Category Archives: Leadership Decentralized

The economy is in deep trouble again. Coronavirus is to blame

Posted on by • Posted in 2020 Election Issues, Air Travel, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy, Economy Reopening, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Recession, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vaccine • Leave a comment

https://www.cnn.com/2020/07/23/business/coronavirus-economy-recovery/index.html

The economy is in deep trouble again. Coronavirus is to blame - CNN

Restaurant reservations are waning. The rebound in air travel is leveling off. And foot traffic at stores is dwindling once again. There is mounting evidence that America’s fragile economic recovery is already stalling as the number of coronavirus infections and deaths spike.

Real-time economic indicators bottomed out in May as stay-at-home orders were lifted and many Americans felt safe enough to start visiting shopping centers, restaurants and even airports.
That gave hope, perhaps prematurely, of a rapid V-shaped recovery for the United States from the historic collapse caused by the pandemic.
But there is now a growing sense that the recovery is losing steam as coronavirus infections surge in California, Texas, Florida and other Sun Belt states.
“The premature reopening of the U.S. economy has resulted in an intensification of the pandemic, which is now causing growth in the economy to slow,” Joe Brusuelas, chief economist at RSM International, wrote in a note to clients Tuesday.
The stall of the fragile recovery comes as Congress debates whether the economy needs more stimulus — and if so, how much to provide. The $600 weekly enhanced unemployment benefits expire this month unless lawmakers take action.
Economists say there is nothing to debate: The recovery is faltering.
“Activity is now clearly contracting in COVID hot spots, including the Sun Belt and the West,” Aneta Markowska, chief economist at Jefferies, wrote in a report on Monday.
That is hardly surprising, given that 22 states have either reversed or paused their reopening due to health concerns.

Recovery hopes overdone?

This doesn’t mean the US economy will keep shrinking in the third quarter. Economists are still betting GDP will turn sharply positive after having collapsed by an estimated 34% during the second quarter. But now they worry that the forecasts for blockbuster growth may be overly optimistic.
For instance, S&P Global Economics warned Wednesday that its estimate for a surge in third quarter GDP at an annualized pace of 22.2% is “at risk of weakening” because of the health crisis.
“Although our base case is for a gradual recovery through next year,” S&P economists wrote, “the [recent] surge in COVID-19 and hospitalizations has raised concerns that a more likely scenario is that the COVID-19 recession has not bottomed out.”
The latest real-time economic indicators suggest those concerns are warranted.
More turbulence for air travel: The resurgence of coronavirus infections is derailing the travel industry’s modest recovery. The number of air passengers processed through TSA security lines fell during the week ended July 20, compared with the prior week, according to Bank of America. This metric is down more than 70% from a year ago.
United (UAL) CEO Scott Kirby told CNBC on Wednesday that the airline doesn’t “expect to get anywhere close to normal until there’s a vaccine that’s been widely distributed to a large portion of the population.”
Restaurant trouble: As the CNN Business Recovery Dashboard clearly shows, restaurant reservations on OpenTable have weakened in recent weeks. During March and April, as the pandemic wreaked havoc, reservations were down nearly 100% from a year ago. That figure rebounded to down “only” 50% in mid-June, but has since rolled over and stood at -65% as of Monday.
Foot traffic to Chipotle (CMG) was down 47% during the first week in June, according to Placer.ai, an analytics platform that uses anonymized location data. Traffic improved to down just 30% by the end of June, but has since “stagnated” through mid-July, Placer.ai said.
Retail slowdown: In April, US retail traffic declined by a staggering 98%, according to Cowen. Traffic steadily improved, with June traffic down 57%, but that rebound has stalled. US retail traffic fell 47% from a year ago during the second week of July, Cowen said, a slight deterioration from the first week in July when traffic was down 45%.
Small business shutdowns: As of Sunday, 24.5% of small businesses in the United States were closed, according to Jefferies. That is worse than late June, when only 19% were closed. Jefferies pointed to “particular weakness in COVID hot spots” and noted that small business employment had dropped to levels unseen since the end of May.
Weaker spending: After plunging by as much as 31% year-over-year in early April, purchases on credit cards issued by Synchrony turned positive in late June. However, Synchrony (SYF) said Tuesday that spending during the first two weeks of July was down 2%.
Unemployment website visits: Web traffic to state unemployment portals “leveled off at still-high levels, suggesting labor market momentum has stalled,” Jefferies said. That jibes with official government statistics in the CNN Business Recovery Dashboard that show unemployment claims have tumbled from their spike this spring but remain elevated. In fact, another 1.4 million Americans filed for first-time unemployment benefits last week — the first increase in weekly claims since late March.
“The spread of the virus since mid-June has clearly had an adverse effect on economic activity,” economists at Bank of America wrote in a note to clients Wednesday. “It is clear that the path of the economic recovery cannot be disentangled from the path of the virus.”

No vaccine, no recovery?

That’s not to say all real-time indicators are negative right now. For instance, Jefferies said one of the last metrics to bottom out, a US job listing index that the bank created with alternative data platform Thinknum, continued to improve even last week.
Still, the New York Federal Reserve’s weekly economic index, which is composed of metrics on the labor market, consumer behavior and goods production, dropped for the first time since hitting the pandemic low point in late April.
All of this raises stakes in the race to develop a vaccine that is effective against Covid-19.
Vaccine hopes, on top of unprecedented easy money from the Federal Reserve, have helped catapult the stock market. The S&P 500 has spiked 46% since the March 23 low and is now positive for the year.
Real progress is being made on the vaccine front, underscored by a $1.95 billion deal announced Wednesday for Pfizer (PFE) to produce millions of Covid-19 vaccine doses for the US government.
Yet healthcare execs remain more cautious than Wall Street. Seventy-three percent of healthcare industry leaders polled by Lazard estimate that a vaccine won’t be widely available until at least the second half of 2021.
“It is becoming quite clear that absent an accessible and widely distributed vaccine,” RSM’s Brusuelas said, “there will be no complete economic recovery.”

 

 

Initial Unemployment Claims Rise For First Time in 16 Weeks; Air Travel, Restaurant Reservations, and Retail Businesses Face Declines and Closures

Posted on by • Posted in 2020 Election Issues, Air Travel, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninformed • Leave a comment

https://www.cnn.com/2020/07/23/economy/coronavirus-unemployment-benefits/index.html

Travel fears at their highest since 9/11 due to coronavirus - Axios

On Thursday, for the first time in 16 weeks, the Department of Labor reported an increase in initial unemployment claims, with 1.4 million Americans filing for the first time during the week of July 20. First-time claims peaked in late March with 6.9 million claims, and have fallen each week since until last week. Continued claims for the week were at 16.2 million, showing a drop in almost 1 million claims from the previous week. As unemployment claims look to be increasing, the additional $600 in weekly unemployment benefits is set to expire on July 31 (CNN).

Additional economic indicators point to uncertainty. Air travel continues to drop as cases surge nationwide, with 70 percent fewer passengers traveling through security lines compared to a year ago. As we have previously reported, airlines including United and American Airlines have prepared for massive job cuts, and companies including Southwest and United have cut flight schedules by as much as 65 percent (WSJ).

Restaurant reservations have also plummeted, dropping an additional 15 percent from mid-June to late July. Retail and small businesses are also taking a hit as cases continue to rise, with more than 24 percent of small businesses in the U.S. closed as of Sunday, down from 19 percent in late June (CNN).

 

 

 

6 months in: What will the new normal look like for hospitals?

