in emergency room visits during the pandemic, officials from the Centers for Disease Control and Prevention said there were worrisome signs that people who had heart attacks waited until their conditions worsened before going to the hospital.

Without income, many people feel they have no choice. Thomas Chapman stopped getting paid in March and ultimately lost his job as a director of sales. Even though he has high blood pressure and diabetes, Mr. Chapman, 64, didn’t refill any prescriptions for two months. “I stopped taking everything when I just couldn’t pay anymore,” he said.

After his legs began to swell, and he felt “very, very lethargic,” he contacted his doctor at Catalyst Health Network, a Texas group of primary care doctors, to ask about less expensive alternatives. A pharmacist helped, but Mr. Chapman no longer has insurance, and is not sure what he will do until he is eligible for Medicare later this year.

“We’re all having those conversations on a daily basis,” said Dr. Christopher Crow, the president of Catalyst, who said it was particularly tough in states, like Texas, that did not expand Medicaid. While some of those who are unemployed qualify for coverage under the Affordable Care Act, they may fall in the coverage gap where they do not receive subsidies to help them afford coverage.

Even those who are not concerned about losing their insurance are fearful of large medical bills, given how aggressively hospitals and doctors pursue people through debt collections, said Elisabeth Benjamin, a vice president at Community Service Society of New York, which works with people to get care.

“Americans are really very aware that their health care coverage is not as comprehensive as it should be, and it’s gotten worse over the past decade,” Ms. Benjamin said. After the last recession, they learned to forgo care rather than incur bills they can’t pay.

Geralyn Cerveny, who runs a day care in Kansas City, Mo., said she had Covid-19 in early April and is recovering. But her income has dropped as some families withdrew their children. Although her daughter is urging her to get some follow-up testing because she has some lingering symptoms from the virus, she is holding off because she does not want to end up with more medical bills if her health plan will not cover all of the care she needs. She said she would dread “a fight with the insurance company if you don’t meet their guidelines.”

Others are weighing what illness or condition merits the expense of a doctor or tests and other services. Eli Fels, a swim instructor and personal trainer who is pregnant, has been careful to stay up-to-date with her prenatal appointments in Cambridge, Mass. She and her doctor have relied on telemedicine appointments to reduce the risk of infection.

But Ms. Fels, who also lost her jobs but remains insured, has chosen not to receive care for her injured wrist in spite of concern over lasting damage. “I’ve put off medical care that doesn’t involve the baby,” she said, noting that her out-of-pocket cost for an M.R.I. to find out what was wrong “is not insubstantial.”

At Maimonides Medical Center in Brooklyn, doctors have already seen the impact of delaying care. During the height of the pandemic, people who had heart attacks and serious fractures avoided the emergency room. “It was as if they disappeared, but they didn’t disappear,” said Dr. Jack Choueka, the chair of orthopedics. “People were dying in home; they just weren’t coming into the hospital.”

In recent weeks, people have begun to return, but with conditions worsened because of the time they had avoided care. A baby with a club foot will now need a more complicated treatment because it was not addressed immediately after birth.

Another child who did not have imaging promptly was found to have a tumor. “That tumor may have been growing for months unchecked,” Dr. Choueka said.

 

 

 

 

Comparing COVID-19 to past pandemics

Posted on by • Posted in Clinical Research, Clinical Testing, Coronavirus, Infection Control, Infection Control Plan, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://mailchi.mp/d594e7a0c816/the-weekly-gist-june-19-2020?e=d1e747d2d8

 

Although the coronavirus is easily the most disruptive disease event of our lifetimes, pandemics have ravaged humanity over history, leaving devastating death tolls in their tracks. This graphic compares lives lost in some of the worst worldwide pandemics on record. While a staggering 450,000 people have died from COVID-19 worldwide, the current pandemic represents a mere 0.2 percent of the deadliest plague in recorded human history, the Black Death.

Caused by the bubonic plague, the Black Death took an estimated 200 million lives over just a five-year span during the Middle Ages, killing an estimated 30 to 50 percent of Europe’s population. Arguably, the entire course of history was altered by the Black Death—will the same be true for COVID-19?

