Category Archives: Infectious Virus

Quantifying the massive blow to hospital volumes

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https://mailchi.mp/f4f55b3dcfb3/the-weekly-gist-may-15-2020?e=d1e747d2d8

Even after hearing dozens of reports from health systems about how steep their COVID-related volume losses have been, we were still floored by this analysis from healthcare analytics firm Strata Decision Technology, documenting a 55 percent drop in patients seeking hospital care across the country.

The report, which analyzed data from 228 hospitals in 51 health systems across 40 states, found that no clinical service line was immune from steep volume losses. The graphic below shows volume loss by service line in March-April 2020 compared to the same period in 2019.

Unsurprisingly, ophthalmology, gynecology, ortho/spine and ENT—all specialties with a high portion of elective cases, and heavily dependent on procedures—saw volume declines of greater than 70 percent. But even obstetrics and neonatology (which we expected to be “pandemic proof”) and infectious disease (which we thought might be busier in the throes of COVID-19) saw losses of 20-30 percent.

Looking at specific procedures, complex elective surgeries like spinal fusion and hip and knee replacements were almost completely obliterated. Precipitous declines in encounters for chronic diseases like coronary heart disease and diabetes (down 75 and 67 percent, respectively) and cancer screenings (a 55 percent decline in breast health and a 37 percent decline in cancer care overall) point to the likelihood of worrisome disease exacerbations, and a future full of more complex patients.

The volume losses, plus a 114 percent rise in uninsured patients, led to average two-week losses of $26.5M per health system across the study’s cohort. Strata will continue to track and publish volume changes, but this early snapshot paints a bleak picture of staggering financial hits, and “lost” patient care that will carry lasting ramifications for the health of communities nationwide.

 

 

 

 

Consumers trust providers but aren’t hearing from them

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https://mailchi.mp/f4f55b3dcfb3/the-weekly-gist-may-15-2020?e=d1e747d2d8

Last week, we reported that consumer healthcare confidence is down—it’s unclear when people will feel safe enough to return to reopened care sites. Recent polling data provided by our friends at Public Opinion Strategies, and detailed in the graphic below, shows that direct provider communication is crucial to reengaging patients and rebuilding their trust in seeking care.

The majority of Americans receive health-related information from news media outlets, but only 18 percent say they regularly hear it from their doctors or providers—yet 66 percent of Americans view doctors and providers as highly trusted sources of information. Consumers are looking to providers to demonstrate and communicate a commitment to safe operations that are as “COVID-free” as possible.

In particular, many patients would feel safe returning to a healthcare facility if their doctor assured them it’s safe to go. Health systems are taking myriad steps to provide COVID-safe care—staggering appointments, eliminating waiting rooms, screening temperatures upon arrival, providing masks, enhancing sterilization and testing at-risk patients—more communication about the specifics of their efforts, directly to patients, will be vital to restoring consumer confidence. (See more survey data gathered by Public Opinion Strategies here.)

 

 

 

 

Trump faces criticism over lack of national plan on coronavirus

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Trump faces criticism over lack of national plan on coronavirus

COVID-19 National Health Plan – Primary Care – Central Patient ...

The Trump administration is facing intense criticism for the lack of a national plan to handle the coronavirus pandemic as some states begin to reopen.

Public health experts, business leaders and current administration officials say the scattershot approach puts states at risk and leaves the U.S. vulnerable to a potentially open-ended wave of infections this fall.

The White House has in recent days sought to cast itself as in control of the pandemic response, with President Trump touring a distribution center to tout the availability of personal protective equipment and press secretary Kayleigh McEnany detailing for the first time that the administration did have its own pandemic preparedness plan.

Still, the White House lacks a national testing strategy that experts say will be key to preventing future outbreaks and has largely left states to their own devices on how to loosen restrictions meant to slow the spread of the virus. Trump this week even suggested widespread testing may be “overrated” as he encouraged states to reopen businesses.

The Centers for Disease Control and Prevention (CDC) on Thursday night issued long-awaited guidance intended to aid restaurants, bars and workplaces as they allow employees and customers to return, but they appeared watered down compared to previously leaked versions.

Some experts said the lack of clear federal guidance on reopening could hamper the economic recovery. 

“A necessary condition for a healthy economy is a healthy population. This kind of piecemeal reopening with everyone using different criteria for opening, we’re taking a big risk,” said Mark Zandi, chief economist at Moody’s Analytics.

The lack of coherent direction from the White House was driven home this week by damaging testimony by a former top U.S. vaccine official who claims he was ousted from his post improperly.

“We don’t have a single point of leadership right now for this response, and we don’t have a master plan for this response. So those two things are absolutely critical,” said Rick Bright, who led the Biomedical Advanced Research and Development Authority until he was demoted in late April.

The U.S. faces the “darkest winter in modern history” if it does not develop a more coordinated national response, Bright said. “Our window of opportunity is closing.”

From the start, the White House has let states chart their own responses to the pandemic.

The administration did not issue a nationwide stay-at-home order, resulting in a hodgepodge of state orders at different times, with varying levels of restrictions.

Facing a widespread shortage, states were left to procure their own personal protective equipment, ventilators and testing supplies. Trump resisted using federal authority to force companies to manufacture and sell equipment to the U.S. government.

Without clear federal guidance, state officials were competing against each other and the federal government, turning the medical supply chain into a free-for-all as they sought scarce and expensive supplies from private vendors on the commercial market.

“The fact that we had questions about our ability to have enough mechanical ventilators, and you had states basically bidding against each other, trying to secure personal protective equipment …  it shouldn’t be happening during a pandemic,” said Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.