Posted on by • Posted in Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Treatment, Cost Management, Cost Reduction, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Economic Recovery, Economy Reopening, Elective Procedures, Elective Surgery, Employee Protections, Employer-Based Health Insurance, Financial Pressure, Financial Viability, Financially Distressed, Health Insurance Coverage Adequacy, Health System, Hospital, Hospital Industry, Labor Agreement, Labor Relations, Labor Strike, Labor Union, Leadership Decentralized, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Primary Care, Public Health, Public Safety, Quarantine, Social Distancing, Supply Chain, Telemedicine, Triage, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Virtual Care Strategy, Virtual Healthcare, Virtual Visit, Worker Protection • Leave a comment

https://www.healthcaredive.com/news/6-months-in-new-normal-hospitals-covid/581524/

Experts say a sustained state of emergency is likely until there is a cure or vaccine for COVID-19.

The first U.S. hospital to knowingly treat a COVID-19 patient was Providence Regional Medical Center in Everett, Washington, on Jan. 20. Since then, every aspect of healthcare has been upended, and it’s becoming increasingly clear all parts of society will have to adapt to a new baseline for the foreseeable future.

For hospitals and doctors’ offices, that means building on a major shift to telemedicine, new workflows to allow for more infection control and revamping the supply chain for pharmaceuticals, personal protective equipment and other supplies. That’s on top of ongoing challenges of burned out workers and staff shortages further exacerbated by the pandemic.

Looking out even further, the industry will have to figure out how to treat potential chronic conditions in COVID-19 survivors and, until an effective vaccine is developed, how to manage new outbreaks of the disease.

Experts say U.S. hospitals are generally in a much better position for dealing with COVID-19 now than they were in March, and providers are learning more every week about the best treatments and care practices.

A June survey of healthcare executives conducted by consultancy firm Advis found that 65% of respondents said the industry is prepared for a fall or winter surge, about the inverse of what an earlier survey with that question showed.

“We’ve evolved. We’re in a much better state now than we were in the beginning of the pandemic,” Michael Calderwood, associate chief quality officer at Dartmouth-Hitchcock Medical Center, told Healthcare Dive. “There’s been a lot of learning.”

But the number of positively identified cases has now topped 4 million, and little political will exists to reinstitute widespread shutdowns even in areas where surges have filled ICUs to capacity. No treatment or vaccine for the disease exists or appears imminent. Testing and contract tracing efforts are too few and remain scattered and uncoordinated.

Whether there is a clear nationwide second wave or smaller surges in various parts of the country at different times, hospitals will need to remain in an effective state of emergency that requires constant vigilance until there is a cure or vaccine.

“Until we’re armed with that, we’re always going to have to be working like this. I don’t see any other way,” Diane Alonso, director of Intermountain Healthcare’s abdominal transplant program, told Healthcare Dive.

The fall will bring additional challenges. Flu season usually begins to ramp up in October, and if the strains in wide circulation this year are severe, that will further stress the health system. While some schools have announced they will be virtual-only for the rest of 2020, others are committed to in-person classes. That could mean increased community spread, especially in college towns. Colder weather that forces people indoors — where the novel coronavirus is far more likely to spread — will also be a complicating factor.

So far, hospitals have been reluctant to once again halt elective procedures, though some have had to, arguing that the care is still necessary and can be done safely when the proper protections are in place. But that doesn’t mean volume will rebound to pre-pandemic levels.

“While we think demand will come back, we’ve seen some flattening on demand in certain aspects that may be the new indicator of the new norm in terms of how people seek care,” Dion Sheidy, a partner and healthcare advisory leader at advisory firm KPMG, told Healthcare Dive.

Accelerating trends to provide care outside hospitals

When the number of COVID-19 cases first surged in the U.S. and stay-at-home orders were implemented nationwide, telehealth became a necessary way for urgent care to continue.

Virtual visits skyrocketed in March and April as CMS and private payers relaxed regulations and expanded coverage. Some of that will be rolled back, but much may persist as patients and providers grow more used to using telehealth and platforms become smoother.

Virtual care can’t replace in-person care, of course, and some patients and doctors will prefer face-to-face visits. The middle- to long-term result is likely to be that telehealth thrives for some specialties like psychiatry, but drops substantially from the highest levels during shutdowns throughout the country.

Other care settings outside of the hospital may see upticks as well, including at-home and retail-based primary and urgent care.

Renee Dua, the CMO of home healthcare and telemedicine startup Heal, said the company has seen virtual visits increase eight fold since the pandemic began in the U.S. and a 33% increase in home visits as people seek to continue care while reducing their risk of exposure to the coronavirus.

“The idea that you do not use an office building to get care — that’s why we started Heal — we bet on the fact that the best doctors come to you,” Dua told Healthcare Dive.

And care does need to continue, particularly vital services like vaccinations and pediatric checkups.

“You cannot ignore preventive screenings and primary care because you can get sick with cancer or with infectious diseases that are treatable and preventable,” Dua said.

Movements toward non-traditional settings existed before anyone had heard of COVID-19, but the realities of the pandemic have shifted resources and spurred investment that will have lasting effects, Ross Nelson, healthcare strategy leader at KPMG, told Healthcare Dive.

“What we’re going to see is there going to be an acceleration of the underlying trends toward home and away from the hospital,” he said.

Some of this was already underway. Multiple large health systems have established programs to provide hospital-level care at home and major employers have inked contracts to have primary care delivered to employees at on-site clinics.

PPE, staff shortages lingering

A key problem for hospitals in the first COVID-19 hotspots, such as Washington state and New York City, was a lack of necessary personal protective equipment, including N95 masks, gowns, face shields and gloves.

Also running low were supplies like ventilators and some drugs necessary for putting people on those machines.

While advances have certainly been made, the country did not have enough time to build up those supply stores before new surges in the South and West. The result has been renewed worries that not enough PPE is available to keep healthcare workers safe.

Chaun Powell, group vice president of strategic supplier engagement at group purchasing organization Premier, said “conservation practices continue to be the key to this” as COVID-19 surges roll through the country. The longer those dire situations continue, the more stress is put on the supply chain before it has a chance to recover.

Premier’s most recent hospital survey found that more than half of respondents said N95s were heavily backordered. Almost half reported the same for isolation gowns and shoe covers.

Calderwood said there has been improvement, however. “We have a much longer days-on-hand PPE supply at this point and the other thing is, we’ve begun to manufacture some of our own PPE,” he said. “That’s something a number of hospitals have done in working with local companies.”

But the ability to manufacture new PPE in the U.S. also depends on the availability of raw materials, which are limited. That means significant advancements in domestic production are likely several months away, Powell said.

Health systems have stepped up the ability to coordinate and attempt to get equipment where it’s needed most, especially for big-ticket items like ventilators. Providers are more hesitant, however, to let go of PPE without the virus being better contained.

The backstop supposed to help hospitals during a crisis is the national stockpile, which the federal government is attempting to resupply. It doesn’t appear to be enough, though, at least not yet, Calderwood said.

“One thing that concerns me is we did have a national stockpile of PPE, and I get the sense that we’ve kind of burned through that supply,” he said. “And now we’re relying on private industry to meet the need.”

Another problem hospitals face as the pandemic drags on is maintaining adequate staffing levels. Doctors, nurses and other front-line employees are in incredibly stressful work environments. The great potential for burnout will exacerbate existing shortages, just as medical schools are still trying to figure out how to continue with training and education.

“Those areas are concerning to our hospitals because our hospitals depend on a whole myriad of medical staff,” Advis CEO Lyndean Brick said. “Whether it’s physicians, nurses, technicians, housekeepers — that whole staff complement is what’s at the core of healthcare. You can have all the technology in the world but if you don’t have somebody to run it that whole system falls apart.”

On top of that is the increase in labor strife as working conditions have deteriorated in some cases. Nurses have reported fearing for their safety among PPE shortages and alleged lapses in protocol. Brick said she expects strike threats and other actions to continue.

Changing workflows

When COVID-19 cases started ramping up for the first time in the U.S., hospitals throughout the country, acting on CMS advice, shut down elective procedures to prepare their facilities for a potential influx of critical patients with the disease. In some areas, hospitals did have to activate surge plans at that time. Others have done so more recently as the result of increases in the South and West.