The 1918 Spanish Flu, the deadliest pandemic in modern history, claimed 40-50 million lives worldwide across 15 months. Unlike COVID-19, the Spanish Flu—caused by the H1N1 virus—was notable for being atypically fatal in otherwise healthy people, including in children younger than five and especially in adults between the ages of 20 and 40.

The Spanish Flu ebbed and flowed over three very distinct waves across two years, killing 675,000 Americans in total. That’s more than five-and-a-half times the current US COVID-19 death toll, but today we’re less than six months into the coronavirus pandemic.

The vast majority of Spanish Flu deaths occurred in the illness’s second wave, beginning in the fall of 1918—if history repeats itself, the worst of our current pandemic could still be in front of us. 

One stark difference between 1918 and today: the advancement of medical science in the last century has allowed a swift, global effort to create a COVID-19 vaccine—over 125 vaccines are currently in development and 18 have progressed to human trials.

 

 

Cartoon – Flattening the I.Q. Curve

Posted on by • Posted in 2020 Election Issues, Cartoon, Centers for Disease Control & Prevention (CDC), Coronavirus, Economic Crisis, Economy Reopening, Freedom, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mislead, Misleading, National Strategy, Pandemic, Partisanship, Public Health, Public Safety, Quarantine, Scientists, Social Distancing • Leave a comment

Editorial cartoons

Cartoon – How to handle people who won’t wear a mask

Posted on by • Posted in 2020 Election Issues, Cartoon, Coronavirus, Freedom, Infection Control, Infection Control Plan, Infectious Virus, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

Mike Smith Cartoon: 051420 smith cartoon masks -

Trump says Covid-19 is ‘dying out.’ Experts fear his dismissiveness could prolong the crisis

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Credibility, Crisis, Crisis Management, Economic Crisis, Economy Reopening, False Hope, False Narrative, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mislead, Misleading, Mixed Message, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Scientists, Social Distancing, Transparency, Trust, Truth • Leave a comment

Trump says Covid-19 is ‘dying out.’ Experts fear his dismissiveness could prolong the crisis

The Trump Administration Paid Millions for Test Tubes — and Got ...

The White House is taking a new position on the coronavirus pandemic: a daily count of 750 deaths is a testament to the federal government’s successful pandemic response.

On Wednesday, when U.S. health officials reported nearly 27,000 new Covid-19 cases, President Trump said in a television interview that the virus was “dying out.” He brushed off concerns about an upcoming rally in Tulsa, Okla., because the number of cases there is “very miniscule,” despite the state’s surging infection rate. In a Wall Street Journal interview Wednesday, Trump argued coronavirus testing was “overrated” because it reveals large numbers of new Covid-19 cases, which in turn “makes us look bad,” and suggested that some Americans who wear masks do so not only to guard against the virus, but perhaps to display their anti-Trump animus.

But a range of public health experts told STAT that this messaging not only diverts attention from a pandemic that has already caused 120,000 U.S. deaths, but has more practical implications: It could make it difficult for local governments to enlist the public in the mitigation measures necessary to reduce the continued spread of the virus.

“The science behind how people process public warnings in a crisis supports this: You have to have people speaking with one voice,” said Monica Schoch-Spana, a medical anthropologist at the Johns Hopkins Center for Health Security. “You need a chorus.”

Conflicting directives can make it more difficult for recommendations coming from state and local leaders to have an impact, said Sara Bleich, a professor of public health policy at Harvard’s T.H. Chan School of Public Health.

“It sends a mixed message, which is confusing, particularly because while many people will get infected, most will not get severely sick, so it’s easy to say this won’t happen to me,” she said. “And it’s that sort of attitude that will keep us in this situation for a very long time.”

While the president has for weeks, if not months, underplayed the pandemic, his sharp and repeated remarks this week represent a remarkable attempt from the leader of American government to effectively declare the U.S. Covid-19 epidemic over.