Internally, the administration struggled to mount a unified front as various agencies jockeyed for control. Multiple agencies have been providing contradictory instructions.

At first, Department of Health and Human Services (HHS) Secretary Alex Azar led the White House coronavirus task force.

Roughly a month, later he was replaced by Vice President Pence. The Federal Emergency Management Agency (FEMA) was later tasked with leading the response to get supplies to states, while senior White House adviser Jared Kushner led what has been dubbed a “shadow task force” to engage the private sector. Now, FEMA is reportedly winding down its role, and turning its mission back over to HHS.

The CDC has been largely absent throughout the pandemic. Director Robert Redfield has drawn the ire of President Trump as well as outside experts, and he has been seen infrequently at White House briefings.

“I think seeing the nation’s public health agency hobbled at a time like this and looking over its shoulder at its political bosses is something I hoped I would never see, and I’ve been working with the CDC for over 30 years,” said Lawrence Gostin, a professor of public health at Georgetown University.

“I think that people will die because the public health agency has lost its visibility and its credibility and that it’s being politically interfered with,” he added.

The administration recently has taken some steps to improve on the initial response to the pandemic.

Ventilator production has increased, and the U.S. is no longer seeing a shortage of the devices. 

Testing has improved dramatically as well, though experts think the U.S. needs to be testing thousands of more people per day before the country can reopen.

The administration also unveiled plans to expand the Strategic National Stockpile’s supply of gowns, respirators, testing supplies and other equipment, after running out of supplies early in the pandemic.

Adalja said the administration’s positive steps are coming way too late. 

“It’s May 15, we should have been in this position January 15,” he said.

McEnany on Friday for the first time detailed the White House’s preparedness plan that replaced the Obama-era pandemic playbook, an acknowledgement that Trump’s predecessor did leave a road map, despite claims to the contrary from some of the president’s allies.

She did not give many specifics on the previously unknown plan. Instead, McEnany declared the Trump administration’s handling of the virus had been “one of the best responses we’ve seen in our country’s history.”

Yet as states look to reopen businesses and get people back to work, the White House is taking a back seat as governors set their own guidelines for easing stay-at-home orders and restrictions on social activities.

The White House in April issued a three-step plan for states to reopen their economies, but it has largely been ignored by states and by the president.

Dozens of governors have begun easing restrictions on businesses and social activities without meeting the White House guidelines. Trump has been urging them to move even faster, backing anti-lockdown protesters in Michigan, Virginia, Minnesota and Pennsylvania.

Even scaled-down guidance from federal agencies is critical for providing a road map for state and local leaders, and for businesses considering how best to resume operations, said Neil Bradley, chief policy officer with the U.S. Chamber of Commerce.

“We need guidance because it helps instill confidence about the right types of approaches to take, but when you begin to move away from guidance and into either regulations or very strict approach, then that’s increasingly going to be unworkable in lots of different locations,” Bradley said.

 

 

 

Seven weeks into coronavirus lockdowns, Fed has a new, darker message

Posted on by • Posted in 2020 Election Issues, Bankruptcy, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Economy, Economy Reopening, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Financially Distressed, Health Policy, Infection Control, Infectious Virus, Job, Job Market, Job Search, Job Security, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Uncertainty • Leave a comment

https://www.yahoo.com/news/seven-weeks-coronavirus-lockdowns-fed-182614531.html

Seven weeks into coronavirus lockdowns, Fed has a new, darker ...

One Thursday morning seven weeks ago, Federal Reserve Chair Jerome Powell made a rare appearance on NBC’s “Today Show” to offer a reassuring message to Americans dealing with economic fallout from measures to contain the coronavirus outbreak.

There is “nothing fundamentally wrong with our economy,” Powell told viewers, while pointing out the U.S. central bank’s outsized ability to take on lending risk and provide a financial “bridge” over the temporary economic weakness the country was experiencing.

Speaking after the Fed cut interest rates to near zero and rolled out a plan to backstop credit for small- and mid-sized companies, Powell emphasized the first order of business was to get the virus under control.

“The sooner we get through this period and get the virus under control, the sooner the recovery can come,” said Powell, echoing remarks made the day before by Anthony Fauci, a top U.S. health official helping to coordinate the federal government’s response to the coronavirus crisis.

At the time, Powell said he expected economic activity would resume in the second half of the year, and maybe even enjoy a “good rebound.”

But on Wednesday, he offered a much more sober outlook.

In an interview webcast by the Peterson Institute for International Economics, Powell warned of an “extended period” of weak economic growth, tied to uncertainty about how well the virus could be controlled in the United States. “There is a sense, growing sense I think, that the recovery may come more slowly than we would like,” he said.

Fauci, the director of the National Institute of Allergy and Infectious Diseases, was similarly somber when he told lawmakers earlier this week that the country was by no means in “total control” of the outbreak.

“There is a real risk that you will trigger an outbreak that you may not be able to control and, in fact, paradoxically, will set you back, not only leading to some suffering and death that could be avoided, but could even set you back on the road to try to get economic recovery,” Fauci said.

The pandemic has killed more than 83,000 people in the United States so far, and many epidemiological models now point to a death toll that will surpass 100,000 in a matter of weeks.

Overall new cases of the virus continue to climb as well, as states end lockdowns and reopen local economies without the widespread, uniform testing and contact tracing policies that helped stamp out initial outbreaks in South Korea and Germany.

UNCERTAIN FUTURE

Powell’s remarks on Wednesday mirrored warnings this week from a clutch of regional Fed presidents who outlined the country’s uncertain future.