But few have resorted to once again halting electives. Brick told Healthcare Dive she doesn’t expect that to change, mostly because hospitals have by and large figured out how to properly continue that care.

She trusts any that can’t do so safely, won’t try.

“For the majority of our providers, except in the occasional state where they’re having a real problem right now, I think that we’re going to see elective surgeries still continue,” Brick said. “Because most of our hospitals have capacity right now. They’re able to do this successfully and securely, and it’s really detrimental to patients to not get the care that they need.”

Hospitals rely on elective procedures to drive their revenue, an added motivation to find ways to keep them running even when COVID-19 is detected at greater levels in the community.

Intermountain, based in Salt Lake City, recently performed its 100th organ transplant of the year, ahead of last year’s pace despite the disruption of the COVID-19 crisis.

Alonso, the program director for abdominal transplants, said that while transplants are considered essential services, staff did pause some procedures when electives were halted and have re-evaluated workflow to be as safe as possible to patients, who are at higher risk after surgery because they are immunocompromised.

The hospital developed a triage system to help evaluate what services are necessary based on what level of COVID-19 spread is present in the community and how many beds and staffers are available to treat them.

The system’s main hospital has certain floors and employees designated for COVID-19 treatment. Staff have been reallocated for certain needs like testing and there are plans available if doctors and surgeons need to be deployed to the ICU.

As many outpatient visits as possible are being changed to virtual, but in the building, patients are screened for symptoms and required to wear masks and follow distancing protocols.

At the transplant center, doctors were at one point divided into teams in case someone got sick and coworkers had to self-isolate.

“We went through a dry run where, at the beginning, we shut down incredibly hard to see how we could do it operationally,” Alonso said. Intermountain hasn’t had to do that again, but is ready if such measures become necessary, she said.

Brick and others said that despite the genuinely frightening circumstance brought by the pandemic, hospitals’ responses have been admirable and providers have been quick to adapt. Slow or nonexistent leadership at the federal level, especially in sourcing and obtaining PPE, has been the bigger roadblock.

“Across the board, the whole healthcare industry has responded beautifully to this,” Brick said. “Where our country has fallen down is we don’t have a master plan to deal with this. Our federal leadership is reactionary, and we are not coordinating a master plan to deal with this in the long term. That’s where my concerns are at. My concerns are not at our local hospitals. They have their acts together.”

 

 

 

 

Houston, Miami, other cities face mounting health care worker shortages as infections climb

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Emergency Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Front Lines, Health System, Healthcare Providers, Healthcare Worker Shortages, Hospital, Hospital Capacity, Hospital Industry, Intensive Care (ICU), Leadership Decentralized, Mortality, National Strategy, Nurses, Out of Control, Pandemic, Pandemic Fatigue, Personal Protective Equipment (PPE), Physician, Physician Burnout, Supply Chain, Telemedicine, Triage • Leave a comment

https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR14P9OGxTOPU8pMgjsVof7YlOAPv-vfxq2MBm9RlpYFVVa3qvpmvyIjFyA

Shortages of health care workers are worsening in Houston, Miami, Baton Rouge and other cities battling sustained covid-19 outbreaks, exhausting staffers and straining hospitals’ ability to cope with spiking cases.

That need is especially dire for front-line nurses, respiratory therapists and others who play hands-on, bedside roles where one nurse is often required for each critically ill patient.

While many hospitals have devised ways to stretch material resources — converting surgery wards into specialized covid units and recycling masks and gowns — it is far more difficult to stretch the human workers needed to make the system function.

“At the end of the day, the capacity for critical care is a balance between the space, staff and stuff. And if you have a bottleneck in one, you can’t take additional patients,” said Mahshid Abir, a senior physician policy researcher at the RAND Corporation and director of the Acute Care Research Unit (ACRU) at the University of Michigan. “You have to have all three … You can’t have a ventilator, but not a respiratory therapist.”

“What this is going to do is it’s going to cost lives, not just for covid patients, but for everyone else in the hospital,” she warned.

The increasingly fraught situation reflects packed hospitals across large swaths of the country: More than 8,800 covid patients are hospitalized in Texas; Florida has more than 9,400; and at least 13 other states also have thousands of hospitalizations, according to data compiled by The Washington Post.

Facilities in several states, including Texas, South Carolina and Indiana, have in recent weeks reported shortages of such workers, according to federal planning documents viewed by The Post, pitting states and hospitals against one another to recruit staff.

On Thursday, Louisiana Gov. John Bel Edwards (D) said he asked the federal government to send in 700 health-care workers to assist besieged hospitals.

“Even if for some strange reason … you don’t care about covid-19, you should care about that hospital capacity when you have an automobile accident or when you have your heart attack or your stroke, or your mother or grandmother has that stroke,” Edwards said at a news conference.

In Florida, 39 hospitals have requested help from the state for respiratory therapists, nurses and nursing assistants. In South Carolina, the National Guard is sending 40 medical professionals to five hospitals in response to rising cases.

Many medical facilities anticipate their staffing problems will deteriorate, according to the planning documents: Texas is hardest hit, with South Carolina close behind. Needs range from pharmacists to physicians.

Hot spots stretch across the country, from Miami and Atlanta to Southern California and the Rio Grande Valley, and the demands for help are as diffuse as the suffering.

“What we have right now are essentially three New Yorks with these three major states,” White House coronavirus task force coordinator Deborah Birx said Friday during an appearance on NBC’s “Today” show.

But today’s diffuse transmission requires innovative thinking and a different response from months ago in New York, say experts. While some doctors have been able to share expertise online and nurses have teamed up to relieve pressures, the overall strains are growing.

“We missed the boat,” said Serena Bumpus, a leader of multiple Texas nursing organizations and regional director of nursing for the Austin Round Rock Region of Baylor Scott and White Health.

Bumpus blames a lack of coordination at national and state officials. “It feels like this free-for-all,” she said, “and each organization is just kind of left up to their own devices to try to figure this out.”

In a disaster, a hospital or local health system typically brings in help from neighboring communities. But that standard emergency protocol, which comes into play following a hurricane or tornado, “is predicated on the notion that you’ll have a concentrated area of impact,” said Christopher Nelson, a senior political scientist at the RAND Corporation and a professor at the Pardee RAND Graduate School.

That is how Texas has functioned in the past, said Jennifer Banda, vice president of advocacy and public policy at the Texas Hospital Association, recalling the influx of temporary help after Hurricane Harvey deluged Houston three years ago.

It is how the response took shape early in the outbreak, when health-care workers headed to hard-hit New York.

But the sustained and far-flung nature of the pandemic has made that approach unworkable. “The challenge right now,” Banda said, “is we are taxing the system all across the country.”

Theresa Q. Tran, an emergency medicine physician and assistant professor of emergency medicine at Houston’s Baylor College of Medicine, began to feel the crunch in June. Only a few weeks before, she had texted a friend to say how disheartening it was to see crowds of people reveling outdoors without masks on Memorial Day weekend.

Her fears were borne out when she found herself making call after call after call from her ER, unable to admit a critically ill patient because her hospital had run out of ICU space, but unable to find a hospital able to take them.

Under normal circumstances, the transfer of such patients — “where you’re afraid to look away, or to blink, because they may just crash on you,” as Tran describes them — happens quickly to ensure the close monitoring the ICU affords.

Those critical patients begin to stall in the ER, stretching the abilities of the nurses and doctors attending to them. “A lot of people, they come in, and they need attention immediately,” Tran said, noting that emergency physicians are constantly racing against time. “Time is brain, or time is heart.”

By mid-July, an influx of “surge” staff brought relief, Tran said. But that was short-lived as the crisis jumped from one locality to the next, with the emergency procedures to bring in more staff never quite keeping up with the rising infections.