The president’s rhetoric comes at a time that his coronavirus task force, which once conducted daily briefings, has not addressed the public since May. The president’s resumption of campaign rallies flouts federal guidance that encourages mask use (Trump’s campaign will hand out masks and hand sanitizer at the rally, but has not said it will require attendees to use them) and discourages large indoor gatherings. And the president has repeatedly claimed, misleadingly, that persistently high U.S. case totals are simply the result of increased testing.

Health experts say that political leaders preaching caution and modeling proper behavior — such as wearing a mask and demonstrating proper hand hygiene — can send a powerful signal to people that these steps can not only protect them, but their communities. They say that, essentially, national and state leaders need to walk the walk in a situation when individual behavior, like staying home when sick and cooperating with contact tracing, can make a large impact in curbing contagion.

Trump’s counterproductive behavior, Schoch-Spana said, extends far beyond the consistently dismissive tone he has taken toward the health risks of Covid-19. With few exceptions, the president has refused to wear a mask in public, and has insisted on continuing in-person briefings and White House events that effectively defy federal health guidance about gathering indoors in large groups.

“It’s not just words, it’s actions,” she said. “So when you have the nation’s top executive refusing to wear a mask, holding meetings where people are shoulder to shoulder, where he’s signing executive orders — that is also a form of communication.”

Experts also say continued federal commitments to combating the virus are crucial as the public grows tired of abatement measures. Instead, Trump has only elevated his monthslong campaign of downplaying the virus.

And Vice President Mike Pence, in a Wall Street Journal op-ed, framed the declines in cases and deaths since April as “testament to the leadership of President Trump” — even as hundreds of Americans are still dying every day and cases are not dropping further.

Rep. Donna Shalala (D-Fla.), who served as health secretary during the Clinton administration, said she hoped Americans would listen to public health guidance from local officials, not Trump and Pence.

“The president of the United States is dangerous to the health of the people of my district, because he’s giving out misinformation and false hope,” she said. “For those that believe him, they’re putting themselves and their families at risk.”

Public health experts have raised a number of issues with the administration’s messaging.

For one, a plateau of cases and deaths should not be celebrated, they say. While some countries in Europe and Asia have not only flattened their curve but driven them down, that hasn’t happened in the United States. Daily cases and deaths dipped from the peak in April, but have averaged about 20,000 and 800, respectively, for weeks.

Beyond those numbers representing real people getting sick and dying, there are other problems with sustained high levels of spread. The more cases there are, the more difficult it is for the surveillance system, including contact tracing, to keep up. It’s also more likely that some of the cases will spiral into explosive spread; 20,000 cases can turn into 40,000 a lot faster than one case can turn into 20,000.

Plus, a failure to suppress spread now could lead to more prolonged disruptions to daily life. If transmission rates come fall are still what they are now in certain communities, that makes it harder to reopen schools, for example.

Experts also point to evidence suggesting that the daily case and death numbers won’t stay flat for long. While new cases in the Northeast and Midwest are declining, a number of states in the West and South — Arizona, Texas, Florida, California, and Oregon among them — have reported record number of new cases this week. What worries public health officials is that, without measures to stem those increases, those outbreaks could keep growing. Those thousands of new cases also signal that, in a week or two, some portion of those people will show up in the hospital, and, about a week after that, a number of them will be dead, even as clinicians have learned more about treating severe Covid-19.

Some states in the South and West are already reporting record hospitalizations from Covid-19.

The White House’s shrug has been echoed by some governors, who insist, like Pence and Trump, that increased testing explains away the rise in cases. That is certainly one reason; testing has become more widespread, so states are capturing a more accurate reading of their true case burden.

But experts say increased testing can only account for some of the data states are reporting. Other metrics — including rising hospitalizations, filling ICUs, and the increasing rate of tests that are positive for the virus — signal broader spread.

Until Wednesday, leaders of Texas and Arizona also bristled at efforts from city and county officials to institute mask requirements, but acceded to growing pressure even as they have not ordered statewide mandates.

Cameron Wolfe, an infectious disease expert at Duke University, said he was seeing a growing “fatigue” among the public to keep up with precautionary steps like physical distancing and mask wearing. People letting down their guard was coinciding with an increase of cases in states, including North Carolina.