U.S. central bank officials, and especially the Fed chief, historically choose their words carefully, to avoid alarming or exciting investors or causing swings in financial markets, making their universally dour outlook more remarkable.

St. Louis Fed President James Bullard said the situation could lead to a new Great Depression, with millions of so-far temporary job losses becoming permanent, and businesses failing “on a grand scale.”

“We have to get better at this and get more risk-based with our health policy,” Bullard said.

The U.S. economy can return to growth in the second half of the year, Cleveland Fed President Loretta Mester said on Tuesday, with more testing and contact tracing. If that happens, she said, “as some of the stay-at-home restrictions are lifted, the economy will begin to grow again in the second half of this year and unemployment will begin to move down.”

However, a more pessimistic scenario, in which a surge in infections requires businesses to shut down again or the crisis leads to more bankruptcies or instability in the banking sector, is “almost as likely,” she said.

 

 

 

 

Amid reports of White House clashes with CDC, experts raise alarms about lack of coronavirus screening at airports

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, Economy Reopening, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Scientists, Social Distancing • Leave a comment

https://www.yahoo.com/news/coronavirus-screening-airports-144105500.html

Terminal 1 at John F. Kennedy International Airport in New York City. (Lev Radin/Pacific Press/LightRocket via Getty Images)

As the nation begins to reopen amid the coronavirus pandemic, some people are looking to the skies — and experts don’t necessarily like what they see, arguing there are not enough safeguards in place to protect passengers and crew. 

While air travel has fallen sharply due to the virus, the airports are open and planes are flying both domestically and internationally. The Centers for Disease Control and Prevention has issued travel guidelines encouraging air passengers to wear face coverings, “keep 6 feet of physical distance from others” and only board planes for essential travel. However, these guidelines are merely suggestions. 

There is no requirement for masks, and there have been multiple reports of crowded conditions in airports and on planes, which have left passengers alarmed. The Transportation Security Administration, which screens passengers and luggage at airports, has also experienced over 560 confirmed cases of COVID-19, the disease caused by the coronavirus, and six deaths from the illness.

Despite these concerns, there are currently no coronavirus screening procedures for domestic air travelers, and a congressional investigation has also raised questions about the level of screening being conducted for international passengers. Speaking in the Oval Office on April 28, President Trump told reporters his administration is working on implementing a procedure for temperature checks and COVID-19 tests for air travelers.

“We’re also setting up a system where we do some testing, and we’re working with the airlines on that,” Trump said.

According to a May 6 government document reviewed by Yahoo News, the CDC was “developing a tool for predicting risk of importation of COVID-19 among international travelers” and meeting with the White House National Security Council “to discuss strategies for screening arriving international passengers from countries with substantial COVID-19 transmission.”

However, there have been reports of discord between the CDC and the White House. On May 9, USA Today reported CDC officials were overruled by the White House after they raised concerns about a potential plan to establish temperature checks at the airports. While some COVID-19 patients do have high fevers, many do not and others are entirely asymptomatic. 

USA Today’s report included an email Dr. Martin Cetron, the CDC’s director of global mitigation and quarantine, sent to officials with the Department of Homeland Security criticizing the temperature checks as “a poorly designed control and detention strategy.” 

Cetron, the CDC and DHS did not respond to requests for comment. The White House did not respond to questions about the reported disagreements from the CDC or whether the Trump administration believes temperature checks are an adequate screening measure for airports.

Rep. Raja Krishnamoorthi, the chairman of the House oversight subcommittee on economic and consumer policy, has investigated coronavirus screening procedures at airports. Earlier this week, the Illinois Democrat told Yahoo News he was concerned by the report that the White House is pursuing a temperature screening plan over the objections of CDC officials. 

“The White House has been ignoring and sidelining America’s public health experts at the CDC, instead relying on nonexpert political appointees to make public health decisions,” Krishnamoorthi said. “I am troubled by reports that officials at the Centers for Disease Control and Prevention could raise this public health concern and be essentially overruled by presidential aides. The desire to lure Americans back into traveling by making them feel like they are safe cannot outweigh the need to actually keep this country safe.”

Krishnamoorthi has previously raised concerns about what he described as “lax” screening procedures for international travelers coming into the United States from coronavirus hot spots in March as the pandemic exploded around the globe. Trump has repeatedly pointed to restrictions he imposed on travelers from China — where the virus originated — on Jan. 31 as evidence of his strong efforts to curb its spread in the United States.

However, the restrictions on China contained exemptions that allowed over 400,000 people to subsequently travel from that country to the United States. And on May 7, Krishnamoorthi’s subcommittee released the results of an investigation that focused on two other early coronavirus hot spots — Italy and South Korea. Krishnamoorthi said he believes Trump has focused on “rhetoric and bluster rather than actually effective screenings.”

“Just from what we found with Italy and South Korea, there was no border closing. There was no screening. Unfortunately, the lack of screening probably had some very serious consequences at a time when cases were exponentially rising in the United States.”

Krishnamoorthi’s investigation, which included extensive briefings from officials, found that the White House National Security Council’s Policy Coordination Committees decided in March to rely on South Korean and Italian officials to screen passengers in those countries who were headed to the United States. The probe further found the U.S. had “limited” oversight for those screenings in Italy and that only 69 passengers were prevented from coming to the U.S. from those two countries in March. Once they arrived, the investigation found passengers entering from the two countries did not receive additional health screenings.