An ER physician in the Rio Grande Valley said all three of the major trauma hospitals in the area have long since run out of the ability to absorb new ICU patients.

“We’ve been full for weeks,” said the physician, who spoke on the condition of anonymity because he feared retaliation for speaking out about the conditions.

“The truth is, the majority of our work now in the emergency department is ICU work,” he said. “Some of our patients down here, we’re now holding them for days.” And each one of those critically ill patients needs a nurse to stay with them.

When ICU space has opened up — maybe two, three, four beds — it never feels like relief, he said, because in the time it takes to move those patients out, 20 new ones arrive.

Even with help his hospital has received — masks and gowns were procured, and the staff more than doubled in the past few weeks with relief nurses and other health-care workers from outside — it still is not enough.

The local nurses are exhausted. Some quit. Even the relief nurses who helped out in New York in the spring seem horrified by the scale of the disaster in South Texas, he said.

“If no one comes and helps us out and gives us the ammo we need to fight this thing, we are not going to win,” the doctor said.

One of the root causes of the problem in the United States is that emergency departments and ICUs are often operating at or near capacity, Abir and Nelson said, putting them dangerously close to shortages before a crisis even hits.

Texas, along with 32 other states, has joined a licensure compact, allowing nurses to practice across state borders, but it is becoming increasingly difficult to recruit from other parts of the country.

Texas medical facilities can apply to the Department of State Health Services for staffers to fill a critical shortage, typically for a two-week period. But two weeks, which would allow time to respond to most disasters, hardly registers in a pandemic, so facilities have to ask for extensions or make new applications.

South Carolina last week issued an order that allows nursing graduates who have not yet completed their licensing exams to begin working under supervision. Prisma Health, the state’s biggest hospital system, said this week that the number of patients admitted to its hospitals has more than tripled in the past three weeks and is approaching 300 new patients a day.

“As the capacity increases, so does the need for additional staff,” Scott Sasser, the incident commander for Prisma Health’s covid-19 response said in a statement. Prisma has so far shifted nurses from one area to another, brought back furloughed nurses, hired more physicians and brought in temporary nurse hires, among other measures, Sasser said.

Bumpus has fielded calls from nurses all over the country — some as far afield as the United Kingdom — wanting to know how they can help. But Bumpus says she does not have an easy answer.

“I’ve had to kind of just do my own digging and use my connections,” she said. At first, she said, interested nurses were asked to register through the Texas Disaster Volunteer Registry; but then the system never seemed to be put to use.

Later she learned — “by happenstance … literally by social media” — that the state had contracted with private agencies to find nurses. So now she directs callers to those agencies.

Even rural parts of Texas that were spared initially are being ravaged by the virus, according to John Henderson, CEO of the Texas Organization of Rural and Community Hospitals.

“Unless things start getting better in short order, we don’t have enough staff,” he acknowledged. As for filling critical staffing gaps by moving people around, “even the state admits that they can’t continue to do that,” Henderson said.

The situation has become so dire in some rural parts of the state that Judge Eloy Vera implored people to stay home on the Starr County Facebook page, warning, “Unfortunately, Starr County Memorial Hospital has limited resources and our doctors are going to have to decide who receives treatment, and who is sent home to die.”

Steven Gularte, CEO of Chambers Health in Anahuac, Tex., 45 miles from Houston, said he had to bring in 10 nurses to help staff his 14-bed hospital after Houston facilities started appealing for help to care for patients who no longer needed intensive care but were not ready to go home.

“Normally, we are referring to them,” Gularte said. “Now, they are referring to us.”

Donald M. Yealy, chair of emergency medicine at the University of Pittsburgh Medical Center, said rather than sending staff to other states, his hospital has helped others virtually, particularly to support pulmonary and intensive care physicians.

“Covid has been catalytic in how we think about health care,” Yealy said, providing lessons that will outlast the pandemic.

But telehealth can do little to relieve the fatigue and fear that goes with front-line work in a prolonged pandemic. Donning and doffing masks, gowns and gloves is time consuming. Nurses worry about taking the virus home to their families.

“It is high energy work with a constant grind that is hard on people,” said Michael Sweat, director of the Center for Global Health at the Medical University of South Carolina.

Coronavirus has turned the regular staffing challenge at Harris Health in Houston into a daily life-or-death juggle for Pamela Russell, associate administrator of nursing operations, who helps provide supplemental workers for the system’s two public hospitals and 46 outpatient clinics.

Now, 162 staff members — including more than 50 nurses — are quarantined, either because they tested positive or are awaiting results. Many others need flexible schedules to accommodate child care, she said. Some cannot work in coronavirus units because of their own medical conditions. A few contract nurses left abruptly after learning their units would soon be taking covid-positive patients.

Russell has turned to the state and the international nonprofit Project Hope for resources, even as she acts as a morale booster, encouraging restaurants to send meals and supporting the hospital CEO in his cheerleading rounds.

“It’s hard to say how long we can do this. I just don’t know” said Russell, who praised the commitment of the nurses. “Like I said, it’s a calling. But I don’t see it being sustainable.”

 

 

 

 

U.S. passes 4 million coronavirus cases as pace of new infections roughly doubles

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Blame, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Credibility, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Financial Pressure, Financial Viability, Financially Distressed, Health Insurance Coverage Adequacy, Health Policy, Honesty, Infection Control, Infection Control Plan, Infectious Virus, Integrity, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Misinformation, Mislead, Misleading, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Public Health, Public Safety, Quarantine, Recession, School Reopening, Scientists, Social Distancing, Trust, Truth, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Wishful Thinking • Leave a comment

https://www.washingtonpost.com/politics/us-passes-4-million-coronavirus-cases-as-pace-of-new-infections-roughly-doubles/2020/07/23/d0125192-cd02-11ea-b0e3-d55bda07d66a_story.html?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR3Ve5MnHiStJnPO_mzkc1c2sHE2EM6QOG-2HochFPBmJe6hnyvcmqEVQ4U

The United States on Thursday passed the grim milestone of 4 million confirmed coronavirus infections, and President Trump announced he was canceling the public celebration of his nomination for a second term, as institutions from schools to airlines to Major League Baseball wrestled with the consequences of a pandemic still far from under control.

The rapid spread of the virus this summer is striking, taking just 15 days to go from 3 million confirmed cases to 4 million. By comparison, the increase from 1 million cases to 2 million spanned 45 days from April 28 to June 11, and the leap to 3 million then took 27 days.

Trump’s cancellation of the in-person portion of the Republican National Convention planned for next month in Jacksonville, Fla., represented a remarkable reversal. He had insisted for months on a made-for-television spectacle that would have packed people close together in a state that is now an epicenter of the resurgent pandemic.

On Thursday, he conceded that was not going to work. “The timing for this event is not right,” Trump said during the latest of somber, solo White House briefings this week. “It’s just not right with what’s been happening.”

Florida reported 173 deaths on Thursday, its highest single-day count of new deaths, and also reported more than 10,200 new coronavirus cases.

In a scathing statement blaming the surge of new cases on Trump’s “failure to care,” presumptive Democratic nominee Joe Biden said the president “quit on this country and waved the white flag of surrender.”

Meanwhile, nearly every public health metric suggests America is badly losing its fight against the virus.

Positivity rates have reached alarming levels in numerous states, hospitalizations are soaring, and more than 1,100 new coronavirus deaths were reported across the United States on Wednesday, marking the first time since May 29 that the daily count exceeded that number, according to Washington Post tracking.

The rolling seven-day average of infections has doubled in less than a month, reaching more than 66,000 new cases per day Wednesday. The U.S. death toll now exceeds 141,000.