He said medical experts and health workers needed to model proper behavior to show others that the coronavirus epidemic was still something that required action. But, he added, “that also comes from political leaders buying into this.”

Federal and state authorities, he said, need to be “taking this to heart. That has not yet happened. That needs to change if we’re going to get people to buy into this.”

 

 

 

 

Mask-wearing becomes political even as some governors ease resistance

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Freedom, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Motivation, National Strategy, Pandemic, Partisanship, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

Mask-wearing becomes political even as some governors ease resistance

More US states mandate wearing masks | The Canberra Times ...

Some state and local leaders are softening their resistance to issuing public masking requirements as emerging research shows face coverings can slow the spread of COVID-19, even as others are doubling down on their opposition.

The debate over whether to require face coverings in public has become increasingly politicized in recent weeks, even as COVID-19 cases have increased in the Sun Belt and some other parts of the country as lockdowns across the country have greatly eased.

Governors in southern, conservative states have been reluctant to issue statewide mandates on public mask-wearing, and in some cases have prevented local governments from taking stronger actions. 

“We want to make sure that individual liberty is not infringed upon by government and hence government cannot require individuals to wear a mask,” Texas Gov. Greg Abbott (R) said Wednesday in an interview with Waco television station KWTX.

Abbott, who frequently recommends mask-wearing, has resisted calls from local leaders to require it, and has also prohibited them from enforcing local orders with civil or criminal penalties on individuals.

However, two Texas counties on Wednesday announced businesses must impose a mask rule on staff and customers or face fines of up to $1,000, which Abbott said would be allowed under his executive order.

“Businesses … they’ve always had the opportunity and the ability, just like they can require people to wear shoes and shirts, these businesses can require people to wear face masks if they come into their businesses. Now local officials are just now realizing that that was authorized,” he said.

Texas has experienced a rapid increase in COVID-19 cases that experts say is likely related to the state’s decision to lift lockdown measures ahead of Memorial Day. The state reported 3,129 new COVID-19 cases Wednesday, its largest single-day increase. Nearly 2,800 people were hospitalized with COVID-19 as of Wednesday, a new high for the state.

In Arizona, which has also seen a surge in cases, Gov. Doug Ducey (R) on Wednesday again resisted calls to issue a statewide masking requirement, but in a reversal, said he would allow local governments to take their own actions. Larger cities including Phoenix and Tucson plan to do so.

“Every Arizonan should wear a face mask,” he said at a Wednesday press conference. “This is an issue of personal responsibility, and we’re asking Arizonans to make responsible decisions to protect the most vulnerable in our communities.” 

While a number of coastal states and cities led by Democrats have strict mask requirements when in public settings such as grocery stores, where staying six feet away from others may not be possible, some Republicans appear to see it as a restriction on freedom and have emphasized individual responsibility.

Trump has almost exclusively declined to wear a mask, and has criticized his political rival Joe Biden, the Democratic candidate for president, for wearing one. 

“I see Biden. It’s like his whole face is covered,” Trump said in an interview published Thursday in The Wall Street Journal. “It’s like he put a knapsack over his face. He probably likes it that way. He feels good that way because he does. He seems to feel good in a mask, you know, feels better than he does without the mask, which is a strange situation.”

The debate of whether to wear masks has sparked division on Capitol Hill, where two Republicans this week refused to follow a new directive from House Speaker Nancy Pelosi (D-Calif.) 

“I consider masks much more effective at spreading panic and much less effective at stopping a virus,” said Rep. Tom McClintock (R-Calif.), during a hearing yesterday. He later put on a mask. 

Polls have shown Democrats are more likely to wear masks in public than Republicans; a Gallup poll conducted in April found 75 percent of Democrats have worn a mask in public, compared to half of Republicans.

However, emerging evidence shows face coverings can slow the transmission of COVID-19. A study published in Health Affairs this week found that mandated use of face masks in public was associated with a reduction in the daily COVID-19 growth rate in 15 states and Washington, D.C., compared to states that did not have such requirements.

Governors of other states experiencing outbreaks, including Henry McMaster (R) of South Carolina, have recommended but don’t require people to wear face masks in public. City council members in Columbia, S.C., however, are reportedly considering a requirement for the state’s largest city.