“Potentially thousands and thousands of people came across without screenings” from what were two of the leading coronavirus hot spots at the time, Krishnamoorthi told Yahoo News. “It doesn’t take a lot to believe that folks came over and seeded further outbreaks here in this country.”

Jonathan Ullyot, a spokesperson for the White House National Security Council, responded to questions about Krishnamoorthi’s investigation with a statement touting the government’s steps to screen international arrivals earlier this year.

“The reality is that the United States government took early and decisive action to mitigate the risk from global hot spots, including China, Iran, South Korea, and the Schengen area of Europe,” Ullyot wrote. “After restricting travel from China on January 31 … the security directive put forth by the administration required enhanced medical screenings for all passengers before they departed on flights to the United States from Northern Italy and South Korea.”

According to Ullyot, the screenings in Italy and South Korea “included checking the passenger’s temperature, visual observations to detect signs of illness, and questionnaires.” While Ullyot did not dispute Krishnamoorthi’s contention that the U.S. relied on officials in those countries to conduct the screenings and that few passengers were denied boarding, he said “U.S. mission staff visited airports” in both countries to “observe these screening procedures.”

A senior Trump administration official, who requested not to be named, said all international arrivals to the United States are subject to Customs and Border Protection (CBP) screenings that are following CDC guidelines. The official explained that those guidelines require CBP officers to refer travelers “to the CDC, DHS contract medical screeners, or local health authorities for health screening” if they are exhibiting symptoms or have traveled from countries that have experienced major outbreaks.

According to the official, the CBP has “established processes to identify travelers who have traveled to the United States directly or indirectly from areas that are experiencing COVID-19 outbreaks.”

Domestic air passengers, however, are treated differently.

“With regard to domestic travel, there’s not more screening beyond what TSA normally does,” Krishnamoorthi said. 

He said that lack of screening for domestic travelers is particularly worrisome as areas of the country are beginning to lift lockdown restrictions. He suggested this could lead to a situation where business people “go back and start traveling” and then “transport these cases everywhere.”

“We have to look at the science of it more closely, and we have to develop a more precise way of screening,” Krishnamoorthi said.

Randy Babbitt, a former administrator of the Federal Aviation Administration, said the lack of new screening procedures is not as much of a problem right now since “nobody’s flying.” However, he said it will become a pressing issue as the country reopens and airports become more crowded.

“People are going to start flying and as it ramps back up, that becomes a different question,” Babbitt told Yahoo News.

Babbitt further explained that one difficulty with establishing comprehensive procedures for airports is that so many different government agencies are involved in air travel. However, he pointed to proposals generated by Stonebriar Strategy Group Thought Leadership Initiative, a nonprofit consultancy, as a realistic potential road map.

Howard Thrall, the president and senior partner of the group, said the organization is comprised of multiple retired consultants and executives who have worked in the industry. According to Thrall, a  veteran executive who has worked for multiple aviation and aerospace companies, the group came together because they were “totally amazed” a coronavirus airport screening system has not yet been established. 

“This is really a pro bono exercise for a bunch of old graybeards,” Thrall said.

The Stonebriar Strategy Group’s proposal calls for screening perimeters to be established outside airports, where rapid COVID-19 tests, questionnaires and temperature checks could be administered to travelers and workers. Setting up a screening perimeter would mean that even if passengers ended up in close proximity during boarding or on planes, they could have a higher degree of confidence those around them were not contagious.

Along with addressing safety concerns, Thrall said implementing these screenings could help the economy since aviation is a substantial part of the nation’s gross domestic product and boosting consumer confidence is crucial to returning the industry to normal levels. He pointed to the aftermath of the Sept. 11 attacks, when the TSA was formed and security screening procedures were transformed, as evidence that airport procedures can quickly be revamped.

The Stonebriar Strategy Group’s detailed proposal estimated it would cost approximately $6.8 million per airport, per year, to establish coronavirus screening perimeters. With approximately 5,000 public airports in the country, that would mean a total cost of about $34 billion.

However, Thrall argued that cost is realistic relative to the urgent need and the trillions of dollars the government is spending to address the coronavirus. 

“That’s why we wrote it up. It wasn’t happening and it could happen. This is not a big deal,” Thrall said. “I mean, it’s not going to be free by any means, but this is very, very manageable.”

 

 

 

Rick Bright, ousted director of vaccine agency, warns that administration lacks ‘centralized, coordinated plan’

Posted on by • Posted in 2020 Election Issues, Biomedical Advanced Research and Development Authority (BARDA), Chloroquine, Clinical Testing, Contact Tracing, Coronavirus, Credibility, Crisis, Crisis Management, Denial, Dept of Health and Human Services (HHS), Economic Crisis, Economic Recovery, Economic Stimulus, Economy Reopening, Emergency Preparedness, Health Policy, Hydroxychloroquine, Infection Control, Infectious Virus, Leadership Culture, Leadership Intent, Leadership Listens, Leadership Trust, National Strategy, Personal Protective Equipment (PPE), Scientists, Supply Chain, Transparency, Trust, Truth, Vaccination, Vaccine • Leave a comment

https://www.cnn.com/2020/05/14/politics/coronavirus-whistleblower-testimony/index.html?fbclid=IwAR0KfVp-njw8vqKFdaLbBC4r4NAx3KeS4rFg2vmFbSneW7PcqOwVYult9rc

Virus whistleblower tells lawmakers US lacks vaccine plan | Where ...

Rick Bright, the ousted director of a crucial federal office charged with developing countermeasures to infectious diseases, testified before Congress on Thursday that the US will face an even worse crisis without additional preparations to curb the coronavirus pandemic.