As a result, many businesses appear to be pulling back after their attempts to resume more normal operations proved premature, and an additional 1.4 million American workers filed for unemployment benefits last week. It was the first time since March that new claims rose. Another 980,000 new Pandemic Unemployment Assistance claims — the benefits offered to self-employed and gig workers — were also filed.

Congress, meanwhile, struggled to confront the crisis. Senate Republicans killed Trump’s payroll tax cut proposal on Thursday, widening an unusual rift with the White House over the cost and contents of the latest national coronavirus relief package.

Senate Majority Leader Mitch McConnell (R-Ky.) had planned to roll out a $1 trillion GOP bill Thursday morning, but that was canceled amid the intraparty conflicts.

Administration officials then floated a piecemeal approach, involving several different aid bills, but ran into opposition from lawmakers in both parties.

Trump’s briefing Thursday afternoon, his third of the week, reflected an effort to increase popular support for his management of the coronavirus outbreak, which even many of his allies have criticized. About 2 out of 3 Americans disapprove of Trump’s handling of the pandemic, a new poll found.

Trump dismissed or played down the risk of the virus for months after it had begun spreading in the United States and has been a self-described cheerleader for rapid reopening of businesses and schools shuttered to help slow its spread.

The survey of 1,057 adults in the United States, conducted by the Associated Press-NORC Center for Public Affairs Research, also showed that 3 out of 4 Americans, including a majority of Republicans, support mandatory face coverings when people are outside their own homes.

Democrats overwhelmingly favor mask mandates, at 89 percent. The majority of Republicans — 59 percent — also support them.

Ninety-five percent of Democrats and 75 percent of Republicans say they wear face coverings when leaving home. Overall, more Americans — 86 percent — are wearing masks compared with in May, when 73 percent were doing so.

Trump resisted wearing a mask in public until earlier this month, despite calls to set a good example from the top. He now calls it patriotic to wear a mask, though he still does not wear one consistently and says people should decide for themselves. Trump carries a black-cloth version in his pocket, which he says is sufficient for those instances when he is close to people who have not been screened for the virus.

Trump’s shift may reflect a growing consensus in favor of masks, although it is not clear that opposition to them has ebbed among some of the president’s strongest political supporters.

The business community is struggling, too. American Airlines and Southwest Airlines posted big quarterly losses between April and July in their earnings reports released Thursday, projecting that travel demand will not rebound anytime soon.

In American’s second quarter, revenue dropped more than 86 percent, to $1.6 billion, from nearly $12 billion a year ago, according to a Securities and Exchange Commission filing. The company posted a net loss of nearly $2.1 billion, attributing it to stay-at-home orders, border closures and travel restrictions.

“As a result, we have experienced an unprecedented decline in the demand for air travel, which has resulted in a material deterioration in our revenues,” the company said in the earnings report. “While the length and severity of the reduction in demand due to Covid-19 is uncertain, we expect our results of operations for the remainder of 2020 to be severely impacted.”

Southwest posted revenue of $1 billion in its second quarter, an almost 83 percent dip compared with a year ago. The company also posted a net loss of $915 million.

Trump also took a small step back from his insistence that schools should open on time this fall, conceding instead that some schools might need to delay in-person learning. Many school districts have already announced that decision.

Trump has been critical of guidance from the Centers for Disease Control and Prevention, saying it made it too tough for schools to reopen, and promised new guidelines would be issued. On Thursday, the CDC released several documents emphasizing the benefits of in-person school, in line with Trump’s messaging. Some of the guidance was written by White House officials rather than experts at the CDC, people familiar with the process said. They spoke on the condition of anonymity to discuss internal decision-making.

The new guidelines for school administrators mention precautions outlined in previous documents, but they appear to drop specific reference to keeping students six feet apart — something many schools find almost impossible to do if they are fully reopened. This document also suggests that schools consider closing only if there is “substantial, uncontrolled transmission” of the virus, and not necessarily even then.

Florida Gov. Ron DeSantis (R) echoed Trump in making a case for students to return to classrooms, despite the state’s teachers union suing over an order forcing schools to fully reopen. Meanwhile, a new poll showed that most parents would prefer to delay the start of in-person school.

During an appearance on “Fox & Friends,” DeSantis said that schoolchildren are “by far at the least risk for coronavirus, thankfully.”

“We also know they play the smallest role by far in transmission of the virus, and yet they’ve really been asked to shoulder the brunt of our control measures,” said DeSantis, a close Trump ally who had volunteered his state for the Republican convention next month.

DeSantis said that the “evidence-based decision” is for all parents to have the option of in-class instruction for their children if they choose. He said those who are not comfortable with sending their children back to school could continue distance learning.

The role children play in spreading the virus is still being studied, with experts saying that results are not definitive. A South Korean study found that children over the age of 10 were as likely to transmit the virus as adults, while those under 10 were less likely to spread it.

Deborah Birx, the White House coronavirus response coordinator, said Wednesday on Fox News that the United States is launching a study of its own, adding that the data “really needs to be confirmed here.”

Among the most visible American institutions searching for a path forward is the sports industry. Major League Baseball began a pandemic-shortened season on Thursday, playing in empty stadiums amid questions about whether the sport can make it through October without having to abort. It is as much a science experiment as a championship pursuit.

Players are prohibited from spitting or high-fiving. Foul balls that wind up in the stands will remain there.

Anthony S. Fauci, the nation’s leading infectious-disease expert, threw out the first pitch for the Washington Nationals home opener against the New York Yankees. Nationals star outfielder Juan Soto tested positive for the coronavirus on Thursday and missed the game.

Meanwhile, Japan marked a year’s delay of the Olympic Games on Thursday. Tokyo was to host the 2020 Summer Olympics starting Friday. A 15-minute ceremony in Tokyo’s newly built $1.4 billion Olympic Stadium started the countdown to the delayed games, now set to begin on July 23, 2021. The city also marked a new daily record in reported cases on Thursday, with 366.

A poll this week by Japan’s Kyodo News Agency found that fewer than 1 in 4 people in Japan even want to host the games anymore. One-third of respondents said the games should be canceled, while 36 percent expressed interest in postponing them for more than a year.

 

 

 

‘The virus doesn’t care about excuses’: US faces terrifying autumn as Covid-19 surges

Posted on by • Posted in 2020 Election Issues, Asymptomatic Transmission, Blame, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Credibility, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert Opinion, False Hope, False Narrative, False Reassurance, Health Policy, Health System, Herd Immunity, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Misinformation, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Partisanship, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Safety, Quarantine, School Reopening, Scientists, Social Distancing, Trust, Truth, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vulnerable Populations, Wishful Thinking • Leave a comment

https://www.theguardian.com/world/2020/jul/18/us-coronavirus-fall-second-wave-autumn

The breathing space afforded by lockdowns in the spring has been squandered, with new cases running at five times the rate of the whole of Europe. Things will only get worse, experts warn.

In early June, the United States awoke from a months-long nightmare.

Coronavirus had brutalized the north-east, with New York City alone recording more than 20,000 deaths, the bodies piling up in refrigerated trucks. Thousands sheltered at home. Rice, flour and toilet paper ran out. Millions of jobs disappeared.

But then the national curve flattened, governors declared success and patrons returned to restaurants, bars and beaches. “We are winning the fight against the invisible enemy,” vice-president Mike Pence wrote in a 16 June op-ed, titled, “There isn’t a coronavirus ‘second wave’.”

Except, in truth, the nightmare was not over – the country was not awake – and a new wave of cases was gathering with terrifying force.

As Pence was writing, the virus was spreading across the American south and interior, finding thousands of untouched communities and infecting millions of new bodies. Except for the precipitous drop in New York cases, the curve was not flat at all. It was surging, in line with epidemiological predictions.

Now, four months into the pandemic, with test results delayed, contact tracing scarce, protective equipment dwindling and emergency rooms once again filling, the United States finds itself in a fight for its life: swamped by partisanship, mistrustful of science, engulfed in mask wars and led by a president whose incompetence is rivaled only by his indifference to Americans’ suffering.