Alabama Gov. Kay Ivey (R) hasn’t issued a statewide mask requirement for the public, but employees of certain businesses are required to wear them while working.

In Montgomery, Ala., which has the largest COVID-19 outbreak in the state, Mayor Steven Reed (D) issued an executive order Wednesday requiring face coverings be worn in public after a similar ordinance failed to pass the city’s council.

Florida Gov. Ron DeSantis (R) has also resisted a statewide mask requirement, though localities can require their use in public. On Tuesday, he encouraged people to wear masks when social distancing isn’t possible but said it would not be a requirement.

“In terms of forcing that under penalty of criminal law, we’re not going to be doing that. I think it would be applied unevenly and I just don’t think it would end up working,” DeSantis said at a press conference.

The state is also seeing an increase in cases, which DeSantis ties to increased testing. However, public health experts note that the percentage of tests coming back positive is also increasing, a sign of ongoing community transmission. 

In Nebraska, where the rate of COVID-19 transmission has been declining, Gov. Pete Ricketts (R) encourages the use of masks in public but has threatened to withhold federal relief funding from localities that require their use in government buildings.

“The governor encourages people to wear a mask but does not believe that failure to wear a mask should be the basis for denying taxpayers’ services,” spokesman Taylor Gage told the Omaha World-Herald.

Not all Republican governors have resisted masking mandates. Maryland Gov. Larry Hogan and Massachusetts Gov. Charlie Baker were early to issue wide-ranging mask requirements in their states.

Meanwhile, Democratic governors are mandating mask requirements or say they are seriously considering it. 

As cases continue to climb in North Carolina, Gov. Roy Cooper (D) said this state leaders are considering making mask-wearing in public settings mandatory but has not done so yet.

Oregon Gov. Kate Brown (D) announced Wednesday that people living in seven of the state’s counties will have to wear masks in public beginning June 24 as the state sees an increase in cases.

Democratic governors of states hit hard early in the pandemic including New York, Washington and New Jersey have required the use of face coverings in public for several weeks.

California Gov. Gavin Newsom (D) issued a statewide mask order Thursday amid an increase in COVID-19 cases in his state.

“Science shows that face coverings and masks work,” Newsom said Thursday. “They are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.” 

 

 

 

 

In countries keeping the coronavirus at bay, experts watch U.S. case numbers with alarm

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Experts abroad watch U.S. coronavirus case numbers with alarm ...

As coronavirus cases surge in states across the South and West of the United States, health experts in countries with falling case numbers are watching with a growing sense of alarm and disbelief, with many wondering why virus-stricken U.S. states continue to reopen and why the advice of scientists is often ignored.

“It really does feel like the U.S. has given up,” said Siouxsie Wiles, an infectious-diseases specialist at the University of Auckland in New Zealand — a country that has confirmed only three new cases over the last three weeks and where citizens have now largely returned to their pre-coronavirus routines.

“I can’t imagine what it must be like having to go to work knowing it’s unsafe,” Wiles said of the U.S.-wide economic reopening. “It’s hard to see how this ends. There are just going to be more and more people infected, and more and more deaths. It’s heartbreaking.”

China’s actions over the past week stand in stark contrast to those of the United States. In the wake of a new cluster of more than 150 new cases that emerged in Beijing, authorities sealed off neighborhoods, launched a mass testing campaign and imposed travel restrictions.

Meanwhile, President Trump maintains that the United States will not shut down a second time, although a surge in cases has convinced governors in some states, including Arizona, to walk back their opposition to mandatory face coverings in public.

Commentators and experts in Europe, where cases have continued to decline, voiced concerns over the state of the U.S. response. A headline on the website of Germany’s public broadcaster read: “Has the U.S. given up its fight against coronavirus?” Switzerland’s conservative Neue Zürcher Zeitung newspaper concluded, “U.S. increasingly accepts rising covid-19 numbers.”

“The only thing one can say with certainty: There’s nothing surprising about this development,” a journalist wrote in the paper, referring to crowded U.S. beaches and pools during Memorial Day weekend in May.