“Our window of opportunity is closing,” Bright said. “Without better planning, 2020 could be the darkest winter in modern history.”
Bright criticized the Trump administration for failing to implement a “standard, centralized, coordinated plan” to combat the virus and questioned its timeline for a vaccine. His testimony came a week after filing a whistleblower complaint alleging he was fired from his job leading the Biomedical Advanced Research and Development Authority for opposing the use of a drug frequently touted by President Donald Trump as a potential coronavirus treatment.
About an hour before Bright’s hearing, Trump tweeted that he had “never met” or “even heard of” Bright, but considers the NIH senior adviser a “disgruntled employee, not liked or respected by people I spoke to and who, with his attitude, should no longer be working for our government!”
Before the House Committee on Energy and Commerce’s health subcommittee, Bright urged the Trump administration to consider a number of actions, including increasing production of essential equipment and establishing both a national test strategy and a national standard of procurement of supplies. He calls on top officials to “lead” through example and wear face coverings and social distance.
Bright claimed that the administration missed “early warning signals” to prevent the spread of the virus. He said that he would “never forget” an email from Mike Bowen, the hearing’s other witness and the vice president of the medical supply company Prestige Ameritech, indicating that the US supply of N95, the respirator masks used by health care professionals, was at a perilous level.
“He said, ‘We’re in deep shit,'” testified Bright. “‘The world is.'”
Bright said he “pushed” that warning “to the highest levels” he could at Health and Human Services but received “no response.”
“From that moment, I knew that we were going to have a crisis for health care workers because we were not taking action,” said Bright. “We were already behind the ball.”
In his written statement, Bright blamed the leadership of HHS for being “dismissive” of his “dire predictions.” Bright wrote that he knew the US had a “critical shortage of necessary supplies” and personal protective equipment during the first three months of the year and prodded HHS to boost production of masks, respirators, syringes and swabs to no avail. He alleged that he faced “hostility and marginalization” from HHS officials after he briefed White House trade adviser Peter Navarro and members of Congress “who better understood the urgency to act.”
And he charged that he was removed from his post at BARDA and transferred to “a more limited and less impactful position” at NIH after he “resisted efforts to promote” the “unproven” drug chloroquine.
A Department of Health and Human Services spokesperson responded that it was “a personnel matter that is currently under review” but said it “strongly disagrees with the allegations and characterizations.”
Bright is seeking to be reinstated to his position as the head of BARDA. The Office of Special Counsel, which is reviewing Bright’s complaint, has determined that was a “substantial likelihood of wrongdoing” in removing him from his post, according to Bright’s attorneys.
Rep. Anna Eshoo, a California Democrat and the panel’s chairwoman, said Bright “was the right person, with the right judgment, at the right time.”
“We can’t have a system where the government fires those who get it right and reward those who get it completely wrong,” added Eshoo.
In his testimony, Bright also cast doubt on the Trump administration’s goal of manufacturing a vaccine in 12 to 18 months as overly optimistic, calling it “an aggressive schedule” and noting that it usually takes up to 10 years to make a vaccine.
“My concern is if we rush too quickly, and consider cutting out critical steps, we may not have a full assessment of the safety of that vaccine,” Bright said. “So, it’s still going to take some time.”
Some Republicans on the subcommittee said that the hearing shouldn’t have been held at all.
Rep. Michael Burgess of Texas, the top Republican on the panel, said “every whistleblower needs to be heard,” but added the hearing was “premature” and a “disservice” to the Special Counsel’s investigation since Bright’s complaint was filed only a week ago.
And Republican Rep. Richard Hudson of North Carolina claimed that the hearing was not about the whistleblower complaint but “undermining the Administration during a national and global crisis.”
Thursday’s subcommittee meeting comes two days after a blockbuster hearing in the Senate that featured Dr. Anthony Fauci, who leads the National Institute of Allergy and Infectious Diseases. Fauci said that access to a vaccine in time for the fall school year would be “a bit of a bridge too far” and warning against some schools opening too soon, which Trump later called “not an acceptable answer.”
Fauci testified from his modified quarantine at home since he had made contact with a White House staffer who tested positive. But Bright appeared masked and in-person for his hearing on Capitol Hill, as did the lawmakers who questioned him. Many members of the House have steered clear of Capitol Hill since the onset of the outbreak, although they are expected to return on Friday to vote on a multi-trillion dollar Democratic bill responding to the crisis.

 

 

The pandemic broke America

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economic Stimulus, Economy Reopening, Emergency Preparedness, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Essential Businesses, Essential Health Benefits, Essential Workers, Health Insurance Coverage Adequacy, Health Policy, Infection Control, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Partisanship, Preexisting Conditions, Public Health, Public Safety, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.axios.com/coronavirus-america-broken-2baa69e4-60e6-49a5-932a-5d118441ae20.html

The coronavirus pandemic broke America - Axios

Eight weeks into this nation’s greatest crisis since World War II, we seem no closer to a national strategy to reopen the nation, rebuild the economy and defeat the coronavirus.

Why it matters: America’s ongoing cultural wars over everything have weakened our ability to respond to this pandemic. We may be our worst enemy.

  • The response is being hobbled by the same trends that have impacted so much of our lives: growing income inequality, the rise of misinformation, lack of trust in institutions, the rural/urban divide and hyper-partisanship.
  • We’re not even seeing the same threat from the virus. Democrats are far more likely than Republicans to be worried about getting seriously ill, while Republicans — including the president — are more likely to think the death counts are too high.