With flu season on the horizon and Donald Trump demanding that millions of students return to school in the fall – not to mention a presidential election quickly approaching – the country appears at risk of being torn apart.

“I feel like it’s March all over again,” said William Hanage, a professor of epidemiology at the Harvard TH Chan School of Public Health. “There is no way in which a large number of cases of disease, and indeed a large number of deaths, are going to be avoided.”

The problem facing the United States is plain. New cases nationally are up a remarkable 50% over the last two weeks and the daily death toll is up 42% over the same period. Cases are on the rise in 40 out of 50 states, Washington DC and Puerto Rico. Last week America recorded more than 75,000 new cases daily – five times the rate of all Europe.

“We are unfortunately seeing more higher daily case numbers than we’ve ever seen, even exceeding pre-lockdown times,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. “The number of new cases that occur each day in the US are greater than we’ve yet experienced. So this is obviously a very worrisome direction that we’re headed in.”

The mayor of Houston, Texas, proposed a “two-week shutdown” last week after cases in the state climbed by tens of thousands. The governor of California reclosed restaurants, churches and bars, while the governors of Louisiana, Alabama and Montana made mask-wearing in public compulsory.

“Today I am sounding the alarm,” Governor Kate Brown said. “We are at risk of Covid-19 getting out of control in Oregon.”

As dire as the current position seems, the months ahead look even worse. The country anticipates hundred of thousands of hospitalizations, if the annual averages hold, during the upcoming flu season. Those hospitalizations will further strain the capacity of overstretched clinics.

But a flu outbreak could also hamper the country’s ability to fight coronavirus in other ways. Because the two viruses have similar symptoms – fever, chills, diarrhea, fatigue – mistaken diagnoses could delay care for some patients until it’s too late, and make outbreaks harder to catch, one of the country’s top health officials has warned.

“I am worried,” Dr Robert Redfield, the director of the Centers for Disease Control (CDC), said last week. “I do think the fall and the winter of 2020 and 2021 are probably going to be one of the most difficult times that we have experienced in American public health because of … the co-occurrence of Covid and influenza.”

Other factors will be in play. A precipitous reopening of schools in the fall, as demanded by Trump and the education secretary, Betsy DeVos, without safety measures recommended by the CDC, could create new superspreader events, with unknown consequences for children.

“We would expect that to be throwing fuel on the fire,” said Hanage of blanket school reopenings. “So it’s going to be bad over the next month or so. You can pretty much expect it to be getting worse in the fall.”

The list of aggravating circumstances goes on and on. A federal unemployment assistance program that gave each claimant an extra $600 a week is set to expire at the end of July. A new coronavirus relief package is being held up in Congress by Republicans’ accusations that states are wasting money, and their insistence that any new legislation include liability protections for businesses that reopen during the pandemic.

Cable broadcasts and social media have been filled, meanwhile, with video clips of furious confrontations on sidewalks, in stores and streets over wearing facial masks. In Michigan, a sheriff’s deputy shot dead a man who had stabbed another man for challenging him about not wearing a mask at a convenience store. In Georgia, the Republican governor sued the Democratic mayor of Atlanta for issuing a city-wide mask mandate.

The partisan divide on masks is slowly closing as the outbreaks intensify. The share of Republicans saying they wear masks whenever they leave home rose 10 points to 45% in the first two weeks of July, while 78% of Democrats reported doing so, according to an Axios-Ipsos poll.

Another divide has proven tragically resilient. As hotspots have shifted south, the virus continues to affect Black and Latinx communities disproportionately. Members of those communities are three times as likely to become infected and twice as likely to die from the virus as white people, according to data from early July.

The raging virus has prompted speculation in some corners that the only way out for the United States is through some kind of “herd immunity” achieved by simply giving up. But that grossly underestimates the human tragedy such a scenario would involve, epidemiologists say, in the form of tens of millions of new cases and unknown thousands of deaths.

“I think that every single serology study that’s been done to date suggests that the vast majority of Americans have not yet been exposed to this virus,” Nuzzo said. “So we’re still very much in the early stages.

“Which is good, that’s actually really good news. I don’t want to strive for herd immunity, because that means the vast majority of us will get sick and that will mean many, many more deaths. The point is to slow the spread as much as possible, protect ourselves as much as possible, until we have other tools.”

But the ability of the US to take that basic step – to slow the spread, as dozens of other countries have done – is in perilous doubt. After half a year, the Trump administration has made no effort to establish a national protocol for testing, contact tracing and supported isolation – the same proven three-pronged strategy by which other countries control their outbreaks.

Critics say that instead, Trump has dithered and denied as the national death toll climbed to almost 140,000. The Democratic presidential candidate, Joe Biden, who is hoping to unseat Trump in November, blasted the president for refusing until recently to wear a mask in public.

“He wasted four months that Americans have been making sacrifices by stoking divisions and actively discouraging people from taking a very basic step to protect each other,” Biden said in a statement last weekend.

Meanwhile the White House has attacked Dr Anthony Fauci, the country’s foremost expert on infectious diseases whose refusal to lie to the public has enraged Trump, by publishing an op-ed signed by one of the president’s top aides titled “Anthony Fauci has been wrong about everything I have interacted with him on” and by releasing a file of opposition research to the Washington Post.

Trump claimed the number of cases was a function of unusually robust testing, though experts said that positivity rates of 20% in multiple states suggested that the United States is testing too little – and that in any case closing one’s eyes to the problem by testing less would not make it go away.

“We’ve done 45 million tests,” Trump said this week, padding the figure only slightly. “If we did half that number, you’d have half the cases, probably around that number. If we did another half of that, you’d have half the numbers. Everyone would be saying we’re doing well on cases.”

Such statements by Trump have encouraged unfavorable comparisons of the US pandemic response with those in countries such as Italy, which recorded just 169 new cases on Monday after a horrific spring, and South Korea, which has kept cases in the low double-digits since April.

But the United States could also look to many African countries for lessons in pandemic response, said Amanda McClelland, who runs a global epidemic prevention program at Resolve to Save Lives.

“We’ve seen some good success in countries like Ghana, who have really focused on contact tracing, and being able to follow up superspreading events,” said McClelland. “We see Ethiopia: they kept their borders open for a lot longer than other countries, but they have really aggressive testing and active case-finding to make sure that they’re not missing cases.

“I think what we’ve seen is that you need not just a strong health system but strong leadership and governance to be able to manage the outbreak, and we’ve seen countries that have all three do well.”

But in America, the large laboratories that process Covid-19 tests are unable to keep up with demand. Quest Diagnostics announced on Tuesday that the turnaround time for most non-emergency test results was at least seven days.

“We want patients and healthcare providers to know that we will not be in a position to reduce our turnaround times as long as cases of Covid-19 continue to increase dramatically,” the lab said.

“You can’t have unlimited lab capacity, and what we’ve done is allow, to some extent, cases to go beyond our capacity,” said McClelland. “We’re never going to be able to treat and track and trace uncontrolled transmission. This outbreak is just too infectious.”

Public health experts emphasize that the United States does not have to accept as its fate a cascade of tens of millions of new cases, and tens of thousands of deaths, in the months ahead. Focused leadership and individual resolve could yet help the country follow in the footsteps of other nations that have successfully faced serious outbreaks – and brought them under control.

But it is clear that the most vulnerable Americans, including the elderly and those with pre-existing conditions, face grave danger. Republicans have argued in recent weeks that while cases in the US have soared, death rates are not climbing so quickly, because the new cases are disproportionately affecting younger adults.

That is a false reassurance, health experts say, because deaths are a lagging indicator – cases necessarily rise before deaths do – and because large outbreaks among any demographic group speeds the virus’s ability to get inside nursing homes, care facilities and other places where residents are most vulnerable.