Some European health experts fear that the rising U.S. caseloads are rooted in a White House response that has at times deviated from the conclusions of leading scientists.

“Many scientists appeared to have reached an adequate assessment of the situation early on [in the United States], but this didn’t translate into a political action plan,” said Thomas Gerlinger, a professor of health sciences at the University of Bielefeld in Germany. For instance, it took a long time for the United States to ramp up testing capacity.

Whereas the U.S. response to the crisis has at times appeared disconnected from American scientists’ publicly available findings, U.S. researchers’ conclusions informed the actions of foreign governments.

“A large portion of [Germany’s] measures that proved effective was based on studies by leading U.S. research institutes,” said Karl Lauterbach, a Harvard-educated epidemiologist who is a member of the German parliament for the Social Democrats, who are part of the coalition government. Lauterbach advised the German parliament and the government during the pandemic.

Despite its far older population, Germany has confirmed fewer than 9,000 coronavirus-linked deaths, compared to almost 120,000 in the United States. (Germany has about one-fourth of the United States’ population.)

Lauterbach cited in particular the work of Marc Lipsitch, a professor of epidemiology at Harvard University, whose research with colleagues recently suggested that forms of social distancing may have to remain in place into 2022. Lipsitch’s work, Lauterbach said, helped him to convince German Vice Chancellor Olaf Scholz that the pandemic will be “the new normal” for the time being, and it impacted German officials’ thinking on how long their strategy should be in place.

Regarding the effectiveness of face masks, Lauterbach added, “we almost entirely relied on U.S. studies.” Germany was among the first major European countries to make face masks mandatory on public transport and in supermarkets.

Lipsitch said Thursday that he was not previously aware of the impact of his research on German decision-making, but added that he has spoken to representatives of several other foreign governments in recent weeks, including Israeli Prime Minister Benjamin Netanyahu and officials or advisers from Canada, New Zealand and South Korea.

Even though Lipsitch cautioned it was impossible for him to say how or if his conversations influenced foreign governments’ thinking, he credited the overall European response as “science-based and a sincere effort to find out what experts in the field believe is a range of possible scenarios and consequences of decisions.”

Lipsitch said he presented some of his research to a White House group in the early stages of the U.S. outbreak but said the Trump administration’s response to the pandemic did not reflect his conclusions. “I think they have cherry-picked models that at each point looked the most rosy, and fundamentally not engaged with the magnitude of the problem,” he said.

The White House has defended its approach as science-based. After a study by Imperial College London predicted 510,000 deaths in Britain and 2.2 million in the United States if the pandemic remained fully uncontrolled, for instance, the Trump administration indicated that it was taking the research into account.

“If we didn’t act quickly and smartly, we would have had, in my opinion and in the opinion of others, anywhere from 10 to 20 and maybe even 25 times the number of deaths,” Trump said two months later,

But European researchers dispute that the U.S. government’s reliance on scientists to inform decision-making comes anywhere near the degree to which many European policymakers have relied on researchers.

After consulting U.S. research and German studies, for instance, German leaders agreed to make reopening dependent on case numbers, meaning restrictions snap back or reopening gets put on hold if the case numbers in a given region exceed a certain threshold.

Meanwhile, several U.S. states have reopened despite rising case numbers.

“I don’t understand that logic,” said Reinhard Busse, a health management professor a the Technical University of Berlin.

Lauterbach said that while most Germans disapproved of Trump before the pandemic, even his staunchest critics in Germany were surprised by how even respected U.S. institutions including the Centers for Disease Control and Prevention (CDC) struggled to respond to the crisis.

The CDC, for instance, initially botched the rollout of test kits in the early stages of the outbreak.

“Like many other aspects of our country, the CDC’s ability to function well is being severely handicapped by the interference coming from the White House,” said Harvard epidemiologist Lipsitch. “All of us in public health very much hope that this is not a permanent condition of the CDC.”

Some observers fear the damage will be difficult to reverse. “I’ve always thought of the CDC as a reliable and trusted source of information,” said Wiles, the New Zealand specialist. “Not anymore.”