Without even a basic agreement on the danger of the pandemic and its toll, here’s how we see the national response unfold:

  • The Centers for Disease Control and Prevention, the crown jewel of the globe’s public health infrastructure, has been sidelined, its recommendations dismissed by the White House.
  • President Trump declares the U.S. has “prevailed on testing” at a time when health experts say we still need far more daily tests before the country can reopen safely.
  • Distribution of the promising coronavirus drug remdesivir was initially botched because of miscommunication between government agencies.
  • More than two thirds of Americans say it’s unlikely they would use a cell phone-based contact tracing program established by the federal government, a key component of a testing regime to control the virus.
  • The second phase of a program to aid small businesses isn’t fully allocated because firms are either concerned about its changing rules, confused about how to access it, or find the structure won’t help them stay in business.
  • With the unemployment rate at a post-Depression record last month, and expected to go higher, there is no meaningful discussion between the parties in Congress on aid to the out-of-work.
  • States and local governments are facing billions in losses without a strategy for assistance.
  • The virus is literally inside the White House. Aides have tested positive for coronavirus, leading to quarantines for some of the nation’s top public health officials and a new daily testing regime for White House staff and reporters who enter the West Wing.
  • The No. 1 book on Amazon for a time was a book by an anti-vaxxer whose conspiracy-minded video about the pandemic spread widely across social media, leading to takedowns by platforms like YouTube and Facebook.

The other side: There’s better news at the state level. “Governors collectively have been winning widespread praise from the public for their handling of the coronavirus outbreak,” the Washington Post reports.

Between the lines: Nationwide, 71% of Americans approve of the job their governor is doing, according to the Post. For Trump, the figure is 43%.

  • And former presidents we often expect to help rally the nation in trying times are scarce.
  • George W. Bush released a video, in which his face barely appeared, calling for unity in the fight against the virus. Barack Obama was recorded in leaked remarks to former staffers calling Trump’s coronavirus response “an absolute chaotic disaster.” Trump attacked both of them on Twitter.

The bottom line: An existential threat — like war or natural disaster — usually brings people together to set a course of action in response. Somehow, we’ve let this one drive us apart.

 

 

 

 

Guns in Michigan Capitol: Defense of liberty or intimidation?

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Free Speech, Freedom, Gun Control, Gun Violence, Hate, Health Policy, Infection Control, Infectious Virus, Pandemic, Partisanship, Protest, Public Debate, Public Discourse, Public Good, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://www.csmonitor.com/USA/Politics/2020/0504/Guns-in-Michigan-Capitol-Defense-of-liberty-or-intimidation

Guns in coronavirus protests: Defense of liberty or intimidation ...

WHY WE WROTE THIS

Bringing assault weapons to the Michigan Legislature for a protest against coronavirus restrictions? To one group, it’s why the Second Amendment exists. To many others, it’s unfathomable.

It was a first for Michigan state Sen. Sylvia Santana. Before heading to the statehouse in Lansing last Thursday, she slipped into a bulletproof vest.

Ms. Santana’s husband, a sheriff’s deputy, warned her about potential trouble at a rally to protest the decision to extend a coronavirus lockdown.

A group of armed white men entered the Capitol and shouted at lawmakers. To Ms. Santana, some were dressed like they were “going to war.” Several Confederate flags, a swastika, and a misogynistic sign aimed at Gov. Gretchen Whitmer could be seen outside.

“I thought that was very scary,” says Ms. Santana, an African American who represents parts of Detroit and all of neighboring Dearborn. “We’re there to do a job, and it’s not to dodge bullets as we try to do our jobs in a bipartisan fashion to make sure we’re keeping all Michiganders safe.”

Four days on from the protest, her concern lingers. The pandemic has intensified many societal fault lines – from health care inequities to political polarization – and gun control is no exception. Feeling that state officials are overreaching, a tiny minority of protesters are flexing their Second Amendment rights in Michigan and beyond.

But at a time of crisis, their crusade against the perceived tyranny of government is seen by many as tyrannical in its own right – recklessly using their liberties to intimidate others.

The core question is: Where should the line be drawn? For protesters, guns in statehouses is one of the purest expressions of the power the Second Amendment invests in citizens. But no constitutional right is absolute.

“Where do people who see no problem with guns downtown or near a hospital or in the legislature, where do they draw the line?” Sanford Levinson, co-author of “Fault Lines in the Constitution.” “That’s an interesting question both politically and legally, because courts are really receptive to line drawing. I don’t think you’d find any judge who says, ‘Yeah, I welcome guns in my courtroom.’”

In that way, the struggle over whether to allow firearms in legislatures “is part of the culture war,” he adds.

Are hard-line tactics effective?

Today, 21 state capitols allow guns in some form, according to a Wall Street Journal report. But only a few, including Michigan, allow citizens to openly carry under the rotunda. Many Republican-led states balk at open carry in the people’s hall for personal safety reasons, and courts have upheld bans in places like legislatures and polling places, holding that guns can chill other people’s rights.

Elements of race have long played a role. The modern gun control movement is linked to the signing of the Mulford Act in 1967, which banned open carry in California. The bill gained momentum after two dozen Black Panthers legally brought firearms to the state capitol to protest against it. The National Rifle Association backed the bill.

Incidents like the one in Michigan, however, could do more to damage gun rights than advance them. “It’s really now an open question to what extent hard-line pro-gun policies are politically advantageous,” says Mr. Levinson, also a visiting professor at Harvard Law School in Cambridge, Massachusetts.