“If we don’t do anything to stop the virus, it’s going to be very difficult to prevent it from getting to people who will die,” said Nuzzo.

There is a question of whether the United States, for all its wealth and expertise – and its self-regard as an exceptional actor on the world stage – can summon the will to keep up the fight. People are tired of fighting the virus, and of fighting each other.

“I think unfortunately people are emotionally exhausted from having to think about and worry about this virus,” said Nuzzo. “They feel like they’ve already sacrificed a lot. So the worry that I have is, what willingness is there left, to do what it takes?”

It is as if the country is “treading water in the middle of the ocean”, Hanage said.

“People tend to be shuffling very quickly between denial and fatalism,” he said. “That’s really not helpful. There are a number of things that can be done.

“What I would hope is that this marks a point when the United States finally wakes up and realizes that this is a pandemic and starts taking it seriously.

“Folks tend to look at what has happened elsewhere and then they make up some kind of magical reason why it’s not going to happen to them.

“People keep making these excuses, and the virus doesn’t care about the excuses. The virus just keeps going. If you give it the opportunity, it will take it.”

 

 

 

 

New unemployment insurance claims rise for the first time since March

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employer-Based Health Insurance, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Health Insurance Coverage Adequacy, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.washingtonpost.com/business/2020/07/23/another-14-million-workers-filed-unemployment-benefits-last-week-pandemic-continues-weigh-labor-market/

 

Some 1.4 million workers filed for unemployment last week, the first increase in months, as the pandemic continues to weigh on the labor market

The number of new unemployment claims rose for the first time in months last week, to 1.4 million — a troubling sign for the labor market that’s weathering a new round of closures as the pandemic spreads.

For the week ending July 18, about 109,000 more jobless claims were filed compared to the week prior, according to the Department of Labor.

“What you’re seeing is that, as the economy slows, the pace of claims picks back up — which really puts at risk the monthly jobs report over the next few months,” said Joseph Brusuelas, the chief economist at RSM. “The July numbers are going to be tenuous, but it’s August that I’m worried about.”

The number of workers continually claiming unemployment insurance went down, however, a statistic that lags by a week, to 16.1 million workers for the week ending July 11, from 17.4 million for the week ending July 4.

In addition to the 1.4 million seeking unemployment nationwide last week, another 980,000 new Pandemic Unemployment Assistance claims were filed, the benefits offered to self-employed and gig workers.

The numbers come as millions of unemployed workers are about to exhaust stimulus payments from two federal benefits programs whose expiration economists have warned could have dire effects on the economy.

Brusuelas said the numbers are a sign that the burst of economic activity that marked the country’s reopening has waned, and that shrinking consumer demand remained a significant risk for businesses and the workers they employ across the country.

“We are going to see a much slower pace of growth the reset of the year,” he said. “While we still are retaining our call for a swoosh-shaped recovery, one has to acknowledge a w-shaped recovery is possible.”

The extra $600 a week in unemployment benefits that the federal government has offered to supplement more modest state unemployment benefits will end this week, as lawmakers wrangle over legislation that could extend it.

Including the new benefits available to gig workers and the self-employed, more than 53 million applications have been filed for some form of unemployment insurance during the pandemic.

 

 

Coronavirus numbers confusing you? Here’s how to make sense of them

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://theconversation.com/coronavirus-numbers-confusing-you-heres-how-to-make-sense-of-them-142624?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20July%2021%202020%20-%201683216237&utm_content=Latest%20from%20The%20Conversation%20for%20July%2021%202020%20-%201683216237+Version+A+CID_b109e0db9fc0132f981f087222693bc8&utm_source=campaign_monitor_us&utm_term=Coronavirus%20numbers%20confusing%20you%20Heres%20how%20to%20make%20sense%20of%20them

Coronavirus numbers confusing you? Here's how to make sense of them

Turn on the TV news, or look at a news website, and you’ll see charts, graphics, and dashboards that supposedly indicate the latest with COVID-19 – statistics revealing the number of tests, cases, hospitalizations and deaths, along with where they happened and whether they are rising or falling.

Different stories are told depending on the dashboard. But one thing is certain: These indicators lag behind the actions we take, or don’t take, on COVID-19. As researchers who focus on public health, we can tell you that a fully accurate, real-time snapshot of the progress of the virus isn’t possible.

Some don’t get tested

There are many reasons for this. Here’s one: diagnostic testing data are incomplete. Someone infected with COVID-19 must first come in contact with the virus either through the air or (less likely) environmental surfaces. Symptoms show between two and 14 days later. But at least 40% of those infected will never manifest symptoms, or show such mild ones they don’t even suspect they have COVID-19. So they may never get tested, which means they won’t show up in the total number of tests, or the total number of cases.

Another example: because of the lack of testing availability – a widespread problem in the U.S. since the start of the pandemic – not everyone who should be tested gets a test.

And another: the tests themselves are not perfect. Up to one-third who get a negative result may actually be infected. This happens because they are tested before they have a viral load sufficient enough for detection. Or maybe the sampling is not adequate. Or perhaps the test itself simply failed.

In Florida, people wait outside a COVID-19 testing station.

Case numbers don’t tell the full story

This is why problems arise when we use case numbers to determine disease levels in a community. Case counts actually reflect what was happening in a community weeks earlier. Four weeks, for instance, could elapse between the time a person is exposed to the virus and when they are reported as a case. Even the best testing results often take a week to report to public health authorities, and longer to appear on dashboards. Some testing results, seriously delayed, may take ten days or more.

Other factors impact the metrics. Laboratory results, often released in batches, may introduce artificial variation in case numbers. Someone who tested two days ago, then got a result back immediately, might be added on the same day as someone who was sick two weeks ago, but whose test results were delayed. To smooth out these variations, it helps to look at a rolling seven-day case average.

Hospitalization is a clearer metric for assessing the level of community disease. Those who are seriously ill, in most cases, will be hospitalized whether previously tested or not. Data suggests roughly one in five infected persons are hospitalized. Individuals seem to do okay for the first week, with more life-threatening symptoms showing in the second. That means hospitalizations represent exposures that happened three or four weeks earlier.

Again, a seven-day rolling average evens out artificial variations. There is one caveat for this: Though hospitalization is a useful metric, only about 20% of infected people need it. That means hospitalization numbers alone underestimate the number of people infected and what age groups they represent.

States vary on cause of death

The death numbers are not a reliable indicator either. In some states, to count as a COVID-19 death, the deceased must have had a test reporting positive. In other states, probable cases are reported.

As clinicians learn how to better treat COVID-19, fatality rates are dropping. Deaths, the longest lagging indicator, reflect people who were infected six or eight weeks earlier. When comparing one region to another, deaths are best expressed as rates – a ratio of deaths to population.

Another issue: News reports do not always clearly distinguish between diagnostic testing, which shows if you currently have COVID-19, and antibody testing, which shows if you had it in the past, and now harbor antibodies that can fight it. So far, however, antibody testing has not provided a useful picture of who has been infected and who has not. Once that happens, it could provide researchers and clinicians with some indicators on how widely the virus has spread.

Though the dashboards are ubiquitous on television, none of these frequently used indicators they feature is perfect. Still, taken together, they provide a reasonable approximation of COVID-19 transmission in communities. But as authorities make decisions, they should take into account the numbers are weeks old.

What does this mean to you? Understanding these limitations may help you understand your risk. We are still in the midst of a pandemic that is not under control. Being educated will help all of us from becoming a part of tomorrow’s lagging indicators.

 

 

 

 

Axios-Ipsos poll: The skeptics are growing

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Partisanship, Public Health, Public Safety, Quarantine, Scientists, Social Distancing, Trust, Truth • Leave a comment

https://www.axios.com/axios-ipsos-poll-gop-skeptics-growing-deaths-e6ad6be5-c78f-43bb-9230-c39a20c8beb5.html

Axios-Ipsos poll: The skeptics are growing - Axios

A rising number of Americans — now nearly one in three — don’t believe the virus’ death toll is as high as the official count, despite surging new infections and hospitalizations, per this week’s installment of the Axios-Ipsos Coronavirus Index.

Between the lines: Republicans, Fox News watchers and people who say they have no main source of news are driving this trend.

Why it matters: It shows President Trump’s enduring influence on his base, even as Americans overall say they are increasingly dissatisfied with his handling of the virus and political support is shifting toward Joe Biden.

What they’re saying: “We live in highly tribal and partisan times, and people are more likely to believe cues and signals from their political leaders than the scientists or the experts,” says Cliff Young, president of Ipsos U.S. Public Affairs.

  • “And that’s just the purest form of populism, the demonization of experts to further political ends. But to what end? Fantasy is meeting reality head-on right now.”
  • “People can see the world around them, they know it’s different, but they still can think that the media and politicos are using it to go after Trump.”

By the numbers: Overall, 31% of Americans say they believe the number of Americans dying is lower than the number reported, up sizably from 23% when we asked the same question in May.

Here’s what’s driving the shift in Week 17 of our national survey:

  • Republicans who say the death count is overinflated rose from 40% to 59%.
  • Among independents, that share rose from 24% to 32%.
  • The small share of Democrats with that view was effectively flat, ticking up from 7% to 9%.
  • Most Americans still believe the actual number of deaths is either higher (37%) or on par with (31%) the official count.

Where you get your news has a strong correlation to your faith in the numbers.

  • Fox News watchers who say deaths are being over-counted shot up from 44% to 62%, even higher than Republicans overall.
  • Other big gains came from those who say they have no primary news source, from 32% to 48%; and those whose primary sources include local news, from 30% to 44%.
  • There was a smaller increase among people whose primary news source is one of the networks or major U.S. newspapers, while views of those who primarily watch CNN and MSNBC remained about the same.

The big picture: The survey shows most Americans are digging in for a long fight against the virus, even if they have conflicting views about what to believe.

  • 72% say they’re prepared to maintain social distancing or self-quarantining for as long as it takes — up from 49% in May — as people realize the end is more than a couple of months off.

This survey finds the highest overall use of face masks since the pandemic began — with 99% of Democrats and 75% of Republicans now saying they’re wearing a mask sometimes or all of the time when they go out.

  • But there’s enough inconsistency in people’s precautions to undercut much of the gains.
  • Only 40% say they wore masks sometimes or all the time when visiting family and friends. And parents are less likely to make their children wear masks outside the home than to do so themselves.

1 big finger wag: Most Americans blame someone other than themselves for the crisis.

  • Three-fourths of respondents say most other Americans are behaving in ways that are making the country’s recovery from the COVID-19 pandemic worse, while one-fourth said they’re making it better.
  • Democrats were more likely (83%) than other groups to say others are making things worse.

 

 

 

 

Op-Ed: We Still Don’t Know the Risk Posed by COVID-19

Posted on by • Posted in 2020 Election Issues, Clinical Research, Clinical Research Funding, Clinical Testing, Clinical Trials, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Food and Drug Administration (FDA), Infection Control, Infection Control Plan, Infectious Virus, Leadership Decentralized, Misinformation, Misinterpret, Mislead, Misleading, Mistrust, Mixed Message, Mortality, National Strategy, Pandemic, Public Health, Public Safety, Quarantine, Scientists, Social Distancing, Uncertainty • Leave a comment

https://www.medpagetoday.com/infectiousdisease/covid19/87629?xid=fb_o&trw=no&fbclid=IwAR2V6CbOCIXDf2K9sJCcRb0PhbqM4inXixe_poOFYudOcoUFZCmU2JzyrDg

Op-Ed: We Still Don't Know the Risk Posed by COVID-19 | MedPage Today

The need for a coordinated national research strategy

Confused about the risks of dying from the coronavirus or of catching it from someone who seems healthy? We all are, and the dizzying differences in scientific opinion are now linked to political perspectives. Progressives cite evidence that loosening restrictions would cost lives and offer little benefit to the economy, while conservatives embrace evidence that the risks are low. We offer a guide to help navigate the tangle of numbers and suggest a way forward.

Google and many others display the number of cases and deaths (3.6 million and 138,840, respectively, by July 17). This invites a simple calculation for understanding the risk: divide the number who have died by the number who have been diagnosed. So, the chance of dying if infected is about 3.9%. Right? Well, not so fast. Six months into the pandemic, neither the number of deaths nor the number of people infected is known.

Some argue that deaths have been overemphasized since people who die of COVID are mostly older and sicker. Others suggest deaths have been overcounted since if a patient tests positive for COVID-19, it will likely be listed as the cause of death even if the person succumbs to another illness or, in some jurisdictions, dies due to an accident or suicide. Others argue that deaths have been undercounted.

Missing from the tally on any given day are those who died before testing was available, those who died shortly before or after but whose death has not yet been reported, or who died as an indirect result of the epidemic such as failing to seek medical care for fear of going to the hospital.

One carefully designed recent analysis compared deaths this year to the number of people who die during a “normal” year. The analysis concluded that through May, almost 100,000 people died from COVID-19 in addition to 30,000 who died from other causes related to the pandemic.

In short, uncertainty remains about the number of deaths due to COVID-19, which is supposed to be the easy part.

Estimating the number of people who have been infected is harder still. Most infected people are never formally diagnosed and never become one of the “cases” in the news. The limitations of the tests and the difficulty of attracting a representative population to be tested make it hard to estimate the true number of infections. The preferred test (reverse transcription polymerase chain reaction-based tests) uses RNA technology to see if the virus is present in nasal or oral swabs. It is a good test, but still may miss infections in up to 30% of cases.

A second type of test uses blood samples to look for an antibody called immunoglobulin (Ig)G that implies the person was previously infected. Based on IgG test results, the CDC assumes that 5% to 8% of the population has been infected. That would mean 24 million Americans have already had COVID-19 or a very similar illness. That is more than 10 times the number of confirmed cases.

The number is consequential: a higher infection rate for the same number of deaths implies that the virus is less deadly. A review by a prominent epidemiologist considered 23 population studies with sample sizes of at least 500 people and found the percentage who have positive antibodies ranged from 0.1% to 48% — a 480-fold difference. Although the study was robustly criticized and at odds with highly cited, peer-reviewed research, it has appeared in over 30 news outlets, and the range of estimates allows people to pick a number that justifies their political position.

Contributing to this uncertainty is the FDA decision to, in a hurry to catch up for lost time, temporarily relax its standards for approving tests. Among over 300 antibody tests currently on the market, data on only a handful are publicly available, and some are being recalled.

The other number we need to know is how many people are spreading the infection without knowing it. Estimates are all over the place. Some major employers, including Stanford Healthcare, have systematically tested all of their employees and found very few infected people who do not have symptoms. In contrast, a CDC study of young, healthy adults working on an aircraft carrier found that 20% of those infected reported no symptoms.

So here we are, months into the epidemic without consensus on the basic information about how many people are infected, the risk of death for those infected, or the risk of asymptomatic transmission. In contrast to official agencies that use transparent methods to report the weather or the unemployment rate, trust in our official health statistics agencies has broken down as reports continue to emerge form myriad sources with conflicting methodologies and motivations.

The time has come to activate impartial groups, like the National Academy of Medicine, to build consensus on how to monitor the epidemic. We know the risks are serious. As cases have started to rise, whether or not the number of U.S. deaths is higher or lower than 130,000, the risk of inaction is too high.

We are staying near home, wearing masks, and treating COVID-19 as a serious threat to public health.