Ms. Santana was certainly not persuaded. “I, as a state lawmaker, want to hear your concerns and your position on the issue. But I don’t feel that bringing assault weapons to the capitol and using symbols of hatred will make me understand your issue better.”

The scenes in Michigan, which has been hit hard by COVID-19, only make it harder to have already difficult conversations, others say. Part of self-defense is respecting the preferences other people have for their own security, which might mean leaving guns at home when overtones of intimidation are possible.

“When your eyes look at these pictures of groups of people … in a public building that is supposed to be a center of democratic exchange and debate, and you see a group of people carrying military weapons, that is not a vision of democracy,” says Hannah Friedman, a staff attorney at Giffords Law Center to Prevent Gun Violence in San Francisco. “That’s a vision of intimidation by a minority of people.”

Such concerns were heightened further this weekend, when employees at businesses in Stillwater, Oklahoma, faced a threat of violence with a gun while trying to force customers to wear masks, as mandated by the local government.

“I think we were heard”

But Ashley Phibbs has a different view.

Ms. Phibbs, a project manager and mother who helped organize the Michigan rally, acknowledged with regret that many in attendance didn’t abide by social distancing rules. She also confirmed the display of hate symbols. But she insisted those were agitators and not part of her group, Michigan United for Liberty, which has sprung up to oppose what members see as repressive COVID-19 restrictions.

“I know how it can seem to people who aren’t active in rallies and who are looking at it from the outside in, and I try to be very understanding of that,” says Ms. Phibbs. “But … I don’t think that anyone was there to really make anyone fearful. I didn’t see anything that would have really caused fear, aside from loud noises from the people yelling. But a lot of people are also sometimes afraid of guns in general.”

In the end, she says, “I think we were heard. I think overall [the rally] was positive.”

Knowing your audience

Other gun-rights advocates saw problems with the optics.

As he watched news from Michigan Thursday, Caleb Q. Dyer saw some familiar faces. The New Hampshire barista and former state legislator had been a keynote speaker at a Michigan Libertarian Party event last year.

But he worried that his friends in Michigan were sending “mixed messages” by failing to abide by public health rules.

In fact, he usually brings witty protest gear – such as a sign that says “arm the homeless” – to disarm fear. It’s a fine line, he says, between free speech and armed intimidation.

“People aren’t ready to have the discussion that a lot of these gun-carrying protesters want to have, which is that none of these laws are even remotely effective or just,” says Mr. Dyer. “But they’re not going to have that discussion if they cannot carry themselves in such a way that the opposition won’t think … that they’re murderous and violent.”

 

 

 

 

 

Window of Opportunity is Closing for Coronavirus Response

Posted on by • Posted in 2020 Election Issues, ACA, Biomedical Advanced Research and Development Authority (BARDA), Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Dept of Health and Human Services (HHS), Economic Crisis, Economic Stimulus, Economy, Economy Reopening, Emergency Preparedness, Employee Benefits, 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, Hydroxychloroquine, Infection Control, Infectious Virus, Job, Job Market, Job Search, Job Security, Leadership Decentralized, Medicaid, Medicaid Expansion, Mortality, Out of Pocket Expenses, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Safety, Quarantine, Social Distancing, Strategy National, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Ventilators • Leave a comment

https://www.axios.com/rick-bright-testimony-opening-statement-6817ae7a-5196-4357-b83c-d3ff96990efd.html?stream=health-care&utm_source=alert&utm_medium=email&utm_campaign=alerts_healthcare

Window of opportunity – definition and meaning – Market Business News

A top vaccine doctor who was ousted from his position in April is expected to testify Thursday that the Trump administration was unprepared for the coronavirus, and that the U.S. could face the “darkest winter in modern history” if it doesn’t develop a national coordinated response, according to prepared testimony first obtained by CNN.

The big picture: Rick Bright, the former head of the Biomedical Advanced Research and Development Authority (BARDA), will tell Congress that leadership at the Department of Health and Human Services ignored his warnings in January, February and March about a potential shortage of medical supplies.

  • He will testify that HHS “missed early warning signals” and “forgot important pages from our pandemic playbook” early on — but that “for now, we need to focus on getting things right going forward.”
  • Bright’s testimony also reiterates claims from a whistleblower report he filed last week that alleges he was ousted over his attempts to limit the use of hydroxychloroquine — an unproven drug touted by President Trump — to treat the coronavirus.

What he’s saying: Bright will testify he urged HHS to ramp up production of
masks, respirators and medical supplies as far back as January. Those warnings were dismissed, Bright says, and he was “cut out of key high-level meetings to combat COVID-19.”

  • “I continue to believe that we must act urgently to effectively combat this deadly disease. Our window of opportunity is closing. If we fail to develop a national coordinated response, based in science, I fear the pandemic will get far worse and be prolonged, causing unprecedented illness and fatalities.”

Bright will call for a national strategy to combat the virus, including “tests that are accurate, rapid, easy to use, low cost, and available to everyone who needs them.”

  • “Without clear planning and implementation of the steps that I and other experts have outlined, 2020 will be darkest winter in modern history.”

Read Bright’s prepared statement.

 

 

 

 

COVID-19 by the numbers: 51 stats, dollar figures and dates for hospital leaders to know

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Economy Reopening, 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.beckershospitalreview.com/hospital-management-administration/covid-19-by-the-numbers-51-stats-dollar-figures-and-dates-for-hospital-leaders-to-know.html?utm_medium=email

Coronavirus death rate in US compared to countries like Italy ...

In recent months, hospitals and health systems across the U.S. have made dramatic changes to quickly respond to the COVID-19 pandemic. To help provide a more detailed picture of the COVID-19 pandemic and response efforts, Becker’s Hospital Review has compiled key stats, dollar figures and dates for hospital and health system leaders to know.

COVID-19 relief aid 

Congress has allocated $175 billion in relief aid to hospitals and other healthcare providers to cover expenses or lost revenues tied to the COVID-19 pandemic. 

The first $50 billion in funding from the Coronavirus Aid, Relief and Economic Security Act was delivered to hospitals in April. HHS distributed $30 billion based on Medicare fee-for-service reimbursements and another $20 billion based on hospitals’ share of net patient revenue.

In addition, HHS is sending $12 billion to 395 hospitals that provided inpatient care for 100 or more COVID-19 patients through April 10 and disbursing another $10 billion to hospitals, clinics and health centers in rural areas.

HHS recently provided a list of hospitals that received payments from the general distribution and rural targeted allocation of the provider relief fund as well as hospitals that received COVID-19 high-impact payments.

Below are the 10 health systems that received the most funding from the general distribution and rural targeted allocation of the provider relief fund based on data updated May 12. Each health system received payments and agreed to the terms and conditions for receiving relief aid as of May 6. 

1. Dignity Health: $180.3 million

2. NewYork-Presbyterian Hospital: $119 million

3. Cleveland Clinic: $103.3 million

4. Stanford Health Care: $102.4 million

5. Intermountain Healthcare: $97.9 million

6. Memorial Hermann Health System: $92.4 million

7. NYU Langone Hospitals: $92.1 million

8. Sutter Health: $82.7 million

9. County of Los Angeles: $80.8 million (County operates four hospitals)

10. Hackensack Meridian Health: $76.8 million

 

Below are the 10 hospitals that received the most funding from the $12 billion COVID-19 high-impact fund based on data updated May 8. 

1. Long Island Jewish Medical Center (New Hyde Park, N.Y.): $277.7 million

2. Holy Name Medical Center (Teaneck, N.J.): $213.4 million

3. Tisch Hospital (New York City): $203.2 million

4. Montefiore Hospital-Moses Campus (New York City): $156.7 million

5. Columbia University Irving Medical Center (New York City): $152.7 million

6. NewYork-Presbyterian Queens (New York City): $143.3 million

7. Mount Sinai Medical Center (New York City): $140.8 million

8. Sandra Atlas Bass Heart Hospital (Manhasset, N.Y.): $137.5 million

9. Maimonides Medical Center (New York City): $131.5 million

10. Weill Cornell Medical Center (New York City): $118.6 million

 

COVID-19 vulnerability 

Every state in the U.S. will be affected by COVID-19, but some are more vulnerable due to limited ability to mitigate and treat the virus, and to reduce its economic and social impacts, according to a COVID-19 vulnerability index created by the Surgo Foundation.

The Surgo Foundation, a privately funded think tank, created an index that combines indicators specific to COVID-19 with the CDC’s social vulnerability index, which measures the expected negative impact of disasters of any type. The Surgo Foundation’s index takes into account factors that fall into one of several categories, including socioeconomic status, minority status, housing type, epidemiologic factors and healthcare system factors. Each state and the District of Columbia received a score in each category and an overall score, with a higher score indicating that the state is more vulnerable. Read more about the methodology here.

Below are the 10 states with the highest composite scores based on the vulnerability index. 

1. Mississippi: 1

2. Louisiana: 0.98

3. Arkansas: 0.96

4. Oklahoma: 0.94

5. Alabama: 0.92

6. West Virginia: 0.9

7. New Mexico: 0.88

8. Nevada: 0.86

9. North Carolina: 0.84

10. South Carolina: 0.82

 

Where COVID-19 cases, deaths are decreasing most

An analysis from The New York Times based on county-level data shows some U.S. cities are seeing sustained decreases in COVID-19 cases and deaths.

Below are the top five metro areas where COVID-19 cases have decreased the most (relative to population) in the past week. The list reflects The New York Times‘ rankings as of May 13 at 6:30 a.m. CDT. 

1. Grand Island, Neb.
Change rate: -394 cases per 100,000 population

2. Waterloo-Cedar Falls, Iowa
Change rate: -265 cases per 100,000 population

3. Pine Bluff, Ark.
Change rate: -197 per 100,000 population

4. New York City area
Change rate: -184 cases per 100,000 population

5. Boston
Change rate: -139 cases per 100,000 population

 

Below are the top five metro areas where COVID-19 deaths have decreased the most in the past week. 

1. Grand Island, Neb.
Change rate: -11.8 deaths per 100,000 population

2. New York City area
Change rate: -11.1 deaths per 100,000 population

3. Fairfield County (Conn.)
Change rate: -9.7 deaths per 100,000 population

4. Hartford, Conn.
Change rate: -9.7 deaths per 100,000 population

5. Springfield, Mass.
Change rate: -9.5 deaths per 100,000 population

 

States resuming elective surgeries 

Below are the states that have allowed or announced plans to allow healthcare providers to resume elective surgeries as of May 13. There are different restrictions in each state, which are detailed in executive orders and other documents from the state. 

April 22
California
Texas
Utah

April 24
Oklahoma

April 26
Colorado

April 27
Arkansas
Indiana
Iowa
Kentucky
Louisiana
Mississippi
Pennsylvania

April 28
New York
West Virginia

April 30
Alabama
Tennessee

May 1
Arizona
Illinois
Ohio
Oregon
Virginia

May 4
Alaska
Florida
Nebraska

May 15
Vermont

May 18
Washington

May 31
South Dakota